Date Presented 04/20/2023
Although it potentially exists in isolation, childhood apraxia of speech (CAS) often presents with co-occurring challenges of sensory processing disorder (SPD). This study analyzes responses from speech therapists and OT practitioners elicited via focus group and survey, evaluating perspectives on comorbid presentation and treatment of CAS and SPD. Themes revealed collaborative synergies to improve clinical experiences for children with CAS and SPD.
Primary Author and Speaker: Zahava Friedman
Contributing Authors: Kate Nealon
PURPOSE: Childhood Apraxia of Speech (CAS) is a neurologic pediatric speech sound disorder characterized by impairment of precision and consistency of movements required for speech production (Murray et al., 2021). Sensory Processing Disorder (SPD) occurs when children struggle to register, process and integrate information from various senses (Mulligan et al., 2021). CAS by definition is a motor-based disorder that frequently co-occurs with sensory processing difficulties in the pediatric population, due to neurological connections between processing of sensory information and producing effective motor output (Newmeyer, 2009). While potentially existing in isolation, CAS more often presents with co-occurring difficulties in acquiring and processing language as well as observed sensory processing delays. This comorbid presentation of CAS and SPD can confound both assessment and treatment and the perspectives of clinicians working with these clinically complex populations. Understanding the complexity of both CAS and SPD is integral to appropriate differential diagnosis and prognostication (Iuzzini et al., 2017). In current clinical practice, therapists evaluate each disorder individually, without accounting for potential influence of comorbid presentations. Purpose of the current study was exploration and analysis of responses from both SLPs and OTs elicited via focus group and survey, to evaluate perspectives of these professionals on potential comorbid presentation and treatment of CAS and SPD.
DESIGN: In this qualitative study, reflexive thematic analysis was utilized to analyze discipline-specific focus groups and Qualtrics Survey responses. Participants were seven (7) licensed SLPs and eight (8) licensed OTs with minimum one year of clinical experience working with children with SPD and/or CAS.
METHOD: Guided questions were asked both verbally and via Qualtrics survey to both sets of clinicians. Focus of guided questions included: assessment methods, differentially diagnostic characteristics, interdisciplinary team roles. The SLP and OT co-PIs for this study led each focus group and data was coded and analyzed via reflexive thematic analysis. Repetitive ideas/elements/themes were coded, grouped and categorized to evaluate the perspectives of clinicians.
RESULTS: Upon reflexive thematic analysis of SLP and OT focus groups, the following themes emerged: (1) Sensory/Tactile input is impacted in children with SPD and CAS, limiting clarity and consistency of output. (2) Praxis/ Motor Coordination is highly inconsistent and not-well established for children with CAS. (3)Social Awareness/Prosody components of CAS linger long after sounds are intelligible. (4) Soft Landing- Both groups of professionals felt that deeper understanding of comorbid presentation of movement, speech and sensory processing was necessary (5) Lack of consensus among SLPs or OTs regarding assessment or intervention practices for CAS or SPD.
CONCLUSION: A unique finding from this study was perceptions of SLPs that CAS was preemptively substituted for a diagnosis of Autism Spectrum Disorder (ASD), with OT’s similarly regarding SPD as an ‘acceptable, soft landing’ label, replacing a potentially more comprehensive understanding with diagnosis of ASD.
IMPACT STATEMENT: Findings from this study will help improve clinical experiences for children with CAS and/or SPD through the expansion of clinician’s shared knowledge and experience pertaining to these complex disorders. Future work will examine the comorbid presentations of CAS and SPD in clinical settings and explore the impact of these comorbid presentations on assessment of CAS and SPD via interprofessional collaborative approaches.
Iuzzini-Seigel, J., Hogan, T. P., & Green, J. R. (2017). Speech Inconsistency in Children With Childhood Apraxia of Speech, Language Impairment, and Speech Delay: Depends on the Stimuli. Journal of speech, language, and hearing research : JSLHR, 60(5), 1194–1210. https://doi.org/10.1044/2020_JSLHR-20-00581
Mulligan, S., Douglas, S., & Armstrong, C. (2021). Characteristics of idiopathic sensory processing disorder in young children. Frontiers in integrative neuroscience, 15, 9. https://doi.org/10.3389/fnint.2021.647928
Murray, E., Iuzzini-Seigel, J., Maas, E., Terband, H., & Ballard, K. J. (2021). Differential diagnosis of childhood apraxia of speech compared to other speech sound disorders: A systematic review. American Journal of Speech-Language Pathology, 30(1), 279–300. http://dx.doi.org/10.1044/2020_AJSLP-20-00063
Newmeyer, A. J., Aylward, C., Akers, R., Ishikawa, K., Grether, S., deGrauw, T., Grasha, C., & White, J. (2009). Results of the Sensory Profile in children with suspected childhood apraxia of speech. Physical & occupational therapy in pediatrics, 29(2), 203–218. https://doi.org/10.1080/01942630902805202