Wednesday, May 1, 2013

May 2nd - What is CAS?

Day 2 of Better Hearing and Speech Month

What is CAS?

Childhood Apraxia of Speech (CAS) is defined by the American Speech and Hearing Association as a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words.  

What does CAS mean for Cha-Cha?

"Imagine if you will, a little boy who has a dream, a dream to communicate. He wishes he could answer your question so that you understand his response. He wishes he could ask for clarification when he doesn't know exactly what you want him to say or do. He wishes to connect with his friends in their verbal play or to raise his hand in eagerness to answer his teacher. Because in his mind, he knows what he wants to say, yet he just can't get it out. Imagine this little boy is yours." - from the new book Speaking of Apraxia. A Parents Guide to Childhood Apraxia of Speech by Leslie A. Lindsay R.N, BSN

Cha-cha has only known CAS before we even know he had it.  Cha-cha and CAS at 2 was very different than Cha-cha and CAS at 4.  He's gone from severe CAS to moderate-mild CAS in 2 years.  What it means that he attends an integrated preschool in our city with neurotypical peers and other special needs children 4 half days a week. During that time, he gets direct speech services from a SLP 3 times a week for 30 minutes.  Due to his low tone and gross motor planning issues, Cha-cha also gets Physical Therapy 30 minutes a week.  During the school day, he participates in structured and unstructured activities to engage in social interactions with peers.  As you can imagine, it is very difficult for his peers to understand what he is trying to say during their play. In addition to school, Cha-cha participates in private speech therapy 60 minutes, twice a week.  We spend a lot of time invested in helping him communicate effectively.

Cha-cha is able to communicate his wants and needs with his family fairly well.  We have difficulty understanding him if there is background noise, if his back is towards us or if he is in another room. We have to be patient to listen to him and his drawn out speech. We often have to ask him to repeat himself or we have to ask questions to clarify what he is saying.  Bee-bee tries her best to be patient, but at least a few times a week I hear her say, "Blah-blah-blah" if she can't understand him or if he talks over her. Often, hubby and I will look at each other and try to repeat what he has said so we can make sense of it.  Now that he's older, he wants to talk about things that are not in context (for instance, a conversation about houses in the woods with fires in them was him trying to talk about Native American Wetu's - yes, that took about 2 days to understand what he was talking about). He's come up with strategies to use other words to describe what he's talking about if we can't understand his words. Sometimes, he will just give up, shrug and walk away, but thankfully most of the time he is pleasantly persistent.

Cha-cha is a quiet boy - mostly by nature, but I feel that he is very introspective.  At a young age, he would use those big blue eyes to soak it all in.  He doesn't miss a beat and as he's gotten older, he comes up with one liners to go with his beat. When he wants your attention, he starts conversations with "Let me tell you a story..." or "I need to tell you something..." or "I need to ask you a question..." (of course it's in his southern drawl/British/French weird accent). He is definitely more vocal when he has the attention of a very familiar adult or if he is in the car and we can't see his face when he's talking (making it more difficult to understand him while driving). I've found that practicing his language works best when we're not at home, but at a new environment like a zoo or a museum where he has lots of questions to ask. He shies away from kids his age. Most four year olds don't have the patience to wait and listen, or ask him to repeat his words. Cha-cha often has grandiose plans in his play that can be difficult for other children to access (for example, most kids just build towers or maybe buildings with blocks - but Cha-cha makes construction sites to build bakeries and a bank nearby to borrow the money to pay the workers...).

Cha-cha doesn't know anything different than who he is.  CAS has always been a part of him. He definitely gets frustrated at times and can get burnt out of therapy or practice if his limits are pushed.  It falls upon his team to help him achieve goals and push limits. Thankfully, he redirects easily and is often comforted by cuddles or deep pressure squeezes. Cha-cha is often happy and content. He gives the best hugs and sloppy kisses around! ;)

For more information about CAS, please look at the ASHA website or 

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