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Childhood Apraxia of SpeechChildhood Apraxia of Speech
Checklist:Checklist:A Ser ies of Characterist ics toA Ser ies of Characterist ics to
Facili tate DiagnosisFacili tate Diagnosis
Kay Giesecke, MS, CCCKay Giesecke, MS, CCC--SLPSLP
Specialist in CAS since 1995Specialist in CAS since 1995
Heather MacFadyen, MA, CCCHeather MacFadyen, MA, CCC--SLPSLP
Childhood Apraxia of SpeechChildhood Apraxia of Speech
General Definition:General Definition:
1.1. Previously known as:Previously known as: Developmental/Verbal Apraxia, verbalDevelopmental/Verbal Apraxia, verbal
dyspraxia, etcdyspraxia, etc. ASHA and CASANA now use. ASHA and CASANA now useChildhood Apraxia of Speech (CAS)Childhood Apraxia of Speech (CAS)
common among all titles is the wordcommon among all titles is the word praxispraxis..
2.2. Motor Speech disorder:Motor Speech disorder:
a disruption in motor planning and/ora disruption in motor planning and/orprogrammingprogramming
What is Praxis?:What is Praxis?:
PraxisPraxis
planned movementplanned movement
neurological process by which cognitionneurological process by which cognition
directs motor actiondirects motor actionability to formulate orability to formulate or
plan different actionsplan different actionsbefore the actualbefore the actual
motor executionmotor execution (Ayres, 1985)(Ayres, 1985)
ApraxiaApraxia lack of praxislack of praxis
What is Motor Planning?What is Motor Planning?
The execution of a motor plan is the result ofThe execution of a motor plan is the result of
praxispraxis
the visible result of a successful invisible processthe visible result of a successful invisible process
Not simply a series of postures, must includeNot simply a series of postures, must include
information about theinformation about the sequencingsequencing of theseof these
postures;postures;
In regards to speech, how the articulators willIn regards to speech, how the articulators will
transitiontransition from one posture to the next.from one posture to the next.(Vellem(Velleman, 2003)an, 2003)
More specific definition of CASMore specific definition of CAS
Symptom complexSymptom complex/syndrome/syndrome
No one feature is adequate for diagnosisNo one feature is adequate for diagnosis
Each child has a different combination ofEach child has a different combination of
speech errorsspeech errors
thus the need for a checklist of CASthus the need for a checklist of CAS
characteristics.characteristics.
Top 3 Features from ASHATop 3 Features from ASHA
1.1. Inconsistent errors on consonants andInconsistent errors on consonants andvowels in repeated productions ofvowels in repeated productions ofsyllables or wordssyllables or words
2. Lengthened and disrupted co2. Lengthened and disrupted co--articulatory transitions between soundsarticulatory transitions between soundsand syllablesand syllables
3. Inappropriate prosody3. Inappropriate prosody
In addition, ASHA lists 18 other speechIn addition, ASHA lists 18 other speechfeatures that might be present.features that might be present.
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CAS Assessment ProtocolCAS Assessment Protocol
Traditional assessment which includes:Traditional assessment which includes:
Case HistoryCase HistoryHearingHearingPure Tone and TympanometryPure Tone and Tympanometry
Developmentally appropriate exp. and rec.Developmentally appropriate exp. and rec.
language measurement (if possible)language measurement (if possible)
Language SampleLanguage Samplecalculate MLU, examinecalculate MLU, examine
morphology and intelligibilitymorphology and intelligibility
Oral Mechanism ExamOral Mechanism Exam
Oral Motor Screening TestOral Motor Screening Test
CAS Assessment Protocol Cont.CAS Assessment Protocol Cont.
Speech:Speech:
Single word articulation test (if possible); childSingle word articulation test (if possible); childmay have to imitate items after examinermay have to imitate items after examiner
Formal or informal phonological analysis,Formal or informal phonological analysis,including syllable and word shapesincluding syllable and word shapes
Consonant inventoryConsonant inventoryisolation and stimulabilityisolation and stimulability
Vowel/diphthong inventoryVowel/diphthong inventoryisolation andisolation andsyllablessyllables
Prosodic analysisProsodic analysis
CAS ChecklistCAS Checklist
Childhood Apraxia of SpeechChildhood Apraxia of Speech
ChecklistChecklist
Developed by Kay Giesecke in 1996Developed by Kay Giesecke in 1996
Used in her private practice to facilitateUsed in her private practice to facilitate
diagnosis of CASdiagnosis of CAS
Based on previous research in the area ofBased on previous research in the area of
apraxiaapraxia
OneOne of the tools used in the diagnosticof the tools used in the diagnostic
processprocess
CAS Checklist ItemsCAS Checklist Items
1. Severely delayed speech development (Jaffe, 1984;1. Severely delayed speech development (Jaffe, 1984;Watkins, 1992)Watkins, 1992) *Persistent speech sound disorder; ASHA Ad hoc*Persistent speech sound disorder; ASHA Ad hoc--CAS,CAS,20072007
2. Language comprehension superior to language2. Language comprehension superior to languageproduction (Jaffe, 1984; Watkins, 1992; Velleman,production (Jaffe, 1984; Watkins, 1992; Velleman,2003)2003)
3. Slow or minimal improvement despite intervention (Hall,3. Slow or minimal improvement despite intervention (Hall,Jordan, & Robin, 1993; Velleman & Strand, 1994;Jordan, & Robin, 1993; Velleman & Strand, 1994;ShribergShriberg, et al., 1997; ASHA Ad hoc, et al., 1997; ASHA Ad hoc--CAS, 2007)CAS, 2007)**delayed progress may be due to inappropriate intervention**delayed progress may be due to inappropriate intervention
4. Single words more intelligible than conversation (4. Single words more intelligible than conversation (CraryCrary,,1993; Hall et al., 1993)1993; Hall et al., 1993) *Reduced Intelligibility; ASHA Ad hoc*Reduced Intelligibility; ASHA Ad hoc--CAS,CAS,20072007
CAS Checklist Items, cont.CAS Checklist Items, cont.
5. Strong occurrence of phonological processes5. Strong occurrence of phonological processes((CraryCrary, 1993), 1993)
6. Omission errors are the most prominent (6. Omission errors are the most prominent (CraryCrary,,
1993; Hall et al., 1993)1993; Hall et al., 1993)7. Initial consonants tend to be more misarticulated7. Initial consonants tend to be more misarticulatedthan final (than final (KamenKamen, 1995), 1995)
**initial consonants may be as affected as final consonants in t**initial consonants may be as affected as final consonants in t he case ofhe case of
severe speech disorderssevere speech disorders
8. Difficulties in sound sequencing (8. Difficulties in sound sequencing (CraryCrary, 1993;, 1993;Hall et al, 1993)Hall et al, 1993) *Syllable sequencing, ASHA Ad hoc*Syllable sequencing, ASHA Ad hoc--CAS, 2007CAS, 2007
CAS Checklist Items, cont.CAS Checklist Items, cont.
9. Isolated movements better than sequenced9. Isolated movements better than sequencedmovements (Hall et al, 1993;movements (Hall et al, 1993; KamenKamen, 1996), 1996)
10. Errors increase as word length or performance10. Errors increase as word length or performanceload increases (load increases (CraryCrary, 1993; Edwards, 1973;, 1993; Edwards, 1973;
Velleman & Strand, 1994Velleman & Strand, 1994))11. Probable differences between repetition and11. Probable differences between repetition and
conversation (conversation (CraryCrary, 1993), 1993)
12. Prosodic aspects of speech are abnormal12. Prosodic aspects of speech are abnormal((CraryCrary, 1993; Hall et al., 1993;, 1993; Hall et al., 1993; RosenbekRosenbek &&Wertz, 1972;Wertz, 1972; YossYoss && DarleyDarley, 1974; Top 3, ASHA, 1974; Top 3, ASHA
Ad hocAd hoc--CAS, 2007)CAS, 2007)
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CAS Checklist Items, cont.CAS Checklist Items, cont.
13. Presence of groping behaviors or salient posturing of13. Presence of groping behaviors or salient posturing ofarticulators (Hall et al, 1993; Jaffe, 1984;articulators (Hall et al, 1993; Jaffe, 1984; KamenKamen, 1996), 1996)
**Effortful productions; ASHA Ad hocEffortful productions; ASHA Ad hoc--CAS, 2007)CAS, 2007)
14. Inconsistency of errors14. Inconsistency of errors--misarticulate a word one time,misarticulate a word one time,then say it correctly another time (Hall et al, 1993;then say it correctly another time (Hall et al, 1993;KamenKamen, 1996;, 1996; RosenbekRosenbek & Wertz, 1972; Top 3, ASHA& Wertz, 1972; Top 3, ASHAAd hocAd hoc--CAS, 2007)CAS, 2007)
15. Variability of errors15. Variability of errors--different errors in the same worddifferent errors in the same wordand word position during repeated trials (Hall et al, 1993;and word position during repeated trials (Hall et al, 1993;KamenKamen, 1996; Top 3, ASHA Ad hoc, 1996; Top 3, ASHA Ad hoc--CAS,2007)CAS,2007)
16. Problems with nasality (Hall et al, 1993; Jaffe, 1984)16. Problems with nasality (Hall et al, 1993; Jaffe, 1984)
CAS Checklist Items, cont.CAS Checklist Items, cont.
17. Voicing errors (Hall et al, 1993; Jaffe, 1984;17. Voicing errors (Hall et al, 1993; Jaffe, 1984;YossYoss && DarleyDarley, 1974; AHSA Ad hoc, 1974; AHSA Ad hoc--CAS, 2007)CAS, 2007)
18. Vowel and18. Vowel and dipthongdipthong errors (Hall et al, 1993;errors (Hall et al, 1993;Watkins, 1992; ASHA Ad hocWatkins, 1992; ASHA Ad hoc--CAS, 2007)CAS, 2007)
19. Most difficulty with fricatives, affricates, and19. Most difficulty with fricatives, affricates, andconsonant blends; least difficulty with bilabialsconsonant blends; least difficulty with bilabialsand nasals (Jaffe, 1984;and nasals (Jaffe, 1984; KamenKamen, 1996; Dean, 1996; Dean2008)2008)
20. Epenthesis20. Epenthesis--addition of schwa in consonantaddition of schwa in consonantclusters (Hall et al, 1993; Dean, 2008)clusters (Hall et al, 1993; Dean, 2008)
**Difficult to assess if the child is not producing consonant cl**Difficult to assess if the child is not producing consonant clustersusters
Administration of the checklistAdministration of the checklist
Information obtained from observations, formal testing,Information obtained from observations, formal testing,and parent report.and parent report.
If the child demonstrates the listed characteristic= 1 pointIf the child demonstrates the listed characteristic= 1 point
If the child does not demonstrate the characteristic = 0If the child does not demonstrate the characteristic = 0pointspoints
If the child does not produce sufficient spontaneousIf the child does not produce sufficient spontaneousspeech to determine the presence/absence of thespeech to determine the presence/absence of thecharacteristic and/or the errors are so severe thecharacteristic and/or the errors are so severe thecharacteristic does not apply= 1 point undercharacteristic does not apply= 1 point under N/AN/A
Add the totalAdd the total N/AN/A items to the total characteristicsitems to the total characteristicsexhibitedexhibited to obtain the severity ratingto obtain the severity rating
Interpreting the ResultsInterpreting the Results
Based on a review of 80 different caseBased on a review of 80 different case
studies the following guidelines werestudies the following guidelines were
developed for interpreting the results fromdeveloped for interpreting the results from
the CAS checklistthe CAS checklist
Diagnostic CategoriesDiagnostic CategoriesSpeech delay/disorder, not CASSpeech delay/disorder, not CAS
Group 1Group 1
Score = 0 to 12 (out of 20)Score = 0 to 12 (out of 20) -- 26 cases26 cases
Demonstrated 5 to 12 of theDemonstrated 5 to 12 of the
characteristics listed on the checklist.characteristics listed on the checklist.
Features not sufficient for diagnosis ofFeatures not sufficient for diagnosis of
CASCAS
Prognosis same as type and severity ofPrognosis same as type and severity of
disorder diagnosed.disorder diagnosed.
Severe Speech delay, not CASSevere Speech delay, not CAS
Case History #1Case History #1
Jacob, 3;8 (at initiation of therapy)Jacob, 3;8 (at initiation of therapy)
Was previously in speech therapy with noWas previously in speech therapy with no
progressprogress
Previous therapist did not encouragePrevious therapist did not encourage
parent involvementparent involvement
Enrolled in intensive speech therapy andEnrolled in intensive speech therapy and
was dismissed in 14 monthswas dismissed in 14 months
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Pre-test
3/19/1998
53 errors
PR= -1%
Post-test
5/13/1999
4 errors
PR= 71%
Severe Speech delay, not CASSevere Speech delay, not CAS
Case History #2Case History #2
Michelle, 2;6Michelle, 2;6
Previously enrolled in individual and groupPreviously enrolled in individual and grouptherapy, strong parent involvementtherapy, strong parent involvement
Previous SLP diagnosed her with CASPrevious SLP diagnosed her with CAS
Received a brief assessment and scored aReceived a brief assessment and scored a 66on the CAS checkliston the CAS checklist
Parent sent a tape to Kaufman to confirmParent sent a tape to Kaufman to confirmdiagnosis ofdiagnosis of apraxiaapraxiaKaufmanKaufman stated that thisstated that thischildchild maymay have been apraxic but was not anyhave been apraxic but was not anylongerlonger
Assessment
Results
43 errors
PR= 8%
CAS Characteristics
Demonstrated:
-Severely delayed speech
-Lang comp superior to
Lang exp
-Single words more
intelligible than
conversation
-Isolated movements
better than sequenced
movements
-Differences between
repetition and
conversation
-Most difficulty with
affricates, fricatives and
blends (age appropriate)
Group 2Group 2Severe Articulation & PhonologicalSevere Articulation & Phonological
Disorder with Apraxia ComponentsDisorder with Apraxia Components
Score= 13 to 15 (out of 20) 16 casesScore= 13 to 15 (out of 20) 16 cases
Presented with severe speech sound errors,Presented with severe speech sound errors,expressive language delays, and groping, butexpressive language delays, and groping, butexhibited:exhibited:NoNo problems with vowel productionproblems with vowel production
NoNo difficulties with prosody (a differential diagnosticdifficulties with prosody (a differential diagnosticcharacteristic according to research bycharacteristic according to research by ShribergShriberg et al,et al,1997)1997)
NoNo initial consonant omissionsinitial consonant omissions
NoNo variability in errors in the same word duringvariability in errors in the same word during
repeated trialsrepeated trials
Group 2Group 2Severe Articulation & PhonologicalSevere Articulation & Phonological
Disorder with Apraxia ComponentsDisorder with Apraxia ComponentsRequireRequire use of apraxic therapy techniquesuse of apraxic therapy techniques, such, such
as: drill and repetition, use of hierarchies, andas: drill and repetition, use of hierarchies, and
adjustment of performance load.adjustment of performance load.
Continue toContinue to struggle with production of newstruggle with production of newwordswords even after dismissal from therapy (basedeven after dismissal from therapy (based
on parent surveys).on parent surveys).
Prognostic implicationsPrognostic implicationsdemonstrated speechdemonstrated speech
skills within normal limits afterskills within normal limits after 11 to 2 years ofto 2 years of
intense therapy.intense therapy.
Severe Articulation & PhonologicalSevere Articulation & Phonological
Disorder with Apraxia ComponentsDisorder with Apraxia Components
Case HistoryCase History
Carl, 3;11 (at initiation of therapy)Carl, 3;11 (at initiation of therapy)
Demonstrated 15 out of 20 characteristicsDemonstrated 15 out of 20 characteristics
on checklist.on checklist.
Did NOT demonstrate vowel errors,Did NOT demonstrate vowel errors,
abnormal prosody, problems with nasality.abnormal prosody, problems with nasality.
Demonstrated final consonant deletion,Demonstrated final consonant deletion,
fronting, syllable reduction, deaffricationfronting, syllable reduction, deaffrication
Dismissed from therapy in 22 monthsDismissed from therapy in 22 months
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Pre-test
9/15/1999
55 errors
PR= -1%
Post-test
7/2/2001
5 errors
PR= 52%
Group 3Group 3
Moderate to Severe CASModerate to Severe CAS
w/out Major Concomitant Disordersw/out Major Concomitant Disorders
Score= 16 to 20 (out of 20)Score= 16 to 20 (out of 20) 1313 casescases
All but oneAll but one case (who scored a 16),case (who scored a 16),demonstrated vowel errorsdemonstrated vowel errors. That one case. That one caseproduced mostly vowels and a few initialproduced mostly vowels and a few initialconsonants.consonants.
These children also all had problems withThese children also all had problems withprosody, inconsistency and variability ofprosody, inconsistency and variability oferrors, and disrupted coerrors, and disrupted co--articulatoryarticulatorytransitionstransitions..
Group 3Group 3
Moderate to Severe CASModerate to Severe CAS
w/out Major Concomitant Disordersw/out Major Concomitant Disorders
Prognostic ImplicationsPrognostic Implications
Two out of nine of these students wereTwo out of nine of these students were
able to have speech that sounded normalable to have speech that sounded normal
after 2 to 4 years of intense individualafter 2 to 4 years of intense individual
apraxia therapy with extensive parentalapraxia therapy with extensive parental
involvement.involvement.
The other 7 are still in therapy.The other 7 are still in therapy.
Moderate to SevereModerate to Severe
Childhood Apraxia of SpeechChildhood Apraxia of Speech
Case HistoryCase HistoryAndrew, 5.1 (at initiation of therapy)Andrew, 5.1 (at initiation of therapy)
Demonstrated 18 out of 20 characteristics onDemonstrated 18 out of 20 characteristics onchecklist.checklist.
Demonstrated vowel errors, abnormal prosody,Demonstrated vowel errors, abnormal prosody,inconsistency of errors, disrupted coinconsistency of errors, disrupted co--articulation.articulation.
Demonstrated final consonant deletion,Demonstrated final consonant deletion,backing, syllable reduction, cluster reduction,backing, syllable reduction, cluster reduction,deaffricationdeaffrication
Had gross motor problems & learningHad gross motor problems & learningdifferences.differences.
Left to finalize therapy goals in public schoolLeft to finalize therapy goals in public schoolafter 46 months of therapy with Apraxia Dallas.after 46 months of therapy with Apraxia Dallas.
Case StudyCase Study
At initiation of therapy at Apraxia DallasAt initiation of therapy at Apraxia Dallas
Andrew was unable to complete anAndrew was unable to complete an
Articulation Test but on 16 imitativeArticulation Test but on 16 imitative
productions he said:productions he said:
tuhtuh/tub dada/pajamas nah/knife/tub dada/pajamas nah/knife pupu/spoon/spoon
guhguh/girl/girl muhtimuhti/monkey/monkey wawa/watch/watch kahkah/car/car
bubu/blue/blue ka/carrotka/carrot buhbuh/brush/brush tehteh/chair/chair
Post-test
7/21/2008
0 errors
PR= 99%
After 8
months
9/3/2004
51 errors
PR= -1%
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Group 4Group 4
Severe Childhood Apraxia of SpeechSevere Childhood Apraxia of Speech
with Major Concomitant Disorderswith Major Concomitant Disorders
Score= 16 to 20 (out of 20)Score= 16 to 20 (out of 20) 18 cases18 cases
Demonstrated all 3 top features from ASHADemonstrated all 3 top features from ASHAThe presence of other complicating issues, suchThe presence of other complicating issues, such
as cognitive delays, medical conditions, andas cognitive delays, medical conditions, and
disorders/syndromes will effect the childdisorders/syndromes will effect the childss
progress in therapy.progress in therapy.
Prognostic implicationsPrognostic implications -- unlikely to beunlikely to be
dismissed from therapy as within normal limitsdismissed from therapy as within normal limits
but can usually improve speech.but can usually improve speech.
Severe Childhood Apraxia ofSevere Childhood Apraxia of
Speech Case HistorySpeech Case History
Joseph, 7;6 (at initiation of therapy)Joseph, 7;6 (at initiation of therapy)
Diagnosed withDiagnosed with hypoplasiahypoplasia and MRand MR
Previously enrolled in therapy for 6 years,Previously enrolled in therapy for 6 years,pursuing augmentative communicationpursuing augmentative communication
Demonstrated 20 out of 20 items on theDemonstrated 20 out of 20 items on thechecklist (didnchecklist (didnt demonstrate initialt demonstrate initialconsonants worse than final orconsonants worse than final orepenthesis)epenthesis)
Discontinued private therapy after 7 yearsDiscontinued private therapy after 7 years
Pre-test:
4/15/2002
66 errors*
PR= -1%
*all items were
imitated
After 6 months
of therapy:
11/4/2002
33 errors
PR= -1%
After 1 year
of therapy:
5/2003
27 errors
PR=
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Unable to complete checklistUnable to complete checklist
Case HistoryCase HistoryHannah, 3;8Hannah, 3;8
Diagnosed withDiagnosed with PraderPrader--WilliWilli SyndromeSyndrome
Only produced /n, m/ and a few vowels at theOnly produced /n, m/ and a few vowels at theevaluationevaluation
Could not complete formal speech/languageCould not complete formal speech/languagetesting or the CAS checklisttesting or the CAS checklist
Received additional therapy at school, whereReceived additional therapy at school, wherethey diagnosed her with a severe receptive andthey diagnosed her with a severe receptive andexpressive speech disorder, severe speechexpressive speech disorder, severe speechdisorder, moderate oraldisorder, moderate oral--motor impairment, andmotor impairment, andhypernasalhypernasal vocal quality.vocal quality.
ReferencesReferences
ReferencesReferences
American SpeechAmerican Speech--LanguageLanguage--Hearing Association (2007) Childhood Apraxia of Speech PositionHearing Association (2007) Childhood Apraxia of Speech Position Statement;Statement; www.asha.orgwww.asha.org/policy./policy.
Ayres, A. J. (1985).Ayres, A. J. (1985). Developmental dyspraxia and adultDevelopmental dyspraxia and adult--onset apraxia.onset apraxia. TorrenceTorrence, CA: Sensory Integration International., CA: Sensory Integration International.
CraryCrary, M. (1993)., M. (1993). Developmental motor speech disordersDevelopmental motor speech disorders .. San Diego, CA: Singular Publishing Group, Inc.San Diego, CA: Singular Publishing Group, Inc.
Dean, Lucinda. (Feb.,2008) Short Course on CAS at the Texas SpeeDean, Lucinda. (Feb.,2008) Short Course on CAS at the Texas Speech and Hearing Association Convention.ch and Hearing Association Convention.
Edwards, M. (1973). Developmental verbal dyspraxia.Edwards, M. (1973). Developmental verbal dyspraxia. British Journal of Communication Disorders,British Journal of Communication Disorders,8, 648, 64--70.70.Hall, P., Jordan, L., & Robin, D. (1993).Hall, P., Jordan, L., & Robin, D. (1993). Developmental apraxia of speech: Theory and clinical practiceDevelopmental apraxia of speech: Theory and clinical practice . Austin, TX: Pro. Austin, TX: Pro --Ed.Ed.
Jaffe, M. (1984). Neurological impairment of speech production:Jaffe, M. (1984). Neurological impairment of speech production:Assessment and treatment. In J. Costello (ed.),Assessment and treatment. In J. Costello (ed.),Speech Disorders inSpeech Disorders inChildren.Children. (pp. ?). City?: College(pp. ?). City?: College--Hill Press.Hill Press.
KamenKamen, R. (1996). Class handouts on Developmental Apraxia of Speech., R. (1996). Class handouts on Developmental Apraxia of Speech. Dallas, TX: UTD.Dallas, TX: UTD.
Morley, M., Court, D., & Miller, H. (1954). Developmental dysartMorley, M., Court, D., & Miller, H. (1954). Developmental dysarthria.hria. British Medical Journal,British Medical Journal, 1, 81, 8--10.10.
RosenbekRosenbek , J.C., & Wertz, R.T. (1972). A review of 50 cases of developmen, J.C., & W ertz, R.T. (1972). A review of 50 cases of developmental apraxia of speech.tal apraxia of speech. Language, Speech, and HearingLanguage, Speech, and HearingServices in SchoolsServices in Schools, 3, 23, 3, 23--33.33.
ShribergShriberg , L.D.,, L.D.,AramAram, D.M., & Kwiatkowski, J. (1997). Developmental apraxia of speec, D.M., & Kwiatkowski, J. (1997). Developmental apraxia of speech: III. A subtype marked by inappropriate stress.h: III. A subtype marked by inappropriate stress.Journal of Speech, Language and Hearing ResearchJournal of Speech, Language and Hearing Research , 40(2), 313, 40(2), 313--337.337.
StrubStrub, R.L., & Black, F.W. (1981)., R.L., & Black, F.W. (1981). Organic brain syndromes: An introduction to neurobehavioral disoOrganic brain syndromes: An introduction to neurobehavioral disorders.rders. Philadelphia: Davis.Philadelphia: Davis.
Velleman, S., & Strand, K. (1994).Velleman, S., & Strand, K. (1994). Developmental Verbal Dyspraxia.Developmental Verbal Dyspraxia. inin J.BernthalJ.Bernthal& N.& N. BanksonBankson (Eds.)(Eds.) Child Phonology:Child Phonology:Characteristics, Assessment, and Intervention with Special PopulCharacteristics, Assessment, and Intervention with Special Populationsations (pp. 110(pp. 110--139). New York:139). New York: ThiemeThieme Medical Publishers.Medical Publishers.
Velleman, S. (2003).Velleman, S. (2003). Childhood apraxia of speech research guide.Childhood apraxia of speech research guide. Clifton Park, NY: Thomson Delmar Learning.Clifton Park, NY: Thomson Delmar Learning.
Watkins, R. (1992). Class notes on Developmental Apraxia of SpeeWatkins, R. (1992). Class notes on Developmental Apraxia of Speech. Dallas, TX: UTD.ch. Dallas, TX: UTD.
YossYoss, K.A., &, K.A., & DarleyDarley, F.L. (1974). Developmental apraxia of speech in children., F.L. (1974). Developmental apraxia of speech in children. Journal of Speech and Hearing ResearchJournal of Speech and Hearing Research, 17, 399, 17, 399--416.416.
**Additional speech assessment measures:**Additional speech assessment measures:
--Verbal Motor Production Assessment for Children (VMPAC; Hayden &Verbal Motor Production Assessment for Children (VMPAC; Hayden & Square 1999)Square 1999)
--Test of Syllable Sequencing Skills (packaged with Moving AcrossTest of Syllable Sequencing Skills (packaged with Moving Across Syllables; Kirkpatrick et al., 1990)Syllables; Kirkpatrick et al., 1990)
-- Profiling Elements of Prosodic SystemsProfiling Elements of Prosodic Systems--Child version (PEPSChild version (PEPS--C; Wells &C; Wells & PeppePeppe 2003)2003)