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The development of a child is a critical life-stage process during which the parents should be attentive to the signs that potentially indicate physical or mental impairment or other forms of dysfunction of development. Apparently, one of such conditions is apraxia of speech (CAS) that represents a form of speech disorder based on the dysfunction of motor coordination. The analysis of this issue demonstrates that there are specific factors of development of a child that allow revealing CAS, which negatively affects respiration, phonation and other subsystems of speech. The results of the analysis suggest that carrying out a standardized test and an informal assessment would allow revealing the cases of the disorder at earlier stages of development. As a result, early assessment and treatment increase the probability for partial mitigation of speech disorder of this type.

Nature of Impairment

CAS belongs to a specific category of speech dysfunctions that impair a childs speech as a result of disorders of different nature. Experts define the condition as neurological childhood (pediatric) speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (Backer, 2014, p. 2). The negative effect of this impairment is caused by neuromuscular deficits that affect different levels of speech production. As a result, a child having CAS may have delayed speech or problems with articulating sounds or other activities. In general, apraxia of speech can be divided into three forms including the one caused by neurological etiologies including trauma, infections and other; complex neurobehavioral disorder; and CAS caused by no other known neurological or behavioral disorders (Backer, 2014, p. 2). In previous decades, experts in pediatric medicine and speech pathology had no agreement regarding the cases that can be exactly characterized as CAS. For example, in the middle of the XX century scholars typically referred to it as speech aphasia. The evidence that indicates this is the basic description of the speech pathology including the loss of ability for imitating non-speech motions including the movement of jaw, tongue or lips, inexpressive speech, speech utterances combined with normal receptive speech characteristics (Backer, 2014). The contemporary analysis of the indicated evidence demonstrates that these features are characteristics of motor execution failure or deficit, which is apraxia.

 

The development of the evidence base and scientific methodology has significantly enhanced the aspect of defining CAS meaning that experts are aware of not only basic etiology but also genetic factors potentially leading to its evolvement. For example, the discussed condition may occur due to neurodevelopmental disorders or genetic mutation whereas the major part of disorders is idiopathic (Murray, McCabe, Heard, & Ballard, 2015). In particular, experts argue that intragenic deletion of FOXP2 gene negatively affects speech functions (Turner et al., 2013). In order to reveal this correlation, the researchers assessed such characteristics as speech, oral motor function, language, literacy skills, and cognition in children and their families. The results of the experiment demonstrated that the subjects having a minor intragenic deletion of FOXP2 had a potential to suffer from motor speech disorder of different complexity leading to language and literacy problems (Turner et al., 2013). Therefore, genetic analysis can be defined as the means that can reveal the probability of evolvement of the described pathology.

Although the modern science achieves success in monitoring and revealing CAS in children, the aspect of its diagnosing is still controversial. Despite this subject has been investigated by many scholars, there is no agreement regarding the existence of a single neurological or behavioral diagnostic marker for all cases that involve apraxia of speech (Murray et al., 2015). Typically, the assessed diagnostic markers include the spheres that objectively demonstrate the presence of the condition. Such domains include language, speech, prosody, voice, articulatory capabilities and other (Shriberg et al., 2017). However, there has been a controversy for decades about CAS as an official diagnosable disorder due to the variability in clinical features reported as being used to diagnose CAS (Backer, 2014, p. 4). Therefore, the scope of knowledge about apraxia of speech and the methodology of its assessment require revision. The outcomes of the changes should lead to the enhancement of the modern tools for providing a valid differential diagnosis of CAS.

Impact on Subsystems and Speech Sound Production

The contemporary procedure of providing a differential diagnosis of CAS is based on the collection of the evidence of its negative effect on diverse subsystems of speech and speech sound production. Due to the fact that CAS is a dysfunction, it impacts on speech production subsystems of a person and other related subsystems as well. For example, motor apraxia in a child of a median age of 5 years influences fine motor skills whereas CAS affects respiration, phonation, articulation, and prosody (Turner et al., 2013). This effect is demonstrated by the evidence, according to which a child often makes mistakes when producing words. Typical examples of it include utterance in spontaneous speech, negative effect on suprasegmentals of prosody and voice (Turner et al., 2013). As a result, children having CAS demonstrate abnormal mixed nasality, mistakes in word stress placement, reduction of speech tempo and other. Other investigations demonstrated that children with apraxia of speech often have inconsistent speech features, errors in timing and coarticulation of speech sounds, defective prosody, pronunciation, speech perception and linguistic skills (Murray et al., 2015). In all of these cases, the cause for speech apraxia is different, but the outcomes are similar and depend on the gravity of the experienced neuromuscular deficit. At the same time, scholars claim that due to CAS a cascade effect in learning is possible, when speech impairment interferes with the development of phonological and lexical skills (Chilosi et al., 2015). Thus, it is presumable that earlier stages of diagnosing of apraxia of speech should be easier to do, because the assessment subjects should not suffer from the cascade effect of the dysfunction. When performing such analysis, scholars typically advise considering the three domains of the effect of CAS. These aspects include errors in consonants and vowels when producing repeated syllables or words, abnormal coarticulatory transitions between sounds and syllables such as lengthening and disruption, and defective prosody mainly manifested by inadequate lexical or phrasal stress (Murray et al., 2015). The experts claim that the consideration of these domains allows diagnosing CAS with the level of accuracy that exceeds the one of the modern CAS assessment toolkits (Murray et al., 2015). Consequently, children require objective assessment for revealing and treatment of apraxia of speech at its earlier stages that is possible when considering its above-mentioned markers and speech sound production levels.

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Assessment

The procedures of assessment of CAS that can be described as efficient mainly include a formal assessment with the help of a standardized test and an informal assessment with the help of a speech-language sample analysis. Due to the fact that apraxia of speech is mainly caused by neuromuscular deficit (Backer, 2014) the design of the tests should include the components that require a specific muscular load of a childs speech subsystems. The traditional analysis of the criteria used for assessment of CAS previously consisted of approximately 50 criteria that were gradually reduced to six supported by the scholarly literature. These aspects include inconsistent productions, groping/effortful productions, general oral-motor difficulties, inability to imitate sounds, increasing difficulty with sound production as the utterance length increased, and poor sequencing of sounds (Backer, 2014, p. 4). At the same time, scholars had a tendency to combine these markers with feeding coordination problems and motor weakness, which had no evidential and theoretical support (Backer, 2014). Therefore, it is advised to consider the six indicated domains when assessing the results of the standardized test and informal assessment procedures.

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The proposed standardized test and informal assessment with the help of a speech-language sample analysis should have a framework that follows the most recent updates in the theory of diagnosing and treating CAS. In particular, literature reviews of materials devoted to apraxia of speech assessment conclude that there are three most critical evaluations including sound system assessment, an oral structural-functional examination, and a motor-speech examination (Backer, 2014). All of these interventions have a potential for effectively revealing the most critical outcomes of the disorder, which is why they should merge with the proposed test inventory. In particular, they allow identifying limited phonemic inventories, vowel and consonant distortions, perception and production of voicing errors ... oral nonverbal apraxia, ... articulatory postures, and increased difficulty of [speech sounds] production (Backer, 2014, p. 7). Therefore, the proposed standardized test should consist of the two phases that address structural-functional and motor-speech aspects of speech production of a child accordingly. The results of the standardized examination should be presented on the basis of consideration of the above-mentioned six domains of speech and language production. In its turn, informal assessment should be presented as general sound system evaluation framed as a short interview or reading. The selection of the topics and the suggested questions and reading samples proposed to a child should incorporate sound and syllable patterns that can be potentially challenging for a child with CAS to produce. When having this assessment, a person has to reach a specific score that is possible when producing the potentially difficult segments of the interview/reading session without utterance, deviation of prosody and other indicators of apraxia of speech. Last, it should be noted that each phase of the test should be created with the regard to the age of a child and his or her language proficiency. Therefore, it is possible that instead of interview of reading session, children aged below 3-4 years would have a session in the repetition of sound sequences after the examining person. This methodology would increase the level of access of children and their families to the test for revealing the cases of CAS as early as possible.

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Furthermore, scholars advise enhancing the quality of the tests by adding the use of automatic speech monitoring tools that can be used remotely and are not financially challenging to families that require CAS assessment of their children (Shahin, Ahmed, McKechnie, Ballard, & Gutierrez-Osuna, 2014). Speech decoding tools such as acoustic model alignment and analysis can allow revealing the indicators of apraxia of speech with high probability because of their method of comparison and contrast of recorded and role model speech samples. The use of such tools allows revealing the cases of CAS and differentiating them from speech delay due to consideration of diagnostic markers based on the impact of CAS on speech subsystems (Shriberg et al., 2017). The proposed methodology should further enhance the efficacy of the proposed standardized test and informal assessment as well as their availability to diverse children. Therefore, in the case of the application of the standardized examination and informal evaluation, it is possible to timely address the needs of a child in terms of correcting his or her speech dysfunction.

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The analysis of the problem of childhood apraxia of speech reveals that it is possible to reveal the cases of CAS if children undergo the proposed formal and informal assessment tests. The framework of the suggested formal approach is a two-part examination that reveals structural-functional and motor-speech skills of a child considering the six markers of efficient speech and language production. Furthermore, an informal test designed as an interview, a reading session or a session of repeating the sounds after the examiner should be initiated. The complexity of the proposed initiative depends on the age of a child, which allows decreasing the entrance level to the children of earlier years. The efficacy of these interventions is based on the fact that they contain the components directed toward revealing the problems of neurodevelopmental origin associated with dysfunction of motor coordination that affects different layers of speech sound production. Therefore, applying these tools it is possible to mitigate the problems leading to the development of CAS in children at the earlier stages. Thus, the proposed initiative has a perspective of providing the best opportunity for efficient assessment of apraxia of speech in children that increases the efficacy of their further treatment.

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