How is severity of CAS determined?
Does severity change over time?
How does severity impact treatment?
What methods are evidence-based for different severity levels?

How is severity of CAS determined?

There is no single factor that determines severity. During the evaluation, the speech-language pathologist may consider several factors to determine the level of severity of the CAS including:

The number of sounds (consonants and vowels) the child produces and how well the child can combine those in different words/syllables. Children with severe CAS may have very few sounds and use only a few words, whereas children with mild or even moderate CAS may have many more sounds and words, but have difficulty with longer, multisyllable words.

The degree of difficulty the child demonstrates with movements to produce speech. Severe CAS will be apparent even when the child attempts simple, single words, while mild CAS may only be observed when the child says longer words, or when talking in connected sentences.

The number of features of CAS that are observed during the evaluation. Children with more features are generally considered to have more severe CAS.

The child’s response to cueing provided by the clinician during the dynamic motor speech assessment. Children who struggle to imitate words even when the clinician provides maximal cues may be considered severe, while children who are able to make rapid corrections to speech errors with just a little cueing by the therapist may be considered mild or moderate.

Sometimes clinicians may give an initial severity rating based on observations during the assessment but then modify the rating as they observe the child’s early response to treatment.

See examples of children with different severity levels of CAS here.

Does severity change over time?

Yes, especially with effective treatment. In fact, the goal of treatment is to lessen the severity of the CAS. Although some experts believe that CAS is a lifelong disorder, most agree that effective treatment is essential for  and the earlier that treatment begins, the better.  Children who receive appropriate treatment should be expected to improve and may eventually only demonstrate very mild signs of the disorder. However, delaying treatment or not receiving the appropriate treatment may result in a greater lifelong disability.

It is important to note that when a child has CAS and another developmental disorder (such as Down Syndrome) the rate of progress may be slower even with effective treatment and the child may not achieve the same long-term outcome as a child with only CAS.

How does severity impact treatment?

Different methods of treatment were developed to target different CAS severity levels. Therefore, a child may begin therapy using one method and then transition to a different method as the CAS improves. Age is also a factor because some therapy methods were designed for older children. The following is a summary of current evidence-based treatment methods that correlate with age/severity:

Dynamic Tactile and Temporal Cueing (DTTC) – Developed specifically treatment of moderate to severe CAS. DTTC can be used with younger children just beginning treatment.

Nuffield Dyspraxia Program (NDP3) – Developed for children age 4-12 with mild to severe speech motor impairment, including CAS.

Rapid Syllable Transition Treatment (ReST) – Developed specifically for children age 4-13 who have a main diagnosis of CAS without any other complications. ReST is designed to treat less severe CAS.

Integrated Phonological Awareness Intervention (IPA) – Designed for children age 4-7 to improve speech production, phonological awareness, and letter sound knowledge. IPA was found effective for children with less severe CAS.

Learn more about these different treatment methods here.

There are other methods to treat CAS that do not have sufficient evidence of efficacy (effectiveness in a controlled condition such as a research study) and are therefore not included in this list.  

Treatment of Severe CAS

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Treatment of Moderate CAS

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Treatment of Mild CAS

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