CAS and Literacy: Review of literacy skills of children with childhood apraxia of speech
This study reported the results of a systematic review of the literature resulting in the inclusion of 23 articles (202 total participants with CAS) to answer key questions about the literacy skills of children with CAS.
What are the literacy skills of children with CAS?
Preschool children with CAS demonstrated poorer early literacy skills (letter-sound knowledge, phonological awareness skills, print awareness) compared to typically developing children and children with a phonological disorder. In speech disordered children, receptive vocabulary, letter-sound knowledge and print knowledge contributed more to phonological awareness skills than speech accuracy and a wide range of phonological awareness was also noted in speech disordered children.
School age and adolescent children with CAS also performed below average in reading skills and one study (Miller et. al, 2019) reported a higher incidence of low-proficiency reading in children with CAS (65%) than children with other speech sound disorders (24%). Risk for reading difficulty seemed to be highest for children with CAS and comorbid language disorder. Overall, reading skills of children and adolescents with CAS is varied with some demonstrating average reading ability and others demonstrating a range of reading difficulties.
What literacy interventions are effective for children with CAS?
Integrated phonological awareness approach (IPA) which targets speech, phonological awareness and literacy skills concurrently was associated with improved literacy skills in a small group of children with CAS. Shared storybook reading with explicit instruction in phonological awareness skills was associated with improvements in phonological awareness in a small study of two children with CAS.
Literacy assessment and instruction typically involves speech. Children demonstrate literacy skills by producing sounds, blending sounds into words, and later through measures of reading fluency which most often involve oral reading. The literacy skills of children with speech sound disorders, including CAS, may be challenging to assess because the speech errors may be mistaken for literacy errors or may impede the child’s ability to complete assessment tasks. An example of this dilemma is the use of timed oral reading tasks to assess reading fluency. Another example is that children are typically taught to segment words into syllables and to isolate sounds when decoding words or when spelling. This might be especially difficult for a child with CAS. This article points out the need to utilize thoughtful and well-constructed assessment and intervention strategies for literacy skills so that speech disorders are not confused with or impacted by literacy skills.
Clinical Implications
It is important for clinicians, teachers, and parents to be aware that children with CAS are at risk for difficulty acquiring literacy skills. Clinicians should monitor literacy skills of children with CAS, especially when concomitant language disorders are present.
Input phonics (working on and measuring phonic skills without requiring a speech response) could be important during assessment of early literacy skills and in literacy intervention. Tasks at allow children to read and demonstrate their comprehension of reading without reading aloud are particularly important for children with CAS. Although there are no programs like this designed specifically for children with CAS, clinicians might look to interventions designed for children with cerebral palsy who also often have difficulty with the speech production components of literacy assessment/intervention.
Early and preventative intervention may also be an important consideration for children with CAS. Clinicians may want to consider involving parents in providing frequent and rich early literacy experiences to children with CAS and in working closely with preschool and early grade teachers to assure that children with CAS progress in literacy acquisition.