Comparison of Diagnostic Results Using the KSPT and CAS Checklist

1. Comparison of Diagnostic Results Using the KSPT and CAS Checklist Kay J. Giesecke, MS, CCC-SLP Specialist in Childhood Apraxia of Speech since 1996

2. Childhood Apraxia of Speech General Definition: • Motor Speech disorder: • a disruption in motor planning and/or programming • Previously known as: • Developmental/Verbal Apraxia, verbal dyspraxia, etc. ASHA and CASANA now use Childhood Apraxia of Speech (CAS) • common among all titles is the word “praxis”

3. What is praxis? • Praxis – • planned movement • “neurological process by which cognition directs motor action…ability to formulate or plan different actions…before the actual motor execution” (Ayres, 1985) • Apraxia – lack of praxis

4. Top 3 Features from ASHA • 1. Inconsistent errors on consonants and vowels in repeated productions of syllables or words • 2. Lengthened and disrupted co-articulatory transitions between sounds and syllables • 3. Inappropriate prosody In addition, ASHA lists 18 other speech features that might be present.

5. Today’s Objectives • List the top three characteristics of CAS listed in the ASHA position statement of 2007. • 2. Identify the names, number of items, and time needed to administer two diagnostic instruments for CAS, The Kaufman Speech Praxis Test and the CAS Checklist. • 3. Identify how the severity rating is determined on the two diagnostic instruments. • 4. Identify the similarities and differences in the results provided by the two diagnostic instruments.

6. Overriding Goal Learn 2 valid protocols that can be used to accurately diagnose presence and severity of CAS without being afraid to make the diagnosis or making the diagnosis without a valid testing protocol.

7. What is the KSPT? Kaufman Speech Praxis Test (1995) is diagnostic tool to assist in diagnosis and treatment of CAS • Composed of 155 repetitive verbal items + a subjective rating scale for intelligibility and a checklist of characteristics of Verbal Dyspraxia to indicate diagnosis & severity – no graphics or manipulatives on test. • Appropriate for ages 2.0 to 5.11 years • Repetitive items are divided into 3 norm referenced parts yielding a raw score, standard score, %ile rank and age equivalent. Norms also available on intelligibility scale. No norms on severity scale.

8. KSPT Administration • Time: Approximately 30+ minutes • May administer 2-4 parts plus severity scale depending on child’s ability • Child repeats 74 or more items • Scoring time: Approximately 30 minutes • Administered after other testing - specifically after a complete oral mechanism exam

9. What is the CAS Checklist The CAS Checklist (2010) is diagnostic tool to assist in the diagnosis of CAS • A diagnostic list of the 20 common characteristics of CAS documented by research • Appropriate for ages 3.0 to 14.0 years • Results yield a raw score, a norm referenced severity rating, and prognostic implications based on the eclectic evidence based CAS therapy program used at Apraxia Dallas.

10. CAS Checklist Administration • Time: Approximately 15 minutes • Administer complete checklist to all • SLP and parents review and decide items • Scoring time: Approximately 5 minutes • Administered after other testing - specifically articulation, phonological, lang. testing, and complete oral mech. exam

11. KPST CAS checklist Ages 2.0 to 5.11 Admin – 1 hour+ Diag and Treatment Incl. Vowel testing Norms on sds/words Severity Checklist Severity list ->range; no norms No prognosis Not for screening $180 Ages 3.0 to 14.0 Admin – 20 minutes Diagnostic only Incl. Vowel testing No sds./words nor norms on them Severity Checklist Norms on severity Prognostic implications Can be used for screening $85

12. Both Useful Tools • Can be used together or separately. • Both norm referenced documentation of presence or absence of CAS • KSPT gives treatment information; CAS Checklist does not • Results in this study on 3 subjects show that results are comparable in diagnosing presence and severity of CAS

13. Results on Subject #1 • 3.1 year old male in therapy for suspected CAS for 7 months • Administered both diagnostic tools after turned 3 years old • Also administered Preassessment Considerations for CAS, GF Articulation, Vowel Inventory, & Oral Motor Exam

14. Evaluation Results • 17 out of 24 preassessment considerations • On GF – SS 61, 1st %ile, AE of<2.0 yrs. • Missed 5 vowels and all diphthongs in isolation on Vowel Inventory • Below criterion score on DEAP Oral Motor Screen • Sluggish and absent movements on Oral Exam • Previous PLS-4 scores indicated average language skills

15. KSPT Scores Administered Parts 1 & 2 plus Diagnostic Rating Scale Continuum • Part 1 Oral Movement - Raw Score 4/11; Standard Score 66; , 2nd %ile; AE of<2.0 yrs. • Part 2 Simple Phonemic/Syllabic Level Raw Score 18/63; Standard Score < 2.0 years; <1st %ile; AE of <2.0 years • Rating Scale Continuum 0.0 to 2.0 indicating Oral Motor Apraxia as well as Verbal Apraxia and Verbal Dyspraxia - Severe

16. KSPT Diagnostic Rating ScaleContinuum <-Subject 1--______________________> 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 OA Apraxia VD Sev. Mod. Mild Artic Normal Test was published in 1995 when the term Verbal Apraxia (VD above) was still being used. Now the correct term is Childhood Apraxia of Speech. OA=Oral Apraxia Apraxia=absence of motor planning Verbal Dyspraxia (VD)=trouble with motor planning for verbalization

17. CAS Checklist Results • Scored 19 out 20 characteristics of CAS • A score of 18 to 20 on the Checklist indicates Severe CAS • Prognostic Implications: Children in this group will be the least likely to be dismissed from therapy with S/L within normal limits but frequently can make significant gains in verbal communication.

18. # 1 Results Comparison • Both instruments indicate a diagnosis of Severe CAS/Verbal Apraxia • Both Instruments show Vowel/Diphthong errors • Preassessment considerations along with Oral Motor Screen indicate Oral Apraxia as does KSPT alone • KSPT shows break down of errors on various syllable shapes whereas syllable shape analysis of GF responses needed when using CAS Checklist alone

19. Results on Subject #2 • 5.3 year old female in private therapy 1X a week for articulation disorder for 2 years • Still quite unintelligible to average listener even when topic is known-parents suspect CAS • Administered both diagnostic tools on same day • Also administered Preassessment Considerations for CAS, GF Articulation, Vowel Inventory, & Oral Motor Exam

20. # 2 Evaluation Results • 13 out of 24 preassessment considerations • On GF – SS <40, <1st %ile, AE of<2.0 yrs. On Story subtest pervasive FCD; little Coarticulation. • Was able to produce all vowels/diphthongs in isolation & CVs on Vowel Inventory but missed numerous vowels/diphthongs in words on GF. • Phonological processes diagnosed from GF: Final Consonant Deletion, Fronting of velars, Weak syllable reduction; Stopping; Deaffrication, Liquid Simplification, and Cluster Reduction.

21. #2 Evaluation Results Cont. • Below criterion score on DEAP Oral Motor Screen – single movements adequate but unable to do diadochokinesis and sequenced movements • Adequate movements and structure on Oral Exam • Previous language testing indicated average receptive language skills but on GF Story subtest many grammatical errors.

22. # 2 KSPT Scores Administered Parts 1 - 4 plus Diagnostic Rating Scale Continuum • Part 1 Oral Movement - Raw Score 11/11; Standard Score 111; , 54th %ile; AE of >3.6 yrs. • Part 2 Simple Phonemic/Syllabic Level Raw Score 58/63; Standard Score < 1; <1%ile; AE of <2.0years Error types: One CVCV with vowel change, Four CVCs with popped final consonants

23. # 2 KSPT Scores Continued • Part 3 Complex Phonemic/Syllabic Level Raw Score 23/81; Standard Score <1; 1st %ile; AE of <2.0 years • Part 4 Spontaneous Length and Complexity Raw Score 2/7; Standard Score <1; <1st %ile; AE of <2.0 years • Rating Scale Continuum 2.0 to 3.5 indicating Verbal Dyspraxia - Moderate

24. # 2 CAS Checklist Results • Scored 16 out 20 characteristics of CAS • A score of 16 to 18 on the Checklist indicates Moderate CAS • Prognostic Implications: Possibility of normal speech and language in 2 to 4 years with intensive, individual therapy incorporating evidenced based apraxia techniques along with extensive parental involvement.

25. #2 Result Comparison • Both Apraxia tools indicate a diagnosis of Moderate CAS/Verbal Dyspraxia • GF & KSPT both show Vowel/Diphthong errors • Oral Motor Screen and KSPT both indicate CAS, not Oral Apraxia • KSPT shows break down of errors on various syllable shapes whereas syllable shape analysis of GF responses needed when using CAS Checklist alone • Both KSPT & GF results help analyze phonology

26. Important to Diagnose CAS? • Yes, her prior therapy was solely articulation therapy which usually results in minimal progress for the apraxic and drill words were being segmented in order for her to produce all the sounds for each word, as in saying f-a-t. • This approach was not effective in remediating and was perhaps exacerbating the disjointed coarticulation of CAS.

27. Results on Subject #3 • 4.0 year old male in therapy with ECI at age 2; at age 3 did a semester in public school, no therapy last 6 months • Still quite unintelligible to average listener even when topic is known-mother suspected CAS • 6 weeks prior to this evaluation, a pediatric rehab facility diagnosed severe CAS; father seeking 2nd opinion

28. Results on Subject #3 Cont. • Administered both diagnostic tools on same day • Also administered Preassessment Considerations for CAS, GF Articulation, Vowel Inventory, & Oral Motor Exam

29. # 3 Evaluation Results • 14 out of 24 preassessment considerations • On GF – SS 78, 10th %ile, AE of 2.3 yrs. Vowel errors in words also noted. • Correctly produced all vowels and diphthongs in isolation, CVs, & CVCs on Vowel Inventory • Found to have open bite & history of drooling and thumb sucking; unable to do diadochokinesis 3 times on Oral Exam – a characteristic of CAS. • Previous PLS-4 scores indicated average Auditory Comprehension skills & one point below average SS on expressive communication skills

30. # 3 KSPT Scores Administered Parts 1, 3, 4 plus Diagnostic Rating Scale Continuum • Part 1 Oral Movement - Raw Score 9/11; Standard Score 87; , 9th %ile; AE of <2.0 yrs. • Part 3 Complex Phonemic/Syllabic Level Raw Score 37/81; Standard Score 56; <2nd %ile; AE of <2.0years

31. # 3 KSPT Scores Continued • Part 4 Spontaneous Length and Complexity Raw Score 2/7; Standard Score 57; 5th%ile; AE of <2.0 years • Rating Scale Continuum 3.0 to 3.5 indicating Verbal Dyspraxia – Mild to Moderate

32. # 3 CAS Checklist Results • Scored 15 out 20 characteristics of CAS • A score of 13 to 15 on the Checklist indicates Mild CAS • Prognostic Implications: Possibility of normal speech and language in 1 ½ to 2 ½ years with intensive, individual therapy incorporating evidenced based apraxia techniques along with extensive parental involvement.

33. # 3 Results Comparison • KSPT -> a diagnosis of Mild to Moderate Verbal Dyspraxia; CAS Checklist -> diagnosis of Mild CAS • GF & KSPT both show Vowel/Diphthong errors within words but not in isolation • Oral Exam and KSPT both indicate CAS, not Oral Apraxia • KSPT shows break down of errors on various syllable/word shapes whereas syllable shape analysis of GF responses needed when using CAS Checklist alone • Both KSPT & GF results help analyze phonology

34. Important to use a CAS diagnostic tool? • Yes, though pediatric rehab evaluation was thorough and correct in diagnosing CAS, used an unreferenced list of 10 characteristics of CAS with no norms. • Hence diagnosed severe CAS when normed diagnostic tools indicated mild to moderate which have a much better prognosis.

35. Important to use a CAS diagnostic tool? • Wouldn’t diagnose articulation, phonology, stuttering, language disorders, etc. without diagnostic instruments and protocol, hence shouldn’t diagnose CAS without using diagnostic instruments and protocol.

36. Conclusion On the evaluation of these 3 subjects, the Kaufman Speech Praxis Test and the CAS Checklist indicated the same diagnosis in 2 cases and in the third case close to the same diagnosis (Mild CAS compared to Mild to Moderate Verbal Dyspraxia).

37. References • Giesecke, K. & MacFadyen, H. (2010) Childhood Apraxia of Speech Checklist, Dallas, TX; Self Published. • Kaufman, N. (1995). Kaufman Speech Praxis Test, Detroit, Michigan; Wayne State University Press.