“CAS” vs. “TMT”

Hi, Everyone! In Dallas last weekend, so many parents talked to me about their worries over speech delays and possible apraxia (CAS), that I want to talk about “what’s what” with you. Not only “What’s what,” but what to do about it.

First, there is CAS, Childhood Apraxia of Speech, with its wide spectrum of involvement. And then there is TMT Syndrome (which I’ve just named, tongue-in-cheek). What is TMT Syndrome? It’s TOO MUCH TROUBLE syndrome, commonly found lurking in our kiddos with Down syndrome. I know all about TMT syndrome, having raised a son who had it (eye roll), and I see it every week in my students.

What’s the difference?

So what’s the difference? Kids who have TMT syndrome CAN actually make the required sounds for speech, but it’s just too much trouble. It involves too much hard work. So they do the minimum in articulation, knowing full well that Mom and Dad and their siblings will figure it out. Trust me on this. I see it all the time with my students and their families. The problem with this default position is that Joe Schmoe, a potential future employer, is not going to be able to understand them.

On the other hand, children who genuinely have Apraxia CANNOT make the required sounds for articulation…they physically cannot produce either some or most of the necessary sounds. The motor apparatus just doesn’t work. The brain knows exactly what it wants to say, gives the command to the body, but — to oversimplify — there is a disconnect in the wiring and the muscles don’t get a clear message; they can’t cooperate. The child wants to make the sounds, but the body can’t.

Do children with true Apraxia need specialized speech therapy? You bet they do. Will typical speech therapy help them? Not likely. The approach is different.

Solutions: Apraxia

Let’s take the Apraxia solution first:

  1. Find an SLP (Speech Language Pathologist) who specializes in CAS. 
  2. Have him/her do an evaluation of your child.
  3. If the SLP diagnoses CAS, move forward getting specialized speech therapy, as CAS is categorized as a MEDICAL DIAGNOSIS. “Down syndrome developmental delay” is not a medical diagnosis and will not get your child specialized SLP services.
  4. Consider downloading the NACD Apraxia App (http://www.nacd.org/products/speech-therapy-for-apraxia-app/)
  5. If Apraxia is severe and progress is slow, consider a communication app like the highly recommended proloquo2go.
  6. Parents of children with CAS highly recommend using the Gemiini system at home. (Google it.)

Solutions: “Too Much Trouble” Syndrome

Now for the TMT syndrome solution:

  1. Keep uppermost in your mind that your child will have to be able to communicate with the world-at-large one day. 
  2. Hold your child to a standard of articulation that you know they can reach.
  3. Don’t cave. Be consistent. Start with one or two words that you insist they say clearly. Every time.
  4. Gradually increase the number of those words.
  5. Praise, praise, praise.
  6. Use my mirror tool: I can’t teach reading without also teaching articulation, and one good tool I use is a large hand-held mirror (about 8″ or so). I move in close to the child’s face and have them watch my mouth as I say a word. Then I put the mirror right in front of their face and have them immediately imitate what they just saw. This solves two problems: (a) they don’t typically watch our mouths carefully for modeling (why should they?), and (b) they have no idea how their own mouths look when they are trying to do the same thing. This can be a revelation for the child. Using this method, I have many times heard children say words clearly that they’ve never, ever been able to pronounce.

Other problems

Are there other speech/articulation problems that might be bugging our kids? Yes. Nature can get very inventive that way. Again, if you find an SLP who specializes in CAS, there’s a solid chance that s/he is also expert in related conditions which also need specialized therapy. Start with a qualified evaluator and go from there.

Getting clear on this and putting a solution in place will make everyone’s life easier in the long run, I guarantee it.






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Showing 2 comments
  • Tara Mills

    R u in UK?

    • Natalie Hale

      Hi, Tara- I’m in Los Angeles. But I do video consults around the world. I also ship the reading program around the world. Let me know if you have any questions!