Elizabeth Adams Costa, PhD Kate Maina, MHS Nancy Mellon, MS Christine Mitchell, MS Meredith Ouellette, MS Sharlene Wilson Ottley, PhD

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1 Elizabeth Adams Costa, PhD Kate Maina, MHS Nancy Mellon, MS Christine Mitchell, MS Meredith Ouellette, MS Sharlene Wilson Ottley, PhD

2 Disclosure Full-time employee of The River School No other relevant financial or nonfinancial relationships to disclose

3 Childhood Apraxia of Speech Motor planning disorder that involves the breakdown from phonological code into motor commands (Button et al., 2013) Broad range of language problems More likely to present with comorbid reading, spelling, and academic difficulties (Freebairn et al., 2004)

4 Hearing loss is typically a rule out when diagnosing CAS children with hearing loss often present with delayed speech production, including babbling. Reduced motor sequencing movements involved in speech creates atypical development Complicates differential and/or comorbid diagnosis

5 CI+ CAS (n = 10) CI only (n = 10) CI+CAS (2.3 years) CI only (2.0 years) Demographics CI+CAS (5 females, 5 males) CI only (7 females, 3 males) All enrolled in the same inclusive educational environment

6 Assessments Administered Expressive Language Clinical Evaluation of Language Fundamentals 4 th edition (CELF-4) Articulation Goldman-Fristoe Test of Articulation Second Edition (GFTA-2) Phonological Processing Test of Auditory Processing Skills 3 rd Edition (TAPS-3)

7 Working Memory Kaufman Assessment Battery for Children KABC, Sequential Processing Scale Word Reading Wide Range Achievement Test WRAT, word reading Spelling WRAT, spelling

8 Results CI+CAS group performed significantly lower on the following measures.

9 Expressive Language (CELF-4) p=0.01* 96.5 CI Only CI Only CI+CAS 76.4 CI+CAS

10 95 90 Articulation (GFTA-2) p=0.045* CI Only CI Only CI+CAS 80.4 CI+CAS

11 Phonological Processing (TAPS) 105 p=0.01* CI Only CI Only CI+CAS 89.6 CI+CAS

12 Spelling (WRAT) p=0.04* CI Only CI Only CI+CAS CI+CAS

13 105 Working Memory (KBAC) p= CI Only CI Only CI+CAS CI+CAS

14 Conclusion significant difference across domains for CI + CAS, compared to a control group of children with CI only This research supports the possibility of a comorbid and distinct CAS diagnosis

15 Implications How can we intervene to improve outcomes for children with CIs as well as CAS? Employ a motor speech approach to target articulation Begin phonological intervention early Focus on targeting expressive language

16 References Burkholder, R. A., & Pisoni, D. B. (2003). Speech timing and working memory in profoundly deaf children after cochlear implantation. Journal of Experimental Child Psychology, 85, Button, L., Chapman, K., Peter, B., Raskind, W.H., & Stoel-Gammon, C. (2013). Deficits in sequential processing manifest in motor and linguistic tasks in a multigenerational family with childhood apraxia of speech. Clinical linguistics & phonetics, 27 3, Dettman, S. J., Pinder, D., Briggs, R. J., Dowell, R. C., & Leigh, J. R. (2007). Communication development in children who receive the cochlear implant younger than 12 months. Ear Hear, 28(Supplement 2), 11S 18S. Freebairn, L.A., Hansen, A.J., Iyengar, S.K., Lewis, B.A., & Taylor, H.G. (2004). School-age follow-up of children with childhood apraxia of speech. Language, speech, and hearing services in schools, 35 2,

17 Geers, A., & Sedey, A. L. (2011). Language and verbal reasoning skills in adolescents with ten or more years of cochlear implant experience. Ear Hear, 32(Supplement 1): 39S 48S. Geers, A., Tobey, E., Moog, J., & Brenner, C. (2008). Long-term outcomes of cochlear implantation in the preschool years. International Journal of Audiology, 47(Supplement 2): S21 S30. Gupta, P., & MacWhinney, B. (1997). Vocabulary acquisition and verbal short-term memory: Computational and neural bases. Brain and Language, 59, Hansson, K., Forsberg, J., Löfqvist, A., Mäki-Torkko, E., & Sahlén, B. (2004). Working memory and novel word learning in children with hearing impairment and children with specific language impairment. International Journal of Language and Communication Disorders, 39,

18 Holt, R. F., & Svirsky, M. A. (2008). An exploratory look at pediatric cochlear implantation. Ear Hear, 29(4), Maassen, B. (2002). Issues contrasting adult acquired versus developmental apraxia of speech. Seminars in speech and language, 23 4, Mayne, A., Yoshinaga-Itano, C., & Sedey, A. (2000). Receptive vocabulary development of infants and toddlers who are deaf or hard of hearing. The Volta Review, 100(5), Nicholas, J. G., & Geers, A. E. (2007). Will they catch up? Journal of Speech, Language and Hearing Research, 50(4), Niparko, J. K., Tobey, E. A., Thal, D. J., Eisenberg, L. S., Wang, N., Quittner, A. L., & Fink, N.E. (2010). Spoken language development in children following cochlear implantation. The Journal of the American Medical Association, 303(15),

19 Pisoni, D. B., & Cleary, M. (2003). Measures of working memory span and verbal rehearsal speed in deaf children after cochlear implantation. Ear and Hearing, 24, 106S 120S. Pisoni, D. B., & Geers, A. E. (2000). Working memory in deaf children with cochlear implants: Correlations between digit span and measures of spoken language processing. Annals of Otology, Rhinology and Laryngology, 185, Quittner, A. L., Cruz, I., Barker, D. H., Tobey, E., Eisenberg, L. S. & Niparko, J. K. (2013). Effects of maternal sensitivity and cognitive and linguistic stimulation on cochlear implant users language development over four years. Journal of Pediatrics, 162(2),