“Speech-language pathologists are the professionals who diagnose and treat disorders of speech, language, and swallowing. Thus, the assessment and diagnosis of apraxia of speech, as well as all other speech sound disorders, are within the scope of professional responsibilities of SLPs”
*…BUT…*
…Ontario’s Speech-Language Pathologists cannot communicate a diagnosis of CAS.
Wait, what?!
Outside of our province, SLPs can provide/confirm a diagnosis of Childhood Apraxia of Speech (CAS). The reason this task rests with SLPs is because SLPs are the only professionals who have the training and experience to accurately identify the characteristics that are CAS, and because CAS is a set of observable characteristics and not a medical diagnosis. If you are interested in learning more about this, CASANA has an article that explains it nicely: http://www.apraxia-kids.org/library/who-is-qualified-to-diagnosis-childhood-apraxia-of-speech/
Ontario is different and, from my perspective as a parent, this is problematic.
Do diagnosis issues really matter to parents?
Yes!
Yes, because although services vary by municipality, so many of Ontario’s children with apraxia are desperately underserved and it’s terribly hard to advocate for children that are hidden by lack of diagnosis.
Yes, because it matters to parents. Apraxia is hard – being in limbo without a diagnosis sure doesn’t make it any easier.
Yes, because formal diagnosis gives legitimacy. It’s next to impossible to advocate for a child who does not have a specific diagnosis.
Does it really matter to parents if professionals just call it something else and not worry about pursuing an “apraxia” diagnosis?
YES! It does!
If a parent is to make informed decisions about their child’s treatment, they must know exactly what they are dealing with. Substituting a term like motor planning disorder or motor speech disorder (MSD) may be accurate but it is not precise (there are other issues/diagnoses that fall under MSD). Not communicating a specific diagnosis clouds a parent’s ability to connect with the growing research, education, and support available to families dealing with a specific CAS diagnosis.
Does it matter to parents if professionals say “suspected apraxia of speech” instead?
Yes!
It feels like “suspected apraxia of speech” or “suspected CAS” is often used in Ontario with a nudge and wink to say “this-child-has-apraxia-but-I-can’t-say-that-explicitly”.
The difficulty is that “suspected” and “confirmed” are very different. “Suspected” can encourage a wait-and-see attitude that can delay parents from accepting the diagnosis (or family/friends for buying-in and supporting those parents). Additionally, there can be confusion because this term is typically and accurately used to describe children who require further SLP assessment in order for a diagnosis to be made, which is not necessarily how professionals in Ontario use this term. According to the literature on CAS, use of the term “suspected” is supposed to be reserved for those children under 3 and/or less familiar to a speech-language pathologist who might be considering a diagnosis but it is clinically too early to determine an accurate diagnosis.
Does it really matter that families have to travel out of province to get a SLP-made CAS diagnosis?
Absolutely.
Apraxia is a big deal. Any apraxia family you meet in Ontario is making huge investments – whether it’s time, effort, money, or emotion – and we have to recognize that there is prudence in ensuring that a child has the correct diagnosis before making such investments. For this reason, you see families who do travel because they want to know.
This option is limited to those families who are geographically and financially able to pursue it and there is no fairness for our children in that. Additionally, it sure feels silly that families have to go outside of Ontario for a SLP diagnosis of CAS when we have our own excellent and qualified clinicians right here in our province. It’s also frustrating that families have to spent time and money to travel for such a diagnosis when those resources could be spent on therapy instead.
Does it really matter to parents that a child must be referred to a medical professional rather than a SLP for a formal CAS diagnosis?
Yes!
We wouldn’t take a child to a SLP for a medical diagnosis, so why do we find ourselves taking our children to medical doctors to diagnose a speech disorder? Physicians may provide information that contributes to the assessment but speech-language pathologists hold the ability to differentiate apraxia of speech from other speech and/or language disorders such as dysarthria, autism, and stuttering.
Does it matter if SLPs explain the situation to parents?
I think so.
When a child is identified as having the set of characteristics that are Childhood Apraxia of Speech, whether the SLP can ‘diagnose’ this or not, parents have the right to start making choices about their child’s journey for therapy. There is a lot at stake – these are our children! – we can only make informed decisions when we have all the right information.
If you are a SLP, I encourage you to be open with your clients, and to support your families who choose to pursue a diagnosis! Considering reaching out to OPPEN CAS for support on how to do this Ontario without compromising your professional restrictions. OPPEN CAS has a great article here on diagnosing CAS in Ontario: https://oppencas.ca/diagnosis-of-cas-in-ontario-why-its-tricky-why-its-important-and-why-we-need-to-do-better/
If you are a parent considering seeking a formal diagnosis, know that it is not straightforward but it is possible. If it is important to you, I encourage you to talk to your SLP about how to pursue formal diagnosis and know that OPPEN CAS is available to support you both.
Angela Muis remains grateful to her son Huxley’s SLP for being open about CAS diagnosis in Ontario, and for offering her support to seek a formal diagnosis. Ultimately, Angela and her husband, Erick, did pursue formal diagnosis because they feel that diagnosis matters and it’s important to call apraxia by name. Apraxia has been a long and hard road but Huxley’s apraxia is now resolved and along the way, Angela found her calling and is currently completing her Honours Diploma in hopes of becoming a SLP-A/CDA.
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