Childhood apraxia of speech: children at risk for persistent reading and spelling disorder.

This article discusses written language development in children with childhood apraxia of speech (CAS). Children with CAS are at risk for persistent reading and spelling disorder in addition to their spoken communication difficulties. The article highlights four factors that increase the risk of written language disorder in this population: (1) the nature of the speech disorder, (2) the presence of phonological awareness difficulties, (3) genetic risk factors, and (4) the negative impact of early reading difficulty on later written language development. The article suggests that traditional approaches used to target articulation in CAS may do little to develop skills that are critical to early literacy acquisition and stresses the importance of integrating speech, phonological awareness, and literacy goals for this population. Data presented from a pilot intervention study with three children with CAS aged 6 and 7 years highlight the potential benefit of an integrated phonological awareness approach to improve simultaneously speech, phonological awareness, and decoding ability. The need for further empirical evaluation of treatment approaches designed to improve the spoken and written language outcomes of children with CAS is emphasized.