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Comorbidity and severity in childhood apraxia of speech (Chenausky et al., 2023)

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Version 2 2023-07-17, 16:54
Version 1 2023-02-16, 17:30
posted on 2023-07-17, 16:54 authored by Karen V. Chenausky, Becky Baas, Ruth Stoeckel, Taylor Brown, Jordan R. Green, Cassandra Runke, Lisa Schimmenti, Heather M. Clark

Purpose: The purpose of this study was to investigate comorbidity prevalence and patterns in childhood apraxia of speech (CAS) and their relationship to severity.

Method: In this retroactive cross-sectional study, medical records for 375 children with CAS (Mage = 4;9 [years;months], SD = 2;9) were examined for comorbid conditions. The total number of comorbid conditions and the number of communication-related comorbidities were regressed on CAS severity as rated by speech-language pathologists during diagnosis. The relationship between CAS severity and the presence of four common comorbid conditions was also examined using ordinal or multinomial regressions.

Results: Overall, 83 children were classified with mild CAS; 35, with moderate CAS; and 257, with severe CAS. Only one child had no comorbidities. The average number of comorbid conditions was 8.4 (SD = 3.4), and the average number of communication-related comorbidities was 5.6 (SD = 2.2). Over 95% of children had comorbid expressive language impairment. Children with comorbid intellectual disability (78.1%), receptive language impairment (72.5%), and nonspeech apraxia (37.3%; including limb, nonspeech oromotor, and oculomotor apraxia) were significantly more likely to have severe CAS than children without these comorbidities. However, children with comorbid autism spectrum disorder (33.6%) were no more likely to have severe CAS than children without autism.

Conclusions: Comorbidity appears to be the rule, rather than the exception, for children with CAS. Comorbid intellectual disability, receptive language impairment, and nonspeech apraxia confer additional risk for more severe forms of CAS. Findings are limited by being from a convenience sample of participants but inform future models of comorbidity.

Supplemental Material S1. Table of comorbid conditions, categories, and rates of occurrence. 

Chenausky, K. V., Baas, B., Stoeckel, R., Brown, T., Green, J. R., Runke, C., Schimmenti, L., & Clark, H. (2023). Comorbidity and severity in childhood apraxia of speech: A retrospective chart review. Journal of Speech, Language, and Hearing Research, 66(3), 791–803.


This work was supported by National Institute on Deafness and Other Communication Disorders Grants R00 DC017490, awarded to Karen V. Chenausky; P50 DC018006, awarded to Helen Tager-Flusberg, supporting Karen V. Chenausky and Jordan R. Green; and K24 DC016312, awarded to Jordan R. Green.