Which statement about automatic versus volitional speech best supports an AOS diagnosis when automatic speech is relatively preserved and volitional speech is impaired?

• A. Automatic speech is often severely impaired while volitional speech is preserved.
• B. Automatic speech and volitional speech are both severely impaired in AOS.
• C. Automatic speech being relatively preserved supports a non-speech motor disorder rather than pure AOS.
• D. Automatic speech is relatively preserved while volitional speech is impaired.

Answer: (D)

The main idea is that apraxia of speech (AOS) is a problem with planning and programming the movements needed for speech, especially when speech is something you consciously produce. In AOS, automatic, well-practiced speech sequences (like counting, reciting days of the week, or saying common greetings) are often relatively preserved, while volitional or spontaneously generated speech is impaired and shows effortful, distorted articulation with groping and inconsistent errors. This dissociation is a hallmark of AOS: the motor plans for new or effortful speech are disrupted, but the stored, automatic sequences can still come out more smoothly.

So, this pattern—automatic speech being fairly intact while volitional speech is impaired—best supports an AOS diagnosis because it fits the typical motor-planning deficit that characterizes AOS, rather than a broader execution problem that would affect both automatic and volitional speech or point to a non-speech motor issue.