Speech Therapy Frequency for Children with Apraxia
“How much therapy is needed?” This is a question speech therapists get all of the time. How much is enough? How much is too much? Is there ever such a thing as too much speech therapy for childhood apraxia of speech (CAS)? Read on to learn more about speech therapy recommendations from a speech-language pathologist who treats speech sound disorders.
What is Childhood Apraxia of Speech?
Childhood Apraxia of Speech, sometimes referred to as apraxia or its acronym CAS, is a motor speech disorder. Children with this diagnosis have trouble carrying out the specific motor movements to produce clear, precise, and intelligible speech. It is a movement disorder. It is not caused by weakness or cognitive impairment and it is not something that parents or caregivers have caused.
Want to learn more? Check out the blog Childhood Apraxia Of Speech — What The Heck Is That?!? It covers the basics of this diagnosis.
Can Children With CAS Improve Their Speech?
This is the question that every parent and caregiver asks after their child is diagnosed with apraxia? “Will my child improve?” “Will speech get easier for them?” “Will they ever be able to talk?” “How can I help them?”
The answer to these questions are difficult to answer. Speech therapists are not equipped with crystal balls to know the future, but we do know that with individualized, frequent, and intensive speech therapy from a speech-language pathologist knowledgeable and trained in motor speech disorders most children are capable of making good improvements.
What’s the Magic Number of Speech Therapy Sessions?
Spoiler alert — there is not one answer to this question for every child. In the Apraxia Kids quote above, they say that “appropriate speech therapy” is needed to make improvement. Figuring out what is “appropriate” for each child includes figuring out how frequent and for how long speech therapy takes place. There is not a one-size-fits-all recommendation with regards to frequency and duration. Every child is different and every child’s needs are different. There is not magic formula.
Children with more severe apraxia will need more frequent therapy than children who are more intelligible. Younger children will likely need shorter speech therapy sessions while older children may be able to tolerate longer sessions. And the amount or frequency of speech therapy may fluctuate over time.
In my professional experience, children who are 3 or younger may need sessions lasting 30 minutes with movement breaks. Older children, 4 or 5 and older, can often participate in 45 minutes to 60 minutes of speech therapy when allowing for play breaks.
Its unrealistic to ask any child, or adult for that matter, to sit for 60 consecutive minutes! Remember that working on producing the motor patterns for speech is extremely difficulty and effortful for children with CAS. While a child may be able to engage in fun leisure activities for 60 minutes that does not mean that this will translate to how long they are able to engage in speech therapy.
Forcing a child to do drill work for long periods of time can and often does lead to negative reactions to speech therapy. It can feel like torture to some children and forcing them through more minutes will not lead to functional gains in the long run. Factors like a child’s age, temperament, and what is feasible for the family should be considered when determining the service delivery.
What Do The Fancy Researchers Say?
Existing literature tells us “frequent” dosage. Some articles and websites say at least two times a week. Other articles say three to five times a week. A few websites summarize the research out there to help streamline things.
- The American Speech-Language and Hearing Association (ASHA) is a United States-based national professional, scientific, and credentialing association for speech therapists. They summarized current research in their policy on CAS and recommend three to five sessions per week. Here is their citation:
Given the need for repetitive production practice in motor speech disorders like CAS, intensive and individualized treatment is often stressed. A number of research studies support the need for three to five individual sessions per week versus the traditional and less intensive one to two sessions per week (Hall et al., 1993; Skinder-Meredith, 2001; Strand & Skinder, 1999). For younger children, the frequency and length of sessions may need to be adjusted; shorter, more frequent sessions are often recommended (e.g., Skinder-Meredith, 2001).
- This article from Elizabeth Murray and Jenya Iuzzini-Seigel indicates that the most important aspects of therapy is to incorporate principles of motor learning specifically with a high number of speech sessions with a lot of practice. They summarized other articles and reported that two sessions a week was the minimum that showed gains but that most articles recommended 3–5 sessions per week.
- Apraxia kids has more information regarding all things Apraxia of Speech and lists more articles regarding what the literature summarizes. I will put their link here to peruse.
Is Number of Speech Sessions the Most Important Factor?
The frequency and amount of minutes are easy to get hung up on BUT is it the most important factor to help a child? The answer to this is “no”. While frequency is very important, accessing a speech therapist trained and experienced is one of the most important factors. Childhood Apraxia of Speech requires specific types of therapeutic techniques that focus on principles of motor programming and motor planning to help children make progress.
In this blog post I outline the different approaches to treating CAS. It is important for the speech therapist working with children to be familiar with these approaches. Each child is different and the therapy and cues they need will be specific. The speech pathologist should be very familiar with motor planning and the evidence-based approaches to design effective therapy for each child.
Not all speech therapists are comfortable and competent in treating this communication disorder and the “wait and see” approach has yet to positive results.
Need help finding a qualified speech therapist? Check out this directory compiled by Apraxia Kids.
How Do Families Figure Out Frequent Therapy
As we reviewed in this post, frequent and individual speech therapy is recommended to help children with CAS make functional improvements. But how and where do families advocate for therapy?
Schools can and do provide speech therapy. Children over the age of three are eligible for speech therapy with a diagnosis of CAS following a school assessment. When going through the school, families will create a plan called an Individualized Education Plan (IEP) to determine the frequency of speech therapy and whether speech will be provided individualized or a group. The school team will make recommendations as to what they think the child needs. With CAS, families should be looking for specifically individual speech therapy to be included in the IEP.
Many (but not all) insurances will cover speech therapy for a child with an existing CAS diagnosis. Insurance plans are complex so I recommend that each family call their insurance to learn about the specific requirements. Many families will access their insurance benefit in collaboration with school-based speech therapy.
Some families will pay out of pocket when their insurance doesn’t cover speech therapy services or if a provider that they want to work with does not accept insurance. The cost of this can add up so many families will access private pay speech therapy to compliment therapy at school.
Summary
Childhood apraxia of speech (CAS) is a unique motor speech disorder. This means that children with this diagnosis have trouble carrying out the specific motor plan required to produce intelligible speech. Children with CAS often know what they want to say and understand what is being said to them but have trouble speaking clearly and intelligibly.
Children with CAS can and do make improvements. I have seen it when I worked in a hospital and in my private practice. Children with this diagnosis need specific and frequent speech therapy to make improvements. This diagnosis does not improve on its own. When deciding on a therapy plan, the first step is to find a knowledgeable speech therapist who can support each child and family’s unique needs.
While some research has been done there is no “One-size-fits-all” recommendation when it comes to frequency and duration of speech therapy. Most of the research available agrees that speech therapy is recommended at a minimum of twice per week. Most cite at least three times per week is recommended but the length of each session is dependent on a factors such as the child’s age, temperament, and the family’s schedule. Therapy can occur in schools, outpatient clinics or even at home.
The main goal of speech therapy should be improved intelligibility and independence. It is frustrating for children to know what they want to communicate and not be able to say it clearly. It's important that each family work with a knowledgeable and qualified speech therapist who will implement motor learning in therapy and who will help determine the right frequency and duration for their child.
I hope you found this blog about childhood apraxia of speech helpful!
TLC Speech Therapy is a speech pathology private practice, headquartered in Boston, Massachusetts, that specializes in feeding, swallowing, and cognitive-communication skills in infants, children, teens, and adults.
For more information about speech therapy or high-intensity programming, check out our website at tlcspeechtherapy.com or contact us at hello@tlcspeechtherapy.com
Disclaimer :)
As a speech therapist and certified brain injury specialist, I have experience working with children and adults in many different settings. The information in this article is meant to provide some general information about apraxia of speech. It is not meant as clinical advice. If you ever have any concerns, please consult with a physician.
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