Treatment Options for Childhood Apraxia of Speech
Childhood Apraxia of Speech (CAS) is a motor speech disorder that impacts a child’s ability to produce intelligible speech. Treatment options for this diagnosis are specific and some have been well studied. Read on to learn more.
What is childhood apraxia of speech?
Childhood Apraxia of Speech is a motor speech disorder that makes speaking clearly very difficult. It is not caused by weakness, cognitive impairment, and is not something that is caused or could have been prevented. To learn more about this diagnosis, check out this blog.
Who treats childhood apraxia of speech?
Frequent and specific therapy with a specialized speech pathologist is the recommended treatment. This is not a disorder that will be outgrown and it will not go away on its own. Do you need help finding a qualified speech pathologist? Check out the Apraxia Kids speech pathologist directory. You can enter your zip code and find therapists. Check out that link here.
How is it treated?
There are different programs that speech pathologist use to help improve the child’s intelligibility. All the programs designed for CAS are intensive and require frequent practice. Most include cueing, meaning that feedback that is given to children is specific. The most important aspect of treatment for CAS is a thorough understanding of the child’s speech abilities and speech system before therapy starts. This will help to figure out what is impacting their speech production and intelligibility so that therapy can be individualized to their needs.
I have summarized some of the most common and studied treatment programs for Childhood Apraxia of Speech. These approaches will treat the primary needs of CAS and the range of symptoms that accompany this diagnosis. These treatment approaches are familiar to most speech therapists and many speech therapists will pull aspects of a specific program when designing therapy for a child.
Out of the approaches I am listing, the therapeutic approaches that address motor learning have the best efficacy. I want to say that I do not endorse one of these methods over the other. The most important factor is that a knowledgeable speech therapist is providing the therapy and that the child is actively participating.
Therapy should be individualized. All of these programs are very specific. Typical speech therapy is based on meeting the child’s needs and less so on having the child meet the criteria for one of these treatment approaches. As part of therapy, programs are often adapted and they are rarely done exactly as written (unless part of a research study).
I have broken down the approaches into the two main categories:
Motor Programming Approaches
These approaches are based on principles of motor programming and motor planning. These approaches have frequent and intensive practice and focus on accurate motor movements. There approaches include multimodal sensory input (visual cues, auditory cues, touch cues, etc) and give specific feedback regarding the child’s ability to produce the targets.
Dynamic Temporal and Tactile Cueing (DTTC)
- This technique was created for children with severe Childhood Apraxia of Speech (CAS) but also works well with moderate CAS.
- It is a motor-based approach which targets the brain's ability to plan and execute the motor plan to produce speech. It incorporates principles of motor learning to help children learn the correct way to produce speech and to maintain this accuracy over time.
- The focus of therapy is on movement and not on specific sounds. Specific words are selected based on the assessment and are practiced in therapy.
- Vowels and prosody (the stress and inflection in speech) are also addressed. These aspects are typically difficult for children with CAS.
- Cues and support are individualized to each child. The child is given more or less support depending on their specific needs with the goal being independence.
- Maximum practice occurs in therapy to ensure that the child is able to get lots of accurate practice. Lots of accurate practice is vital to effect functional motor learning.
Interested in learning more about DTTC? Check out their website. There are free trainings for speech therapists.
Rapid Syllable Transition Treatment (ReST)
- This technique is specifically for children with CAS, mild to severe, and also works with dysarthria (another motor speech disorder) in children with cerebral palsy.
- Research shows that this technique is effective with children ages 4–13 with a main diagnosis of CAS without other complicating diagnoses.
- ReST is unique in that it uses nonsense words as the targets. These are words that sound like they are real words. The reasoning behind this is it allows children to practice and really concentrate on the movements.
- This techniques focuses on “beats” or stress. Children practice how to say sounds accurately in combination while using the correct prosody and in a smooth way. Children with CAS can sound telegraphic and this aspect of this technique helps to improve the smoothness.
- ReST differentiates itself by teaching new speech movements with specific feedback. Children have support and assistance at the beginning and then as they learn the support is faded. Speed is then targeted to help children to say the new sounds accurately.
- ReST has a specific structure to how speech therapy is delivered and recommended treatment blocks.
Interested in learning more about ReST? Check out their website. There are free trainings for speech therapists.
Nuffield Dyspraxia Programme, Third Edition (NDP3)
- This technique was developed for children with severe speech sound disorders, including CAS. It is most appropriate for children ages 3–7 years but can be adapted for children that are older or younger.
- This program focuses on speech from a bottom up approach. It starts with single sounds, then moving to sound combinations, words, phrases, sentences and then conversation.
- Targets start with what the child can do and then builds on those sounds. On the program’s website, they include an infographic with imagery of a brick wall building from sounds up to conversation.
- The program utilizes pictures, worksheets, and flipbooks to support the speech therapy targets. It includes an assessment, also has a therapy manual for speech therapists to use with children to help guide therapy and planning.
Interested in learning more about NDP3? Check out their website.
Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT)
- PROMPT is a treatment method for children ages 6 months and older with speech delays and disorders, including Childhood Apraxia of Speech.
- PROMPT uses what they call a ‘holistic’ approach including three domains (Social-Emotional, Cognitive-Linguistic, Physical-Sensory). PROMPT assessments and treatment will integrate all three of this domains to improve overall communication.
- Assessment is done using specific tools to determine which areas to focus on in therapy.
- It is best known for its unique and specific tactile-kinesthetic approach with the speech therapists physically guides the face to correctly form words. Therapy will focus on specific words chosen by the speech pathologist to address.
Interested in learning more about PROMPT? Check out their website.
Linguistic Approaches
Linguistic approaches put the focus on functional communication and emphasize linguistic and phonological components of speech. Speech targets are addressed that have a similar pattern of error to help children learn phonological rules.
It is important to note that linguistic approaches to CAS are intended as a complement to motoric approaches, not as a replacement for them. — American Speech Language and Hearing Association
Integrated Phonological Awareness Training (IPA)
- IPA is a program designed for children with speech and language impairment but has also shown to be effective with children with CAS ages 4–7.
- This program is a linguistic-based program rather than a motoric program. It incorporates speech production, phonological awareness (recognizing and manipulating sounds in words) and letter-sound knowledge.
- It is based on research that found that improving a child’s phonological awareness will help with reading, writing, and speech production.
- Requires a specific structure for how frequently speech therapy is provided. Sessions are intensive with a specific and systematic instruction.
- Regular assessment and reassessment occur to ensure that the child’s progress is monitored and that their skills are tracked.
Interested in learning more about IPA? Check out this website.
Cycles Phonological Remediation Approach (Cycles Approach)
- The cycles approach was designed to address development of intelligible speech and children with profound expressive phonological impairments. They defined this as intelligibility percentage less than 20%.
- This approach is for children who use a lot of different phonological processes (predictable error patterns). An example of a phonological process is final consonant deletion. This is a predictable process where the child does not say the final consonant in a word. For example, “Cah” for ‘cat’ or “Daw” for ‘dog’.
- Each phonological process is addressed for a specific amount of time and then cycling to a different phonological processes. The next pattern is targeted after the fixed amount of time has passed regardless of whether the child has mastered the sound.
- There is a specific schedule and hierarchy for all therapy sessions including components of listening to the speech therapist say the word, practice, and homework.
- The cycles are continued until child generalizes to their daily life spontaneously. It is implemented to imitate the typical development of phonological processes. It is used to stimulate the emergence of a specific sound or pattern, not produce mastery of it.
- Research studies for this particular method to treat CAS have had mixed results and sample sizes have been small.
Summary
Speech therapy is recommended for all children with childhood apraxia of speech (CAS). CAS will not improve without intensive, specific and accurate speech therapy.
There are many treatment approaches out there and the ones with the best research incorporate motor programming and cueing. This means that lots of practice occurs with the child learning the accurate way to produce the sounds.
I have listed a lot of different programs and it might seem overwhelming. I want to caution you that not all treatment methods will work for each child, even if the evidence is strong. The main goal of speech therapy should be improved intelligibility and independence.
TLC Speech Therapy is a speech pathology private practice, headquartered in Boston, Massachusetts, that specializes in feeding, swallowing, and communication skills in infants, children, teens, and adults.
For more information check out our website at tlcspeechtherapy.com or contact us at hello@tlcspeechtherapy.com
Want to take a deeper dive?
Learn more and check out these resources:
