Bang for Your Buck: A Single-Case Experimental Design Study of Practice Amount and Distribution in Treatment for Childhood Apraxia of Speech

2019 ◽  
Vol 62 (9) ◽  
pp. 3160-3182 ◽  
Author(s):  
Edwin Maas ◽  
Christina Gildersleeve-Neumann ◽  
Kathy Jakielski ◽  
Nicolette Kovacs ◽  
Ruth Stoeckel ◽  
...  
Keyword(s):  
Single Case ◽  
Evidence Base ◽  
Distributed Practice ◽  
Single Subject ◽  
Single Subject Design ◽  
Apraxia Of Speech ◽  
Childhood Apraxia Of Speech ◽  
Opposite Pattern ◽  
Massed Practice ◽  
Treatment Conditions

Purpose The aim of this study was to examine 2 aspects of treatment intensity in treatment for childhood apraxia of speech (CAS): practice amount and practice distribution. Method Using an alternating-treatments single-subject design with multiple baselines, we compared high versus low amount of practice, and massed versus distributed practice, in 6 children with CAS. Conditions were manipulated in the context of integral stimulation treatment. Changes in perceptual accuracy, scored by blinded analysts, were quantified with effect sizes. Results Four children showed an advantage for high amount of practice, 1 showed an opposite effect, and 1 showed no condition difference. For distribution, 4 children showed a clear advantage for massed over distributed practice post treatment; 1 showed an opposite pattern, and 1 showed no clear difference. Follow-up revealed a similar pattern. All children demonstrated treatment effects (larger gains for treated than untreated items). Conclusions High practice amount and massed practice were associated with more robust speech motor learning in most children with CAS, compared to low amount and distributed practice, respectively. Variation in effects across children warrants further research to determine factors that predict optimal treatment conditions. Finally, this study adds to the evidence base supporting the efficacy of integral stimulation treatment for CAS. Supplemental Material https://doi.org/10.23641/asha.9630599

Efficacy of treatment intensity in German-speaking children with childhood apraxia of speech

2021 ◽  
pp. 026565902110351
Author(s):  
Sabine Leonhartsberger ◽  
Eva Huber ◽  
German Brandstötter ◽  
Ruth Stoeckel ◽  
Becky Baas ◽  
...  
Keyword(s):  
Evidence Base ◽  
Single Subject ◽  
Treatment Intensity ◽  
Apraxia Of Speech ◽  
Childhood Apraxia Of Speech ◽  
Treatment Frequency ◽  
Treatment Conditions ◽  
German Speaking ◽  
Total Therapy ◽  
Learning Principles

Motor learning principles guide treatment of childhood apraxia of speech (CAS). Previous studies found children to benefit from higher-intensity conditions; however, they did not control for the total amount of therapy time. The aims of the article are to examine the effects of high versus low treatment frequency in intervention for CAS in German-speaking children. An alternating single-subject design with multiple baselines was applied to compare frequent, short sessions with fewer, longer sessions in terms of speech production accuracy in four children with CAS while keeping the total therapy time constant. We administered a version of integral stimulation treatment. Despite inter-individual differences, changes under both treatment conditions showed similar positive trajectories for all four children. Untreated control targets also improved across participants and conditions. Maintenance and generalization to untreated targets were observed two weeks and three months post treatment, independent of treatment intensity. Our results show no significant advantage of more intensive treatment when the total therapy time is held constant. This study contributes to the evidence base for the use of integral stimulation in treating children with CAS, and in particular those who speak languages other than English.

Construction of a Therapy program targeting Expressive language in non verbal autistic children

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Safaa R EL-Sady ◽  
Mariam S Shadi ◽  
Marwa G Rezk
Keyword(s):  
Expressive Language ◽  
Treatment Strategies ◽  
Spoken Language ◽  
Single Subject ◽  
Single Subject Design ◽  
Autistic Children ◽  
Language Therapy ◽  
Childhood Apraxia Of Speech ◽  
Therapy Program ◽  
Conversational Language

Abstract Background Some autistic children remain non verbal even after receiving multiple interventions. There is no obvious cause can explain failure of those autistic children who have adequate cognitive ability and communicative intent to acquire spoken language, except childhood apraxia of speech (CAS) that is treated differently than autism. Little is written about specific therapy programs that apply CAS treatment strategies to promote speech production for non verbal autistic children. Purpose The aim of this work is to detect the effectiveness of a therapy program targeting expressive language for non verbal autistic children by applying CAS treatment strategies. Methods pre – post single subject design in which each child acts as his or her own control. All the twenty children included in the study had been received previous language therapy at least for 6 months before the starting of the study with no improvement in verbal output. Results Of the twenty children enrolled in this study, eighteen children developed spoken language at least multiple single words used both during therapy session and at home. Conclusion a structured conversational language therapy program that apply CAS treatment strategies can help non verbal autistic children to acquire expressive language.

A Pilot Single-Case Experimental Design Study of Rapid Syllable Transition Treatment for Italian Children With Childhood Apraxia of Speech

2021 ◽  
pp. 1-15
Author(s):  
Ilaria Scarcella ◽  
Letizia Michelazzo ◽  
Patricia McCabe
Keyword(s):  
Experimental Design ◽  
Single Case ◽  
Lexical Stress ◽  
Effect Sizes ◽  
Apraxia Of Speech ◽  
Childhood Apraxia Of Speech ◽  
Treatment Results ◽  
Italian Children ◽  
Treatment Procedures ◽  
Stress Patterns

Background The Rapid Syllable Transition (ReST) treatment is an effective intervention designed to address the planning and programming disorder found in childhood apraxia of speech. To date, no study has considered its use with children who speak languages other than English. Aim This pilot study aimed to examine the use of ReST treatment with Italian children. We hypothesized that the ReST approach would improve the overall accuracy of the targeted behaviors of lexical stress, smoothness, and phonemic accuracy, whereas phonemic and phonetic accuracy of untreated items would remain stable. Method Two monolingual Italian-speaking children with childhood apraxia of speech received therapy in 12 one-hour sessions, 2–3 times per week, using a single-case experimental design. The treatment procedures used in English were replicated in Italian with one change: In English, two stress patterns are treated. Italian commonly uses three stress patterns; therefore, the stimuli were modified accordingly. Accuracy of articulation, lexical stress, and smoothness were assessed at pretreatment and 1 day, 1 week, and 4 months posttreatment in treated and untreated pseudowords and in real words and sentences. Results Both children improved on treated pseudowords and real words with moderate effect sizes, but only one child generalized to untreated pseudowords. Maintenance of treatment results was observed in both participants. Articulation of control phonemes did not change. Conclusions ReST treatment in Italian is feasible, and a treatment effect was found, showing that its use may be valid in languages other than English. Further research is required. Supplemental Material https://doi.org/10.1044/2021_AJSLP-20-00133

Treating Childhood Apraxia of Speech With the Kaufman Speech to Language Protocol: A Phase I Pilot Study

2018 ◽  
Vol 49 (3) ◽  
pp. 524-536 ◽  
Author(s):  
Maryane Gomez ◽  
Patricia McCabe ◽  
Kathy Jakielski ◽  
Alison Purcell
Keyword(s):  
Pilot Study ◽  
Phase I ◽  
Single Case ◽  
Maintenance Phase ◽  
Preliminary Evidence ◽  
Multiple Baseline ◽  
Response To Treatment ◽  
Apraxia Of Speech ◽  
Childhood Apraxia Of Speech ◽  
Treatment Gains

Purpose A Phase I pilot study was designed to collect preliminary evidence on the use of the Kaufman Speech to Language Protocol (K-SLP; Kaufman, 2014) to treat children with childhood apraxia of speech. We hypothesized that the K-SLP approach would result in more accurate speech production in targeted words, whereas untrained (control) words and speech sounds would remain unchanged. Method A single-case multiple-baseline across behaviors experimental design was used to see if experimental feasibility could be demonstrated. Two children each received a total of 12 1-hr treatment sessions over 3 weeks. The children's response to treatment and experimental control was measured by administering baseline, treatment, and posttreatment probes. Results Both children showed some response to treatment, as measured by percent phonemes correct; however, the response to treatment varied. In general, for the treated words that improved with therapy, accuracy was maintained above baseline level during the maintenance phase. Minimal generalization was observed for this study, with only 1 participant generalizing treatment gains to 2 sets of untrained (similar) words. Conclusion This Phase I pilot study provides limited preliminary evidence for the effectiveness of the K-SLP approach in treating childhood apraxia of speech in some children under the conditions specified in this study. Replication of these results in well-controlled studies is needed before this structured and operationalized version of the K-SLP approach can be recommended for clinical use.

Speech Intervention Effects for Childhood Apraxia of Speech: Quality Appraisal of Systematic Reviews

2020 ◽  
Vol 5 (3) ◽  
pp. 646-653
Author(s):  
Alisha P. Springle ◽  
Amber Breeden ◽  
Anastasia M. Raymer
Keyword(s):  
Systematic Reviews ◽  
Controlled Trial ◽  
Evidence Base ◽  
Motor Programming ◽  
Measurement Tool ◽  
Apraxia Of Speech ◽  
Childhood Apraxia Of Speech ◽  
Positive Effects ◽  
Treatment Research ◽  
Meta Analyses

Purpose A number of justification have examined the effects of speech interventions on outcomes in childhood apraxia of speech (CAS). The findings have been summarized in the form of systematic reviews (SRs) and meta-analyses, which are used to support evidence-based clinical practice decisions. Yet without acceptable rigor, SRs/meta-analyses may be biased in their recommendations. We appraised the quality of existing SRs for CAS treatment using a tool developed within epidemiology, the AMSTAR-2 (A MeaSurement Tool to Assess Systematic Reviews). Method A search of five databases to identify published SRs that coalesced treatment research for CAS revealed six systematic reviews that met inclusion criteria. Two examiners coded each article with the AMSTAR-2 to rate the methodologic rigor of the SRs and extracted summary data. Results One rigorous systematic review included only one randomized controlled trial. A second moderately rigorous review examined multiple single participant research designs. The weight of high-quality evidence supported the positive effects of motor programming treatments for children with CAS. Conclusions Findings of six systematic reviews, two of which were conducted with relative rigor, suggest that motor programming treatments have the best evidence base for treatment decisions pertaining to CAS. Clinicians are referred to online resources to implement these treatments according to published protocols.

Rapid Syllable Transition Treatment—A Treatment for Childhood Apraxia of Speech and Other Pediatric Motor Speech Disorders

2020 ◽  
Vol 5 (4) ◽  
pp. 821-830 ◽  
Author(s):  
Patricia McCabe ◽  
Donna Claire Thomas ◽  
Elizabeth Murray
Keyword(s):  
Ad Hoc ◽  
Single Case ◽  
Controlled Trial ◽  
Speech Disorders ◽  
Apraxia Of Speech ◽  
Childhood Apraxia Of Speech ◽  
Motor Speech ◽  
Motor Speech Disorders ◽  
Treatment Data ◽  
Core Features

Purpose Childhood apraxia of speech (CAS) is a speech disorder that many generalist speech-language pathologists feel underqualified to treat. For children with CAS, this may result in ad hoc interventions resulting in slower progress. Research evidence for various CAS treatments is primarily limited to single-case experimental design studies; however, two treatments (Rapid Syllable Transition Treatment [ReST] and the Nuffield Dyspraxia Programme, Third Edition) have been compared in a single randomized controlled trial. Conclusion This tutorial describes one of those treatments: ReST which was designed to address the three consensus core features of CAS simultaneously: consistency and accuracy of sounds, sequencing, and prosody. The treatment uses nonwords to help children build and store accurate motor plans and programs using principles of motor learning. Treatment data are described, and commonly reported clinical issues are discussed. Recommendations for which children may be suitable for ReST and for evidence-based practice are described.

The Effect of Hand Gesture Cues Within the Treatment of /r/ for a College-Aged Adult With Persisting Childhood Apraxia of Speech

2017 ◽  
Vol 26 (4) ◽  
pp. 1236-1243 ◽  
Author(s):  
Heather Leavy Rusiewicz ◽  
Jessica Lynch Rivera
Keyword(s):  
Speech Sound ◽  
Single Subject ◽  
Apraxia Of Speech ◽  
Speech Sound Disorders ◽  
Childhood Apraxia Of Speech ◽  
Visual Modeling ◽  
Verbal Instructions ◽  
Spatiotemporal Parameters ◽  
Withdrawal Design ◽  
Preliminary Support

Purpose Despite the widespread use of hand movements as visual and kinesthetic cues to facilitate accurate speech produced by individuals with speech sound disorders (SSDs), no experimental investigation of gestural cues that mimic that spatiotemporal parameters of speech sounds (e.g., holding fingers and thumb together and “popping” them to cue /p/) currently exists. The purpose of this study was to examine the effectiveness of manual mimicry cues within a multisensory intervention of persisting childhood apraxia of speech (CAS). Method A single-subject ABAB withdrawal design was implemented to assess the accuracy of vowel + /r/ combinations produced by a 21-year-old woman with persisting CAS. The effect of manual mimicry gestures paired with multisensory therapy consisting of verbal instructions and visual modeling was assessed via clinician and naïve listener ratings of target sound accuracy. Results According to the perceptual ratings of the treating clinician and 28 naïve listeners, the participant demonstrated improved speech sound accuracy as a function of the manual mimicry/multisensory therapy. Conclusions These data offer preliminary support for the incorporation of gestural cues in therapy for CAS and other SSDs. The need for continued research on the interaction of speech and manual movements for individuals with SSDs is discussed.

Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS): A Single-Case Experimental Design Study

2021 ◽  
pp. 1-17
Author(s):  
Molly Beiting ◽  
Edwin Maas
Keyword(s):  
Single Case ◽  
Scientific Evidence ◽  
Speech Sound ◽  
Preliminary Evidence ◽  
Autism Spectrum ◽  
Apraxia Of Speech ◽  
Childhood Apraxia Of Speech ◽  
Baseline Design ◽  
Speech Treatment ◽  
Production Accuracy

Purpose A subset of children with autism spectrum disorder (ASD) has speech sound disorders, including childhood apraxia of speech (CAS). To date, virtually all speech treatment studies consider ASD an exclusionary criterion, resulting in little scientific evidence for treatment of CAS for children who also have ASD. This study proposes and tests a novel approach, Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS), as a theoretically and clinically informed speech treatment option for this population. Method Using a multiple-baseline design within and across participants, three children with co-occurring ASD and CAS received 11–18 treatment sessions. Treatment targets were individually designed and matched with untreated control words. Probes were administered at the start of each session to assess speech production accuracy perceptually. Changes in production accuracy were examined through visual inspection and quantified with effect sizes. Results Findings were mixed, with one child showing significant gains for half of the treated targets at follow-up and two children showing no clear improvement. Conclusions Preliminary evidence suggests potentially positive treatment effects for ACT4CAS when implemented as intended, although treatment intensity and disorder severity likely influence treatment outcome. Replication and comparison of ACT4CAS to other speech treatments is needed. Supplemental Material https://doi.org/10.23641/asha.14110445

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