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Childhood apraxia of speech (CAS) is a complex motor speech disorder which requires a specialized treatment program for a child

to ensure maximum success. The following is the accepted definition of CAS as taken from the American Speech-Language-Hearing Association (ASHA) - Childhood Apraxia of Speech Technical Report: “Childhood apraxia of speech (CAS) is a neurological childhood (pediatric) speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits, (e.g., abnormal reflexes, abnormal tone)…The core impairment in planning and/or programming spatiotemporal parameters of movement sequences results in errors in speech sound production and prosody” (ASHA, 2007a). Below is a statement outlining the guidelines that have been compiled from ASHA’s technical report regarding the treatment of CAS. Treatment Strategies and Goals According to ASHA’s statement: 1) Research supports an integral stimulation approach to treatment “…Efficacy research has been reported only for the integral stimulation approach (Strand & Debertine, 2000; Strand & Skinder,1999)…It incorporates principles of motor learning…Manipulation of parameters that affect motor learning, such as frequency and nature of practice opportunities and knowledge of results and performance, are fundamental elements of the integral stimulation approach” (ASHA, 2007a). 2) Optimum treatment incorporates the principles of motor learning “Overall, the principles of motor learning theory and intensity of speech motor practice appear to be the most often emphasized in an optimal treatment program. These recommendations include the need for distributed practice, in which speech-motor practice is carried out across a variety of activities, settings, and situations, and includes several exemplars per pattern (e.g., Strand & Skinder, 1999)” (ASHA, 2007a) – also see Maas, et. al, 2008. 3) Oral motor exercises are not recommended …speech requires more flexibility, less stereotyped rhythmicity, finer levels of coordination, and lower levels of strength than other nonspeech oral motor activities such as chewing, blowing, and the like…the consensus opinion is nonspeech oro-motor therapy is neither necessary nor sufficient for improved speech production” (ASHA, 2007a) – also see Lof, 2007 and McCauley et. al., 2009. Tec Utilization of a Multi-Sensory Approach According to ASHA’s statement: “Another often-cited recommendation is to take advantage of other areas of strength for children with CAS by utilizing a multisensory approach to treatment. The use of sign language, pictures, AAC systems, visual prompts, and touch cues have been described as being extremely effective for children with CAS, providing functional communication while at the same time supporting and enhancing verbal speech production” (ASHA, 2007a). Generalization of Skills According to ASHA’s statement: “Another important element for optimal progress and carry-over is to involve as many important people in the child's life as possible, in a culturally appropriate manner, in understanding and completing therapy goals outside the treatment setting” (ASHA, 2007a).

Treatment Intensity and Length of Treatment Sessions From ASHA’s statement: “Given the need for repetitive planning, programming, and production practice in motor speech disorders, clinical sources stress the need for intensive and individualized treatment of apraxia, especially for children with very little functional communication. There is emerging research support for the need to provide three to five individual sessions per week for children with apraxia as compared to the traditional, less intensive, one to two sessions per week… Although home practice is critical for optimal progress, it cannot take the place of individual treatment provided by a speech-language pathologist who has expertise in motor speech skill facilitation. For the diverse backgrounds of children seen for early intervention, including their stages of psychological/emotional development, the Committee sees value in endorsing a treatment plan for optimum progress based on provision of intensive therapy…As long as the primary goal is to improve the motoric aspects of the child's speech production (i.e., more time for motor practice), individual therapy should be the preferred approach regardless of age” (ASHA, 2007a) Early Intervention According to ASHA statement: “Although the specific forms of treatment may change over time, the Committee recommends that children with CAS receive intensive services, especially in the earlier stages of intervention. The rationale for this recommendation is based on the assumption that the child's potential for normalization of speech and prosody may be substantially reduced if not addressed during early periods of growth and development” (ASHA, 2007a). Qualifications of SLP According to ASHA’s statement: “…speech language pathologists must be adequately trained in areas such as differential diagnosis of childhood motor speech disorders, motor learning theory, cueing strategy usage, and other intervention techniques that clinical researchers have reported as effective” (ASHA, 2007a). References American Speech-Language-Hearing Association. (2007a). Childhood Apraxia of Speech [Technical Report]. Available from American Speech-Language-Hearing Association. (2007b). Childhood Apraxia of Speech [Position Statement]. Available from Caruso, A., & Strand, E. A. (Eds.). (1999). Clinical management of motor speech disorders in children. New York: Thieme Medical. Lof, G.L. (2007). Logic, Theory and Evidence Against the Use of Nonspeech Oral Motor Exercises to Change Speech Sound Production. Available from Maas E, Robin DA, Austermann Hula SN, Freedman SE, Wulf G, Ballard KJ, Schmidt RA. (2008). Principles of Motor Learning in Treatment of Motor Speech Disorders. American Journal of SpeechLanguage Pathology,17, 277–298.

McCauley RJ, Strand E, Lof GL, Schooling T, Frymark T. (2009). Evidence-Based Systematic Review: Effects of Nonspeech Oral Motor Exercises on Speech. American Journal of Speech-Language Pathology, 18, 343-360. Rosenbek, J., Lemme, M., Ahern, M., Harris, E., and Wertz T., (1973). A treatment for apraxia of speech in adults. Journal of Speech and Hearing Disorders, 38, 462-472. Strand, E., & Debertine, P. (2000). The efficacy of integral stimulation intervention with developmental apraxia of speech. Journal of Medical Speech-Language Pathology, 8, 295-300. Strand, E. & Skinder, A. (1999). Treatment of developmental apraxia of speech: Integral stimulation methods. In A. Caruso & E. Strand (Eds.), Clinical management of motor speech disorders in children (pp. 109-148). New York: Thieme. Strand, E. A., Stoeckel, R., & Baas, B. (2006). Treatment of Severe Childhood Apraxia of Speech: A Treatment Efficacy Study. Journal of Medical Speech-Language Pathology, 14, (4) 297-307.