Evaluation of A Combibed Treatment Approach For Childhood Apraxia of Apeech

Clinical Linguistics & Phonetics, April–May 2010; 24(4–5): 335–345
Evaluation of a combined treatment approach for childhood

apraxia of speech
JENYA IUZZINI & KAREN FORREST

Clin Linguist Phon Downloaded from informahealthcare.com by Monash University on 10/28/14
Indiana University, Bloomington, IN, USA
(Received 16 November 2009; Accepted 21 December 2009)
Abstract
The current study investigated the impact of a dual treatment approach that included stimulability
training protocol (STP) paired with a modified core vocabulary treatment (mCVT) on the speech
sounds produced by children with CAS. The combined treatment was assessed for changes in
consistency and expansion of the phonetic inventories of four participants. The children participated
in 20 treatment sessions over the course of 10 weeks. Each session was comprised of 10 minutes of
For personal use only.
stimulability training and 45 minutes of mCVT that included words that were chosen by the child and
his or her parents. The words were restricted to contain at least one complex phoneme that was omitted
from the child’s inventory. All children evidenced inventory expansion (average of five sounds) and
increased percentage consonants correct (PCC; average of 20% increase), and three of the four children
evidenced increased consistency in sound use. The effectiveness of STP paired with mCVT is explained
by principles of motor and phonological learning.
Keywords: childhood apraxia of speech, treatment, evaluation
Introduction
A primary goal of treatment for children with speech-sound acquisition disorders is to expand
the phonetic inventory ‘as quickly and efficiently as possible’ (Miccio and Elbert, 1996: 335).
Although many protocols are successful in facilitating speech sound acquisition in children
with phonological disorders (PD), limited inventories often persist in children with
Childhood Apraxia of Speech (CAS) (Ozanne, 1995; Powell, 1996). These differential effects
of treatment support the hypothesis that PD and CAS are distinct disorders that necessitate
different remediation approaches. As such, research is needed to identify treatments that
foster speech sound acquisition in children with CAS.
Because CAS has a history of controversy with diverse definitions and diagnostic criteria
(Guyette and Diedrich, 1981; Forrest, 2003) the focus of research has been on determining
the specific features that characterize the disorder. Some consensus has emerged recently
wherein CAS is defined as a neurologically-based speech disorder, characterized by incon-
sistent errors of consonants and vowels (ASHA, 2007). This definition provides the necessary
Correspondence: Jenya Iuzzini, MA, CCC-SLP, Department of Speech and Hearing Sciences, Indiana University, Bloomington, IN
47405, USA. Tel: 812-855-7768. Fax: 812-855-5531. E-mail: iuzzini@umail.iu.edu
ISSN 0269-9206 print/ISSN 1464-5076 online © 2010 Informa UK Ltd.
DOI: 10.3109/02699200903581083
336 J. Iuzzini & K. Forrest
first step in developing protocols that can be subjected to tests of effectiveness in treating
children with CAS. The present study evaluated one such approach that combines a modified
Core Vocabulary Treatment (Dodd, Crosbie, and Holm, 2004) with stimulability training
(Miccio and Elbert, 1996; Powell, 1996).
Stimulability, wherein a child attempts to imitate a sound presented in isolation and at the
syllable level, has long been used to supplement articulation testing (Travis, 1931; Milisen,
1954). More recently, stimulability has been used as the basis of a treatment protocol (Miccio
and Elbert, 1996; Powell and Miccio, 1996) that focuses on increasing the number of
stimulable sounds that a child can produce. Because stimulable sounds are likely to emerge
without direct intervention (Powell, Elbert, and Dinnsen, 1991) increasing the number of
stimulable sounds in a child’s system can reduce the number of targets requiring direct
phonological treatment (but see Rvachew, Rafaat, and Martin, 1999, for a differing
perspective).
Miccio and Elbert (1996) suggest that sound play evoked during stimulability may serve as
a foundation for speech acquisition and may foster generalization in children with PD (Elbert
and McReynolds, 1978). They tested this hypothesis in a case study of a 3;4 year old child
with a severe speech delay who was not stimulable for any sounds omitted from her phonetic
inventory. A treatment protocol was designed which targeted enhancement of stimulability by
teaching sounds, presented in isolation or in CV context, which were associated with gestures
that represented the sound’s characteristics. For example, the picture stimulus for the
phoneme /p/ was of a character named ‘putt-putt pig’ which was paired with a gesture in
which the hands moved in an abrupt forward movement with each attempted /p/, thereby
mimicking the stopping of the consonant. Both stimulable and non-stimulable sounds were
included in Miccio and Elbert’s protocol. As a result of this treatment, the participant became
stimulable for 26 additional sounds or syllable sequences. In addition, following stimulability
treatment, the participant produced more CVC and adult word forms than prior to treatment
wherein she often reduced her productions to CV or VC sequences. Miccio and Elbert
concluded that stimulability training led the child to experience success and become more
confident in attempting production of the non-stimulable sounds. These tenets are suggested
to foster speech acquisition in children with CAS as well (Strand and Skinder, 1999).
Powell (1996) used a stimulability training protocol (STP) to increase the phonetic
inventory of a 4-year old boy with a persistent speech sound disorder associated with
CAS. The child had received prior treatment that targeted stabilization of known sounds
such that consistency was enhanced but only small changes to the child’s inventory were
noted. By contrast, Powell focused on stimulability of unknown aspects of the child’s
phonology as a means of expanding the child’s phonetic inventory. Treatment sessions
included 5 minutes of sound-stimulability play that utilized the concepts outlined by
Miccio and Elbert (1996) followed by direct intervention to stabilize production of emerging
contrasts. The number of sounds in the child’s inventory expanded during the 3 months of
intensive treatment and the inventory complexity also increased.
STP focuses primarily on increasing the inventory of speech-delayed children, but it has
not been shown to impact inconsistent production, a primary feature of CAS. By contrast,
Core Vocabulary Treatment (CVT) is documented to increase consistency in children with
inconsistent speech production or CAS (Crosbie, Holm, and Dodd, 2005), but doesn’t
directly expand the child’s phonetic inventory. In the traditional CVT, treatment words are
selected by the participant, family members, and teacher such that the words are highly
functional. Core words may be multisyllabic and include words that the child uses frequently,
including names, places, foods, function words, and games. The clinician facilitates the
Combined treatment for CAS 337
child’s best production by breaking the word into syllables and then teaches the word to the
child syllable-by-syllable and sound-by-sound. Once the child’s best, but not necessarily
error-free, production of each syllable of the word is achieved; the clinician recombines the
sounds and syllables of the words to train whole word production. Again, errors are permitted
provided the production is considered the child’s best production. A limit of CVT is that
participants may continue to exhibit disordered speech following treatment, such that addi-
tional phonological treatment is needed (Dodd and Bradford, 2000).
On the basis of past research (Miccio and Elbert, 1996; Powell, 1996; Crosbie et al.,
2005), the current research developed a protocol to target both phonological inventory
expansion and consistent sound production in children with CAS. This procedure, the
modified CVT (mCVT) includes complex phonological targets (Dinnsen, Chin, and Elbert,
1992) presented in all word positions of a core vocabulary. These targets are presented in
words selected by each participant and his/her family as important elements of the child’s
daily life. In the current study, the combined impact of the mCVT and STP was assessed on
a group of four children who exhibited inconsistent consonants characteristic of CAS
(ASHA, 2007).
Methods
Participants
Two males and two females, aged 3;7–6;10 (years;months), were recruited from a newspaper
advertisement and flyers posted throughout the Indiana University campus, community, and
pre-schools. Three of the four children had received treatment prior to enrolment in this
study, but persisted in exhibiting severely disordered speech sound production as character-
ized by low percentage consonants correct (PCC; Shriberg and Kwiatkowski, 1982) scores
and highly variable sound substitutes.1 The present study was part of a larger investigation of
CAS and included evaluations that are not part of the current report (i.e. speech perception
testing, non-word repetition, and acoustic and language probes). The procedures used in this
study were approved by the Indiana University-Bloomington Institutional Review Board.
Each child’s parent signed a statement of informed consent prior to initiation of testing and
again prior to participation in treatment.
Each participant was assessed over the course of two, 1-hour sessions. The evaluation
included a pure tone hearing screening at 25 dB for octave frequencies between 250–8000
Hz; the Goldman-Fristoe Test of Articulation-2 (Goldman and Fristoe, 2000; GFTA-2); an oral
mechanism exam (Robbins and Klee, 1987); the Peabody Picture Vocabulary Test-3 (Dunn
and Dunn, 1997; PPVT-3); a non-word repetition task; a speech perception test; and the
collection of acoustic and language samples. Children who had standard scores below 85 on
the GFTA-2 were considered to have a phonological or articulatory disorder (PAD) and
therefore were eligible for further evaluation for potential entry into the treatment portion of
the study. All children with PAD completed the Clinical Evaluation of Language Fundamentals-
Preschool (Wiig, Secord, and Semel, 1992; CELF-P) and a 200-word sound probe which
provided 340 opportunities for multiple productions of all English consonants in all word
positions. The probe served to identify sounds in error and the consistency of the substitutes
used for those errors. Participant responses were recorded on-line by graduate student
clinicians, using broad phonetic transcription, and were video- or audio-taped. A second
graduate clinician also transcribed the sound probe from the recording, and any disagreement
in transcription between the clinicians was resolved by consensus at the time of transcription.
Children with PAD were sub-divided into two groups based on the consistency of substitu-
tions for sounds in error on the 200 word probe; children who demonstrated inconsistent
substitutions were designated as having CAS, whereas children with more consistent substitu-
tion patterns were considered to have PD (please note, children with PD are not discussed in
this report). Specifically, the consonant substitute inconsistency percentage (CSIP), described
below, was calculated for each child. Previous investigation of consistency among children with
PAD revealed that children with PD typically exhibited more consistent productions, specifi-
cally CSIPs of less than 25%, whereas children with CAS evidenced inconsistency scores of
greater than 25% (Iuzzini and Forrest, 2008). Dodd, Crosbie, Zhu, Holm, and Ozanne (2002)
use a different metric of inconsistency and suggest that children with an inconsistent speech
disorder are defined by greater than 40% variability of productions on the Inconsistency
Assessment from the Diagnostic Evaluation of Articulation and Phonology (Dodd et al.,
2002; DEAP). DEAP assesses variability across three productions of each of 25 targets.
Transcriptions of probe items were used to construct place–voice–manner charts from
which measures of consonant production and error consistency were computed. The PCC
(Shriberg and Kwiatkowski, 1982) was calculated as:
number target productions

PCC ¼ 100:
total number of productions
This measure, which assesses the relative number of correctly articulated consonants in a
speech sample, was used to indicate the severity of the production disorder. CSIP, an index of
the variability of production errors, was calculated as:
number of different substitutes across all targets

CSIP ¼ 100:
number of non-target productions
For example, P4 produced 14 errors and five correct productions of /ʃ/ on the sound inventory
probe. Of the 14 /ʃ/ errors, she produced four different substitutes. As such, the sound would be
considered part of her inventory (Stoel-Gammon and Dunn, 1985); however, the number of
total errors and of different substitutes would contribute to both the PCC (i.e. (5/19)100 ¼
26.3% for /ʃ/) and CSIP for /ʃ/ (i.e. (4/14)100 ¼ 28.5%) for this child. That is, incorrect
productions were included in all measures, even if the sound was part of the child’s inventory.
Summary information from testing of all children in the present study, along with their pre-
treatment inconsistency, PCC, and treatment targets are provided in Table I.
Table I. Summary of participant characteristics.
P CA Sex GFTA-2 SS PPVT-3 SS Targets Pre tx PCC (%) Pre tx CSIP (%) Pre tx ISP (%)
P1 3;7 M 64 95 l, 39.42 47.72 25.88

P2 6;10 F < 40 95 l 31.5 36.9 25.29
P3 5;1 F < 40 122 s 34 34 22.64
P4 6;5 M < 40 91 r 29.42 29.6 20.5
P ¼ participant; CA ¼ chronological age (years; months); GFTA ¼ Goldman Fristoe Test of Articulation–2nd Edition;
SS ¼ Standard Score; PPVT-3 ¼ Peabody Picture Vocabulary Test–3rd Edition; Targets ¼ Phonological targets used in
modified Core Vocabulary Treatment; Pre tx PCC ¼ Pre-treatment percentage consonants correct; Pre tx CSIP ¼
Pre-treatment consonant substitute inconsistency percentage; Pre tx ISP ¼ Pre-treatment inconsistency severity
percentage; Testing not repeated.
Although CSIP may be a useful metric for determining diagnostic classification of CAS vs
PD, it may not be a sensitive index of change because its calculation is dependent on the
number of phonemes in error; therefore, decreased inconsistency may be masked by
decreased errors rates. For that reason, a third metric was developed to track consistency
changes independent of number of errors. The Inconsistency Severity Percentage (ISP) was
determined by the relation of inconsistency to the total number of productions and was
calculated as:
number of different substitutes across all targets

ISP ¼ 100:
total number of productions
Treatment procedures
A single-subject, multiple-baseline-across-subjects design was used for this study. Children
received direct intervention on one or two complex phonological targets (Dinnsen et al.,
1992) within the mCVT framework. Parents were instructed to generate 30 words containing
the target sound(s), which were meaningful and commonly used by his/her child (e.g. names
of friends, family, characters, action words, etc.). From this list, the clinician then selected 10
words for each participant such that the treatment sound(s) occurred at least once in each
possible word position. Baseline data were collected for each child prior to treatment onset via
sound-specific probes for each treatment sound. Each child participated in three or four pre-
treatment administrations of the probe with the final probe being administered within the
week that treatment began. Baseline periods extended from 3 (P1) to 34 (P4) weeks across the
subjects. All children exhibited a stable baseline on target sounds prior to the start of
treatment (i.e. within 10% variation across baseline sessions). These probes also were used
to test for generalization of the treated sounds to untreated words, as described below.
Stimulability targets were determined during the first treatment session by presentation of
each sound omitted from the child’s inventory, as determined by the pre-treatment 200 word
probe, in a C or CV context. Any sound that wasn’t stimulable within this context was included
in the STP. Each child participated in STP for the first 10 minutes of each session followed by
the mCVT for 45 minutes. As outlined in Miccio and Elbert (1996), each isolated sound (e.g. /s/)
or CV (e.g. stop-vowel such as /pʌ/) was paired with a picture (e.g. putt-putt pig) and a gesture.
As the child became more accurate in production of the stimulability targets, verbal models were
decreased and participants responded primarily to the pictorial targets,2 receiving a verbal model
when necessary. Once the child independently produced one of the STP stimuli accurately in
90% of trials across three sessions, the sound was removed from the STP training and accurate
production of that sound was then cued for the child in the mCVT trials.
Both mCVT and STP protocols contained two phases: imitation and spontaneous produc-
tion. Feedback during each phase was provided on a continuum that ranged from continuous
to variable. During the imitation phase, a model was provided to the participant and then
feedback was provided to the subject immediately following production. Once the child
produced 18 accurate productions out of every 20 trials across three sets of trials, the feedback
was decreased to variable reinforcement which provided feedback following, on average,
every three responses. When the child reached criterion on 18/20 correct productions across
three consecutive sets of 20 trials, the child moved to spontaneous production in response to
the picture stimuli. Again, continuous feedback was provided, followed by variable feedback
as the child met the criterion for progression through the stages.
The 10 mCVT words were changed once the child produced accurate responses on 18/20
trials, across three sets, with variable reinforcement. Progress in mCVT treatment was mon-
itored with the use of sound-specific generalization probes which tested the child’s production
of the target sounds and their cognates in all word positions on 30 untreated words. The
criterion for termination of treatment was 20 correct productions out of 30 trials on the
generalization probe, or completion of 20 treatment sessions, whichever was achieved first.
Data analysis
Comparisons were made between pre-treatment and post-treatment phonetic inventories for
each child. This included evaluation of the number of sounds added to the inventory, PCC,
CSIP, and ISP changes. A negative CSIP or ISP difference score reflects increased consis-
tency, whereas a positive PCC difference indicates inventory expansion.
Results
Prior to treatment onset, all participants evidenced less than 10% accuracy of treatment-
target production across repeated administration of the sound-specific generalization probe
used to establish the pre-treatment baseline and treatment progress. Treatment onset was
staggered across subjects in accord with the multiple-baseline across subjects design. No
changes in target production accuracy were evidenced for any subject until at least the third
week of treatment, thereby suggesting that experimental control was maintained throughout
the study and that any inventory changes were related to treatment.
As presented in Figure 1, the mCVT coupled with STP yielded a 20% increase in PCC, on
average, with individual gains ranging from 9–32%. On average, children gained five phones,
with individual improvements ranging from one-to-10 phones. Two of the children (P2 and
Figure 1. Pre- and post-treatment percentage consonants correct by subject. Individual data plotted for P2 repre-
sents pre- and post-treatment PCC for her second phase of treatment. However, data from both phases of her
treatment are included in the group average. Error bars over the averages represent the standard deviation of the
group data.
Table II. Phonetic inventories of participants.
Participant Pre-treatment inventory Treatment targets Sounds acquired post-treatment Regression
P1 pbtdkgfʃmnŋh lƟ szl
P2 btdfðsmnwh l pkgvƟzʧʤjl
P3 pbtkgvƟðʧwjhl s dfszʃʤŋ
P4 pbtdkfƟszʃʧʤmnj r gvðwhl Ɵʤ
‘Regression’ ¼ sounds not evidenced post-treatment which were included in pre-treatment inventory.
P4) added the treatment target and other complex sounds to their inventories, whereas P1
and P3 did not evidence the mCVT target sound in their post-treatment inventories. In
addition to direct intervention with mCVT on a treatment target, all subjects received STP on
unstimulable sounds. As such, some of the inventory gains may have resulted from that aspect
of treatment. Changes in the phonetic inventory of each participant are presented in Table II.
Following treatment, three of the four subjects showed reduced CSIPs, indicating a
reduction in the percentage of substitute inconsistency; however, P4 evidenced increased
CSIP. Across subjects, CSIP decreased an average of 5.6%. The greatest change in CSIP was
noted for P1, and P2 evidenced the least change in this metric even though she added 10
sounds to her post-treatment inventory. The limited change in CSIP for P2 may relate to the
interaction of inventory expansion and reduced inconsistency. Because the number of non-
target productions serves as the denominator for the CSIP calculation, a reduction of errors
(i.e. more sounds produced correctly) would yield a higher CSIP if other factors remained
constant. This effect is seen in P4, who demonstrated increases in CSIP following treatment
which was caused by a 14% reduction in the number of non-target productions. The fact that
CSIP remained relatively constant for P2 indicates that the decrease in number of sounds in
error was accompanied by a similar decrease in variability.
Comparison of pre- vs post-treatment ISP, presented in Figure 2, shows that, although
subjects had modest changes in CSIP, on average, they made more substantial decreases in
ISP. These changes indicate that the number of different substitutes used in a child’s
inventory was reduced as a result of treatment; a finding that is consistent with the data
presented by Crosbie et al. (2005). Again, P1, P2, and P3 showed substantial decreases in
variability, whereas P4 maintained a constant level of inconsistency between pre- and post-
treatment evaluations.
Discussion
Results of this investigation indicate a combined therapy approach that includes stimulability
training and core vocabulary with complex phonological targets holds promise for treating
children with CAS. The combined STP and mCVT procedures provided greater benefits
than was demonstrated in the independent application of each protocol in children with PD
(Miccio and Elbert, 1996) or CAS (Crosbie et al., 2005). For example, the participant in
Miccio and Elbert’s (1996) case study gained only two phonemes ([v] and [ŋ]) as a result of
STP, whereas Crosbie et al. (2005) demonstrated that CVT alone increased PCC by an
average of 15.9% in children with CAS. In the current study, children’s PCC’s increased by
an average of 20% and phonetic inventories increased by an average of five sounds.
The present study extends the work of Powell (1996) by supporting STP as an adjunct to
direct intervention as a means of fostering generalization in children with CAS. As Powell notes,
Figure 2. Variability difference scores (post–pre-treatment) for each subject and group average change. CSIP ¼
Consonant substitute inconsistency percentage; ISP ¼ Inconsistency severity percentage. Individual data plotted for
P2 represents CSIP and ISP difference scores from her second phase of treatment. However, data from both phases of
her treatment are included in the average. Error bars over the averages represent the standard deviation of the group data.
‘Given that children with persistent sound system disorders (including DAS) do not—by
definition—generalize readily, it becomes imperative for the clinician to plan explicitly for
generalization’ (p. 318). Previous research in motor and phonological learning supports the
constructs of the mCVT and STP as a means of enhancing generalization of learned behaviours.
CVT is based on the use of words that are common in a child’s vocabulary and that the child
is motivated to produce intelligibly. Clearly, such words will include multiple syllable forms and
a variety of different sounds that yield a variety of treatment targets. Principles of motor learning
support the use of a high number (e.g. Park and Shea, 2003; 2005) of variable targets (e.g. Shea
and Kohl, 1991) to facilitate greater learning and retention. That is, a random practice schedule
that targets different movement patterns is likely to increase learning compared to a blocked
presentation of stimulus items. By its nature of targeting words with different syllable shapes
and number, the child is exposed to a random practice schedule during the mCVT protocol.
Although not a principle of mCVT design, the procedure also may aid generalization by its
use of high frequency words. That is, treatment words are chosen on the basis of their use in a
child’s daily lexicon including names of friends, family members, etc., which should be high
frequency words. Research on phonological and lexical acquisition repeatedly demonstrates
that high frequency treatment targets foster learning and generalization (Morrisette and
Gierut, 2002; Storkel and Morrisette, 2002).
The modification of CVT in the current experiment was implemented on the basis of other
principles of motor and phonological learning wherein complex, unknown behaviours foster
acquisition of simpler targets. There is extensive literature that demonstrates that complex
phonological targets (i.e. later learned sounds with more complex dimensions) yield general-
ization to simpler sounds, whereas treatment of simpler phones does not promote general-
ization to more complex sounds (see Gierut, 1998 for a review). Further, studies of motor
learning demonstrate contextual interference whereby learning is reduced when behaviours
are similar (Battig, 1979; Magill, 2004). The introduction of a complex sound into a child’s
phonological system as used in the mCVT in this study limits interference and enhances
generalization to simpler sounds that were excluded from the child’s pre-treatment phonetic
inventory. The more focused mCVT with complex treatment targets may explain the greater
improvement in PCC than is seen by more traditional CVT protocols.
Finally, STP provides a foundation for movement and phonological patterns associated
with speech. As Powell et al. (1991) have shown, children can learn to produce stimulable
sounds without direct intervention on those targets. The inclusion of STP in the current
procedure increased the number of stimulable sounds in the children’s inventories and
mCVT provided a useful frame for generalization of that knowledge to lexical targets.
Further, STP provided a framework for early success in treatment that enhanced motivation.
Within the motor control literature, stimulability as it occurs in imitation is thought to map an
observed behaviour into the motor system of the learner. In fact, recent studies have identified
the unique contribution of mirror neurons to this sensory-motor mapping. In the present
study, STP provided children with sensory models to imitate and map onto motor control
(DiPellegrino, Fadiga, Fogassi, Gallese, and Rizzolatti, 1992; Rizzolatti, Fadiga, Fogassi, and
Gallese, 1996; Rizzolatti and Craighero, 2004).
In summary, STP in combination with a phonologically focused mCVT may increase the
phonetic inventory, phonemic accuracy, and consistency in children with inconsistent speech
sound disorders, including CAS. The mCVT plus STP protocol meets many of the goals of
phonological treatment outlined by Miccio and Elbert (1996): It provides the child with early
success through STP; children’s phonetic inventories expand; non-stimulable sounds are
learned; the speech is associated with a child’s vocabulary of interest; and, most importantly,
the mCVT with STP fosters system-wide generalization through high frequency words,
complex sounds, and syllable shapes. Clearly, research into effective treatment for CAS is
just beginning, but the procedure outlined in this article may provide some clinical guidance
for speech acquisition in this population.
Acknowledgement
This research was supported by the National Institutes of Health grant DC-04575 awarded to
the second author.
Declaration of interest: The authors report no conflicts of interest. The authors alone are
responsible for the content and writing of the paper.
Notes
1. Participant 2 underwent two phases of the current combined treatment. No inventory nor consistency changes
were noted after phase one; therefore, her data represent changes associated with the second round of interven-
tion. Average data, however, include both her first and second phases of treatment.
2. Artwork for Miccio’s stimulability therapy character cards has been archived and is available for download at www.
speech-language-therapy.com/awm.pdf (Bowen, 1998).
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Evaluation of A Combibed Treatment Approach For Childhood Apraxia of Apeech

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Clinical Linguistics & Phonetics, April–May 2010; 24(4–5): 335–345

Evaluation of a combined treatment approach for childhood

JENYA IUZZINI & KAREN FORREST

Indiana University, Bloomington, IN, USA

(Received 16 November 2009; Accepted 21 December 2009)

Keywords: childhood apraxia of speech, treatment, evaluation

number target productions

the variability of production errors, was calculated as:

number of different substitutes across all targets

Table I. Summary of participant characteristics.

P1 3;7 M 64 95 l, 39.42 47.72 25.88

number of different substitutes across all targets

tency, whereas a positive PCC difference indicates inventory expansion.

Table II. Phonetic inventories of participants.

Participant Pre-treatment inventory Treatment targets Sounds acquired post-treatment Regression

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