Clinical Question

In children with childhood apraxia of speech (CAS/ verbal dyspraxia) does intervention (e.g., DTTC, Integrated Phonological Awareness Approach, AAC, Combined Melodic Intonation Therapy + Multimodal approach, +/- PML principles) improve speech (+/- literacy, overall communication skill) when compared to no intervention?

Critically Appraised Topic

The CAS treatment literature to date tests the effects of one treatment or more than one treatment in combination. No comparisons of treatment versus control groups or comparisons of two or more treatments exist, making it difficult to know which treatment is most efficacious. The literature comprises feasibility and early efficacy studies (Robey, 2004; Fey & Finestack, 2009) that have a level of evidence of III or IV (NHMRC, 2009). The papers were not systematically rated using a known methodological quality scale in this CAT. There are some preliminary guidelines as to which treatment has evidence for treating different aspects of CAS. At this stage, the best evidence for treating articulation is for DTTC or Integrated Phonological Awareness intervention due to replication across cases, larger sample sizes and demonstration of generalisation and maintenance. Phonological awareness skills also could be improved using Integrated Phonological Awareness intervention. The best evidence for prosodic accuracy is DTTC or ReST. AAC may be beneficial as a supplement or alternative to verbal communication in those with intellectual disability or poor speech outcomes and those experiencing frustration or behavioural impairment. The combined Stimulability and modified core vocabulary also demonstrates feasibility for some with CAS with a primary concern of inconsistency. Participants across studies varied and at this stage the results are best generalised to clients who are similar to the participants studies with caution. Clinical data collection on treatment, generalisation and control items is recommended. Much further research is required. Areas of potential future research recommended by this group include to compare treatment to a control condition, compare treatments to determine which may work more efficiently and effectively, compare treatment intensity, test more principles of motor learning to determine the best combination for prompting transfer / generalisation of skills, to test the use of parent involvement in therapy and determine the best treatments for differing ages, severity and child with a range of comorbid disorders.

Childhood Apraxia of Speech CAT 2012