Research Priorities for Childhood Apraxia of Speech: A Long View.

This article introduces the Journal of Speech, Language, and Hearing Research Special Issue: Selected Papers From the 2022 Apraxia Kids Research Symposium. The field of childhood apraxia of speech (CAS) has developed significantly in the past 15 years, with key improvements in understanding of basic biology including genetics, neuroscience, and computational modelling; development of diagnostic tools and methods; diversity of evidence-based interventions with increasingly rigorous experimental designs; and understanding of impacts beyond impairment-level measures. Papers in this special issue not only review and synthesize the some of the substantial progress to date but also present novel findings addressing critical research gaps and adding to the overall body of knowledge. A second aim of this prologue is to report the current research needs in CAS, which arose from symposium discussions involving researchers, clinicians, and Apraxia Kids community members (including parents of children with CAS). Four primary areas of need emerged from discussions at the symposium. These were: (a) What questions should we ask? (b) Who should be in the research? (c) How do we conduct the research? and (d) How do we move from research to practice? Across themes, symposium attendees emphasized the need for CAS research to better account for the diversity of people with CAS and improve the timeliness of implementation of high-level evidence-based practice across the lifespan. It is our goal that the articles and prologue discussion in this special issue provide an appreciation of advancements in CAS research and an updated view of the most pressing needs for future research.

A single case experimental design study using an operationalised version of the Kaufman Speech to Language Protocol for children with childhood apraxia of speech.

PURPOSE: A Phase I study was conducted to examine the treatment effectiveness of the Kaufman Speech to Language Protocol using a research-operationalised protocol. It was hypothesised that articulatory accuracy would improve as a result of the treatment and that these improvements would be maintained after treatment was discontinued. METHOD: A single case experimental design was used to evaluate the effectiveness of the Kaufman Speech to Language Protocol. Four children with a confirmed childhood apraxia of speech diagnosis were included in this study. Each child received 12 individual 1 hr treatment sessions that each consisted of an approximation setting phase and a practice phase. Probe data was collected during treatment and at post-treatment time points to measure treatment effectiveness and to measure changes in the untreated words. Untreated (control) sounds were included to test whether recorded improvements in articulatory accuracy could be attributed to the Kaufman Speech to Language Protocol. RESULT: Two of the four children demonstrated a response to the intervention and maintenance of these changes, while the two remaining children demonstrated some generalisation in the absence of improved target (treatment) words. No specific child factors were clearly associated with positive treatment outcomes. CONCLUSION: This study replicated the findings of an earlier pilot study and found that the operationalised protocol for the Kaufman Speech to Language Protocol is effective in improving articulatory accuracy for some children with childhood apraxia of speech. Additional replication with a further refined treatment protocol and a larger sample size is needed to support a recommendation of clinical use of the Kaufman Speech to Language Protocol.

A survey of the clinical management of childhood apraxia of speech in the United States and Canada.

PURPOSE: Limited information is available about the current practices of generalist speech-language pathologists (SLPs) in relation to their management of childhood apraxia of speech (CAS). This study was designed to investigate four primary questions separately for the US and Canada; 1. What treatment approaches are used by SLP clinicians to treat CAS? 2. What treatment format and intensity are used to deliver CAS treatment? 3. What are the attitudes and perspectives of SLPs to evidence-based practice (EBP) as it pertains to CAS treatment? and 4. What are the perceived barriers to the implementation of EBP in CAS treatment? METHOD: An online questionnaire was used to investigate the four primary research questions. The questionnaire was distributed online through social media, some state-based associations and through forums affiliated with national speech-language-hearing associations. RESULTS: Most survey respondents reported frequently using an eclectic approach to treat CAS (US 85%; Canada 89%). Although no intervention emerged as the most preferred primary treatment for CAS, US-based clinicians more commonly reported using the Kaufman Speech to Language Protocol (K-SLP) (33%) and Dynamic, Temporal and Tactile Cueing (DTTC) (28%); while clinicians in Canada used PROMPT ® (31%). SLPs demonstrated a positive attitude towards EBP however, they identified a range of perceived barriers that impacted their implementation of EBP. CONCLUSION: SLPs in the US and Canada frequently used an eclectic approach to treat CAS which is consistent with previous findings both in the CAS literature and the wider speech disorders literature. The more commonly used primary interventions were the K-SLP and DTTC (US); and PROMPT ® (Canada), with one of the strongest factors that influenced clinicians' choice of intervention being familiarity with the treatment approach. Face to face therapy was preferred by clinicians across both countries, with clinicians in the US providing therapy between 2-5 times per week, while those in Canada delivered therapy up to once per week. Clinicians identified a number of barriers to implementing evidence-based practice, among which, being time poor was most commonly selected across clinicians in both the US and Canada.

Clinical management of childhood apraxia of speech: A survey of speech-language pathologists in Australia and New Zealand.

Purpose: A number of studies have been published that have investigated the practices of speech-language pathologists in relation to speech sound disorder intervention; however, specific research about the treatment of childhood apraxia of speech is not available. This study aimed to describe the treatment approaches being used by speech-language pathologists, explore their perspectives of evidence-based practice and identify perceived barriers to implementing empirical research recommendations. Method: An online survey was distributed to speech-language pathologists in Australia and New Zealand. In total, 109 valid surveys were completed by participants who answered a series of multiple choice, yes/no, short answer and Likert-scaled questions. Result: Speech-language pathologists demonstrated a strong preference for eclectic interventions to treat childhood apraxia of speech. When asked to identify the primary treatment approach they used (whether as a stand-alone; or as the primary approach within an eclectic intervention), the most frequently used intervention was the Nuffield Dyspraxia Programme. Many speech-language pathologists reported valuing empirical research evidence, despite identifying a range of barriers that impact their ability to implement evidence-based practice in childhood apraxia of speech treatment. Conclusion: Although many speech-language pathologists use the Nuffield Dyspraxia Programme as their primary intervention, most clinicians use it as part of an eclectic/hybrid intervention. The effectiveness of eclectic interventions for childhood apraxia of speech has not been empirically evaluated.

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

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.