The Effects of Yoga Breathing Before Motor Speech Practice in Acquired Apraxia of Speech: An n-of-1 Trial.

A previous study discovered that two speakers with moderate apraxia of speech increased their sequential motion rates after unilateral forced-nostril breathing (UFNB) practiced as an adjunct to speech-language therapy in an AB repeated-measures design. The current study sought to: (1) delineate possible UFNB plus practice effects from practice effects alone in motor speech skills; (2) examine the relationships between UFNB integrity, participant-reported stress levels, and motor speech performance; and (3) sample a participant-led UFNB training schedule to contribute to the literature's growing understanding of UFNB dosage. A single-subject (n-of-1 trial), ABAB reversal design was used across four motor speech behaviors. A 60-year-old female with chronic, severe apraxia of speech participated. The researchers developed a breathing app to assess UFNB practice integrity and administer the Simple Aphasia Stress Scale after each UFNB session. The participant improved from overall severe to moderate apraxia of speech on the Apraxia Battery for Adults. Visual inspection of graphs confirmed robust motor speech practice effects for all variables. Articulatory-kinematic variables demonstrated sensitivity to the UFNB-plus-practice condition and correlated to stress scale scores but not UFNB integrity scores. The participant achieved 20-minute UFNB sessions 4 times per week. Removal of UFNB during A2 (UFNB withdrawal) and after a 10-day break during B2 (UFNB full dosage) revealed UFNB practice effects on stress scale scores. UFNB with motor speech practice may benefit articulatory-kinematic skills compared to motor speech practice alone. Regular, cumulative UFNB practice appeared to lower self-perceived stress levels. These findings, along with prior work, provide a foundation to further explore yoga breathing and its use with speakers who have apraxia of speech.

Dynamic Temporal and Tactile Cueing in Young Children With Childhood Apraxia of Speech: A Multiple Single-Case Design.

PURPOSE: Childhood apraxia of speech (CAS) is a multivariate motor speech disorder that requires a motor-based intervention approach. There is limited treatment research on young children with CAS, reflecting a critical gap in the literature given that features of CAS are often in full expression early in development. Dynamic Temporal and Tactile Cueing (DTTC) is a treatment approach designed for children with severe CAS, yet the use of DTTC with children younger than 3 years of age has not been examined. METHOD: A multiple single-case design was employed to examine the use of DTTC in seven children with CAS (aged 2.5-5 years) over the course of 6 weeks of intervention. Changes in word accuracy were measured in treated words from baseline to posttreatment and from baseline to maintenance (6 weeks posttreatment). Generalization of word accuracy changes to matched untreated words was also examined. A linear mixed-effects model was used to estimate the change in word accuracy for treated and untreated words across all children from baseline to posttreatment and to maintenance. A quasi-Poisson regression model was used to estimate mean change and calculate effect sizes for treated and untreated words. RESULTS: Group-level analyses revealed significant changes in word accuracy for treated and untreated words at posttreatment and maintenance. At the child level, six of seven children displayed medium-to-large effect sizes where word accuracy increased in an average of 3.4/5 words across all children. Each child displayed some degree of generalization to untreated targets, specifically for words with the same syllable shape as the treated words. CONCLUSIONS: These results demonstrate that DTTC can yield positive change in some young children with CAS. Key differences in each child's performance are highlighted.

[Early indicators of childhood apraxia of speech in late talkers: general guidelines to intervention]. / Indicadores tempranos de dispraxia verbal en el inicio tardío: orientaciones para la intervención Inmaculada.

INTRODUCTION: The population of children with slow emergence of language development varies widely, both in their initial profile and in their response to intervention. In this sense, there is a group of late talkers who continue to show persistent language difficulties, in some cases exhibiting signs compatible with verbal dyspraxia. METHOD: In this paper we present the different response to intervention of two profiles of late talkers. Specifically, the Target Word© program (Hanen Centre) was implemented, which is addressed to latetalking children and their families. It combines the technique of focused stimulation with guidance to parents on strategies that stimulate global language development. RESULTS: Much of the symptomatology shown in one case of poor progress coincides with retrospective descriptions of children subsequently diagnosed with dyspraxia and can be considered early indicators of the disorder: unintelligibility, reduced consonant inventory or difficulties in word repetition. DISCUSSION: The different response to intervention contributes to diagnostic decision making and the early implementation of specific strategies directed to improve speech learning skills by incorporating motor learning principles. The few studies of intervention in suspected verbal dyspraxia in early childhood offer promising results on a variety of speech assessment indicators, and provide practitioners with valuable information with which to support the intervention in this population.

Introducción: La población de niños que comienzan con lentitud el desarrollo del lenguaje varía ampliamente, tanto en su perfil inicial como en la respuesta a la intervención. En este sentido, existe un grupo de niños, denominados hablantes tardíos, que continúan mostrando dificultades persistentes en el lenguaje. Algunos de estos niños muestran signos compatibles con la dispraxia verbal, y que se ponen de manifiesto a lo largo de la intervención. Método: En este trabajo presentamos la diferente respuesta a la intervención de dos perfiles de hablante tardío. Concretamente, se aplicó el programa Target Word©, del centro Hanen, que conjuga la técnica de la estimulación focalizada con la orientación a padres sobre estrategias que promueven el desarrollo del lenguaje. Resultados: Gran parte de la sintomatología mostrada en uno de los dos casos, que experimentó un progreso pobre, coincide con las descripciones retrospectivas de niños posteriormente diagnosticados con dispraxia y pueden considerarse indicadores tempranos del trastorno: ininteligibilidad, inventario consonántico reducido o dificultades en la repetición de palabras. Discusión: La diferente respuesta a la intervención contribuye a la toma de decisiones diagnósticas y a la aplicación temprana de estrategias específicas para la mejora de las habilidades de aprendizaje del habla mediante la incorporación de los principios del aprendizaje motor. Los escasos estudios de intervención en casos de sospecha de dispraxia verbal en la infancia temprana ofrecen resultados prometedores en diversos indicadores de evaluación del habla, y proporcionan a los profesionales una información valiosa en la que fundamentar la intervención en esta población.

A Comparison of Sound Production Treatment and Metrical Pacing Therapy for Apraxia of Speech: A Single-Case Experimental Design.

PURPOSE: The purpose of this investigation was to compare the effects of two specific treatment protocols for acquired apraxia of speech (AOS): Sound Production Treatment (SPT) and Metrical Pacing Therapy (MPT), and to examine changes in communicative participation. METHOD: Four speakers with chronic AOS and aphasia were each administered SPT and MPT in a replicated crossover design (ABACA/ACABA) with nonconcurrent multiple baselines across participants and behaviors. Treatment outcomes were compared with respect to whole word correctness (WWC) for treated and untreated multisyllabic word targets. Speech intelligibility was assessed using the Chapel Hill Multilingual Intelligibility Test, and communicative participation was measured using the Communicative Participation Item Bank at baseline, washout, and follow-up phases. RESULTS: Three of the four participants experienced statistically significant improvements in WWC with SPT, and three of the four participants with MPT. Based on a priori criteria, three participants demonstrated relatively greater benefit from SPT and one participant demonstrated relatively greater benefit from MPT. There were measurable improvements in intelligibility following SPT for three of the four participants. Only one participant in this investigation reported a significant change in communicative participation, and only following MPT. CONCLUSIONS: This study demonstrated that individuals in the chronic stages of AOS can benefit from both SPT and MPT, corroborating prior research on articulatory kinematic and rate and/or rhythm control treatment approaches. It contributes a comparison of two protocols for AOS with respect to whole word targets, intelligibility, and individual self-report of communicative participation changes. More participants showed a relative advantage of SPT over MPT. One individual reported communicative participation improvement after MPT. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23971929.

The Impact of Telehealth on the Efficacy of Sound Production Treatment.

PURPOSE: This investigation was designed to systematically examine the acquisition, maintenance, and response generalization effects of Sound Production Treatment (SPT) delivered via telehealth in comparison to existing in-person outcomes for SPT. METHOD: A multiple-baseline design across behaviors and participants was used with two individuals with chronic apraxia of speech (AOS) and aphasia. Accuracy of target speech sounds in treated and untreated words within phrases served as the dependent variable. RESULTS: Both participants demonstrated positive gains for treatment and generalization items. Participant 1 demonstrated gains for both sets of treatment items with the application of treatment, but production accuracy at 2 and 6 weeks posttreatment was inconsistent. Participant 2 demonstrated large gains for both sets of treatment items with good maintenance at 2 and 6 weeks posttreatment. Effect sizes for both participants were similar to the traditional (in-person) SPT effect size benchmarks. CONCLUSIONS: The positive outcomes from this study indicate that individuals with AOS can benefit from SPT delivered via telehealth. These findings warrant further research examining the effects of SPT through telehealth and should include individuals with AOS with varying severity. This investigation serves as the first telehealth study to systematically examine treatment outcomes for SPT.

The Outcomes of Remote Administration of Combined Aphasia and Apraxia of Speech Treatment: A Single-Subject Experimental Design Study.

PURPOSE: This study was designed to examine the outcomes of Combined Aphasia and Apraxia of Speech Treatment (CAAST) administered remotely in terms of acquisition and generalization effects and to compare these effects to previous in-person CAAST studies and Response Elaboration Training (RET)/Modified-Response Elaboration Training (M-RET) benchmarks. METHOD: Multiple probe designs across participants and behaviors were employed with three speakers with chronic aphasia and apraxia of speech. Correct information units (CIUs) were the primary outcome measure to measure changes in language production. Percent consonants correct (PCC) was used as the secondary outcome measure to evaluate changes in speech sound accuracy. Production of CIUs was compared with existing benchmarks from Bunker et al.'s (2019) meta-analysis of previous RET/M-RET studies. In addition, both CIUs and PCC were compared with the most recent CAAST in-person studies. RESULTS: All participants demonstrated substantial increases in CIUs for treated and untreated picture sets, comparable to outcomes of in-person CAAST administration. These language changes were maintained at posttreatment intervals for all participants. PCC also improved for all participants, with gains in articulatory accuracy being maintained posttreatment. CONCLUSIONS: Improvements in CIU production and PCC for all three participants were in keeping with results from Wambaugh et al. (2017). These findings provide additional support for the efficacy of CAAST and indicate that remote administration may be a viable alternative to in-person application. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23418635.

Shared characteristics of intervention techniques for oral vocabulary and speech comprehensibility in preschool children with co-occurring features of developmental language disorder and a phonological speech sound disorder: protocol for a systematic review with narrative synthesis.

INTRODUCTION: Evidence suggests that over one-third of young children with developmental language disorder (DLD) or speech sound disorder (SSD) have co-occurring features of both. A co-occurring DLD and SSD profile is associated with negative long-term outcomes relating to communication, literacy and emotional well-being. However, the best treatment approach for young children with this profile is not understood. The aim of the proposed review is to identify intervention techniques for both DLD and SSD, along with their shared characteristics. The findings will then be analysed in the context of relevant theory. This will inform the content for a new or adapted intervention for these children. METHODS AND ANALYSIS: This search will build on a previous systematic review by Roulstone et al (2015) but with a specific focus on oral vocabulary (DLD outcome) and speech comprehensibility (SSD outcome). These outcomes were identified by parents and speech and language therapists within the prestudy stakeholder engagement work. The following databases will be searched for articles from January 2012 onwards: Ovid Emcare, MEDLINE Complete, CINAHL, APA PsycINFO, Communication Source and ERIC. Two reviewers will independently perform the title/abstract screening and the full-text screening with the exclusion criteria document being revised in an iterative process. Articles written in languages other than English will be excluded. Data will be extracted regarding key participant and intervention criteria, including technique dosage and delivery details. This information will then be pooled into a structured narrative synthesis. ETHICS AND DISSEMINATION: Ethical approval is not needed for a systematic review protocol. Dissemination of findings will be through peer-reviewed publications, social media, and project steering group networks. PROSPERO REGISTRATION NUMBER: CRD4202237393.

Dose frequency randomized controlled trial for Dynamic Temporal and Tactile Cueing (DTTC) treatment for childhood apraxia of speech: protocol paper.

BACKGROUND: Childhood apraxia of speech (CAS) is a pediatric motor-based speech sound disorder that requires a specialized approach to intervention. The extant literature on the treatment of CAS commonly recommends intensive treatment using a motor-based approach, with some of the best evidence supporting the use of Dynamic Temporal and Tactile Cueing (DTTC). To date, a rigorous and systematic comparison of high and low dose frequency (i.e., frequency of therapy sessions) has not been undertaken for DTTC, resulting in a lack of evidence to guide decisions about the optimal treatment schedule for this intervention. The current study aims to fill this gap in knowledge by comparing treatment outcomes when dose frequency is varied. METHODS: A randomized controlled trial will be conducted to examine the efficacy of low versus high dose frequency on DTTC treatment outcomes in children with CAS. A target of 60 children, 2;6-7;11 years of age, will be recruited to participate in this study. Treatment will be provided in the community setting by speech-language pathologists who have completed specialized training administering DTTC in a research reliable manner. True randomization with concealed allocation will be used to assign children to either the low or high dose frequency group. Treatment will be administered in 1-h sessions either 4 times per week over a 6-week period (high dose) or 2 times per week over a 12-week period (low dose). To measure treatment gains, probe data will be collected before treatment, during treatment, and 1 day, 1 week, 4 weeks, and 12 weeks post-treatment. Probe data will consist of customized treated words and a standard set of untreated words to assess generalization of treatment gains. The primary outcome variable will be whole word accuracy, encompassing segmental, phonotactic, and suprasegmental accuracy. DISCUSSION: This will be the first randomized controlled trial to evaluate dose frequency for DTTC treatment in children with CAS. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT05675306, January 6, 2023.

Clinical practice of childhood apraxia of speech in Hong Kong: A web-based survey study.

BACKGROUND: A survey study on clinical practice not only provides insight into the implementation of knowledge, but also informs future investigations. There is a limited understanding of childhood apraxia of speech (CAS) in Cantonese speakers. This study examined the clinical practice of CAS in Hong Kong and discussed future directions of research for better evidence-based practice. METHODS: Qualified Hong Kong pediatric speech-language pathologists (SLPs) completed the online questionnaire, which had a total of 48 questions regarding their knowledge of and experience with CAS in Cantonese speakers, including assessment, diagnosis, and treatment. RESULTS: Seventy-seven responses were received from Hong Kong SLPs. Most of the SLPs (83.2%) rated their understanding of CAS as either "a little" or "fair". About half (53.2%) of the respondents had worked with children with CAS. No standardized assessment or objective/quantitative measures were used clinically. Instead, seven assessment tasks, including imitation of polysyllabic words and speech and language samples were used commonly. Perceptual judgment of clinical features is still the most popular approach for diagnosis, with a variety of lists in use. Of concern was that, in addition to using some evidence-based approaches, local SLPs treated CAS using approaches that have limited evidence, in the context of less treatment frequency, targeting both speech and language skills within the same session, and with only partial implementation of the approaches. CONCLUSIONS: The results suggest that the understanding of CAS among local SLPs requires attention. One reason for this is that evidence regarding the assessment, diagnosis, and treatment of Cantonese speakers with CAS is still limited. Future investigations are needed.

Speech Therapy Interventions for Acquired Apraxia of Speech: An Updated Systematic Review.

PURPOSE: This systematic review aims to summarize and evaluate the available literature on speech and language therapy interventions for acquired apraxia of speech since 2012. METHOD: A systematic search in six electronic databases was performed from 2013 to 2020. The following primary outcomes were summarized: (a) improvement in targeted behaviors, (b) generalization, and (c) maintenance of outcomes. Moreover, studies were evaluated for the level of evidence and the clinical phase. RESULTS: Of the 3,070 records identified, 27 studies were included in this review. The majority of the studies (n = 22) used articulatory kinematic approaches followed by intersystemic facilitation/reorganization treatments (n = 4) and other approaches (n = 1). According to the classes defined in Clinical Practice Guideline Process Manual (Gronseth et al., 2017), one was Class II, 10 were Class III, 10 were Class III-b (fulfill Class III criteria except for independence of assessors' criterion), and five were Class IV. In terms of clinical phase, one study classified as Phase III, 10 as Phase II, and 15 as Phase I. CONCLUSIONS: Among the interventions for apraxia of speech, articulatory kinematic treatments have become prominent over the last 8 years. Focusing on self-administrated therapies, use of technology for therapy administration and development of treatments that focus on apraxia of speech and aphasia simultaneously were identified as new advancements in the apraxia of speech literature. The methodological quality, clinical phase, and level of evidence of the studies have improved within the past 8 years. Large-scale randomized controlled trials for articulatory kinematic approaches and future studies on other treatment approaches are warranted. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22223785.

A Pilot Randomized Control Trial of Motor-Based Treatments for Childhood Apraxia of Speech: Rapid Syllable Transition Treatment and Ultrasound Biofeedback.

PURPOSE: Both Rapid Syllable Transition Treatment (ReST) and ultrasound biofeedback are effective approaches to treating childhood apraxia of speech (CAS). The purpose of the study was to compare outcomes from these two motor-based treatment approaches for school-age children with CAS. METHOD: In a single site, single blind randomized control trial, 14 children with CAS ages 6-13 years were randomly assigned to 12 sessions over 6 weeks of either of ultrasound biofeedback treatment (with a speech motor chaining practice structure) or ReST. Treatment was delivered at The University of Sydney by students trained and supervised by certified speech-language pathologists. Transcriptions from blinded assessors were used to compare the two groups on speech sound accuracy (percent phonemes correct) and prosodic severity (lexical stress errors and syllable segregation) in untreated words and sentences at three time points: pretreatment, immediately posttreatment, and 1-month posttreatment (i.e., retention). RESULTS: Both groups showed significant improvement on treated items indicating a treatment effect. At no time was there a difference between groups. Both groups showed a significant improvement in speech sound accuracy on untreated words and sentences from pre to post and neither group showed an improvement in prosody pre-post. Changes to speech sound accuracy were retained by both groups at 1-month follow-up. Significant improvement in prosodic accuracy was reported at the 1-month follow-up. CONCLUSIONS: ReST and ultrasound biofeedback were equally effective. Either ReST or ultrasound biofeedback may be viable treatment options for school-age children with CAS. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22114661.

Self-Reported Communication Attitudes of Children With Childhood Apraxia of Speech: An Exploratory Study.

PURPOSE: Much of the research literature on childhood apraxia of speech (CAS) has focused on understanding, diagnosing, and treating the impairment, rather than examining its functional effect on children's daily lives. This study focuses on the Personal Factors component of the World Health Organization International Classification of Functioning, Disability and Health-Children and Youth Version Framework. Specifically, the purpose was to examine the self-reported communication attitudes of children with CAS. METHOD: Two validated communication attitude questionnaires were administered to 12 children with CAS enrolled in an intensive speech-focused intervention (age range: 4-10 years old). Children's scores were compared to the questionnaires' typically developing norms. Descriptive analyses explored relationships between communication attitude and CAS severity, caregiver perceptions of communicative participation, frustration ratings during therapy, and change in communication attitude over a brief time. RESULTS: Older (ages 6-10 years) but not younger (ages 4-5;11 [years;months]) children with CAS were more likely to have negative attitudes about their speech. No clear relationships were observed between communication attitudes and caregiver perceptions of communicative participation; small positive relationships were observed between communication attitude and frustration during therapy. For the younger children, there was also a relationship with CAS severity. For most children, no change in communication attitude was observed over a brief period, though one child appeared to develop more negative and one appeared to develop more positive attitudes. CONCLUSIONS: These initial findings suggest that older children with CAS may be at greater risk for negative communication attitudes than their peers without CAS. The findings also highlight the need to include more child self-report measures in research. Further implications for CAS assessment and intervention are discussed. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21834432.

"I still have issues with pronunciation of words": A mixed methods investigation of the psychosocial and speech effects of Childhood Apraxia of Speech in adults.

PURPOSE: Adolescents with Childhood Apraxia of Speech (CAS) are likely to have persistent speech errors compared to non-CAS peers (Lewis et al., 2018) and may have ongoing psychosocial issues (e.g. Carrigg, Parry, Baker, Shriberg, & Ballard, 2016). Beyond this, little is known about the long-term consequences of CAS in adulthood. This study explored whether adults who were reported to have had CAS as children have ongoing psychosocial or speech impacts. METHOD: A cross-sectional descriptive design, with mixed-method analyses of demographic, psychosocial, and speech data was used. Data were collected via a four-part online survey. Part one consisted of questions about demographic information and participants' self-reported performance in speech, language and literacy. Parts two and three investigated the psychosocial impacts of CAS using the Brief Fear of Negative Evaluation Scale - Revised (BFNE- R) and The State-Trait Anxiety Inventory (STAI). Part four collected single word and connected speech data via an online audio recording, which was then transcribed following the Connected Speech Transcription Protocol (CoST-P). Analyses of speech characteristics reported in CAS was completed using Phon software. RESULT: There were 17 participants in part one, 16 in parts two and three, and six in part four. Participants reported elevated levels of state (p = 0.01) and trait (p = 0.0001) anxiety compared to normative data. Ongoing segmental and suprasegmental speech errors were observed, with a significant difference between percent phonemes correct in single words versus connected speech (p = 0.03). Participants who provided a speech sample had difficulty with correct stress, use of juncture, and had increased intra- and inter-word segregation. Participants with better speech reported less anxiety. CONCLUSION: Psychosocial effects and speech characteristics associated with CAS in childhood appear to persist into adulthood. Confirmation of these results and research to determine treatment and psychosocial support needs past early childhood is warranted.

Changes in variability during intervention for childhood apraxia of speech: implications for therapy.

Typically developing children are variable in their speech production with decreasing variability indicating mastery of speech. Excessive variability which does not change over time may be an indication of unstable motor plans as often seen in children with childhood apraxia of speech (CAS). Dynamic Systems Theory (DST) provides a framework for understanding the role of variability in speech development and disorder. There are few studies that explore the impact of therapy on speech variability. This work explores the impact of therapy on perceptual speech production variability. It is a post-hoc analysis of data collected in two intervention studies of a motor-based treatment approach with children with CAS and explores DST variability effects in speech skill acquisition based on the case data from those studies. There were six participants in total across the two studies. Findings were mixed showing some non-linear changes in variability with larger changes in variability observed in participants who engaged in more extensive therapy. However, the pattern of variability change was not consistent across the participants. These findings suggest that targeting variability in therapy may be an effective way to improve the speech of children with CAS. A model for utilising variability in therapy is presented.

Effects of limb apraxia intervention in patients with stroke: A meta-analysis of randomized controlled trials.

OBJECTIVE: Limb apraxia, a complication of stroke, causes difficulties in performing activities of daily living (ADL). To date, there are no studies on the effectiveness of limb apraxia interventions. We conducted a meta-analysis to assess the effectiveness of limb apraxia interventions in reducing its severity and improving ADL. METHODS: We conducted a search of randomized controlled trials (RCTs) related to limb apraxia till December 2021 using the databases of PubMed, Embase, CINAHL, and the Cochrane Library. We measured the outcome variables in the subgroups of total apraxia (TA), ideational apraxia (IA), ideomotor apraxia (IMA), and ADL. The Physiotherapy Evidence Database (PEDro) scale was used to assess the quality. RESULTS: Five RCTs were selected, and of the 310 participants, 155 were in the experimental and 155 in the control group. A random-effects model was used for the effect size distribution. The limb apraxia intervention methods included gesture and strategy training (three and two studies, respectively). The effect sizes of the outcome variables in the subgroups were small for the TA and IA, with 0.475 (95% confidence interval [CI]: -0.151-1.102; p = 0.137) and 0.289 (95% CI: -0.144-0.722; p = 0.191), respectively. IMA had a medium effect size of 0.731 (95% CI: -0.062-1.525; p = 0.071), not statistically significant, whereas ADL effect size was small and statistically significant, 0.416 (95% CI: 0.159-0.673; p = 0.002). CONCLUSIONS: Gesture and strategy training had statistically significant effects on ADL as limb apraxia interventions. Therefore, the effectiveness of the apraxia interventions needs to be further evaluated through continuous RCTs.

Prologue to the Forum: Care of the Whole Child: Key Considerations When Working With Children With Childhood Apraxia of Speech.

PURPOSE: This prologue introduces the LSHSS Forum: Care of the Whole Child: Key Considerations When Working With Children With Childhood Apraxia of Speech. The goals of the forum are to provide (a) an overview of several co-occurring conditions and challenges that may affect children in this population and (b) methods and materials to enhance diagnostic accuracy and treatment efficacy to help children with childhood apraxia of speech (CAS) to thrive. METHOD: The prologue provides an overview of what it means to care for the whole child and introduces the five articles in the forum, including research and clinical focus articles as well as tutorials. Infographics, assessment templates, video examples, case studies, and treatment goals are included throughout the forum to promote translation from research to practice. CONCLUSION: Children with CAS may experience a breadth of skills, challenges, and diagnoses. By learning (a) to identify possible co-occurring conditions, (b) when to make referrals, and (c) how to best accommodate and treat children when different conditions are present, speech-language pathologists can further increase the quality of care provided and ability to advocate for some of our most vulnerable clients and their families.

Predicting Treatment Outcomes in Rapid Syllable Transition Treatment: An Individual Participant Data Meta-Analysis.

PURPOSE: The purpose of this study is to identify predictors of treatment outcomes in Rapid Syllable Transition Treatment (ReST) for childhood apraxia of speech through an individual participant data meta-analysis. METHOD: A systematic literature search identified nine ReST studies for inclusion. Individual participant data were obtained, and studies were coded for methodological design, baseline participant characteristics, service delivery factors, and treatment outcomes. Bivariate analyses were conducted to identify potential predictor variables. Multiple linear regressions were then performed to identify predictors of treatment outcomes. RESULTS: Data for 36 participants from seven studies were included in the statistical analyses. In multivariate modeling, better performance on treated pseudowords posttreatment was predicted by higher baseline expressive language and Goldman-Fristoe Test of Articulation scores, lower speech inconsistency and percentage of vowels correct, and higher pretreatment accuracy on pseudoword targets. Better performance on untreated real words posttreatment was predicted by higher pretreatment accuracy on real words. Gains in performance and retention of gains were not significantly predicted by any individual variable or combination of variables. CONCLUSIONS: Baseline speech and expressive language skills and accuracy on pseudowords and real words were significant predictors of absolute posttreatment performance. Regardless of baseline characteristics, all children were statistically as likely to achieve gains during ReST and retain these gains for up to 4 weeks posttreatment. Large-scale prospective research is required to further examine the effects of dose frequency and co-occurring language impairments on treatment outcomes and the complex co-effects of percentage of vowels correct with other potential predictors. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19611714.

Diagnosis and Treatment of Childhood Apraxia of Speech Among Children With Autism: Narrative Review and Clinical Recommendations.

PURPOSE: Treatment for children with autism spectrum disorder (ASD) and low verbal ability is a largely neglected area of study. Existing research focuses on language abilities; however, a subset of children with ASD also has speech sound disorders (SSDs). The purpose of this tutorial is to provide clinicians with evidence-based recommendations to guide speech assessment and treatment among children with ASD, low verbal ability, and suspected childhood apraxia of speech (CAS). METHOD: Multifaceted search procedures were used to identify studies that have assessed or treated speech sound production among children with ASD. A narrative review and synthesis of the literature is followed by practical clinical recommendations based on best available evidence. CONCLUSIONS: It is critically important to consider all possible hindrances to the development of functional communication ability for children with ASD. Speech sound production has been identified as a key predictor of expressive language outcomes, yet there are very few studies that address assessment and treatment of SSDs among children with ASD. Less is known about the presentation of CAS among children with ASD and low verbal ability. More research is needed to determine whether existing speech assessment and treatment methods are appropriate for children with ASD, if modifications are needed, or if new methods should be designed.

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.