Purpose: To present a systematic review of single-case experimental treatment studies for childhood apraxia of speech (CAS). Method: A search of 9 databases was used to find peer-reviewed treatment articles from 1970 to 2012 of all levels of evidence with published communication outcomes for children with CAS. Improvement rate differences (IRDs) were calculated for articles with replicated (n > 1), statistically compared treatment and generalization evidence. Results: Forty-two articles representing Phase I and II single-case experimental designs (SCEDs; n = 23) or case series or description studies ( n = 19) were analyzed. Six articles showed high CAS diagnosis confidence. Of the 13 approaches within the 23 SCED articles, treatments were primarily for speech motor skills ( n = 6), linguistic skills ( n = 5), or augmentative and alternative communication ( n = 2). Most participants responded positively to treatment, but only 7 of 13 approaches in SCED studies reported maintenance and/or generalization of treatment effects. Three approaches had preponderant evidence (Smith, 1981). IRD effect sizes were calculated for Integral Stimulation/Dynamic Temporal and Tactile Cueing, Rapid Syllable Transition Treatment, and Integrated Phonological Awareness Intervention. Conclusions: At least 3 treatments have sufficient evidence for Phase III trials and interim clinical practice. In the future, efficacy needs to be established via maintenance and generalization measures. Supplemental Material: https://doi.org/10.23641/asha.6170225

Purpose: The gold standard for diagnosing childhood apraxia of speech (CAS) is expert judgment of perceptual features. The aim of this study was to identify a set of objective measures that differentiate CAS from other speech disorders. Method: Seventy-two children (4–12 years) diagnosed with suspected CAS by community speech-language pathologists were screened. Forty-seven participants underwent diagnostic assessment including presence/absence of perceptual CAS features. Twenty-eight children met 2 sets of diagnostic criteria for CAS (ASHA, 2007b; Shriberg, Potter & Strand, 2009); another 4 met the CAS criteria with co-morbidity. Fifteen were categorized as non-CAS with phonological impairment, submucous cleft, or dysarthria. Following this, 24 different measures from the diagnostic assessment were rated by blinded raters. Multivariate discriminant function analysis was used to identify the combination of measures that best predicted expert diagnoses. Results: The discriminant function analysis model, including syllable segregation, lexical stress matches, and percent phonemes correct from a polysyllabic picture-naming task, and articulatory accuracy on repetition of /pətəkə/, reached 91% diagnostic accuracy against expert diagnosis. Conclusions: Polysyllabic production accuracy and an oral motor examination that includes diadochokinesis may be sufficient to reliably identify CAS and rule out structural abnormality or dysarthria. Testing with a larger unselected sample is required.

Purpose: Dysprosody is considered a core feature of childhood apraxia of speech (CAS), especially impaired production of lexical stress. Few studies have tested the effects of intervention for dysprosody. This Phase II study with 3 children investigated the efficacy of a treatment targeting improved control of relative syllable durations in 3-syllable nonwords representing strong-weak (SW) and weak-strong (WS) stress patterns (e.g., BAtigu or baTIgu). Treatment sessions were structured along the principles of motor learning (PML) approach. Method: Three children, age 7 to 10 years, with mild to moderate CAS and normal language development participated in an intensive 3-week treatment. Within-participant designs with multiple baselines across participants and behaviors were used to examine acquisition, generalization, and maintenance of skill. Results: All children improved in their ability to control relative duration of syllables in SW and WS nonwords. Improvement was also noted in control of loudness and pitch contrasts. Treatment effects generalized to untreated nonword stimuli, but minimal change was seen in production of real words. Conclusion: Findings support the efficacy of this approach for improving production of lexical stress contrasts. Structuring the intervention according to the PML approach likely stimulated strong maintenance and generalization effects.

Purpose: This randomized controlled trial compared the experimental Rapid Syllable Transition Treatment (ReST) to the Nuffield Dyspraxia Programme (3rd edition, NDP3), used widely in clinical practice in Australia and the United Kingdom. Both programs aim to improve speech motor planning/programming for children with apraxia of speech, but they differ in types of stimuli used, level of stimulus complexity at initiation of treatment, and the principles of motor learning that they apply. Method: Treatment was delivered to 26 children with mild to severe CAS aged 4–12 years through trained and supervised speech-language pathology students in 1-hour sessions, 4 days a week for 3 weeks at a university clinic. Articulation and prosodic accuracy were assessed at pretreatment, 1 week, 1 month, and 4 months post-treatment using blinded independent assessors to compare treatment, maintenance and generalization effects. Results: The ReST and NDP3 treatments demonstrated large treatment effects. ReST maintained treatment gains from 1 week to 4 months post-treatment more effectively than the NDP3. Significant generalization to untreated stimuli was observed for both ReST and NDP3. Conclusions: ReST and NDP3 have strong evidence of treatment and generalization gains in children with CAS when delivered intensively. Overall ReST has greater external evidence from multiple sources but both treatments have support for clinical use.

Consideration of client values and preferences for service delivery is integral to engaging with the evidence-based practice triangle (E³BP), but as yet such preferences are under-researched. This exploratory study canvassed paediatric speech-language pathology services around Australia through an online survey of parents and compared reported service delivery to preferences, satisfaction, and external research evidence on recommended service delivery. Respondents were 154 parents with 192 children, living across a range of Australian locations and socio-economic status areas. Children had a range of speech and language disorders. A quarter of children waited over 6 months to receive initial assessment. Reported session type, frequency, and length were incongruent with both research recommendations and parents’ wishes. Sixty per cent of parents were happy or very happy with their experiences, while 27% were unhappy. Qualitative responses revealed concerns such as; a lack of available, frequent, or local services, long waiting times, cut-off ages for eligibility, discharge processes, and an inability to afford private services. These findings challenge the profession to actively engage with E³BP including; being cognisant of evidence-based service delivery literature, keeping clients informed of service delivery policies, individualizing services, and exploring alternative service delivery methods.