Speech therapy for children with Childhood Apraxia of Speech (CAS): DTTC provided via a blocked schedule (1 x 3hr/ week) or a distributed schedule (3 x 1hr/ week) across 8 weeks.
Dynamic Temporal and Tactile Cueing (DTTC) for children with Childhood Apraxia of Speech (CAS):. Parallel Single Case Experimental Design investigations of dose frequency: blocked (1 x 3-hr / week) and distributed (3 x 1-hr / week)
Marquette University
8 participants
Nov 1, 2023
Interventional
Conditions
Summary
This study investigates two different treatment schedules for an existing evidence-based speech pathology treatment (Dynamic Temporal and Tactile Cueing, DTTC, Strand, 2020) for children with Childhood Apraxia of Speech (CAS). DTTC is one of the few treatments with demonstrated efficacy for CAS (Murray et al., Maas et al., 2014). DTTC has previously been researched in high-intensity contexts, with therapy across 3-5 days per week (e.g Maas & Farinella, 2012; Strand & Debertine, 2000). DTTC involves watching the clinician and receiving tactile cues and is only suitable for in-person treatment. For families, particularly those in rural and remote areas, attending sessions 3-5 times/ week is not practical (Dew et al., 2012). This study will investigate two different session frequencies (3 times/ week and one 3-hr session/ week) while maintaining cumulative intervention intensity at 24 hours of therapy across 8 weeks. The quantitative data about the child's speech outcomes will be supplemented with qualitative information collected via semi-structured interviews with families and clinicians. The quantitive data will be collected using a Multiple Baselines Across Participants design, with 3-5 baseline sessions, 3 treatment phase probe sessions and 3 follow-up sessions (1-day post, 1-week post, 4 weeks post and 3 months post). The probe data set will include each child's individualized 20 treatment items and a 42-item generalisation probe (common to all children). The primary outcome measure is the whole word accuracy (including segmental and prosodic accuracy) and secondary outcome measures include percentage of consonants correct (PCC), % lexical inconsistency (as measured by the Inconsistency Severity Percentage, Iuzzini-Seigel, 2017), intelligibility (as measured by the Intelligibility in Context Scale, McLeod et al, 2012), and functional outcomes (As measure by the functional outcomes in children under six (FOCUS 34, Thomas-Stonell). The qualitative data will be collected using semi-structured interviews with carers and clinicians to explore perceptions of session length and frequency on the ease of therapy and the ability to accommodate therapy with other priorities. The qualitative data will be analysed using reflexive thematic analysis. (Braun & Clarke, 2020)
Eligibility
Inclusion Criteria6
- Children will:
- a) have a primary diagnosis of CAS meeting all methods of identifying CAS
- b) be aged 3-7 years (the core age group of the original DTTC design and efficacy studies)
- c) have a Receptive Language Index standard score of 70 or greater (within 2 standard deviations of the mean) on the Clinical Evaluation of Language Fundamentals – Preschool 2nd edition or Clinical Evaluation of Language Fundamentals – 5th edition (Semel, Wiig, & Secord, 2004; Wiig, Secord, & Semel, 2006; Wiig, Semel, & Secord, 2013, 2017)
- d) have a standard score of 70 or greater (within 2 standard deviations of the mean) on the nonverbal index of the Reynolds Intellectual Assessment Scales – 2nd edition (RIAS-2, Reynolds & Kamphaus, 2015) to ensure appropriate non-verbal intelligence
- e) have at least 20 words they use regularly (allowing for speech inaccuracy and inconsistency) and with communicative intent, as measured using the US or AUS -normed version of the MacArthur Bates (CDI) parent questionnaire (Fenson et al., 2007).
Exclusion Criteria4
- Abnormalities of oral structures (e.g. cleft palate)
- Does not speaks English, and have at least one parent who speaks English
- Has uncorrected hearing or vision problem
- Has other developmental problems (e.g., autism spectrum disorder, global developmental delay)
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Interventions
Intervention: Speech therapy using Dynamic Temporal and Tactile Cuing Treatment (DTTC, Strand 2020). Participants are taught 5 - 20 functional words or phrases (e.g. 'my turn', 'no way'). During the therapy session, the child is instructed to "look at me, copy me". The child copies the clinician's production, and as the child's skills improve, the clinician reduces the support provided (e.g. increasing the time between the clinician's and child's production, increasing the use of tactile cues such as touching the child's chin or cheeks). Provided by: Speech Pathologists (Australia) or Speech-Langauge Pathologists (USA) who have at least 5 years of experience and have attended a half-day training regarding the intervention procedures. Mode of delivery: face-to-face, individually Number of times intervention is administered: Therapy will be provided individually by an experienced speech pathologist for 3 hours per week across 8 weeks. The participants families can select whether they would like to receive (a) one 3-hr session week or (b) three 1-hr sessions per week. Following the treatment, participants will attend follow-up sessions at one day , one week, one month, and three months. Location of intervention: The intervention and follow-up sessions will be held in speech pathology clinics of research partners who are working in private practice. We anticipate working with private practitioners in NSW and in the USA. Personalisation of the treatment: Each participant will have a unique set of 20 treatment items (words or phrases). DTTC treatment is always individualized and uses items that are functionally relevant for each child. This is so that the child is motivated to learn to say the therapy words and phrases. The individualisation of the treatment will occur between the eligibility assessment and the baseline sessions. It will be done by the research team using information about the child's current consonant inventory, word shapes, and motivating words and phrases. Treatment fidelity will be assessed by research team members (Dr Elizabeth Murray and Jenya Iuzzini-Seigel). It will be performed on 6 hours of treatment, using an established checklist for DTTC fidelity. Three hours of therapy in the first week will be examined for fidelity and the remaining 3 hours per participant will be randomly selected. The treating clinician will be provided with feedback about the fidelity rating and coaching to improve any areas of concern. The feedback is provided prior to the child's next session
Locations(1)
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ACTRN12622001135707