Treating Childhood Apraxia of Speech

Childhood apraxia of speech is a developmental speech sound disorder that may lead to
persisting speech errors, often despite years of treatment. Such impairments may lead to
social, academic, and vocational limitations. Thus, there is a need to explore alternate
treatment approaches. This study will explore how to improve speech sound production in
school-age children with CAS by modifying a standard speech therapy program. Two adaptations
to speech therapy will be tested in a 2 x 2 randomized group design.

In Aim 1, a standard treatment schedule of 2 one-hour sessions per week will be compared
against a treatment sequence beginning with an intensive therapy schedule (10 hrs of
treatment in one week), which will then transition to a more distributed practice schedule.
This treatment modification is intended to minimize erred practice between training sessions
in the early stages of learning, then foster generalization through increased time between
practice sessions.

In Aim 2, a standard treatment that includes only verbal feedback to the client during speech
practice will be compared against a treatment sequence that initially includes real-time
ultrasound visual feedback of the tongue during speech, which will be faded over the course
of treatment. Ultrasound visual feedback is designed to train articulatory movements. It may
enhance children's understanding of the articulatory goals of speech movement patterns by
comparing executed tongue movements with intended movements. Prior case reports and single
subject experimental designs have shown that speech sound production may be enhanced by
including ultrasound visual feedback, although no prior randomized group studies have been
conducted.

Beside these modifications, the other aspects of treatment will be held constant. Outcomes
will be evaluated by tracking changes in percent consonants correct from a large speech
sample, scored by individuals who are blind to treatment status. The four groups will be
compared to determine the extent to which speech sound therapy can be enhanced through a
treatment sequence that begins with intensive practice and/or with ultrasound visual
feedback.

Inclusion Criteria:

- Native English speakers who hear English as the dominant language in their home
setting.

- Must pass a hearing screening.

- Score at or better than -2 standard deviations from the mean on the Matrix Reasoning
Task of the Wechsler Abbreviated Scale of Intelligence - 2nd Edition (WASI-2; t-score
≥ 30), Peabody Picture Vocabulary Test - 4th Edition (PPVT-4; standard score ≥ 70),
and the Following Directions subtest of the Clinical Evaluation of Language
Fundamentals - 5th Edition (CELF-5; scaled score ≥ 3).

- Goldman-Fristoe Test of Articulation - 3rd Edition (GFTA-3) percentile ≤ 5th).

- A diagnosis of CAS will be verified based on a polysyllable picture naming task,
diadochokinetic task (puh-tuh-kuh), and syllable repetition task.

Exclusion Criteria:

- Parent report or direct evaluation reveals oral-facial structural abnormalities (e.g.,
cleft palate).

- Parental report of neurobehavioral disorders (e.g., autism spectrum disorders, ADHD,
obsessive-compulsive disorder), or vision problems that are corrected with
glasses/contacts.

- Fail a hearing screening, or failure to meet criteria listed above as Inclusionary