While children with CAS have many similarities to one another, they also display frank differences in communication profiles. Thus, this is a heterogeneous population. It will be important for clinicians to determine the contribution of speech motor processing to the child’s speech difficulty. Children with a diagnosis of CAS will initially need to work, much of the time, at this level in the system. For children with significant speech motor-planning deficits there should be an assumption that the child, at least for a period of time, will need frequent and intensive individual speech therapy.
Frequency and Intensity
One factor that appears to have agreement among experts in speech-motor programming treatment approaches is that early in the therapy process, children with apraxia of speech will need intensive services, most often on an individual basis. A number of factors influence the frequency of therapy, including:
- The severity of the child’s speech-motor impairment and functional communication disorder
- The child’s age and ability to tolerate therapy
- The child’s willingness to practice with parents/caregivers.
Clinicians are likely to find themselves in the role of an advocate to insure that these children, especially those who are severely impaired, receive the appropriate intensity and frequency of treatment. Perhaps a quote by Blakely, as expressed in Hall, Jordan, and Robin (1993) best states this case:
“I do not expect to provide speech education for children with developmental apraxia of speech on a cursory basis for it may be the most important part of their entire education.”
In the early phases of treatment for children with moderate to severe CAS, appropriate frequency may range from 3 – 5 individual speech therapy sessions per week. As children improve and develop speech motor control over volitional utterances, frequency can be reduced accordingly, as long as they maintain and generalize improvements.
Additionally, intensity refers to actual time spent in individual therapy sessions that provides children with CAS opportunities for numerous repetitions of speech movement targets. In keeping with motor learning theory, many repetitions are required in order for motor skills to become volitional and automatic. Speech therapy needs to provide these children with many, many repetitions and response opportunities of targeted utterances. This response intensiveness is in contrast to treatment approaches in which the child is mainly asked to listen vs. respond or to share response time with multiple other children. By the end of a speech therapy session, no matter the length of the actual session, the child with CAS should have produced dozens and dozens of target utterances. This high degree of intensity for responses is not likely to occur in group therapy settings.