Children with apraxia of speech are often described in the professional literature as needing frequent and intensive speech therapy in order to address the motor planning and programming issues which are at the heart of their speech difficulty. Included below are the most relevant citations available in the literature that describe the need for frequency and intensity. Please note that when children with apraxia receive appropriate speech therapy they can and do make progress! As their speech becomes more and more intelligible, frequency of services can be adjusted according. Also, please remember that children must be looked at for their individualized needs and circumstances. In addition to their motor planning and programming needs, children with apraxia often have other speech and/or language needs that must also be factored into therapy. Some children may also require training with augmentative communication devices in addition to therapy specifically targeting their speech production.
Citations from the literature:
Thomas F. Campbell, “Functional Treatment Outcomes in Young Children with Motor Speech Disorders,” page 394, Clinical Management of Motor Speech Disorders in Children, edited by Anthony J. Caruso and Edythe A. Strand, Thieme Medical Publishers Inc., New York, 1999.
“How Many Treatment Sessions Are Required to Improve My Childs Speech?”
“For the phonologically disordered children, an average of 29 individual, 45-minute treatment sessions (range of 21 to 42 sessions) were required for parents to increase their ratings from having less than half of their childs speech understood by an unfamiliar listener to having about three-fourths of their childs speech understood. In stark contrast, the eight children with apraxia speech whose parents stated that three-fourths of their childs speech could be understood following treatment, required 151 individual treatment sessions (ranging from 144 to 168 sessions) to achieve a similar level of parental estimated speech intelligibility. In other words, the children with apraxia of speech required 81% more individual treatment sessions than the children with severe phonologic disorders in order to achieve a similar functional outcome.”
Skinder-Meredith, A. Differential Diagnosis: Developmental apraxia of speech and phonologic delay. Augmentative Communication News; 14 (2 & 3), December 2001.
“Regardless of the primary deficit, children with severe speech impairment need intensive speech therapy early on. Young children benefit from frequent shorter sessions (e.g., up to four times/week for 30 minutes each session). These are preferable over longer, less frequent sessions. In general, children with phonologic delay progress more quickly than children with DAS. This means that the child with DAS will need these intensive services longer.”
Edythe A. Strand and Amy Skinder, Treatment of Developmental Apraxia of Speech: Integral Stimulation Methods, pages 120-121, Clinical Management of Motor Speech Disorders in Children, edited by Anthony J. Caruso and Edythe A. Strand, Thieme Medical Publishers Inc., New York. 1999.
Decisions Regarding Treatment Sessions
Several decisions need to be made regarding the frequency, length, and the type of treatment sessions. Given that most researchers in motor learning agree that motor skill is acquired only through practice (Rose, 1997; Schmidt, 1988, 1991), sessions should be frequent and long enough to allow the practice that is needed. How those sessions are scheduled, however, is important. Magill (1998) suggested that for continuous skill a distributed practice schedule is preferable, whereas for discrete skill, mass practice is better. Fletcher (1992) discussed this concept with respect to speech and suggested that distributed practice will likely yield better speech motor performance and speech motor learning for this serial motor learning task. This brief review of the concept of mass versus distributed practice leads to the suggestion that for children with significant motor planning or programming problems, distributed practice will likely result in better motor learning. For example, if 2 hours of therapy per week are recommended, sessions should be scheduled four times per week for half hour, versus two times a week for an hour. Given that we know frequent repetitive practice is necessary to learn skilled movement, however, it seems logical to assume that individual treatment sessions go much further in offering the child the opportunity to practice the movement gestures with enough frequency for the motor learning to be retained.
Penelope K. Hall, Linda S. Jordan, Donald A. Robin, Developmental Apraxia of Speech: Theory and Clinical Practice, 2nd Edition, page 200, Pro-ed Publishers, Texas, 2007.
“To summarize, although there are differences in definitions of intensive remediation for children with CAS, there appears to be emerging consensus within the literature that therapy should be conducted at least three to five times weekly, in sessions lasting between 30 and 60 minutes each, and that the intervention should be conducted on an individual basis.”
Penelope K. Hall, Linda S. Jordan, Donald A. Robin, Developmental Apraxia of Speech: Theory and Clinical Practice , page 125, Pro-ed Publishers, Texas, 1993.
“Intensive Services are Needed for the Child with DAS. Children with DAS are reported to make slow progress in the remediation of their speech problem. They seem to make slow progress in the remediation of their speech problem. They seem to require a great deal of professional service, typically done on an individual basis. Therefore, clinicians working with DAS must accommodate this need and schedule as much intervention time with the child as the child and/or his/her circumstances can allow. Thus, the clinician may be thrust into the position of becoming an advocate on behalf of the child to assure that services are provided as frequently as possible. In some cases, the clinician may need to help the family find the financial resources or assistance thy may need to cover the costs of professional service; a child with DAS can quickly become an expensive child to his/her family or school system because of the amount of therapy they typically require.
The roles of parents, teachers, peers and siblings in a childs program of remediation will also vary with the circumstances. If the child with DAS can tolerate additional work and interacts well with the selected individual, the speech-language pathologist may include family and/or teachers in the overall programming to provide additional response opportunities for the child to reinforce and strengthen performance on a particular speech target. Creaghead, Newman, and Secord (1989) stated that nightly parental drill is a necessity (p. 274). However, in todays society we recognize that the involvement of the family and teachers in the extra remedial programming may not be a practical recommendation to pursue.
The definition of intensive varies from clinician to clinician and from work setting to work setting. Rosenbek (1985), when discussing therapy with adult apraxics, defines the work as meaning that the patient and the clinician should have daily sessions; Macaluso-Haynes (1978), Haynes (1985), and Blakeley (1983) also advocate daily remediation sessions. Blakeley (a983, p.27) stated that 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.”
Shelley L. Velleman, Ph.D., CCC-SLP, Developmental Verbal Dyspraxia, Apraxia-Kids Website,http://www.apraxia-kids.org/slps/velleman.html
We recommend therapy as intensively and as often as possible. Five short sessions (e.g., 30 minutes) a week is better than two 90-minute sessions. Regression will occur if therapy is discontinued for a long time (e.g., over the summer).
At least some of the therapy, on a regular basis (e.g., once a week) must be provided by an ASHA-certified (“CCC-SLP”), licensed (in those states with licensure) speech-language pathologist. Other professionals who work with the child in other sessions must be supervised by the certified person (e.g., meet with her/him weekly to discuss progress and strategies).
Most of the therapy (e.g., 2-3 times a week) must be provided individually. If group therapy is provided, it will not help unless the other children in the group have the same diagnosis and are at the same level phonologically. Adequate services cannot be provided in whole-classroom activities. Language stimulation, exposure, etc. may have an impact on some social language skills, but are not sufficient. If you are told,”(S)he’ll get it by listening to the other kids”, do not believe it. If (s)he could get it through exposure, (s)he’d have it already.
Nancy Lucker-Lazerson, MA, CCC-SLP, Apraxia? Dyspraxia? Articulation? Phonology? What Does it All Mean? An Introduction to Speech Production Disorders, Apraxia-Kids Website, http://www.apraxia-kids.org/slp/luckerlazerson.html
“The most important thing to remember about speech production disorders is that therapy can, in most cases, make a huge difference. The earlier and more intensive the intervention, the more successful the therapy. Group therapy can be effective for articulation disorders and some phonological processing disorders, but children with Apraxia/dyspraxia really need the intensive, individual therapy. Unfortunately, in these days of managed care, many insurance companies will not reimburse for these types of speech disorders. The public schools, university-based clinics, private practices, and private clinics, such as the Scottish Rite Clinics, will be your best bets.”
Mark D. Simms MD, MPH and Robert L. Schum PhD in the article “Preschool Children Who Have Atypical Patterns of Development”, Pediatrics in Review, Volume 21 * Number 5 * May 2000
“Children who have oral-motor deficits, especially speech apraxia, require intensive speech and language therapy.”
The National Institute on Deafness and Communication Disorders, National Institutes of Health
“Children with developmental apraxia of speech will not outgrow the problem on their own.”
“People with apraxia of speech usually need frequent and intensive one-on-one therapy”
(NIDCD/NIH, Accessed 11/19/2004)