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Will my child benefit from using “X” (a specific technique or program) in therapy?

Ruth Stoeckel, Ph.D., CCC-SLP

Variations of this question are often posted on the Apraxia -KIDS listserv or asked during workshops or educational talks about apraxia.

Based on the limited research evidence we have for treatment of apraxia, the short answer to this question is that the method itself may be less important that assuring the needed intensity of services and having the focus of therapy on learning the movements needed for intelligible speech.

Treatment techniques , visual, auditory, and tactile prompts, can be used with almost any type of stimuli. The training an SLP has had will influence the techniques with which they are most familiar or comfortable, and adjustments in technique will also be predicated on how the child responds in therapy. A treatment program may be a set of predetermined stimuli that are to be presented in a particular way, or it may be a set of “rules” according to which predetermined or clinician-determined stimuli are presented. Because no two children are exactly alike, it should be no surprise that that there isn’t a single technique or program that will be appropriate or effective with every child who has apraxia. The degree to which modifications are needed will be based on each child’s individual needs and characteristics.

An important issue to consider in choosing treatment options is what has been learned from assessment regarding the child’s particular strengths and weaknesses. Factors that affect a child’s ability to communicate include cognitive skills, ability to focus and maintain attention, general motor skills, and language skills, and other co-occurring issues. If a child has co-occurring conditions such as dysarthria or a phonological impairment, the relative degree of involvement of those conditions will affect decisions about treatment. Will the program in question be flexible enough to accommodate these co-occurring factors?

Following assessment, decisions must be made about aspects of treatment such as the frequency and length of sessions, the number and type of stimulus items, and how to engage the child successfully in the therapy process. The child may be seen for individual therapy, group therapy, or some combination of the two. Can the program be adapted to these different conditions?

Decisions need to be made within as well as between therapy sessions, based on the child’s response to treatment. The child’s needs will change over time. As motor planning issues resolve, phonological difficulties may begin to take priority. To be effective, treatment should be adjusted to address those changing needs. Does the program include options to address those changes?

It is possible that all or most of a published program may be suitable for intervention with a particular child. Programs can be valuable in helping a clinician to identify appropriate stimuli, think about levels of difficulty, or to simplify data collection. Programs used in a thoughtful, flexible manner can enhance treatment. A technician is a person who can administer a program according to a given protocol. A clinician is a person who makes clinical decisions about when and how to use components of a program so a child’s progress is maximized. The key is to fit the program to the child rather than fitting the child to the program.

[Ruth Stoeckel, from Rochester, Minnesota, has her B.S. from the University of Iowa, and her M.A. and Ph.D. from the University of Minnesota. She has a breadth of experience working in the schools, private practice as both therapist and training consultant, private rehabilitation agency and clinic. Currently, Ms. Stoeckel is employed at the Mayo Clinic, evaluating and treating young children with a variety of speech-language difficulties, including children with motor speech disorders. She also presents workshops both at both local and national levels on a variety of topics. She is a member of CASANA’s Professional Advisory Board and a frequent contributor to the Apraxia-KIDS listserv and Message Boards.]

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