Principle Investigator: Dr. Susan Rvachew
Other Investigator: Dr. Caroline Erdos
Research Organization: McGill University
Year of Funding: 2012
Funding Amount: $25,000
Title: Comparison of Alternative Prepractice Conditions in the Treatment of Childhood Apraxia of Speech using a Single Subject Randomization Design
Subjects: For this study we recruited English-speaking children from SLP caseloads with suspected or confirmed childhood apraxia of speech (CAS). After extensive assessment at intake we confirmed that 17 met common checklist criterias for a CAS diagnosis. Of those, 12 children, ages 3;7 to 8;9 completed our treatment protocol (18 treatment sessions, 3 per week over 6 weeks, using a randomized single subject alternating treatments design).
Results: Using diagnostic criteria that relied primarily on the Syllable Repetition Task and performance on the Word Inconsistency Task we classified the children as having a phonological planning disorder or a motor planning disorder. Specifically children who could not remember a longer sequence of syllables during the syllable repetition task were diagnosed with a phonological planning problem. Children who had difficulty coordinating the sounds and syllables during the syllable repetition task were diagnosted with a motor planning task. We predicted that these two subgroups of children would show a different response to the different types of treatment that we provided. All the children received a treatment in which they were taught to segment words in individual speech sounds, associate those sounds with visual symbols, and then recombine those sounds into words. This treatment was unique in that the children were taught to use the visual cues as their primary means of remembering the new words and the order of sounds in those words. Children with a phonological planning disorder responded best to this treatment. All the children received a treatment in which they were taught to listen carefully to whole words and identify speech errors in those words. They were encouraged to listen to their own speech and correct their own errors. During speech practice, imitating the SLP’s model was a primary strategy for helping the children produce the words correctly. Children with a motor planning disorder responded best to this treatment.
Conclusions: It is very important to understand that children who meet standard criteria for Childhood Apraxia of Speech do not all have the same kind of planning disorder. Some of those children have a problem with remembering, retrieving and ordering the speech sounds in words. They need a treatment program that helps them to remember and order sounds at an abstract level. Other children have a problem coordinating speech motor gestures. They need to learn to use instrinsic feedback to guide the movements of their articulators and achieve speech motor control.
An N-of-1 Randomized Controlled Trial of Interventions for Children With Inconsistent Speech Sound Errors
Principle Investigator: Dr. Maria Grigos
Co-Investigator: Julie Case
Research Organization: New York University
State/Province/Country: New York
Year of Funding: 2012
Funding Amount: $25,000
Title: Speech Motor Learning in Children with Apraxia
Subjects: 16 children, ages 5;0 to 6; 10 years (8 children with CAS, 8 children with typical speech and language development (TD)
Results: During a novel word-learning task, children with CAS displayed short- and long-term improvements in consonant/vowel accuracy and consistency; however, their performance remained consistently poorer than the TD control group. Articulatory control was also examined in whole words (Case & Grigos, 2016) and in movement transitions at the syllable level (Grigos & Case, 2018). At the whole word level, the children with CAS demonstrated longer duration of jaw movement than TD controls across each of the three time periods. Further, articulator movement variability remained high in the CAS group across all sessions, while children in the TD group produced more stable movements. When looking only at the movement transition within syllables, children with CAS displayed larger opening movements combined with decreased movement variability over the practice period. No changes were observed in the TD group.
Conclusions: Children with CAS displayed a learning effect for consonant accuracy and consistency. Lack of change in movement variability at the whole word level may indicate that children with CAS require additional practice to demonstrate changes in speech motor control, even within production of novel word targets with greater consonant and vowel accuracy and consistency. Changes in speech motor control at the syllable level, however, suggest that children with CAS refine movements at the level of the movement gesture prior to demonstrating changes in speech motor control across longer movement sequences, such as words.
Changes in movement transitions across a practice period in childhood apraxia of speech
Articulatory Control in Childhood Apraxia of Speech in a Novel Word-Learning Task
Principle Investigator: Dr. Jenya Iuzinni-Seigel
Other Investigators: University of Nebraska/MGH Institute of Health Professions
Research Organization: University of Nebraska/MGH Institute of Health Professions
State/Province/Country: Nebraska and Mass.
Year of Funding: 2012
Funding Amount: $12,500
Title of Research Study: Optimal Diagnostic Criteria for CAS in School-aged Children: A Multilevel Approach
Subjects: 22 children with childhood apraxia of speech (CAS), 10 children with speech delay (SD), and 10 with typical development (TD) ranging in age between 6;2 and 17;8
Results: The current data provide preliminary evidence that school-aged children with CAS and SD vary in their display of the ASHA features, which appears to depend, in part, on qualities of the stimuli items that are used to elicit the features. Findings from this dataset also show that poor speech perception is not associated with the core deficit of CAS, but rather, is associated with language impairment that co-occurs in the majority of children with CAS. Finally, we found that children with CAS tend to rely on auditory feedback for production of clear speech whereas those with SD and TD did not demonstrate a substantial discrepancy in their voice onset time or vowel space area when auditory feedback was masked.
Conclusions: We found that type of stimuli matters when eliciting CAS features. Specifically, some stimuli items, such as multisyllabic real words, were highly inconsistent for children with CAS and SD. In contrast, monosyllabic real words were only inconsistent for children with CAS, not for children with SD. Repeated production (5x) of the phrase “Buy Bobby a puppy” was also sensitive and specific in differentiating children with CAS and SD. Children with SD were highly consistent in producing this phrase, whereas children with CAS tended to be inconsistent. Although this phrase seems fairly simple, it taxes areas of challenge for children with CAS: specifically, the voicing distinction, vowels, and coarticulatory transitions between sounds and words. Findings from this dataset also reveal the importance of controlling for linguistic ability when analyzing data from children with CAS.
Speech Inconsistency in Children With Childhood Apraxia of Speech, Language Impairment, and Speech Delay: Depends on the Stimuli
Reliance on auditory feedback in children with childhood apraxia of speech
Poor Speech Perception Is Not a Core Deficit of Childhood Apraxia of Speech: Preliminary Findings