Why is Research Important

Click here to view the Glossary of terms for judging evidence.

What is Evidence-Based Practice?

What kind of evidence should there be?  What is meant by Evidence-Based Practice (EBP)?  EBP refers to the process of clinical decision-making that integrates clinical expertise and client needs and preferences with external research evidence. This last piece (external research evidence), with respect to treatment, refers to findings from careful studies in which the effect of a treatment is systematically examined under controlled circumstances – typically by comparing treatment to absence of treatment or another treatment.

When a new therapy protocol is developed, it is usually tried with a few children initially. This type of research is just the beginning of building evidence.  If the results are positive, then more evidence must be obtained by replication and more controlled studies.  Replication is important, because if something happens only once or twice, it could be a fluke or coincidence, but if the effect can be shown over and over again, it is more and more likely that it can be generalized to a larger population. Other types of studies might include groups of children, with randomized control studies (RCTs), where children are randomly assigned to treatment groups, which are considered the strongest evidence. See the glossary of terms for more detailed discussion of types of studies.

When reading about a program or product, if there is evidence like given above, the website or brochure should give the details of that research.  Or at least give information for where the evidence can be found.  If it is not listed, then it may still be under development or does not exist. Then consumers are relying on less stringent information and clinical judgement to make decisions about the appropriateness of a program or product.

We are fortunate to have some evidence based research to help guide us in diagnosis and treatment of CAS which shows that the best treatment for improving speech is intensive therapy that focuses on the motor movement sequences of speech, follows the principles of motor learning, and uses multisensory cues.  However, even approaches for which there is controlled and replicated evidence may look different for different children, as each child is an individual and many children with CAS have additional areas of concerns. In accordance with the description of EBP above, it is up to the child’s team (which includes the parents/families) to make sound decisions based on the evidence available as to what treatments would be beneficial.  Before making decisions, parents are advised to seek out appropriate professionals (speech language pathologists, doctors, other healthcare providers) to help determine if a specific program or therapy is appropriate for their child.”

“How to Judge Evidence

By Edwin Maas

Some important things to consider when evaluating research evidence:

• Study design: Does the study design control for potential bias or other potential reasons for improvement? Bias (explicit or implicit expectations/hope of improvement on the part of the child/family or researcher) is usually best controlled by blinding; for example, were the data analyzed by blinded research assistants or by the treating SLP or researcher? Other potential reasons that should be controlled include maturation (spontaneous, naturally occurring improvement as a function of getting older), other treatments a child may be receiving outside of the study, and becoming more familiar with the test or testing situation. Both group designs and single-case experimental designs (see Glossary) have ways to control for these alternative explanations.
• Source: Is the evidence published in a peer-reviewed journal? All else being equal, studies in peer-reviewed journals are more credible than studies published as book chapters, magazines, or self-published on the internet (e.g., blog posts). See Glossary for explanation of peer review.
• Replication: Have the findings been replicated, or is there only one study? All else being equal, the more times a program or product has been shown to work, the more likely it is that the effect is real. It is even better when different researchers independently replicate the effects, because it indicates that the effects are not specific to particular clinicians but are likely about the program or product itself.
• Outcomes: Is the effect large and/or meaningful? For example, improvements may be small, or only present in some children, or on a measure that is not relevant to your child’s goals.
• Conflict of interest: Is the only available evidence produced by people with potential conflicts of interest? For example, is the only research done by the developers of the program or product, who may have a financial interest? Note that this does not mean that evidence produced by people with a conflict of interest is necessarily flawed or dishonest or untrustworthy. This consideration just means that, all else being equal, evidence from independent researchers is more credible than evidence from researchers with a conflict of interest.”

“Would This Program Be Good for My Child?

By Laura L Moorer & Edwin Maas

As professionals and concerned parents/caregivers, we are constantly bombarded with information.  Some is fact-based, some more anecdotal, and some just opinion. Often, we are left with more questions than answers after hearing or reading about some program or treatment option. That is a GOOD thing!

Whenever you are researching if a specific program or treatment is right for your child, there are specific questions you should ask yourself:

• Am I being asked to buy something?Keep in mind that any advertisement is trying to sell you something – a product, a book, a training course, a treatment program, etc. It is in the interest of the advertisers that you believe what they are saying. Be skeptical, and look for independent information about the product/program from reputable and independent sources (sources without an inherent conflict of interest). If you are unsure where to find information, ask a professional (e.g., SLP, researcher) whose judgment, expertise, and critical thinking you trust for their opinion.
• Does this sound too good to be true?If so, it’s probably not true. Be leery of programs/therapy that claim to help in several different areas – improves speech, balance, memory, ADHD, cognitive skills, motor skills, auditory processing, listening, language…. Or some combination of these.  One program/therapy isn’t going to fix everything even though there is overlap in many of these areas.
• Will this cause harm?The statement or belief that “if it doesn’t help, it can’t hurt” is rarely true. First, there may be actual harm – for example, the product or program may in fact slow or even reverse progress that was being made, or there may be side effects. Second, there is usually a cost in terms of resources – money spent, time spent, etc. Money and time spent on an ineffective program is money and time not spent on other programs that might be more effective.
• What are the specific goals/outcomes of this product/program/therapy? The program or product information should clearly state what the desired outcome is.
• Do those goals fit within the areas that my child needs to improve at this specific moment in time?(With CAS, it is improving motor planning for speech specifically – not voice, fluency, memory, etc…) There are often more issues that need to be addressed during a child’s journey, so those things should be taken into consideration, either separately or simultaneously.
• Should I read the testimonials?Do not rely only on vague “testimonials” on the product’s or therapy’s website that say “My child was so much better after 3 sessions.”  These statements leave you asking: “Better at what?”  “What actually improved?” Testimonials are not evidence – they are anecdotal and represent an opinion.
• What research or evidence exists for this program/therapy reaching their goals with children with the same diagnosis as my child?Look on reputable sites for evidence such as American Speech-Language-Hearing Association, National Institute of Health, World Health Organization, US Department of Education, and peer reviewed journals.”

Evidence Brief – There are a multitude of different treatment approaches available for CAS. Tricia McCabe, Elizabeth Murray and Donna Thomas from the University of Sydney have graciously enabled us to share their Evidence Brief on childhood apraxia of speech.

1. Videos from 2025 conference interviews about their research (replaces Edwin’s similar video) coming soon!!