What is DTTC?
How is DTTC different from other CAS treatment methods?
Who is a candidate for DTTC?
What evidence supports DTTC?

What is DTTC?

DTTC is a treatment method designed specifically for children with severe CAS,  especially those who were not successful with more traditional forms of therapy,  and has been used successfully with moderate CAS as well. DTTC is a motor-based approach, meaning it is designed to improve the brain’s ability to plan and program movements for speech, which most experts believe is the underlying cause of CAS. The goal of DTTC is to improve the efficiency of neural processing for the development and refinement of movements. The incorporation of a number of principles of motor learning helps the child maintain accurate movement over time.  In DTTC, the therapist selects specific word targets to shape movements of the mouth that are necessary for speech. DTTC is based on motor learning theory and research, integrating Dr. Strand’s personal research and clinical experience treating children with CAS over a span of more than 40 years.

How is DTTC different from other CAS treatment methods?

Like some other methods of treatment, DTTC was designed specifically for children with CAS.  A primary difference is that the focus of treatment is on the movement gesture, rather than an individual sound.  No sounds are worked on in isolation.  Other components of DTTC that differentiate it from other CAS treatment methods include:

Movement, not individual sounds, is the focus of treatment. Work on vowels and prosody (inflection and rhythm of speech) begins early in treatment since they are typically difficult for children with CAS.

Word targets are individualized to each child – there are no word lists or picture cards that are routinely used in therapy. Through careful assessment, the speech-language pathologist determines speech movement patterns the child needs to work on and then selects relevant, functional words for the child that fit the movement goal. The child practices words that are meaningful and relevant for her.

The therapist uses cues that work best for each child. There are no complicated, standardized cues applied to all children. Instead, the clinician uses several different cueing methods such as saying the word slowing, saying the word in unison with the child, modeling mouth movements for the word, and tactile cues, which are not specified, and are suggested to be as simple as possible. All cues are individualized to the child.

The cues the therapist uses to help the child are dynamic meaning more cues are given when needed so the child is successful, but cues are then removed or faded as soon as possible to promote independence. This dynamic cueing means that the therapist is constantly responding to the needs of the child throughout practice to avoid frustration while building skills.

Therapy sessions are structured to provide the child with LOTS of practice because practice is critical for learning any motor skill, including speech. Therapists use simple, fast reinforcement methods keeping the child focused and engaged during practice to maximize motor learning.

Who is a candidate for DTTC?

DTTC is a treatment method designed specifically for children with severe CAS. Prerequisites for the use of DTTC include the ability to focus attention to the clinician’s face for at least a minutes at a time (this is easily increased with reinforcement and success) and the ability to at least attempt direct imitation.  If the child does not yet have the intent to communicate or does not have joint attention, it is best to work on those skills first.

What evidence supports DTTC?

DTTC is supported by multiple research studies across independent researchers with evidence of both maintenance and generalization.  Maintenance means that improvements last beyond the treatment period. Generalization means that skills transfer to other situations, such as new words not directly practiced in therapy. Maintenance and generalization are important components of evidence because they indicate true clinical change as a result of the treatment.  

In a systematic review of treatment outcomes for children with CAS, researchers reviewed 42 peer reviewed articles of 13 different treatment approaches and identified as DTTC one of three treatment methods with sufficient evidence for clinical practice (Murray, McCabe and Ballard, 2014). Learn more about evidence-based treatment methods for CAS here.

Dr. Edythe Strand Explains DTTC

Watch Video

Examples of the DTTC Method

Watch Video

Free DTTC Workshops for SLPS

Learn More