What is different about Treatment for CAS?
What is Evidence-Based Treatment?
Which methods are evidence-based for treatment of CAS?
What are some other important things I should know?

What is different about treatment for CAS?

Almost everything is different because the nature of CAS is different from other speech sound disorders. Traditional speech therapy methods utilize a phonological approach designed to help the child learn and produce sounds in a developmental sequence. Because CAS is disorder of motor planning and programming, effective treatment utilizes a motor-based approach that helps the child learn complex motor control necessary to produce words and sentences. 

Therefore:

Movements NOT sounds are the focus of therapy.

Fewer words are targeted at a time to give the child ample opportunity to practice and master the movement.

The therapist provides cues to help the child with movement, including visual, tactile, and verbal cues.

Initially, maximal cues are provided to help the child, then cues are removed as the child becomes successful to encourage independence and generalization.

Therapy emphasizes accurate production of vowels and prosody (inflection), which are difficult for children with CAS.

What is evidence-based treatment?

Evidence-based treatment means that a treatment has been scientifically studied and found to be effective. There are different degrees or “levels” of evidence. The strongest evidence is a randomized, controlled study (RCT) where a treatment is studied for effectiveness much like a new drug is studied. Other levels of evidence include studies with a small group of children by independent researchers. It is important to point out that unlike drugs, therapy methods ARE NOT regulated by a third party and are therefore not required to have evidence of effectiveness. In fact, many therapy methods have no scientific support of effectiveness at all. However, the American Speech-Language and Hearing Association (ASHA) states that, when available, therapists should use evidence-based treatment methods. Learn more about evidence-based treatment here.

Which methods are evidence-based for treatment of CAS?

Currently only these CAS treatment approaches have  adequate evidence of treatment efficacy:

Dynamic Temporal and Tactile Cueing (DTTC)

Rapid Syllable Transition Treatment (ReST)

Integrated Phonological Awareness Intervention (IPA)

Nuffield Dyspraxia Program, Third Edition (NDP3)

Learn more about these therapy methods here.

What are some other important things I should know about effective treatment for CAS?

Early intervention is important, so correctly diagnosing CAS and beginning a treatment designed specifically for CAS is critical. Waiting an extended period with a label of “possible CAS” and NOT using a CAS therapy approach can delay progress.

Treatment intensity (3-4 times per week) is important, especially for children with severe CAS.

Children must have the opportunity for ample practice to learn a motor pattern. Therapy should limit the number of target words and avoid games/activities that take away from practice time.

Children must actively attend to the therapist’s cues with the intent to improve movement. Often, young children will need help learning to do this. Part of the skill of treating CAS is learning methods to keep the child engaged in intense, repetitive, and difficult practice.

Avoidance, refusal or disruptive behavior may be signs of frustration and signal that adjustments are needed in the therapy program to decrease the level of effort or enhance the meaningfulness of the work for the child.

Selecting meaningful and functional target words that help the child gain access to preferred objects/activities and address specific movement patterns is important. Using randomly selected word lists 
or picture cards that are not personally meaningful to the child may decrease the child’s engagement.

How Parents Can Help

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Dr. Edythe Strand Explains CAS Treatment

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Examples of Therapy Sessions for Children with CAS

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