What is a treatment method?
What methods are used to treat CAS?
What is evidence-based practice?
What ages and disorders does the method treat?

What is a treatment method?

A treatment method or therapy approach is the program that the speech-language pathologist (SLP) will use to treat your child. Treatment methods can be developed by research teams or individual clinicians. Some therapy approaches require formal training and/or certification in order to use the approach. Some SLPs may not use a formal method or may use a combination of approaches. Ideally, a therapy approach should have research evidence that it is effective. This means that the method has been studied and does what it claims to do. Effective approaches typically have the following components:

Frequent and Intensive Practice

This means the child is producing a lot of their target words or phrases during therapy.

Focus on Movement (not sounds)

Since CAS is a motor-based disorder, the focus is on the child learning to move their mouth accurately to sequence speech sounds correctly.

Multisensory Input

The clinician provides the child with more cueing including tactile/touch, visual and auditory cues. Cues should be used when the child needs them for success, but used less as the child makes progress.

Specific Types of Practice

New targets may be practiced many times in a row (called a practice "block"), while older targets may be practiced throughout the session (called "variable" practice).

Carefully Chosen Types of Feedback

The clinician provides different types of feedback to the child depending on their level of therapy. Feedback may be more general (e.g. "That was right!") or more specific (e.g. "You need to put your lips together.")

Focus on Prosody

Prosody in speech includes phrasing/fluency (including repeating words or sounds), rate/speed, use of pauses, intonation/pitch, vocal quality, rhythm and stress/emphasis. Prosody is used to indicate meaning, including mood and emotions. Children with CAS often struggle to produce typical prosody in their speech.

What methods are used to treat CAS?

A number of approaches are used to treat CAS. Some of these programs have been studied for effectiveness and have been shown that they do what they claim to. Other programs have not yet been studied.

Therapy Approach Research Evidence Designed to Treat Age Range More Information
Dynamic Temporal and Tactile Cueing (DTTC) Moderately strong Moderate-Severe CAS 2 years and above DTTC
Rapid Syllable Transition Training (ReST) Very strong CAS and ataxic dysarthria 4-12 years ReST
Integrated Phonological Awareness Training (IPA) Moderately strong Speech-language impairment 4-7 years IPA
Nuffield Dyspraxia Program, Third Edition (NDP3) Very strong Severe speech sound disorders, including CAS 3-7 years (but can be modified for older and younger) NDP3
Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) None for CAS yet (some evidence for less severe motor planning disorders) Communication disorders 6 months and older The PROMPT Institute
The Kaufman Speech to Language Protocol (K-SLP) None for CAS yet Speech sound disorder including CAS and expressive language disorders 2 years and older K-SLP
The Speech-EZ Apraxia Program None CAS and phonological disorders Not specified The Speech-EZ Apraxia Program

What is evidence-based treatment?

Evidence-based practice means that the therapist is using methods or techniques supported by research as effective for treating CAS.  There are many different levels of evidence. Sufficient evidence of efficacy (effectiveness in a controlled condition such as a research study) means that the approach has been studied and the results published in a peer-reviewed publication.  You can learn more about evidence-based treatment here.

DTTC

DTTC has been studied and found to have moderately strong evidence that it successfully treats children with moderate-severe CAS.

ReST

ReST has been studied and found to have very strong evidence for successfully treating mild-moderate CAS and ataxic dysarthria.

IPA

IPA has been studied and found to have moderately strong evidence for successfully treating CAS.

NDP3

NDP3 has been studied and found to have very strong evidence for successfully treating CAS.

PROMPT

PROMPT has not yet been studied for its effectiveness in treating CAS. There is some evidence that PROMPT successfully treats less severe motor planning disorders.

Kaufman

The Kaufman approach (K-SLP) has not yet been studied sufficiently to determine if it successfully treats CAS.

Speech-EZ

The Speech-EZ program has not yet been studied to determine if it successfully treats CAS.

What ages and disorders does the method treat?

Some methods are specifically designed to treat CAS and other methods are not. Regardless of what the approach is designed to treat, studies tell us what populations (ages of children with which diagnoses) the method effectively treats. Keep in mind that the severity of CAS changes over time, so the best therapy approach may change over time as well. For more information about how the severity of CAS changes over time, click here.

DTTC

DTTC was designed to treat CAS. It has moderately strong evidence that it is effective in treating children with moderate-severe CAS ages two and older.

ReST

ReST was designed to treat CAS. It has very strong evidence that it is effective for treating children with mild-moderate CAS and ataxic dysarthria ages 4-12 years.

IPA

IPA was not specifically designed to treat CAS. It has moderately strong evidence that it is effective in treating CAS in children 4-7 years old.

NDP3

NDP3 was designed to treat severe speech sound disorders, including CAS. It has very strong evidence for effectively treating CAS in children 3-7 years old.

PROMPT

PROMPT was designed to treat a variety of communication disorders in children 6 months of age and older. It has not yet been shown to be effective in treating CAS in research studies.

Kaufman

The Kaufman approach (K-SLP) was designed to treat children with speech sound disorders, including CAS, and expressive language disorders. It has not yet been shown to be effective in treating CAS in research studies.

Speech-EZ

The Speech-EZ program was designed to treat CAS and phonological disorders. It has not yet been shown to be effective in treating CAS in research studies.

Remember, you are the expert on your child! If the treatment method doesn’t feel right, talk to your SLP about other options.

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