Monday, May 16, 2011

Childhood Apraxia of Speech Therapy Fundamentals: Part 1 - How Much and How Often?

Childhood Apraxia of Speech (CAS) is neurological speech disorder that causes children to have difficulty with the motor planning, sequencing, and programming necessary to produce volitional speech. Therapy needs to address the core problem of motor planning for speech in the most effective way possible. Every child is different, so therapy must be customized. Therapy for a young child who is nonverbal will be different from therapy for an older child who is using multi-word sentences, but the speech is hard to understand. However, the basic underlying fundamentals of therapy for apraxia are going to be similar. These underlying fundamentals are based on current research and professional consensus.

How much therapy is usually necessary to treat Childhood Apraxia of Speech?

Intensity of Speech Therapy

It is essential that a child with Childhood Apraxia of Speech get as many opportunities as possible to actually produce speech. You cannot improve motor planning skills if no speech production is happening. Therapy for CAS needs to focus on getting as many speech productions as possible from the child during each session. A child is not improving their motor planning skills when they are just listening or watching the therapist or other children. For this reason, it is usually recommended that speech therapy sessions be individual (one-on-one) rather than group (one therapist with several children). It is also recommended that the therapist stay very focused on having the child practice rather than on having the child listen and watch while the therapist "teaches". Therapy for Childhood Apraxia of Speech needs to be very intense.

Frequency and Duration of Speech Therapy

Children with Childhood Apraxia of Speech typically need a lot of therapy to show improvement. One study (Campbell, 1999) showed that "the children with apraxia of speech required 81% more individual treatment sessions than the children with severe phonological disorders in order to achieve a similar functional outcome."

The professional organization of speech language pathologists, the American Speech Language Hearing Association (ASHA) reports that, "There is emerging research support for the need to provide three to five individual sessions per week for children with apraxia as compared to the traditional, less intensive, one to two sessions per week (Hall et al., 1993; Skinder-Meredith, 2001; Strand & Skinder, 1999)." ASHA's technical report also states that, "In view of the Committee's information indicating that children are being enrolled for treatment of CAS at increasingly younger ages, careful consideration should be given to the length of the therapy session. If repetitive practice of speech-motor patterns is targeted in a therapy session, many children in the younger age ranges can remain engaged for only a maximum of 30 minutes per session."

Given a choice, therapy for Childhood Apraxia of Speech should be broken into many shorter sessions per week rather than one or two long sessions per week. This makes sense from a motor planning perspective. You will learn a new motor task (just like riding a bike) faster if you practice a little almost every day rather than practicing for several hours only once a week.


Ideally, therapy for Childhood Apraxia of Speech should be individual sessions 3-5 days a week. Those sessions should be focused on getting as many productions from the child as possible. Sessions should be no longer in length than the amount of time the child can focus on intense practice. These guidelines are most important when the Childhood Apraxia of Speech is judged to be severe.

You just finished Part 1 of a three part series on Childhood Apraxia of Speech Therapy Fundamentals.
Read the other two parts of the series:

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  1. This is great information! Thank you! The shorter times make a ton of sense. Our challenge is motivation and getting those targeted sounds to happen. Can't wait for the rest!

  2. Thanks Gentle Blue. I'm glad you found the information interesting/useful. Motivation for little ones is often a challenge - particularly when things are hard for them. Hopefully you guys will have a breakthrough soon. Good hearing from you again!

  3. Thank you so much for organizing all of this here.
    My first instinct is to research, research, research.... but there is so much to wade through.

    1. You're welcome. My first instinct is always to research as well. The information is definitely overwhelming at first, but then it gets better. Good luck.

  4. I've been reading/researching a lot about CAS as my 21 mo is suspected of having CAS. One thing I wanted to ask you with respect to the how much/how often post above is at what age the 3-5 sessions/week is appropriate? We've been advised by the SLP who did his intial observation that based on his age and the receptive delay and engagement issues that true ST would not be appropriate, so we've been doing things to incorporate 'home therapy' into our day to day, based on her suggestions. I understand the point she was making but as I learn more and more about CAS I wonder if I should be pushing for more. We just recently got him accepted into a different service organization and have an observation with them next week, so we will have that second opinion, but the more I know the better questions I can ask!

  5. “Amazing write-up!”
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