Interventions for childhood apraxia of speech

BACKGROUND: Childhood apraxia of speech (CAS) affects a child's ability to produce sounds and syllables precisely and consistently, and to produce words and sentences with accuracy and correct speech rhythm. It is a rare condition, affecting only 0.1% of the general population. Consensus has been reached that three core features have diagnostic validity: (1) inconsistent error production on both consonants and vowels across repeated productions of syllables or words; (2) lengthened and impaired coarticulatory transitions between sounds and syllables; and (3) inappropriate prosody (ASHA 2007). A deficit in motor programming or planning is thought to underlie the condition. This means that children know what they would like to say but there is a breakdown in the ability to programme or plan the fine and rapid movements required to accurately produce speech. Children with CAS may also have impairments in one or more of the following areas: non-speech oral motor function, dysarthria, language, phonological production impairment, phonemic awareness or metalinguistic skills and literacy, or combinations of these. High-quality evidence from randomised controlled trials (RCTs) is lacking on interventions for CAS. OBJECTIVES: To assess the efficacy of interventions targeting speech and language in children and adolescents with CAS as delivered by speech and language pathologists/therapists. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, eight other databases and seven trial registers up to April 2017. We searched the reference lists of included reports and requested information on unpublished trials from authors of published studies and other experts as well as information groups in the areas of speech and language therapy/pathology and linguistics. SELECTION CRITERIA: RCTs and quasi-RCTs of children aged 3 to 16 years with CAS diagnosed by a speech and language pathologist/therapist, grouped by treatment types. DATA COLLECTION AND ANALYSIS: Two review authors (FL, AM) independently assessed titles and abstracts identified from the searches and obtained full-text reports of all potentially relevant articles and assessed these for eligibility. The same two authors extracted data and conducted the 'Risk of bias' and GRADE assessments. One review author (EM) tabulated findings from excluded observational studies (Table 1). MAIN RESULTS: This review includes only one RCT, funded by the Australian Research Council; the University of Sydney International Development Fund; Douglas and Lola Douglas Scholarship on Child and Adolescent Health; Nadia Verrall Memorial Scholarship; and a James Kentley Memorial Fellowship. This study recruited 26 children aged 4 to 12 years, with mild to moderate CAS of unknown cause, and compared two interventions: the Nuffield Dyspraxia Programme-3 (NDP-3); and the Rapid Syllable Transitions Treatment (ReST). Children were allocated randomly to one of the two treatments. Treatments were delivered intensively in one-hour sessions, four days a week for three weeks, in a university clinic in Australia. Speech pathology students delivered the treatments in the English language. Outcomes were assessed before therapy, immediately after therapy, at one month and four months post-therapy. Our review looked at one-month post-therapy outcomes only. We judged all core outcome domains to be low risk of bias. We downgraded the quality of the evidence by one level to moderate due to imprecision, given that only one RCT was identified. Both the NDP-3 and ReST therapies demonstrated improvement at one month post-treatment. A number of cases in each cohort had recommenced usual treatment by their speech and language pathologist between one month and four months post-treatment (NDP-3: 9/13 participants; ReST: 9/13 participants). Hence, maintenance of treatment effects to four months post-treatment could not be analysed without significant potential bias, and thus this time point was not included for further analysis in this review. There is limited evidence that, when delivered intensively, both the NDP-3 and ReST may effect improvement in word accuracy in 4- to 12-year-old children with CAS, measured by the accuracy of production on treated and non-treated words, speech production consistency and the accuracy of connected speech. The study did not measure functional communication. AUTHORS' CONCLUSIONS: There is limited evidence that, when delivered intensively, both the NDP-3 and ReST may effect improvement in word accuracy in 4- to 12-year-old children with CAS, measured by the accuracy of production on treated and non-treated words, speech production consistency and the accuracy of connected speech. The study did not measure functional communication. No formal analyses were conducted to compare NDP-3 and ReST by the original study authors, hence one treatment cannot be reliably advocated over the other. We are also unable to say whether either treatment is better than no treatment or treatment as usual. No evidence currently exists to support the effectiveness of other treatments for children aged 4 to 12 years with idiopathic CAS without other comorbid neurodevelopmental disorders. Further RCTs replicating this study would strengthen the evidence base. Similarly, further RCTs are needed of other interventions, in other age ranges and populations with CAS and with co-occurring disorders

Protein level and source in single meal influence voluntary intake during subsequent meal

Dietary protein has been shown to be more satiating than other macronutrients. The objective of this present study was to assess the acute effect of a meal differing in protein level and source on subsequent intake. Diets included 15%, 20%, 35%, and 50% levels with same and mixed protein sources over a series of five feeding trials. Protein sources included casein, egg white, and wheat gluten. Rats were adapted to a feeding schedule consisting of a 30 minute breakfast meal (20% of daily calories) provided 60 minutes into the dark period. On test days, ground chow was made available 60 minutes after the breakfast meal. The amount consumed during this test period was measured as an index of the satiating effect of the breakfast meal. A 5 hour ad libitum period concluded the dark period. During each study, each rat received all of the test diets without consuming the same diet on back to back days. There were no differences in the amount of diet consumed during the breakfast meal, nor were there differences in the total calories consumed during the entire 24 hour period on test days. When fed a normal protein level (15% or 20%) there was no effect of protein source on subsequent intake during the test period. When rats consumed a breakfast of 35% wheat gluten protein an increase in subsequent intake resulted; however, when 35% egg white protein was consumed there was a significant decrease in intake indicating that egg white was more satiating than wheat gluten. Mixed diets composed of a 15% or 20% casein protein base and an addition of 20% or 15%, respectively, egg white or wheat gluten protein, totaling 35% of calories as protein, were also assessed. Similar results were seen when rats consumed these mixed egg white/casein or wheat gluten/casein breakfast meal at a total of 35% of calories as protein. At the 50% protein level there was a decrease in subsequent intake, indicating the higher protein level was more satiating. Additionally, the different mineral profile of the 35% egg white diet was assessed showing that this was not a factor affecting the rat’s consumption as the diet of 35% of calories from casein protein with added minerals did not result in a decreased subsequent intake as was seen with the 35% egg white diet. These data support a difference between protein sources in their apparent satiating effect on a subsequent meal when fed to rats at 35% of calories. The three protein sources produced different effects on subsequent intake with egg white decreasing intake, wheat gluten increasing intake, and casein having no effect. All of these effects are a result of an acute response to a randomly assigned breakfast meal at a limited amount of calories. The duration of the effect was short, as total caloric intake on test days was not affected by diet fed at the breakfast meal

Counseling advocacy competencies in action: Lessons learned through the See the Triumph campaign

With the growing emphasis on social justice in the counseling and psychology professions, mental health professionals are increasingly called upon to engage in advocacy work. In this article, the authors describe their advocacy campaign, See the Triumph, which aims to end the stigma surrounding intimate partner violence. See the Triumph is based on research with survivors of intimate partner violence, whose stories inspired the development of the campaign. The article describes how the See the Triumph campaign reflects the American Counseling Association’s Advocacy Competencies, as well as the most significant lessons learned through the campaign

The Relative Influence of Client Characteristics on the Process and Outcomes of Premarital Counseling: A Survey of Providers.

To explore the influence of client characteristics in premarital counseling, a five factor model is presented that includes the social context, family-of-origin influences, individual characteristics, couple interactional processes, and motivation for attending premarital counseling. The findings demonstrate that providers believe that many client characteristics influence the degree to which couples benefit from premarital counseling. Providers rated the influence of the client characteristic factors in the following order (from most to least influential): couple interactional processes, family-of-origin influences, individual characteristics, motivation for premarital counseling, and the social context. Recommendations for future theory development, practice, and research are discussed

Learning from experience: A content analysis of domestic violence fatality review team reports

The mounting cost of domestic violence (DV) homicide in the United States has led to increased attention from law enforcement agencies and social organizations and the establishment of domestic violence fatality review boards or teams (DVFRTs) throughout the country. These teams are tasked with reviewing a specified set of DV-related fatality cases to determine the factors that contributed to the fatalities and whether there are changes that can be made to prevent future similar incidents. There exists, however, little to no standardization of practice and procedures among DVFRTs, resulting in wide variability among the reports they produce. The purpose of this study is to empirically analyze the content of DVFRT reports across the United States to summarize standard practices in DVFRT reporting and to inform the procedures of existing and future DVFRTs. The researchers conducted a content analysis of 47 DVFRT reports to determine what information is most typically included in these reports on state, county, and city levels. A summary of findings and recommendations for DVFRTs is included

Prevention Work: A Professional Responsibility for Marriage and Family Counselors

Although ethical codes encourage marriage and family counselors to undertake prevention work, many practitioners do not include prevention within the scope of their practice. Prevention work includes a number of professional functions that address multiple family issues. Within a developmental framework, marriage and family counselors can bring a unique set of skills and experience to preventive work, and a family systems theoretical orientation helps to inform the practice of preventive efforts designed to enhance familial relationships. Marriage and family counselors can be involved in the practice, theory development, and research of prevention work. Effective prevention work by marriage and family counselors incorporates a consideration of barriers to effective prevention work, professional collaboration, and ethical considerations

Couples Therapy: Integrating Theory and Technique [book review]

In their introduction, the editors state that the aims of this book are “to give voice to and provide space for couples whose relationships have all too often been silenced or over-looked” and to “provide a space to focus on these [racial] differences without contributing to further stereotyping and marginalization” (pp. 1-2). This book does, indeed, provide space for thoughtful dialogue about the experiences of being in an interracial relationship. As this text was originally published as an issue of the Journal of Couple and Relationship Therapy (Vol. 2, No. 2/3, 2003), it is a collection of articles on the topic of clinical work with interracial couples rather than a cohesive guidebook. Because of the wide range of clinical issues and the diversity of the topics addressed, it is a useful reference tool and sourcebook for clinicians whose practice involves working with interracial couples. As many of the authors discuss, interracial couples are becoming increasingly common. Therefore, nearly all clinicians will benefit from an in-depth understanding of the needs and experiences of this population. Clinical Issues with Interracial Couples: Theories and Research provides a foundation for this understanding

Stigma from professional helpers toward survivors of intimate partner violence

The authors explored experiences of stigma from professional helpers toward survivors of intimate partner violence in two related studies with a combined sample of 231 participants. Qualitative interview and quantitative survey data were analyzed with content analysis procedures using an a priori coding strategy. Results suggest that survivors felt stigmatized by mental health professionals, attorneys and judges, health care professionals, law enforcement, professionals in the employment or education systems, parenting-related professionals, as well as friends and family. The most frequently occurring stigma categories were feeling dismissed, denied, and blamed. Participants cited the most common sources of stigma occurred from interactions with professionals in the court system and law enforcement officers. Implications for future research and practice are discussed

Dating Violence Among College Students: Key Issues for College Counselors

The authors present a review of literature examining dating violence among college students. They describe 6 key issues related to dating violence among college students that affect college counselors' work. These key issues relate to the incidence and prevalence of physical, sexual, and psychological violence in college students' dating relationships, risk factors and relationship dynamics associated with dating violence, and counseling issues—including related psychological symptoms and college students' reporting of dating violence to professionals

Methodological Review of Intimate Partner Violence Prevention Research

The authors present a methodological review of empirical program evaluation research in the area of intimate partner violence prevention. The authors adapted and utilized criterion-based rating forms to standardize the evaluation of the methodological strengths and weaknesses of each study. The findings indicate that the limited amount of empirical research related to intimate partner violence prevention demonstrates some consistent methodological strengths and limitations. The authors conclude with a presentation of recommendations for further research in the area of intimate partner violence prevention