Treating Childhood Apraxia of Speech: Evaluating the Kaufman Speech to Language Protocol

A Cochrane review of the treatments used for childhood apraxia of speech (CAS) in 2009 identified the need for more well controlled studies (Morgan & Vogel, 2009). These same recommendations were echoed when the review was completed again in 2018 (Morgan, Murray & Liegeois, 2018). There is currently no gold-standard intervention recommended for children with CAS (Morgan et al., 2018). Since the first Cochrane study was published, research has been conducted to examine a small range of treatment approaches for CAS. Despite the increased publication of treatment research, speech-language pathologists continue to use treatment approaches that are not supported with empirical evidence. The Kaufman Speech-Language Protocol (K-SLP) is a treatment approach that uses successive approximations to improve speech in children with CAS (Kaufman, 2014). At the commencement of this PhD there was no published evidence for the K-SLP. The overall aim of this thesis is to investigate the effectiveness of the K-SLP. To do this, five research studies have been completed. It is imperative to determine what speech-language pathology clinicians currently use to treat CAS in a clinical setting, and the proportion of speech-language pathologists that use the K-SLP to treat CAS. These questions were investigated quantitatively using survey research. The surveys also sought to establish what training, if any, the speech-language pathologists obtained prior to implementing a treatment approach, and whether they administered the treatment according to available protocols. Following these studies, three treatment studies using single case experimental design method were conducted to evaluate the K-SLP. Participants for each of these studies were assessed to confirm their diagnosis of CAS using the diagnostic criteria outlined by the American Speech-Language-Hearing Association (ASHA), childhood apraxia of speech (CAS) technical report (ASHA, 2007). Treatment was provided according to a standardised treatment protocol by either the primary investigator or by trained student clinicians. The result of the three studies is an operationalised protocol for delivering the K-SLP. An additional two chapters exploring results across the three treatment studies are included. The results of our post-hoc analyses indicates that inconsistency should be used as an outcome measure to assess the effectiveness of CAS interventions. Additionally, it was found that the statistical analysis used to measure clinically relevant changes (i.e., effect sizes) impacted the evaluation of clinical research, therefore effect sizes that take into account children’s variable production at baseline (a common feature of CAS; see ASHA, 2007) should be used. The research conducted indicated that the K-SLP was frequently used to treat CAS in the US. Results from the three treatment studies showed that the K-SLP was effective in improving the articulatory accuracy and speech consistency of children with CAS

A survey of the clinical management of childhood apraxia of speech in the United States and Canada

Purpose: Limited information is available about the current practices of generalist speech-language pathologists (SLPs) in relation to their management of childhood apraxia of speech (CAS). This study was designed to investigate four primary questions separately for the US and Canada; 1. What treatment approaches are used by SLP clinicians to treat CAS? 2. What treatment format and intensity are used to deliver CAS treatment? 3. What are the attitudes and perspectives of SLPs to evidence-based practice (EBP) as it pertains to CAS treatment? and 4. What are the perceived barriers to the implementation of EBP in CAS treatment? Method: An online questionnaire was used to investigate the four primary research questions. The questionnaire was distributed online through social media, some state-based associations and through forums affiliated with national speech-language-hearing associations. Results: Most survey respondents reported frequently using an eclectic approach to treat CAS (US 85%; Canada 89%). Although no intervention emerged as the most preferred primary treatment for CAS, US-based clinicians more commonly reported using the Kaufman Speech to Language Protocol (K-SLP) (33%) and Dynamic, Temporal and Tactile Cueing (DTTC) (28%); while clinicians in Canada used PROMPT ® (31%). SLPs demonstrated a positive attitude towards EBP however, they identified a range of perceived barriers that impacted their implementation of EBP. Conclusion: SLPs in the US and Canada frequently used an eclectic approach to treat CAS which is consistent with previous findings both in the CAS literature and the wider speech disorders literature. The more commonly used primary interventions were the K-SLP and DTTC (US); and PROMPT ® (Canada), with one of the strongest factors that influenced clinicians’ choice of intervention being familiarity with the treatment approach. Face to face therapy was preferred by clinicians across both countries, with clinicians in the US providing therapy between 2-5 times per week, while those in Canada delivered therapy up to once per week. Clinicians identified a number of barriers to implementing evidence-based practice, among which, being time poor was most commonly selected across clinicians in both the US and Canada

Clinical management of childhood apraxia of speech : a survey of speech-language pathologists in Australia and New Zealand

Purpose: A number of studies have been published that have investigated the practices of speech-language pathologists in relation to speech sound disorder intervention; however, specific research about the treatment of childhood apraxia of speech is not available. This study aimed to describe the treatment approaches being used by speech-language pathologists, explore their perspectives of evidence-based practice and identify perceived barriers to implementing empirical research recommendations. Method: An online survey was distributed to speech-language pathologists in Australia and New Zealand. In total, 109 valid surveys were completed by participants who answered a series of multiple choice, yes/no, short answer and Likert-scaled questions. Result: Speech-language pathologists demonstrated a strong preference for eclectic interventions to treat childhood apraxia of speech. When asked to identify the primary treatment approach they used (whether as a stand-alone; or as the primary approach within an eclectic intervention), the most frequently used intervention was the Nuffield Dyspraxia Programme. Many speech-language pathologists reported valuing empirical research evidence, despite identifying a range of barriers that impact their ability to implement evidence-based practice in childhood apraxia of speech treatment. Conclusion: Although many speech-language pathologists use the Nuffield Dyspraxia Programme as their primary intervention, most clinicians use it as part of an eclectic/hybrid intervention. The effectiveness of eclectic interventions for childhood apraxia of speech has not been empirically evaluated

Treating childhood apraxia of speech with the Kaufman speech to language protocol : a Phase I pilot study

Purpose: A Phase I pilot study was designed to collect preliminary evidence on the use of the Kaufman Speech to Language Protocol (K-SLP; Kaufman, 2014) to treat children with childhood apraxia of speech. We hypothesized that the K-SLP approach would result in more accurate speech production in targeted words, whereas untrained (control) words and speech sounds would remain unchanged. Method: A single-case multiple-baseline across behaviors experimental design was used to see if experimental feasibility could be demonstrated. Two children each received a total of 12 1-hr treatment sessions over 3 weeks. The children’s response to treatment and experimental control was measured by administering baseline, treatment, and posttreatment probes. Results: Both children showed some response to treatment, as measured by percent phonemes correct; however, the response to treatment varied. In general, for the treated words that improved with therapy, accuracy was maintained above baseline level during the maintenance phase. Minimal generalization was observed for this study, with only 1 participant generalizing treatment gains to 2 sets of untrained (similar) words. Conclusion: This Phase I pilot study provides limited preliminary evidence for the effectiveness of the K-SLP approach in treating childhood apraxia of speech in some children under the conditions specified in this study. Replication of these results in well-controlled studies is needed before this structured and operationalized version of the K-SLP approach can be recommended for clinical use

Treating Childhood Apraxia of Speech With the Kaufman Speech to Language Protocol: A Phase I Pilot Study

Purpose: A Phase I pilot study was designed to collect preliminary evidence on the use of the Kaufman Speech to Language Protocol (K-SLP; Kaufman, 2014) to treat children with childhood apraxia of speech. We hypothesized that the K-SLP approach would result in more accurate speech production in targeted words, whereas untrained (control) words and speech sounds would remain unchanged. Method: A single-case multiple-baseline across behaviors experimental design was used to see if experimental feasibility could be demonstrated. Two children each received a total of 12 1-hr treatment sessions over 3 weeks. The children’s response to treatment and experimental control was measured by administering baseline, treatment, and posttreatment probes. Results: Both children showed some response to treatment, as measured by percent phonemes correct; however, the response to treatment varied. In general, for the treated words that improved with therapy, accuracy was maintained above baseline level during the maintenance phase. Minimal generalization was observed for this study, with only 1 participant generalizing treatment gains to 2 sets of untrained (similar) words. Conclusion: This Phase I pilot study provides limited preliminary evidence for the effectiveness of the K-SLP approach in treating childhood apraxia of speech in some children under the conditions specified in this study. Replication of these results in well-controlled studies is needed before this structured and operationalized version of the K-SLP approach can be recommended for clinical use