Treatment Methods
The research evidence, age of your child and the severity of the CAS are important factors when selecting a treatment method.
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.
Treatment of CAS looks different than the traditional types of speech therapy targeting language or articulation sills. Speech therapy for CAS will typically have the following components:
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A small set of target words (5-7) will be practiced
These words will be selected carefully by the therapist to help the child improve speech motor movements.
Improving motor planning and movement for speech is critical for treatment of CAS.
As motor planning/movement improves, children will be able to produce new words with less difficulty. -
The child will practice saying words over and over in what is known as "drill"
Repetition and practice are key to learning a motor movement. -
The child will need to focus on the therapist's face and imitate movements
The therapist will be modeling and cueing the movements for speech, so children must be watching the therapist. Learning to watch the therapist and attempt to imitate is the first step in motor-based treatment. -
The therapist will give the child cues to help them improve accuracy
If the child makes and error when attempting to say a word, the therapist will use various cues (saying the word first, called "modeling", touching the child's face, giving them a visual cue or instructing the child on what to do differently). Cues help the child say a word correctly and prevent negative practice (saying the word incorrectly over and over). Negative practice can actually make it more difficulty for the child to say the word correctly. -
Games and toys will be used sparingly
Whereas some speech therapy methods use play as the basis of treatment, motor-speech treatment relies more on practice and drill. A child may get a quick turn with a toy or earn a sticker to reinforce participation, but most of the therapy time will be spent in drill. Games and toys may be kept out of reach, or even out of sight, during drill time to encourage the child to focus on the therapist. -
Motor speech therapy is hard work for the child
Motor speech therapy requires considerable focus and effort from the child. Because of this, children need lots of encouragement and most of all, success. Therapists help the child succeed by selecting correct practice words and providing good cues. Parents' encouragement and acknowledgement of the child's hard work is also very, very helpful.
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 | |
| 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 plhttps://promptinstitute.com/anning 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 |
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 has been studied and found to have moderately strong evidence that it successfully treats children with moderate-severe CAS.
- ReST has been studied and found to have very strong evidence for successfully treating mild-moderate CAS and ataxic dysarthria.
- IPA has been studied and found to have moderately strong evidence for successfully treating CAS.
- NDP3 has been studied and found to have very strong evidence for successfully treating CAS.
- 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.
- The Kaufman approach (K-SLP) has not yet been studied sufficiently to determine if it successfully treats CAS.
- 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 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 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 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 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 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.
- 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 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.
Treatment Depends on Severity
Understanding Evidence-Based Treatment
CAS Treatment Methods Supported by Research Evidence