What is different about treatment for CAS?
What is Evidence-Based Treatment?
Which methods are evidence-based for treatment of CAS?
What are some other important things I should know?

What is different about treatment for CAS?


Almost everything is different because the nature of CAS is different from other speech sound disorders. Traditional speech therapy methods utilize a phonological approach designed to help the child learn and produce sounds in a developmental sequence. Because CAS is disorder of motor planning and programming, effective treatment utilizes a motor-based approach that helps the child learn complex motor control necessary to produce words and sentences. 


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 produce target sounds.

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/speech, 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 is evidence-based treatment?

Evidence-based treatment means that a treatment has been scientifically studied and found to be effective. There are different degrees or “levels” of evidence. The strongest evidence is a randomized, controlled study (RCT) where a treatment is studied for effectiveness much like a new drug is studied. Other levels of evidence include studies with a small group of children by independent researchers. You can learn more about different types of studies and evidence here. It is important to point out that unlike drugs, therapy methods ARE NOT regulated by a third party and are therefore not required to have evidence of effectiveness. In fact, many therapy methods have no scientific support of effectiveness at all. However, the American Speech-Language and Hearing Association (ASHA) states that, when available, therapists should use evidence-based treatment methods. Learn more about evidence-based treatment here.

Which methods are evidence-based for treatment of CAS?

Currently only these CAS treatment approaches have  adequate evidence of treatment efficacy:

Dynamic Temporal and Tactile Cueing (DTTC)

Rapid Syllable Transition Treatment (ReST)

Integrated Phonological Awareness Intervention (IPA)

Nuffield Dyspraxia Program, Third Edition (NDP3)

Learn more about these therapy methods here.

What are some other important things I should know about effective treatment for CAS?

Early intervention is important, so correctly diagnosing CAS and beginning a treatment designed specifically for CAS is critical. Waiting an extended period with a label of “possible CAS” and NOT using a CAS therapy approach can delay progress.

Treatment intensity (3-4 times per week) is important, especially for children with severe CAS.

Children must have the opportunity for ample practice to learn a motor pattern. Therapy should limit the number of target words and avoid games/activities that take away from practice time.

Children must actively attend to the therapist’s cues with the intent to improve movement. Often, young children will need help learning to do this. Part of the skill of treating CAS is learning methods to keep the child engaged in intense, repetitive, and difficult practice.

Avoidance, refusal or disruptive behavior may be signs of frustration and signal that adjustments are needed in the therapy program to decrease the level of effort or enhance the meaningfulness of the work for the child.

Selecting meaningful and functional target words that help the child gain access to preferred objects/activities and address specific movement patterns is important. Using randomly selected word lists 
or picture cards that are not personally meaningful to the child may decrease the child’s engagement.

Treatment Methods

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Selecting a Speech-Language Pathologist (SLP)

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Tips for Taking a Team Approach

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Dr. Edythe Strand Explains Treatment of CAS

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Treatment Depends on Severity

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See Examples of Children with Mild, Moderate and Severe CAS

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