Dose frequency randomized controlled trial for Dynamic Temporal and Tactile Cueing (DTTC) treatment for childhood apraxia of speech: protocol paper

Abstract

Background Childhood apraxia of speech (CAS) is a pediatric motor-based speech sound disorder that requires a specialized approach to intervention. The extant literature on the treatment of CAS commonly recommends intensive treatment using a motor-based approach, with some of the best evidence supporting the use of Dynamic Temporal and Tactile Cueing (DTTC). To date, a rigorous and systematic comparison of high and low dose frequency (i.e., frequency of therapy sessions) has not been undertaken for DTTC, resulting in a lack of evidence to guide decisions about the optimal treatment schedule for this intervention. The current study aims to fill this gap in knowledge by comparing treatment outcomes when dose frequency is varied. Methods A randomized controlled trial will be conducted to examine the efficacy of low versus high dose frequency on DTTC treatment outcomes in children with CAS. A target of 60 children, 2;6–7;11 years of age, will be recruited to participate in this study. Treatment will be provided in the community setting by speech-language pathologists who have completed specialized training administering DTTC in a research reliable manner. True randomization with concealed allocation will be used to assign children to either the low or high dose frequency group. Treatment will be administered in 1-h sessions either 4 times per week over a 6-week period (high dose) or 2 times per week over a 12-week period (low dose). To measure treatment gains, probe data will be collected before treatment, during treatment, and 1 day, 1 week, 4 weeks, and 12 weeks post-treatment. Probe data will consist of customized treated words and a standard set of untreated words to assess generalization of treatment gains. The primary outcome variable will be whole word accuracy, encompassing segmental, phonotactic, and suprasegmental accuracy. Discussion This will be the first randomized controlled trial to evaluate dose frequency for DTTC treatment in children with CAS. Trial registration ClinicalTrials.gov identifier NCT05675306, January 6, 2023.

Childhood Apraxia of Speech: A Descriptive and Prescriptive Model of Assessment and Diagnosis

“…This collection of studies indicates a shift towards exploring novel diagnostic biomarkers, refining intervention methods, and understanding the broader psychosocial implications of CAS. These contemporary works delve into areas such as the potential role of gluten sensitivity in CAS [ 37 ], the efficacy of motor-based treatments like dynamic temporal and tactile cueing [ 38 ], and the impact of CAS on children’s self-reported communication attitudes [ 39 ]. The table highlights the ongoing efforts to refine the diagnostic criteria and treatment efficacy, as well as a growing recognition of the importance of including a child’s perspective in the assessment process.…”

“… Administration of validated communication attitude questionnaires to children with CAS enrolled in an intensive speech-focused intervention. 6 [ 38 ] The paper outlined a protocol for a randomized controlled trial comparing the efficacy of DTTC treatment with varying dose frequencies in children with CAS. The study aimed to provide evidence for the optimal treatment schedule for DTTC by examining treatment outcomes at different dose frequencies.…”

“…Motor control measures such as the accuracy of syllable production and oral–motor examinations are critical [ 40 , 64 ]. This tier also integrates motor learning principles, observing how children with CAS acquire and generalize speech motor patterns in response to various treatment modalities [ 38 , 48 ].…”

“…6 [38] The paper outlined a protocol for a randomized controlled trial comparing the efficacy of DTTC treatment with varying dose frequencies in children with CAS.…”

“…Studies focused on the application of motor learning principles in assessment and treatment to determine the ability to generalize learned speech patterns. [38,60] Comorbidity Analysis Investigating the co-occurrence of CAS with other developmental disorders.…”