The Importance of Production Frequency in Therapy for Childhood Apraxia of Speech
Publication: American Journal of Speech-Language Pathology
Volume 20, Number 2
Pages 95-110
Abstract
Purpose
This study explores the importance of production frequency during speech therapy to determine whether more practice of speech targets leads to increased performance within a treatment session, as well as to motor learning, in the form of generalization to untrained words.
Method
Two children with childhood apraxia of speech were treated with an alternating treatment AB design, with production frequency differing in the 2 treatments. The higher production frequency treatment required 100+ productions in 15 min, while the moderate-frequency treatment required 30–40 productions in the same time period. One child was treated 3 times weekly for 11 weeks; the other child was treated twice weekly for 5 weeks. At the conclusion of each treatment phase, 5 min of probes were administered to determine whether generalization had occurred. Maintenance data to measure performance and learning were collected after a break from treatment.
Results
Both children showed improvement on all targets; however, the targets with the higher production frequency treatment were acquired faster, evidenced by better in-session performance and greater generalization to untrained probes.
Conclusions
Both treatment designs were effective, though frequent and intense practice of speech resulted in more rapid response to treatment in 2 children whose primary communication difficulty was childhood apraxia of speech.
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References
American Speech-Language-Hearing Association. (2007). Childhood apraxia of speech [Technical report]. Available from www.asha.org/policy
Baddeley, A. D., & Longman, D. J. A. (1978). The influence of length and frequency of training session on the rate of learning to type. Ergonomics, 21, 627–635.
Ball, L. J., Bernthal, J. E., & Beukelman, D. R. (2002). Profiling communication characteristics of children with developmental apraxia of speech. Journal of Medical Speech-Language Pathology, 10, 221–229.
Ballard, K. J. (2001). Principles of motor learning and treatment for AOS. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 11(4)13–18.
Berman, S. S., Garcia, D., & Bauman-Waengler, J. (2007, November). Cycles approach and integral stimulation: Outcome measures for unintelligible children. Paper presented at the Annual Convention of the American Speech-Language-Hearing Association, Boston, MA.
Betz, S. K., & Stoel-Gammon, C. (2005). Measuring articulatory error consistency in children with developmental apraxia of speech. Clinical Linguistics & Phonetics, 19, 53–66.
Caruso, A. J., & Strand, E. A. (1999). Clinical management of motor speech disorders in children. New York, NY: Thieme.
Chumpelik, D. (1984). The PROMPT system of therapy: Theoretical framework and applications for developmental apraxia of speech. Seminars in Speech and Language, 5, 139–156.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Mahwah, NJ: Erlbaum.
Crary, M. A. (1993). Developmental motor speech disorders. San Diego, CA: Singular.
Daniel, R. (2009). Effects of integral stimulation therapy on speech intelligibility of a child diagnosed with childhood apraxia of speech (Unpublished master’s thesis). Retrieved from www.pdx.edu/sites/www.pdx.edu.sphr/files/media_assets/Daniel_2009_Efficacy_of_Integral_Stimulation_Therapy_CAS.pdf
Davis, B. L., Jacks, A., & Marquardt, T. P. (2005). Vowel patterns in developmental apraxia of speech: Three longitudinal case studies. Clinical Linguistics & Phonetics, 19, 249–274.
Davis, B. L., & Velleman, S. L. (2000). Differential diagnosis and treatment of developmental apraxia of speech in infants and toddlers. Infant-Toddler Intervention: The Transdisciplinary Journal, 10, 177–192.
Duffy, J. (2005). Motor speech disorders. St. Louis, MO: Mosby.
Duhon, G. J., Mesmer, E. M., Atkins, M. E., Greguson, L. A., & Olinger, E. S. (2009). Quantifying intervention intensity: A systematic approach to evaluating student response to increasing intervention frequency. Journal of Behavioral Education, 18, 101–118.
Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S. (2002). Intensive behavioral treatment at school for 4- to 7-year-old children with autism: A 1-year comparison controlled study. Behavior Modification, 26, 49–68.
Faulk, J. F., & Priddy, L. (2005). See it, Say it sound production flip book and activities for apraxia and more!. Greenville, SC: Super Duper.
Forrest, K. (2003). Diagnostic criteria of developmental apraxia of speech used by clinical speech-language pathologists. American Journal of Speech-Language Pathology, 12, 376–380.
Freed, D. B., Marshall, R. C., & Frazier, K. E. (1997). Long-term effectiveness of PROMPT treatment in a severely apractic-aphasic patient. Aphasiology, 11, 365–372.
Goldman, R., & Fristoe, M. (2000). Goldman Fristoe Test of Articulation—Second Edition. Circle Pines, MN: AGS.
Graff, R. B., Green, G., & Libby, M. E. (1998). Effects of two levels of treatment intensity on a young child with severe disabilities. Behavioral Interventions, 13, 21–41.
Hall, P. K. (2000). A letter to the parent(s) of a child with developmental apraxia of speech. Part IV: Treatment of DAS. Language, Speech, and Hearing Services in Schools, 31, 179–181.
Jakielski, K. J., Webb, C. E., & Gilbraith, M. (2006, November). Efficacy of integral stimulation intervention in three siblings with CAS. Poster session presented at the Annual Convention of the American Speech-Language-Hearing Association, Miami, FL.
Jensen, A., & Gildersleeve-Neumann, C. (2005, November). Efficacy of integral stimulation for a child with childhood apraxia of speech. Poster session presented at the Annual Convention of the American Speech-Language-Hearing Association, San Diego, CA.
Keetch, K. M., Schmidt, R. A., Lee, T. D., & Young, D. E. (2005). Especial skills: Their emergence with massive amounts of practice. Journal of Experimental Psychology: Learning, Memory, and Cognition, 31, 970–978.
Kleim, J. A., Barbay, S., & Nudo, R. J. (1998). Functional reorganization of the rat motor cortex following motor skill learning. Journal of Neurophysiology, 80, 3321–3325.
Kleim, J. A., Cooper, N. R., & VandenBerg, P. M. (2002). Exercise induces angiogenesis but does not alter movement representations within rat motor cortex. Brain Research, 934, 1–6.
Knock, T. R., Ballard, K. J., Robin, D. A., & Schmidt, R. A. (2000). Influence of order of stimulus presentation on speech motor learning: A principled approach to treatment for apraxia of speech. Aphasiology, 14, 653–668.
Lewis, B. A., Hansen, A., Iyengar, S., & Taylor, H. G. (2004). School-age follow-up of children with childhood apraxia of speech. Language, Speech, and Hearing Services in Schools, 35, 122–140.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9.
Luke, L. M., Allred, R. P., & Jones, T. A. (2004). Unilateral ischemic sensorimotor cortical damage induces contralesional synaptogenesis and enhances skilled reaching with the ipsilateral forelimb in adult male rats. Synapse, 54, 187–199.
Maas, E., Robin, D. A., Hula, S. N. A., Freedman, S. N., Wulf, G., Ballard, K. J., & Schmidt, R. A. (2008). Principles of motor learning in treatment of motor speech disorders. American Journal of Speech-Language Pathology, 17, 277–298.
Maassen, B. (2002). Issues contrasting adult acquired versus developmental apraxia of speech. Seminars in Speech and Language, 23, 257–266.
Namasivayam, A. K., & van Lieshout, P. (2008). Investigating speech motor practice and learning in people who stutter. Journal of Fluency Disorders, 33, 32–51.
Odell, K. H., & Shriberg, L. D. (2001). Prosody-voice characteristics of children and adults with apraxia of speech. Clinical Linguistics & Phonetics, 15, 275–307.
Olive, M. L., & Smith, B. W. (2005). Effect size calculations and single subject designs. Educational Psychology, 25, 313–324.
Perez, L. A., Lungholt, B. K. S., Nyborg, K., & Nielson, J. B. (2004). Motor skill training induces changes in the excitability of the leg cortical area in healthy humans. Experimental Brain Research, 159, 197–205.
Peter, B., & Stoel-Gammon, C. (2005). Timing errors in two children with suspected childhood apraxia of speech (sCAS) during speech and music related tasks. Clinical Linguistics & Phonetics, 19, 67–87.
Robbins, J., Butler, S. G., Daniels, S. K., Gross, R. D., Langmore, S., Lazarus, C. L., & Rosenbek, J. C. (2008). Swallowing and dysphagia rehabilitation: Translating principles of neural plasticity into clinically oriented evidence. Journal of Speech, Language, and Hearing Research, 51, S276–S300.
Robey, R. R. (1998). A meta-analysis of clinical outcomes in the treatment of aphasia. Journal of Speech, Language, and Hearing Research, 41, 172–187.
Rosenbek, J. (1985). Treating apraxia of speech. In Johns, D. (Ed.), Clinical management of neurogenic communicative disorders (pp. 267–312). Boston, MA: Little Brown.
Rosenbek, J. C., Lemme, M. L., Ahern, M. B., Harris, E. H., & Wertz, R. T. (1973). A treatment for apraxia of speech in adults. Journal of Speech and Hearing Disorders, 38, 462–472.
Schmidt, R. A., & Bjork, R. A. (1992). New conceptualizations of practice: Common principles in three paradigms suggest new concepts for training. Psychological Science, 3, 207–219.
Schmidt, R. A., & Lee, T. D. (1999). Motor control and learning: A behavioral emphasis (3rd ed.). Champaign, IL: Human Kinetics.
Schmidt, R. A., & Wrisberg, C. A. (2004). Motor learning and performance (3rd ed.). Champaign, IL: Human Kinetics.
Schmidt, R. A., Young, D. E., Swinnen, S., & Shapiro, D. C. (1989). Summary knowledge of results for skill acquisition: Support for the guidance hypothesis. Journal of Experimental Psychology: Learning, Memory, and Cognition, 15, 352–359.
Schultz, G. M., Stein, L., & Micaleff, R. (2001). Speech motor learning: Preliminary data. Clinical Linguistics & Phonetics, 15, 157–161.
Semel, E., Wiig, E., & Secord, W. (2004). Clinical Evaluation of Language Fundamentals Preschool—Second Edition. San Antonio, TX: The Psychological Corporation.
Sheppard, J. J. (2008). Using motor learning approaches for treating swallowing and feeding disorders: A review. Language, Speech, and Hearing Services in Schools, 39, 227–236.
Shriberg, L. D. (1994). Five subtypes of developmental phonological disorders. Clinics in Communication Disorders, 4, 38–53.
Shriberg, L., Austin, D., Lewis, B., McSweeney, J., & Wilson, D. (1997). The percentage of consonants correct (PCC) metric: Extensions and reliability data. Journal of Speech, Language, and Hearing Research, 40, 708–722.
Skelton, S. L. (2004). Concurrent task sequencing in single-phoneme phonologic treatment and generalization. Journal of Communication Disorders, 37, 131–155.
Skelton, S. L. (2007, November). Conditions of practice: Motor skill learning for the treatment of speech sound disorders in children. Paper presented at the Annual Convention of the American Speech-Language-Hearing Association, Boston, MA.
Skelton, S. L., & Funk, T. E. (2004). Teaching speech sounds to young children: A pilot study of concurrent treatment using randomly-ordered, variable-complexity task sequences. Perceptual and Motor Skills, 99, 602–604.
Smith, B., Marquardt, T. P., Cannito, M. P., & Davis, B. L. (1994). Vowel variability in developmental apraxia of speech. In Till, J. A., Yorkston, K. M., & Beukelman, D. R. (Eds.), Motor speech disorders advances in assessment and treatment (pp. 81–89). Baltimore, MD: Brookes.
Square, P., Chumpelik, D., Morningstar, D., & Adams, S. D. (1986). Efficacy of the PROMPT system of therapy for the treatment of acquired apraxia of speech: A follow-up investigation. In Brookshire, R. H. (Ed.), Clinical aphasiology: Conference proceedings (pp. 221–226). Minneapolis, MN: BRK.
Strand, E. A. (1995). Treatment of motor speech disorders in children. Seminars in Speech and Language, 16, 126–137.
Strand, E. A., & Debertine, P. (2000). The efficacy of integral stimulation intervention with developmental apraxia of speech. Journal of Medical Speech-Language Pathology, 8, 295–300.
Strand, E. A., & Skinder, A. (1999). Treatment of developmental apraxia of speech: Integral stimulation methods. In Caruso, A. J., & Strand, E. A. (Eds.), Clinical management of motor speech disorders in children (pp. 145–185). New York, NY: Thieme.
Strand, E. A., Stoeckel, R., & Baas, B. (2006). Treatment of severe childhood apraxia of speech: A treatment efficacy study. Journal of Medical Speech-Language Pathology, 14, 297–306.
Swinnen, S. P., Schmidt, R. A., Nicholson, D. E., & Shapiro, D. C. (1990). Information feedback for skill acquisition: Instantaneous knowledge of results degrades learning. Journal of Experimental Psychology: Learning, Memory, and Cognition, 16, 706–716.
Velleman, S., & Strand, K. (1994). Developmental verbal dyspraxia. In Bernthal, J. E., & Bankson, N. W. (Eds.), Child phonology: Characteristics, assessment, and intervention with special populations (pp. 110–139). New York, NY: Thieme.
Velleman, S. L., & Vihman, M. M. (2002). Whole-word phonology and templates: Trap, bootstrap, or some of each? Language, Speech, and Hearing Services in Schools, 33, 9–23.
Wambaugh, J. L., Duffy, J. R., McNeil, M. R., Robin, D. A., & Rogers, M. A. (2006). Treatment guidelines for acquired apraxia of speech: Treatment descriptions and recommendations. Journal of Medical Speech-Language Pathology, 14, 35–67.
Wambaugh, J. L., Kalinyak-Fliszar, M. M., West, J. E., & Doyle, P. J. (1998). Effects of treatment for sound errors in apraxia of speech and aphasia. Journal of Speech, Language, and Hearing Research, 41, 725–744.
Warren, S. F., Fey, M. E., & Yoder, P. J. (2007). Differential treatment intensity research: A missing link to creating optimally effective communication interventions. Mental Retardation and Developmental Disabilities Research Reviews, 13, 70–77.
Wulf, G., & Schmidt, R. A. (1989). The learning of generalized motor programs: Reducing the relative frequency of production of knowledge of results enhances memory. Journal of Experimental Psychology: Learning, Memory, and Cognition, 15, 748–757.
Wulf, G., & Schmidt, R. A. (1997). Variability of practice and implicit motor learning. Journal of Experimental Psychology: Learning, Memory, and Cognition, 23, 987–1006.
Yorkston, K. M., Beukelman, D. R., Strand, E. A., & Bell, K. R. (1999). Management of motor speech disorders in children and adults. Austin, TX: Pro-Ed.
Zimmerman, I. L., Steiner, V. G., & Ponds, R. E. (2002). Preschool Language Scale, Fourth Edition. San Antonio, TX: The Psychological Corporation.
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Copyright © 2011 American Speech-Language-Hearing Association.
History
- Received: Jan 18, 2009
- Revised: Sep 2, 2009
- Accepted: Feb 1, 2011
- Published in issue: May 1, 2011
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