DTTC with Caregiver Training for Childhood Apraxia of Speech

(DTTC Trial)

Recruiting at 1 trial location

Overseen By Julie Case, PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: New York University

Disqualifiers: Autism, Global delay, Down syndrome, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 17

Duration: 8 weeks

40 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how different caregiver training methods impact the effectiveness of speech therapy for children with childhood apraxia of speech (CAS). All participating children will receive Dynamic Temporal and Tactile Cueing (DTTC) therapy twice a week. Caregivers will either receive detailed coaching for home practice or general guidance. The study seeks children who primarily speak English, have been diagnosed with CAS, and do not have other developmental disorders such as autism or Down syndrome. As an unphased trial, it offers a unique opportunity to contribute to understanding and improving speech therapy methods for children with CAS.

Will I have to stop taking my current medications?

The trial does not specify whether participants need to stop taking their current medications. However, children with ADHD can participate if they can attend sessions with medication and/or strategies.

What prior data suggests that Dynamic Temporal and Tactile Cueing (DTTC) is safe for children with childhood apraxia of speech?

Research has shown that Dynamic Temporal and Tactile Cueing (DTTC) is a well-tolerated treatment for children with childhood apraxia of speech (CAS). A review of DTTC treatment results found no serious side effects in young children, indicating that DTTC is generally safe for children with CAS. Additionally, DTTC has been widely studied, and consistent findings across many studies support its safety. Current research considers DTTC safe, offering reassurance to parents and caregivers. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Dynamic Temporal and Tactile Cueing (DTTC) technique for Childhood Apraxia of Speech because it offers a unique approach by actively involving caregivers in the therapy process. Unlike traditional speech therapy that primarily relies on sessions with a speech-language pathologist (SLP), DTTC incorporates both direct and indirect training methods. In the direct training arm, caregivers are coached to administer the treatment at home, providing more consistent and frequent practice. This hands-on involvement can potentially lead to more rapid and sustained improvements in children's speech. By empowering caregivers with the skills and knowledge to support therapy, DTTC aims to enhance the effectiveness of treatment and foster a supportive home environment for speech development.

What evidence suggests that this trial's treatments could be effective for childhood apraxia of speech?

Research has shown that Dynamic Temporal and Tactile Cueing (DTTC) holds promise for children with childhood apraxia of speech (CAS). Studies have found that DTTC can help children speak more clearly and improve their speech-related motor skills. In this trial, participants will be divided into two groups to receive DTTC treatment. In the Direct Training Arm, children will receive DTTC treatment with both a speech-language pathologist (SLP) and their parent/caregiver, who will be coached online by the SLP. In the Indirect Training Arm, children will receive DTTC treatment administered solely by an SLP. Early results suggest that regular use of DTTC leads to noticeable progress in speech development, and it is becoming recognized as an effective way to treat CAS. ^{2 3 6 7 8}

Are You a Good Fit for This Trial?

This trial is for children aged between 2 years and 5 months to 7 years and 11 months with a primary diagnosis of Childhood Apraxia of Speech (CAS) who speak English as their main language. Kids with autism, global developmental delay, Down syndrome, or severe hearing or visual impairments can't join. Those already receiving speech treatment elsewhere are also excluded.

Inclusion Criteria

I am between 2 and 11 years old.

English as the primary and preferred language

I have been diagnosed with Childhood Apraxia of Speech.

Exclusion Criteria

I am not receiving speech therapy from another provider during this study, but I may be getting language or AAC therapy.

I have hearing loss.

I have been diagnosed with a speech disorder.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-Treatment

Caregivers complete an online self-guided educational module about CAS and DTTC

1 week

Treatment

Participants receive DTTC treatment 2x/week for 8 weeks with home practice 3x/week

8 weeks

16 visits (in-person)

Follow-up

Home practice continues at a higher frequency (6x/week) to monitor treatment outcomes

4 weeks

1 visit (in-person), 1 visit (virtual)

What Are the Treatments Tested in This Trial?

Interventions

• Dynamic Temporal and Tactile Cueing (DTTC)

Trial Overview The study tests the effects of caregiver training on DTTC therapy outcomes in kids with CAS. Forty children will receive standard DTTC treatments twice weekly at a clinic over eight weeks. They'll be split into two groups: one gets direct coaching for home practice; the other doesn't.

How Is the Trial Designed?

Group I: Direct Training (DTTC + Coaching + Home Practice) Experimental Treatment 1 Intervention

Children in the Direct Training Arm will receive DTTC treatment 2x/week for 8 weeks with half of each session administered only by the SLP. In the other half of the session, DTTC will be administered by the parent/caregiver with online coaching by the SLP. During the coaching portion of treatment sessions, the SLP will provide direct training to guide the parent/caregiver in the administration of DTTC to support home practice sessions. Parent/caregivers in this Arm will also complete an online, self-paced educational module on CAS prior to the start of treatment and review home practice guidelines with the clinician at the end of each therapy session. Parent/caregivers will engage their children in home practice during the treatment phase and follow-up phase. Home practice will consist of 30-minute practice sessions 3x/week during the 8-week treatment phase and 6x/week during the 4-week follow-up phase.

Group II: Indirect Training (DTTC + Home Practice) Active Control 1 Intervention

Children in the Indirect Training Arm will receive DTTC treatment 2x/week administered by an SLP for 8 weeks. Parent/caregivers in this Arm will complete an online, self-paced educational module on CAS prior to the start of treatment, observe all treatment sessions, and review home practice guidelines with the clinician at the end of each therapy session. Parent/caregivers will engage their children in home practice during the treatment phase and follow-up phase. Home practice will consist of 30-minute practice sessions 3x/week during the 8-week treatment phase and 6x/week during the 4-week follow-up phase.

Dynamic Temporal and Tactile Cueing (DTTC) is already approved in United States, Canada, European Union for the following indications:

Approved in United States as Dynamic Temporal and Tactile Cueing for:

• Childhood Apraxia of Speech (CAS)

Approved in Canada as Dynamic Temporal and Tactile Cueing for:

• Childhood Apraxia of Speech (CAS)

Approved in European Union as Dynamic Temporal and Tactile Cueing for:

• Childhood Apraxia of Speech (CAS)

Who Is Running the Clinical Trial?

New York University

Lead Sponsor

Trials

249

Recruited

229,000+

Hofstra University

Collaborator

Trials

6

Recruited

320+

Published Research Related to This Trial

Children with childhood apraxia of speech (CAS) showed significant improvements in speech intelligibility after undergoing a motor-based intervention called dynamic temporal and tactile cueing (DTTC), with these improvements maintained for at least 6 weeks post-treatment.

The study involved 120 naive listeners who rated the speech of five children, revealing that while individual listeners were consistent in their ratings (intrarater reliability), there was considerable variability between different listeners (interrater reliability), suggesting that using naive listeners in assessments may require careful consideration.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Naive Listener Ratings of Speech Intelligibility Over the Course of Motor-Based Intervention in Children With Childhood Apraxia of Speech. Wang, EW., Grigos, MI.[2023]

Dynamic Temporal and Tactile Cueing (DTTC) is designed to enhance neural processing for better sensorimotor planning and programming in children, providing a structured approach for clinicians to improve motor speech skills.

The article outlines essential elements and clinical decisions for implementing DTTC, emphasizing the importance of motor learning principles to ensure effective treatment and measurement of fidelity in practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dynamic Temporal and Tactile Cueing: A Treatment Strategy for Childhood Apraxia of Speech. Strand, EA.[2021]

In a study involving 10 children with childhood apraxia of speech, both motor speech treatment (PROMPT) and language, nonspeech oral motor treatment led to improvements in speech, which were associated with changes in the brain's left ventral corticobulbar tract.

The PROMPT treatment specifically resulted in additional positive changes in the left dorsal corticobulbar tract, suggesting that this multimodal approach may have beneficial neurobiological effects on speech motor control.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neural Changes Induced by a Speech Motor Treatment in Childhood Apraxia of Speech: A Case Series. Fiori, S., Pannek, K., Podda, I., et al.[2022]

In a study involving 30 children, including 9 with childhood apraxia of speech (CAS), it was found that attenuating auditory feedback significantly impacted the speech production of children with CAS, indicating they rely more on auditory feedback compared to those with speech delay or typical development.

The results suggest that children with CAS may have a deficit in their ability to use feedforward mechanisms for speech, highlighting the importance of auditory feedback in their speech monitoring and production.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reliance on auditory feedback in children with childhood apraxia of speech. Iuzzini-Seigel, J., Hogan, TP., Guarino, AJ., et al.[2015]

Children with childhood apraxia of speech (CAS) showed improvements in consonant accuracy and consistency when learning new words, indicating a learning effect despite their speech production challenges.

The study found that children with CAS had longer jaw movement durations compared to typically developing (TD) peers, suggesting they may need more time to plan and execute speech movements, especially for complex words.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Articulatory Control in Childhood Apraxia of Speech in a Novel Word-Learning Task. Case, J., Grigos, MI.[2020]

Children and adolescents with childhood apraxia of speech (CAS) show significant difficulties with rapid syllable repetition and alternating motor tasks, suggesting a link to cerebellar dysfunction.

The study indicates that motor deficits in CAS may persist into adulthood, as evidenced by similar performance scores in an adult with a probable history of CAS, highlighting the long-term impact of these motor challenges.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparing global motor characteristics in children and adults with childhood apraxia of speech to a cerebellar stroke patient: evidence for the cerebellar hypothesis in a developmental motor speech disorder. Peter, B., Bruce, L., Raaz, C., et al.[2021]

Training parents in rural areas to deliver the dynamic temporal and tactile cueing (DTTC) treatment for childhood apraxia of speech (CAS) showed potential effectiveness, with one child achieving a moderate improvement in speech accuracy.

However, challenges such as social and behavioral issues were reported by parents, indicating that while some families may benefit from this approach, it may not be suitable for all, particularly in rural and remote contexts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Look at Mummy: challenges in training parents to deliver a home treatment program for childhood apraxia of speech in a rural Canadian community. Lim, JM., McCabe, P., Purcell, A.[2021]

A study using a single-subject design with a 21-year-old woman with childhood apraxia of speech (CAS) found that manual mimicry cues combined with multisensory therapy significantly improved her accuracy in producing vowel + /r/ combinations.

The results suggest that incorporating gestural cues into therapy for speech sound disorders (SSDs) may enhance treatment effectiveness, highlighting the need for further research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effect of Hand Gesture Cues Within the Treatment of /r/ for a College-Aged Adult With Persisting Childhood Apraxia of Speech. Rusiewicz, HL., Rivera, JL.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11005957/

Dynamic Temporal and Tactile Cueing in Young Children With ... A systematic review of treatment outcomes for children with childhood apraxia of speech. American Journal of Speech-Language Pathology, 23(3), 486–504.

2. pubs.asha.org pubs.asha.org/doi/10.1044/2025_AJSLP-24-00239

A Pathway to Research-Reliable Dynamic Temporal and ... This work presents a multiphase process for training community clinicians to implement high-fidelity DTTC.

3. clinicaltrials.gov clinicaltrials.gov/study/NCT05675306

Dose Frequency RCT on DTTC in Children With CAS Sixty children with childhood apraxia of speech will be treated with DTTC treatment. A Phase III randomized controlled trial with parallel groups will be ...

4. bmcpediatr.biomedcentral.com bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-04066-2

Dose frequency randomized controlled trial for Dynamic ... 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.

5. childapraxiatreatment.org childapraxiatreatment.org/wp-content/uploads/2023/03/CAS-Child-Perspectives-Qualitative-Study-RFA.pdf

CAS-Child-Perspectives-Qualitative-Study- ... OUAT is currently funding over $2 million in research investigating the effects of Dynamic Temporal and Tactile Cueing. (DTTC; Strand, 2020) ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT05916222

The Effects of Caregiver Training on DTTC Treatment ... The goal of this clinical trial is to investigate the impact of direct vs. indirect caregiver training on treatment outcomes following a period of Dynamic ...

7. pubs.asha.org pubs.asha.org/doi/10.1044/2024_JSLHR-23-00233

Treatment for Childhood Apraxia of Speech: Past, Present, ... Data from the ASHA National Outcomes Measurement System suggest ... dynamic temporal and tactile cueing with children with childhood apraxia of speech.

8. clinicaltrials.gov clinicaltrials.gov/study/NCT05675306

Dose Frequency RCT on DTTC in Children With CAS The goal of this clinical trial is to determine whether the number of treatment sessions per week has an effect on intervention outcomes in 60 children with ...