Motor-based Intervention for Childhood Apraxia of Speech

Overseen By Maria I Grigos, PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: New York University

Disqualifiers: Neurological, Developmental, Genetic disorders, others

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

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 43

Duration: 8 weeks

72 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a new motor-based approach called Dynamic Temporal and Tactile Cuing (DTTC) can improve speech in children with childhood apraxia of speech (CAS). CAS is a disorder where children struggle to plan the movements needed for speaking, making communication very difficult. The trial will assess whether DTTC helps with specific practiced words and if the benefits extend to new words and persist over time. Children diagnosed with CAS, who have normal oral structure, and have not previously received DTTC may be suitable for this trial. As an unphased trial, this study provides a unique opportunity to explore innovative treatment options for enhancing speech in children with CAS.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What prior data suggests that this motor-based intervention is safe for children with apraxia of speech?

Research has shown that Dynamic Temporal and Tactile Cueing (DTTC) is an effective treatment for children with childhood apraxia of speech (CAS). Studies have found that children generally handle DTTC well, with no major reports of harmful effects. This treatment helps children improve their speech by focusing on how they move their mouths to make sounds.

DTTC has been tested in many studies with young children, providing extensive information about its safety. Both caregivers and clinicians view it positively, suggesting it is safe and effective. Although specific data on negative effects is limited, the absence of negative reports in these studies is reassuring.

Overall, based on current research and its use in various clinical settings, DTTC appears to be a safe option for children with CAS. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Dynamic Temporal and Tactile Cuing (DTTC) for childhood apraxia of speech because it focuses on motor-based intervention, which is different from traditional speech therapy methods. DTTC emphasizes the importance of temporal and tactile cues to help kids learn speech movements, potentially offering a more effective approach for developing speech accuracy. Unlike many standard treatments, which often rely on auditory feedback alone, DTTC integrates touch and timing to directly guide speech production, addressing the core motor planning issues in apraxia of speech. This innovative approach could lead to faster and more lasting improvements in speech for children dealing with this challenging condition.

What evidence suggests that Dynamic Temporal and Tactile Cuing might be an effective treatment for childhood apraxia of speech?

Research has shown that Dynamic Temporal and Tactile Cuing (DTTC) is a promising treatment for childhood apraxia of speech (CAS). Studies have found that DTTC helps children improve their speech by teaching them to better plan and control the movements needed for speaking. In one review, children who received DTTC made significant progress in saying words more accurately. This method focuses on enhancing speech movements, crucial for children with CAS who struggle to control their speech muscles. In this trial, participants will be divided into two groups: the Immediate Treatment Group, receiving DTTC shortly after evaluation, and the Delayed Treatment Group, beginning treatment after an 8-week delay. While more research is underway, early results suggest DTTC could effectively help children with this condition communicate better. ^{3 6 7 8 9}

Who Is on the Research Team?

Maria I Grigos, PhD

Principal Investigator

New York University

Are You a Good Fit for This Trial?

This trial is for children aged 2.5 to almost 8 years with Childhood Apraxia of Speech (CAS) who have never had DTTC treatment, can pass a hearing test, and show specific speech difficulties without other neurological or developmental disorders.

Inclusion Criteria

My child has been diagnosed with CAS, showing specific speech difficulties.

I am between 2.5 and 8 years old.

I have never received DTTC treatment.

Exclusion Criteria

My child has a speech fluency disorder, even though they have been diagnosed with CAS.

I have been treated with DTTC before.

I have hearing loss, even though I also have CAS.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-3 weeks

1 visit (in-person)

Pre-Treatment

Probe data collection before treatment begins

5 weeks

5 visits (in-person)

Treatment

Participants receive DTTC treatment four times per week for 8 weeks

8 weeks

32 visits (in-person)

Maintenance

Probe data collection to assess maintenance of treatment effects

5 weeks

5 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Dynamic Temporal and Tactile Cuing

Trial Overview The study tests the effectiveness of Dynamic Temporal and Tactile Cuing (DTTC), a motor-based speech therapy, on improving word production in kids with CAS. It looks at how well they learn treated words, if it helps with untreated words, and if improvements last after treatment ends.

How Is the Trial Designed?

Group I: Immediate Treatment Experimental Treatment 1 Intervention

Participants in the Immediate Treatment Group will receive DTTC Treatment four times per week (45-minute sessions each) for 8 weeks. Total duration will be 180 minutes/week over 32 sessions. Treatment will begin between 1-3 weeks following the diagnostic evaluation.

Group II: Delayed Treatment Experimental Treatment 1 Intervention

The Delayed Treatment Group serves as a control during the period in which participants are waiting to begin treatment. A delayed treatment onset is employed to control for maturation effects. Participants in the Delayed Treatment Group will receive DTTC Treatment four times per week (45-minute sessions each) for 8 weeks. Total duration will be 180 minutes/week over 32 sessions. Treatment will begin after an 8-week delay following the diagnostic evaluation.

Who Is Running the Clinical Trial?

New York University

Lead Sponsor

Trials

249

Recruited

229,000+

Published Research Related to This Trial

The study found that augmented visual kinematic feedback (AVKF) significantly improved speech accuracy in two adults with acquired apraxia of speech (AOS), suggesting that this type of feedback can enhance motor learning for speech production.

Positive effects were observed in both the acquisition of speech motor targets and their generalization to untreated contexts, indicating that AVKF may help individuals with AOS produce more accurate speech over time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of online augmented kinematic and perceptual feedback on treatment of speech movements in apraxia of speech. McNeil, MR., Katz, WF., Fossett, TR., et al.[2021]

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]

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 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]

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 16 children aged 5-6, those with childhood apraxia of speech (CAS) showed improved accuracy in producing practiced words, but did not generalize these gains to unpracticed words, indicating limited transfer of motor learning.

Children with typical development (TD) demonstrated broader improvements in speech motor control, showing changes in both practiced and unpracticed words, suggesting more effective generalization of motor learning principles.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changes in movement transitions across a practice period in childhood apraxia of speech. Grigos, MI., Case, J.[2019]

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]

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 ... The RCT examined DTTC treatment outcomes when provided two times a week for 12 weeks (low dose) or four times a week for 6 weeks (high dose) in ...

3. 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.

4. 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 ...

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_AJSLP-24-00228

Clinician and Caregiver Perspectives on a Community ... Dynamic Temporal and Tactile Cueing (DTTC) is an evidence-based treatment for 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 ...

9. 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.