Introduction
Rapid Syllable Transition treatment (ReST) and Dynamic Temporal and Tactile Cueing (DTTC) have been shown to be effective for children with Childhood Apraxia of Speech (CAS), delivered as intensive therapy (4 days per week) in research settings.

Aims
To present outcomes of an intensive block of therapy for children with CAS and other conditions; and to describe how we organised the therapy block, administered the treatment, collected outcome data, and reflected on our practice.

Method
An intensive block was completed in July 2022, by two SLPs. Clients received 12 sessions of either ReST or DTTC over 3-4 weeks, in a private practice setting. We worked with 8 real-world clients with CAS, some of whom had other conditions such as ADHD, Autism, DLD, and genetic conditions. It was the first time the treating SLPs had been involved in an intensive block.

Results
Data was collected at 3 time points, pre-, post- and follow up, to measure gains in treatment and generalisation to non-treated items. Anonymous survey data was collected from clients’ carers and treating SLPs to determine what worked and what needs to change for next time. All clients improved in both treatment and generalisation data. Client satisfaction was very high.

Conclusion
This is a rare quality improvement / effectiveness study for children with CAS and other conditions. The outcomes demonstrate that the intensive block was feasible and successful in our private practice setting and we encourage other clinicians to plan and provide intensive treatment for their clients with CAS.

Themes: motor speech, intensive therapy, clinical research

Submission Statement:
We consider how private practitioners can respond to research evidence which supports intensive therapy, as well as the needs/preferences of clients and families. We reflect on our experience delivering intensive therapy and encourage others to respond by considering how intensive therapy might be possible in their settings.

Traditionally, private practices provide once-per-week therapy sessions. However, in intervention studies for speech sound disorders, more frequent sessions are used. We trialled a school-holiday intensive as an alternate to once-per-week. We report on set-up and three cases.

The intensive included: 1x planning session, 4x-a-week sessions across 2-weeks, and 1x review session. A probe of target sound/s in treated and untreated words was administered at:
-Baseline 1 (planning)
-Baseline 2 (session 1)
-Post-therapy (review)

Case 1: Leilani (6 years-old, goal: interdental /s/, approach: Principles of Motor Learning, self-monitoring). At baselines 1 and 2, she was 13% accurate for /s/. Post-therapy, she was 100%.

Case 2: Ben (11 years-old, goal: reduction of nasal emission on plosives [/p/, /d/] and fricatives [/ʃ/ and /z/], approach: Principles of Motor Learning, self-monitoring). At baselines 1 and 2, Ben was 0% accurate for /d/, / ʃ/ and /z/, and 50% for /p/. Post-therapy, he was 100% accurate for /p/ and /ʃ/, 33% for /d/, and 17% for /z/.

Case 3: Tim (6-years-old, goal: production of affricates, approach: minimal pairs). At baselines 1 and 2, he was 33% accurate for /dʒ/ and 33% then 50% accurate for /tʃ/. Post-therapy, accuracy was 50% for /dʒ/ and 83% for /tʃ/. Interestingly, Tim achieved 100% accuracy for /dʒ/ at the end of the first intensive week, but this was not maintained post-therapy review.

Speech intensives offer an alternate service delivery model that could be adopted in clinical settings. Measuring outcomes at multiple baselines and post-therapy allowed us to evaluate progress.


Service delivery, speech sound disorder, practice-based evidence, intervention


We reflected on our existing service delivery model for clients with speech sound disorders and the research evidence. In doing so, we identified the need for more frequent sessions for this population. We responded by developing a school holiday speech intensive and evaluated it by collecting practice-based evidence.

Introduction: Otitis Media (OM) is one of the most common infections in young children and can create fluctuating hearing loss. Despite the commonality of this condition, there is a lack of conclusive evidence on its impact on speech production outcomes.

Aim: To identify the impact of otitis media on speech development in children.

Methods: A systematic literature search of peer-reviewed publications since 2000 was conducted using five data bases. Titles and abstracts of 327 articles were reviewed, followed by full-text review of 163 studies; all were independently reviewed by two different authors.

Results: 11 studies met inclusion criteria for this review. Five prospective studies, which formed part of a larger study of 639 children, found no relationship between OM and speech development. Comparatively five studies identified a link between OM history, chronicity of OM and/or elevated hearing levels and speech development. Specifically, OM was linked to a higher intelligibility-speech gap and presence of backing.

Conclusions: Overall findings regarding a relationship between OM and speech sound development were mixed, likely due to the presence of multiple influencing variables such as duration, severity, medical intervention, age, hearing status and socio-economic status. Results of this review are also limited in that the prospective studies only consider cases of OM which are treated and therefore do not represent children who have unidentified and/or untreated OM. Furthermore, many studies did not consistently report on the hearing levels of children and only two studies included cohorts of children from an Indigenous background.

Keywords: Otitis Media, Speech, Children

Submission Statement: Delegates will be challenged to think holistically about the positive impact of adequate treatment pathways for children with OM. Delegates will be encouraged to act as advocates for early identification and treatment of OM when working with children and families to reduce the likelihood of adverse speech production outcomes.

Introduction: Over 50% of children with cleft palate require speech pathology. Implementing evidenced-based intervention is vital to improving the speech of these children, however, there is little high-quality evidence to guide clinicians. Speech pathologists report a high-degree of variability in their practice, difficulties selecting appropriate treatments, and over-reliance on tertiary cleft palate services. Principles of motor learning (PML) can provide clinicians with advice on the structure and frequency of practice and feedback to facilitate maintenance and generalisation in treating speech errors in children with cleft palate.

Aim: This pilot study applies speech intervention using PML to improve speech outcomes for children with cleft palate. It is hypothesised that when using a treatment that applies PML (1) the production of treated phonemes will improve; (2) the effects of practice on phonemes will generalise to untreated exemplars; and (3) the learning will be retained for at least 1-month post-treatment.

Method: Multiple baselines across participant combined with cross-over single-case experimental design was used. Participants were 4 children (5-6 years) with cleft-type speech errors. SLP provided treatment using PML twice a week for 40-50min/sessions for two 8-week phases. The primary dependent variable was percentage of words correct. Perceptual accuracy of target words was scored. Effect sizes were calculated to quantify treatment effect.

Results: All children showed moderate to large effect size for treated items, and generalisation to their untreated items.

Conclusions: Results demonstrate high-intensity speech intervention using PML is effective in improving speech for children with cleft palate and further research is warranted.

Keywords - cleft palate, speech, PML

Submission Statement: Speech pathologists will be equipped to respond confidently when treating speech errors in children with cleft palate. This is achieved by reflection on our skills in treating speech sound disorders in children coupled with new evidence to support the use of PML in treating cleft related speech errors.

Introduction/or rationale
Childhood apraxia of speech (CAS) is a motor-speech sound disorder associated with difficulty planning and programming movement sequences required for speech. Children with CAS may also experience persistent reading, writing and spelling difficulties, however there is a lack of research in this area. It is not known what best practice is to develop the literacy skills of children with CAS, particularly as their speech difficulties may reduce the effectiveness of using standard systemic synthetic phonics techniques.

Aim(s)
To synthesise what is known about the literacy skills of children with CAS and provide recommendations for best practice and further research.

Methods
Using the Covidence platform to structure systematic review of the available literature, nine databases were searched to identify English-language peer-reviewed journal articles reporting on the literacy skills of children with CAS and literacy interventions used in this population. Eligible articles were categorised according to study design, quality, and confidence of CAS diagnosis.

Results
The review identified 25 articles that met the eligibility criteria. Despite partial resolution of speech errors, children with CAS demonstrate persisting literacy difficulties into adolescence and beyond. They present with poorer literacy outcomes compared to both typically developing children and children with other speech sound disorders. The integrated phonological awareness approach and shared storybook reading are two literacy interventions trialed on this population, however both have low-level evidence.

Conclusions
Further research is required to determine an effective form of literacy instruction for this population and suggestions for interim approaches to literacy support will be presented.

Keywords – childhood apraxia of speech, literacy

Submission Statement:
This study acknowledges that little is known on the literacy skills of children with CAS and how to best support these children in their acquisition of literacy. It seeks to respond to this knowledge gap by synthesising what is currently known and providing recommendations for best practice.

Introduction
Childhood Apraxia of Speech (CAS) is a motor-based speech sound disorder that presents in childhood and affects approximately 1-2 school-aged children per 1,000 (ASHA, 2007). It can have a severe impact on the psychosocial and academic development of children including their literacy skills (Moxam, 2020). However, there are limited studies about the knowledge of CAS among teachers and what strategies teachers use to support the literacy skills of children with CAS.

Aim(s)
To discover the level of awareness of CAS and its impact on literacy among teachers.

To determine what literacy-based strategies teachers use with children with CAS.

Method
An online mixed-method cross-sectional survey was used in the study.

Results
There were 169 responses to the survey. Analysis of the responses identified that there is a general awareness that CAS is a condition that can affect literacy. Greater levels of CAS-related knowledge were associated with greater interaction with speech-language pathologists (SLP). Some participants have also made adaptations to literacy for children with CAS under the guidance of an SLP.

Conclusions
This research identified that Australian teachers are generally aware of CAS and its impacts on literacy. In addition, the participants identified a high willingness to work with SLPs to develop their awareness of CAS, providing a path forward for better support for these children.

Keywords - CAS – Teacher knowledge - Literacy


Submission Statement: This research allowed Australian teachers to reflect on their knowledge related to literacy. SLPS should respect the important roles that other professionals play in developing literacy. We now have a duty to respond to teachers’ willingness to work with us in this area.


References:
American Speech-Language-Hearing Association. (2007). Childhood apraxia of speech. Technical Report.https://www.asha.org/policy/TR2007-00278/

Moxam C. (2020). The link between language and spelling: What speech-language pathologists and teachers need to know. Language, Speech & Hearing Services in Schools, 51(4), 939-954. http://doi.org/10.1044/2020_LSHSS-19-00009

Introduction: Cerebral palsy (CP) is the most common childhood physical disability, and most children with CP have speech disorders. Rapid Syllable Transition Treatment (ReST) has been shown to be effective with children with CAS (e.g., Ng et al 2022) and in a single case experimental design study with children with CP (Korkalainen et al 2022). In these studies children’s speech accuracy was shown to improve however communicative participation was not tested.
Aim: To determine whether 6 weeks of telehealth ReST improved speech intelligibility and communicative participation in children with CP more than usual care.
Methods: Single blind randomised control trial. 14 participants aged 8-14 years with moderate CP were randomised to the ReST or usual-care using concealed allocation. ReST was provided for 6 weeks, 3 times a week, while the usual-care remained with their usual intervention. After this, the usual-care group also received ReST.
Intelligibility, the percentage of phonemes correct, and parent-reported measures of communicative participation and satisfaction were measured at pre and post-intervention and at 4 weeks post. Scorers were blinded to the participant identity, group allocation, and the timing of the assessment.
Pre and post-intervention measures were analysed using ANCOVA with 95% confidence intervals.
Results: All outcome measures showed statistically significant changes suggesting that ReST is more effective than usual care in children with CP.
Conclusion: This study is the first to compare ReST with usual care in children with CP and demonstrate changes in communicative participation as well as speech accuracy. Based on the promising results, ReST offers an alternative motor speech intervention for children with CP.

Introduction: The communication skills of autistic children are varied, with a third of autistic children failing to acquire functional communication skills. Recent research has identified that for a few autistic children, lower functional communication skills may be accounted for by childhood apraxia of speech (CAS). The identification of CAS is complex in otherwise neurotypical children and few assessments applicable for autistic children exist. The Dynamic Evaluation of Motor Speech Skills (DEMSS) is a speech imitation assessment designed to differentially diagnose motor speech disorders in minimally verbal children.
Aim(s): This study aimed to investigate the validity and reliability of the DEMSS with a heterogenous group of autistic children. It also aimed to report on the useability of the DEMSS and strategies that promote ease of administration.
Methods: 16 children diagnosed with ASD aged from 42 to 86 months were administered the DEMSS by the second author. The administration was audio and video recorded. This video administration was scored by the first author. The DEMSS scores were compared to existing participant data. Inter-rater, intra-rater reliability were analysed using percent exact agreement, intra-class correlation coefficients and Cohen’s Kappa. Sensitivity and specificity analysis, positive and negative likelihood ratios and AUROC were analysed to determine validity.
Results: Participants with low percentage phonemes correct and low expressive language scores presented with low DEMSS scores. Cues and motivators commonly provided were reported. Mean percent agreement for intra-rater reliability was 92% (r=88-96%).
Conclusions: The DEMSS may be an appropriate to assess the speech of verbal autistic children.

Keywords - Autism, Childhood Apraxia of Speech, Assessment

Submission Statement: Childhood Apraxia of Speech, a severe developmental speech sound disorder can impact social and academic performance as well as psychological wellbeing. Accurate diagnosis of speech sound disorders allows children to receive appropriate access to early intervention services improving outcomes.