One on One Therapy

A Review of Apraxia Remediation

The Cherab Foundation gratefully acknowledges permission to print the following, cited by Jennifer Hecker, a parent advocate for her apraxic son, Reed.

“The type of treatment appeared to influence whether patients improved. More patients improved, and improvement was greater in Group A, individual stimulus-response treatment than in Group B, group treatment. These results imply the way to treat AOS (Apraxia Of Speech) is to treat is aggressively by direct manipulation and not by general group discussion. This is consistent with what has been recommended (Rosenbek, 1978).

The type of treatment appeared to influence whether improvement occurred or not. Four of the five patients who did not improve received group treatment with no direct manipulation of their motor speech deficit.” Apraxia of Speech: Physiology, Acoustics, Linguistics, Management. Rosenbek et al. 1984

“The frequency of professional speech assistance is critical in the habilitation of children with developmental apraxia of speech. This disability calls for all-out attention and deserves serious instruction to the limits of the child’s attention and motivation. When normal children begin their formal education, they do not go to school twice or thrice a week for just a half-hour, even in kindergarten. Thus, I do not expect to provide special education for children with developmental apraxia of speech on a cursory basis, for it may be the most important part of the entire education.” Current Therapy of Communication Disorders, Dysarthria and Apraxia. William H. Perkins 1984

“They use the term developmental apraxia to describe a disorder that is not confined to the phonologic and motoric aspects of speech production but includes difficulty in selection and sequencing of syntactic and lexical units during utterance productions. Most clinicians agree that planning the appropriate treatment approach and methods is crucial to the efficacy of intervention. A variety of factors can facilitate the treatment of DAS. DAS is often characterized as being resistant to traditional methods of treatment. Group therapy decreases the potential of responses per session for each child and, therefore, the motor practice needed by children with apraxia and dysarthria.” Treatment of Motor Speech Disorders in Children by Edythe Strand in “Seminars of Speech and Language” Vol. 16, No. 2. May 1995

“Early stages of treatment need to be carried out on a one-to-one basis for it is only in this way that the patient can learn to develop his own particular strengths and adopt compensatory measures for weaknesses.” Disorders of Articulation, Aspects of Dysarthria and Verbal Apraxia. Margaret Edwards 1984″These children do not seem to make good progress with the usual approaches to clinical treatment of articulation problems. Carefully structured programs that combine muscle movement, speech sound production, and sometimes even work on grammar seem to get better results.” “Developmental Verbal Dyspraxia” on Healthtouch Online, ASHA website

“Children must be seen one-on-one, at least in the early stages of treatment.” Nancy Kaufman, author of the Kaufman Speech Praxis Test and expert on Apraxia, on The Kaufman Children’s Center for Speech and Language Disorders website .

“However, many of the theories, principles, and hierarchies described for adult apraxics are potentially helpful to the clinician designing a motor-programming remedial program for an individual child. (We stress the word individual since the program development for children with DAS must meet the individual, and often unique, needs of each child.)” Intensive services are needed for the child with DAS. Children with DAS are reported to make slow progress in the remediation of their speech problems. They seem to require a great deal of professional service, typically done on an individual basis. Therefore, clinicians working with DAS must accommodate this need and schedule as much intervention time with the child as the child and/or his/her schedule can allow. The definition of “intensive” varies from clinician to clinician and from work setting to work setting. Rosenbek (1985), when discussing therapy with adult apraxics, defines the word as meaning that the patient and the clinician should have daily sessions: Macaluso Haynes (1978), Haynes (1985), and Blakeley (1983) also advocate daily remediation sessions.” Also, “our experience has been that the overall outcome has been best for those children with DAS who were identified as possibly exhibiting DAS and received services as very young children.” Developmental Apraxia of Speech, Theory and Clinical Practice. Penelope Hall et al. 1994

“We recommend therapy as intensively and as often as possible. Five short sessions (e.g., 30 minutes) a week is better than two 90 minute sessions. Regression will occur if the therapy is discontinued for a long time (e.g., over the summer). Most of the therapy (2-3/week) must be provided individually. If group therapy is provided, it will not help unless the other children in the group have the same diagnoses and are at the same level phonologically.” Shelley Velleman, authority and published author on Apraxia, on her website (velleman.html). “Our clinic has had tremendous success with the half-hour format; these sessions are very intense, packed with therapy, and have little
downtime. The earlier and more intensive the intervention, the more successful the therapy. Group therapy can be effective for articulation and some phonological processing disorders, but children with Apraxia need intensive individual therapy.” Nancy Lucker-Lazerson, MA, CCC-SLP, and Clinic Coordinator for the Scottish Rite Clinic for Childhood Language Disorders San Diego, on the Apraxia Kids website.

“A few major principles in particular have direct relevance to the treatment of motor speech disorders. The most obvious, yet surprisingly often disregarded, is that of repetitive practice. Pairing of auditory and visual stimuli is included in most approaches and intensive, frequent, and systematic practice toward habituation of a particular movement pattern is suggested instead of teaching isolated phonemes. It is important to
consider the treatment needs of each child and attempt to find creative solutions that
> allow frequent individual treatment for children that will most benefit.”
Childhood Motor Speech Disorders Edythe Strand

“Given the controlled conditions stipulated in the studies…, it is clear that speech dyspraxia can respond to therapy. All approaches involved an intensive pattern of therapy. Even if not seen daily by a therapist, patients carried out daily practice.” Acquired Speech Dyspraxia, Disorders of Communication: The Science of Intervention. Margaret M. Leahy 1989

“Consistent and frequent therapy sessions are recommended. The intensity and duration of each session will depend on the child. At least three sessions per week are recommended for the child to make consistent progress.” Easy Does it for Apraxia-Preschool, Materials Book. Robin Strode and Catherine Chamberlain

“In stark contrast, the children with apraxia of speech whose parents stated that three-quarters of their child’s speech could be understood following treatment required 151 individual sessions (ranging from 144-168). In other words, the children with apraxia of speech required 81% more individual treatment sessions than those with severe phonological disorders to achieve a similar function outcome.” Functional treatment outcomes for young children with motor-speech disorders by Thomas Campbell in Clinical Management of Motor Speech Disorders A.J. Caruso and E.A. Strand 1999.

(In addition to the information on this page, a great page on 1:1 therapy is at Apraxia-Kids)

1:1 Therapy Question Sent To Children’s Apraxia Network:

Advice From our nonprofit’s SLS/MA/ EDUCATIONAL CONSULTANT, Cheryl Bennett-Johnson

It is interesting to note that when a child is receiving Early Intervention services in the home, therapy is 1:1. It is also interesting to note that children as young as six months of age have received 1:1 services. Every apraxic child is different; with a diagnosis of severe apraxia, the child would benefit from 1:1 therapy. What data does the school SLP (Speech Language Pathologist) present indicating that the age of 5 is too young for 1:1 services?

Remember, when a request for services is not given as requested, the denying party must give a written rationale as to why. The IEP (Individualized Education Program) is an Individualized Education Program. How will the SLP (Speech and Language Pathologist) address the severe oral motor needs of the child within the group setting? What are the short and long term goals and objectives that are specific to the nature of this child’s severe apraxia? Does the SLP plan to devote x amount of minutes providing 1:1 therapy to your child within the group setting? Your child’s disability of apraxia affects his involvement and progress in the general curriculum and access to nonacademic and extracurricular activities because he cannot communicate appropriately to school personnel when needed and communicate effectively through speech and/or writing to classmates and teachers. The severity of his disability warrants 1:1 speech therapy intervention. Your child’s disability of apraxia of speech affects his ability to engage in age-relevant behaviors that typical students of the same age would be expected to be performing or would have achieved {IDEA-Code of Federal Regulations (C.F.R.): 34 C.F R.300.347 (a)(1)(i) Statue 20 United State Code (U.S.C.) 1414 (d)(1)(A)(i)(1).

I am requesting that the parent draft a letter to the Dr. of the Child Study Team, including the information listed above. Indicate that you are not in agreement with the type /amount/duration of the speech therapy services that will be provided to your child. State that you are seeking 1:1 therapy services for your child because… Send the letter certified receipt return requested. Send a copy to the SLP, the District Superintendent of Schools, and the Board of Education President. Severe Apraxia requires the parent to advocate for 1:1 services in the area of speech therapy