DTTC with Caregiver Training for Childhood Apraxia of Speech

(DTTC Trial)

Recruiting at1 trial location

Age: < 18

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: New York University

Disqualifiers: Autism, Global delay, Down syndrome, others

No Placebo Group

Approved in 3 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial tests which type of caregiver training helps children with childhood apraxia of speech improve their speaking abilities more effectively. Children receive specialized speech therapy and practice at home with their caregivers. The study aims to see which method leads to better speech accuracy and communication skills.

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 data supports the effectiveness of the treatment Dynamic Temporal and Tactile Cueing (DTTC) for Childhood Apraxia of Speech?

Research shows that DTTC, a motor-based treatment, can improve speech intelligibility in children with Childhood Apraxia of Speech. Additionally, training parents to use DTTC at home has been found effective in providing more intensive treatment, especially in rural areas. ^{1 2 3 4 5}

Is Dynamic Temporal and Tactile Cueing (DTTC) safe for humans?

The research articles provided do not contain specific safety data for Dynamic Temporal and Tactile Cueing (DTTC) in humans. They focus on the effectiveness and implementation of the treatment for childhood apraxia of speech, but do not address safety concerns. ^{1 3 5 6 7}

How is the DTTC treatment different from other treatments for childhood apraxia of speech?

DTTC (Dynamic Temporal and Tactile Cueing) is unique because it focuses on motor-based intervention, using specific timing and touch cues to help children with childhood apraxia of speech improve their speech intelligibility. This approach is different from other treatments that may not emphasize the same level of motor planning and tactile feedback. ^{1 2 4 5 8}

Research Team

Eligibility Criteria

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.

Trial Timeline

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)

Treatment Details

Interventions

• Dynamic Temporal and Tactile Cueing (DTTC) (Behavioral Intervention)

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.

Participant Groups

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 Canada for the following indications:

Approved in Canada 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+

Dr. Fritz François

New York University

Chief Medical Officer

MD from NYU Grossman School of Medicine

Dr. Robert I. Grossman

New York University

Chief Executive Officer since 2007

MD from NYU Grossman School of Medicine

Hofstra University

Collaborator

Trials

6

Recruited

320+

Findings from Research

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]

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]

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]

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]

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]

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]

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]

References

1. United States 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. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Articulatory Control in Childhood Apraxia of Speech in a Novel Word-Learning Task. [2020]

3. Australia 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. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Neural Changes Induced by a Speech Motor Treatment in Childhood Apraxia of Speech: A Case Series. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Reliance on auditory feedback in children with childhood apraxia of speech. [2015]

6. United States pubmed.ncbi.nlm.nih.gov

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

7. United States 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. [2022]

8. England 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. [2021]