Getting the most “Bang for your Buck” with CAS treatment (with a bonus review of DTTC!)

Treating kids with childhood apraxia of speech (CAS) can be an involved and lengthy process. So what are the optimal conditions for CAS treatment? Maas et al. are on it, giving insight into how we can structure our therapy for kids with CAS. They provided integral stimulation treatment (see below), that differed based on the amount and distribution of practice.

Practice amount (aka cumulative intervention intensity) is the “number of practice trials and sessions provided throughout the treatment period”. Unsurprisingly, more therapy generally led to greater gains for children in this study (ages 4–12, who all had at least 50 words). The more a child practices saying a target word, the more opportunities he has to learn and retain the movement pattern.

Practice distribution refers to how the practice is divided over time, either many trials in a short period (massed practice) or spread out over a longer one (distributed practice). Massed practice led to greater improvement and maintenance of target words for most children in the study. This is consistent with neuroplasticity literature (yay science!). Massed practice might look like working on five targets for four weeks, and then five new targets for four weeks, rather than ten targets for eight weeks straight.


This study also gives us a great review of integral stimulation treatment (the basis of Dynamic Temporal and Tactile Cueing, or DTTC), which is one of the most evidence-based treatments out there for CAS. As a preview the core aspects of integral stimulation are: (1) tactile cues, (2) slowed rate of speech, (3) gradual fading of cues, and (4) focus on whole-target movement accuracy. Free CEUs and downloadable charts are available to learn how to deliver DTTC, so look into it if you serve these kids!


Maas, E., Gildersleeve-Neumann, C., Jakielski, K., Kovacs, N., Stoeckel, R., Vradelis, H., & Welsh, M. (2019). Bang for your buck: A single-case experimental design study of practice amount and distribution in treatment for childhood apraxia of speech. Journal of Speech, Language, and Hearing Research. doi:10.1044/2019_JSLHR-S-18-0212