Treatment of severe childhood apraxia of speech in a 12-year-old male with CHARGE association

This study employed a single subject, multiple baseline across behaviors design to examine the effects of dynamic temporal and tactile cueing (DTTC). The participant is a 12-year-old male with CHARGE association, a complex genetic disorder. He exhibited moderate mental retardation and severe childhood apraxia of speech (CAS). He was nonverbal and exhibited communicative vocalizations that drew negative attention. Treatment was implemented to extinguish aberrant vocalizations, improve his ability to produce accurate movement gestures for a core set of functional words and phrases, reduce rate, and improve comprehensibility. Treatment was provided over three phases. Results are reported for the effects of treatment focused on establishing a core functional vocabulary as well as for pre- and post changes in the number of aberrant vocalizations and speech rate. Changes in his ability to be understood in context are also reported. Our data provide evidence that improvement in functional verbal communication can occur even in children with severe apraxia who are over 12 years of age. Discussion focuses on the need for children with severe apraxia to continue in treatment, sometimes for long periods of time, before the full effects of therapy are seen. Issues related to measures of disability and societal limitation and the need for more treatment efficacy research in children with severe speech disorders are addressed.