1. 12th Biennial National Conference Choices that matter: ECI in a new era …
Childhood Apraxia of Speech (CAS) and the Transdisciplinary Key Worker (TDKW) model
The KW model is effective in teaching children with CAS to communicate. In fact, it could lead to better outcomes for children and families than if they access speech therapy through the traditional model.
7-9 September, Melbourne, Australia

2. Childhood Apraxia of Speech (CAS)
Motor speech disorder
Difficult to diagnose
Long term impact
Little research
ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

3. Current literature Systematic review (Murray, McCabe & Ballard, 2014)
Peer-reviewed articles between
“No conclusions as to which treatments are more efficacious than others for CAS are currently possible”
First RCT comparing NDP3 and ReST (Murray, McCabe & Ballard, 2015)
Evidence for use when delivered intensively (4xsessions a week) and as prescribed by manuals
ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

4. ASHA guidelines (ASHA Technical Report, 2007)
No gold standard for treatment
Current recommendations for practice:
Multisensory cueing
Intense and distributed practice
Involve as many different important people in child’s life as possible for progress and carryover
ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

5. Why the debate about CAS and the TDKW model?
Traditional therapy for CAS
TDKW model
Speech Pathologist
Key Worker
Direct 1:1 therapy
Coaching and capacity building
Hierarchical goals
Functional goals related to child interest
3xweekly therapy sessions
Everyday activities and environments
Specific interventions
ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

6. Roper, Iauch & Gurley, 2005
Caregiver responsiveness, child interests and everyday learning opportunities to teach new words to children with CAS
Outcomes:
Increased number of single words and two-word phrases
Changes in quality of language production
Better understood by others
Started using words for a variety of communicative functions e.g. initiating interactions, requesting
ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

7. ECI principles inherently establish an environment conducive to CAS therapy.
Discussions and observations showed that by working with caregivers to support their children in this way, the CAS treatment guidelines recommended by ASHA are addressed. This suggests that, not only do these principles support a child’s participation in their everyday activities, but could also, based on current understanding and guidelines, be considered inherently conducive to the learning of speech targets for children with CAS.
ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

8. ASHA recommendation Traditional 1:1 KW model
Frequent and distributed practice
3xweekly therapy sessions
Incorporating into everyday activities.
Intensity (high repetition of words in session)
Drilling of speech targets
Targets related to child’s interest in context of everyday activity.
Multi-sensory cueing
Speech Pathologist chooses and implements approach
Parent chooses and learns to implement through coaching practices.
Involve as many different important people in child’s life as possible for progress and carryover
Caregivers provided with a plan to continue at home
Caregivers taught the skills.
Intervention is embedded into everyday activities and natural environments.
Motivation for practice
Child is rewarded for attempts to produce target
Targets reflect the child’s interest. Implemented through responsive parenting strategies.
ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

9. Example
Activity chosen: Baking Child’s interest: Having a role in the cooking and eating the result! Realistic target that expresses child’s interest: CV words “your” “my” “go” “woah!” Responsive parenting strategies: Calmness/emotionally-inviting voice. No pressure to speak. Teaching strategies: modeling, cued articulation, touch cues

10. Example
Activity chosen: Cooking dinner Child’s interest: Having a role in the cooking and eating the result! Realistic target that expresses child’s interest: CV words “your” “my” “go” “woah!” Responsive parenting strategies: Calmness/emotionally-inviting voice. No pressure to speak. Teaching strategies: modeling, cued articulation, touch cues
Involvement of important people in the child’s life for carryover
Natural environments
Frequent and distributed practice
Intensity of practice
Motivation/
attention
Multisensory cueing

11. The difference is in the way therapy is delivered, rather than the therapy itself.
Clinical reasoning
Consider the evidence
Coaching practices and capacity building
Everyday activities, responsive caregiving, child interests
How can I teach this parent what I know about CAS therapy?
Give example of Lachie
ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

12. Better outcomes Child outcomes: Family outcomes:
“participate meaningfully in home and local community activities”
“gain functional, developmental and coping skills”
Family outcomes:
“identify and address the needs of their child(ren) and family”
“nurture and support their child according to their values and preferences”
ECIA (2014)
Give example of Lachie
ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

13. Conclusions Awareness of current literature
Enable parents to make an informed choice
Consistent approach
Give example of Lachie
ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

14. Speech Pathologist – Noah’s Ark East Metro
Thank you
Sarah Legg
Speech Pathologist – Noah’s Ark East Metro
Discussions and observations showed that by working with caregivers to support their children in this way, the CAS treatment guidelines recommended by ASHA are addressed. This suggests that, not only do these principles support a child’s participation in their everyday activities, but could also, based on current understanding and guidelines, be considered inherently conducive to the learning of speech targets for children with CAS.
ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …