Edythe Strand, PhD, CCC-SLP, the creator of the Dynamic Temporal and Tactile Cueing (DTTC) approach for the treatment of Childhood Apraxia of Speech (CAS) teaches this FREE online video course, available through this link.
The online course includes
- An Introduction to CAS; and
- Evidence-Based Treatment & Assessment Methods, including DTTC for the treatment of severe CAS
The course is available for ASHA CEUs through April 1, 2026.
DTTC Therapy for CAS
You may also want to check out Bjorem Speech‘s FREE DTTC Hierarchy Flow Chart to help provide a visual for each of the steps used in DTTC.
What is Childhood Apraxia of Speech (CAS)?
As you know, Childhood Apraxia of Speech (CAS) is a motor speech disorder where children have difficulty planning and coordinating the movements needed to produce speech. The issue here isn’t with the muscles themselves but with the brain’s ability to send the correct signals to the muscles involved in speaking.
Key characteristics of CAS include:
- Inconsistent Sound Errors: A child may say a word correctly one time and incorrectly the next.
- Difficulty with Speech Transitions: Challenges in moving smoothly from one sound or syllable to another.
- Prosodic Errors: Abnormalities in the rhythm, stress, and intonation of speech.
- Vowel Errors: The presence of vowel errors is a distinguishing characteristic of CAS. As with consonant sounds, the child may produce a vowel sound correctly in one instance and incorrectly in another, even within the same speech session.
Children with CAS typically understand language better than they can express it. They might know what they want to say but struggle to coordinate the muscle movements to articulate words properly.
How DTTC Helps with CAS
Dynamic Temporal and Tactile Cueing (DTTC) is a therapeutic method specifically designed to treat Childhood Apraxia of Speech (CAS). As mentioned above, CAS is a motor speech disorder where children struggle with planning and coordinating the movements necessary for speech. DTTC addresses these challenges by focusing on improving the accuracy and consistency of speech movements through a structured and dynamic approach.
DTTC helps in the following ways:
- Emphasis on Motor Planning.
- Targeting Movement Sequences: DTTC focuses on the movements between sounds and syllables, not just the individual sounds. This helps children improve the transitions that are often difficult in CAS.
- Repetitive Practice: By repeatedly practicing specific words and phrases, children develop better motor planning and execution skills.
- Dynamic Cueing Techniques.
- Multisensory Cues: Therapists use visual (e.g., mouth movements), auditory (e.g., emphasizing sounds), and tactile cues (e.g., touch cues on the face) to guide the child.
- Adjustable Support: The level of cueing is dynamically adjusted based on the child’s performance—providing more support when needed and reducing it as the child gains proficiency.
- Temporal Hierarchy.
- Simultaneous Production: Therapy often begins with the child and therapist saying the word together to provide maximum support.
- Immediate Repetition: The child repeats the word immediately after the therapist.
- Delayed Imitation and Spontaneous Production: As the child improves, the therapist increases the time between modeling and the child’s response, eventually leading to independent production.
- Principles of Motor Learning.
- Intensive Practice: Frequent and intensive sessions help reinforce motor patterns.
- Feedback: Immediate feedback on performance helps the child make necessary adjustments.
- Variable Practice Conditions: Changing practice conditions (e.g., speaking at different speeds or volumes) helps generalize skills to various contexts.
- Individualized and Functional Approach.
- Customized Vocabulary: Words and phrases are chosen based on the child’s interests and daily life to increase motivation.
- Parent Involvement: Parents are often trained to provide practice at home, enhancing consistency and progress.
Benefits of DTTC for Children with CAS:
- Improved Speech Accuracy: By focusing on movement patterns and providing tailored support, children can produce sounds and words more accurately.
- Enhanced Consistency: Regular practice and feedback help reduce inconsistent errors common in CAS.
- Greater Confidence: Success in therapy boosts the child’s confidence in their speaking abilities.
- Generalization of Skills: The functional focus of DTTC promotes the transfer of skills from the therapy setting to everyday communication.
DTTC is effective for children with CAS because it directly addresses the core issue of impaired motor planning and sequencing. By using dynamic cueing and a structured temporal hierarchy, Speech-Language Pathologists help children develop the neural pathways necessary for accurate and fluent speech. The approach’s adaptability ensures that each child receives the specific support they need to make meaningful progress in their communication abilities.
For more FREE speech therapy/speech and language therapy resources, check out our full website.
