Intervention for childhood apraxia of speech
Editorial Group: Cochrane Developmental, Psychosocial and Learning Problems Group
Published Online: 16 JUL 2008
Assessed as up-to-date: 22 FEB 2007
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Morgan AT, Vogel AP. Intervention for childhood apraxia of speech. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006278. DOI: 10.1002/14651858.CD006278.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 16 JUL 2008
The diagnostic criteria for Childhood Apraxia of Speech (CAS), and the underlying cause(s) for this disorder, remain heavily debated. Some agreement exists that children with CAS may have impairments in one or more of the following domains: non-speech oral motor function, motor speech function, speech sounds and structures (i.e., syllable and word shapes), prosody, language, phonemic awareness / metalinguistic skills, and literacy .Recently consensus has been reached that only three features across these domains have diagnostic validity: (1) inconsistent error production on both consonants and vowels across repeated productions of syllables or words, (2) lengthened and impaired coarticulatory transitions between sounds and syllables, and (3) inappropriate prosody (ASHA 2007). Perhaps due to the ongoing deliberation over aetiology and diagnosis, little evidence on intervention for CAS is published.
To assess the efficacy of intervention delivered by Speech and Language Pathologists(s)/Speech and Language Therapists targeting CAS in children and adolescents.
The following databases were searched: CENTRAL (Issue 4, 2006), MEDLINE (1966 to 01/2007), CINAHL (1982 to 12/2006), EMBASE (1980 to 01/2007), ERIC (1965 to 01/2007), Linguistics Abstracts Online (1985 to 01/2007), PsycINFO (1872 to 01/2007). Reference lists of articles thus identified were examined.
The review considered randomised controlled trials (RCTs) and quasi-randomised studies of children aged 3 to 16 years with CAS, grouped by treatment types (e.g., perceptual and instrumentally-based biofeedback treatment techniques).
Data collection and analysis
Two authors independently assessed titles and abstracts identified from the searches and obtained full text versions of all potentially relevant articles. Articles were assessed for design and risk of bias. In addition to outcome data, a range of variables about participant group and outcomes were documented.
Of 825 titles and abstracts searched, only 31 abstracts appeared to meet inclusion criteria. The remaining 794 papers were excluded predominantly on the basis of not including participants with CAS (e.g., focused on other developmental speech disorders or adult acquired apraxia of speech), or for not being intervention studies (i.e. being diagnostic or descriptive). All 31 full text articles obtained were excluded following evaluation as they did not meet inclusion criteria on design. . Thus no studies are included in this review.
The review demonstrates a critical lack of well controlled treatment studies addressing treatment efficacy for CAS, making it impossible for conclusions to be drawn about which interventions are most effective for treating CAS in children or adolescents.
Plain language summary
Urgent need for well-designed studies of childhood apraxia of speech
Children who have childhood apraxia of speech (CAS) find it very difficult to make sounds in the right order, which makes it hard for others to understand them. Communication can thus break down between speaker and listener.
At present, there is a lack of agreement in the clinical and research community about how to diagnose CAS (ASHA 2007). The number of treatment investigations reported in the literature has been severely limited, perhaps at least in part due to this lack of consensus on the underlying nature or diagnosis of CAS. This review investigates the effectiveness of treatment delivered by Speech Language Pathologists targeting CAS in children and adolescents.
The review demonstrates that there are currently too few well-controlled studies in this field to enable conclusions to be drawn about the efficacy of treatment for the entire CAS population, and calls for SLPs working in this area to design better studies.
兒童言語失用 (apraxia of speech, CAS) 治療
兒童言語失用診斷條件和潛在原因仍不明確.某程度的共識是:有此病的孩童可能在下面領域有殘障:非語言口語動作功能,動作性語言功能,說話聲音和架構 (例如音節和字的型式), 韻律,語言,音素覺識能力/綜合語言技巧和識字能力.最近達成的共識是:這些領域中只有三個特徵具有診斷效力: (1) 重複發出音節或單字聲音時,母音或子音發音出現不一致的錯誤, (2) 聲音和音節之間的轉換太長或損害, (3) 不適當的韻律 (ASHA 2007). 或許因為病因學和診斷仍未定義,沒什麼證明CAS治療的文獻.
搜尋以下資料庫:CENTRAL (Issue 4, 2006), MEDLINE (1966 to 01/2007), CINAHL (1982 to 12/2006), EMBASE (1980 to 01/2007), ERIC (1965 to 01/2007), Linguistics Abstracts Online (1985 to 01/2007), PsycINFO (1872 to 01/2007). 參考文獻也經過檢查.
本回顧研究包含3 – 16歲CAS兒童的隨機對照試驗和半隨機試驗,依治療方式分組 (感官和依據器具的生物回饋治療技術)
搜尋825個論文標題和摘要,只找到31個摘要符合納入條件.剩下的論文因為沒有CAS受試者 (研究其他發展性言語障礙或成人後天言語失用) 或沒有介入治療 (只有診斷或描述性資料), 而被排除.31篇研究全文經研究後也排除,因為試驗設計不符合納入條件.故本回顧沒有文章符合納入條件.
此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。
兒童CAS患者很難依正確順序發音，別人也難以了解他們。說者和聽者間會缺乏溝通。現在臨床和學界缺少診斷共識 (ASHA 2007). 文獻中有關治療的研究數目很少，可能有一部分是因為缺少CAS本質或診斷共識。本回顧評估對兒童和青少年CAS病人,語言病理學家進行治療的療效.本回顧結果表示沒什麼對照組設計完善的試驗，所以無法知道對所有CAS病人而言，什麼治療最有效。應該找本領域的語言病理學家 (SLP) 設計更好的試驗。