What should the frequency of treatment be for a 5 year old diagnosed with developmental apraxia?
The answer to this question will depend on the severity of the apraxia and what else is contributing to the communication disorder (e.g., cognitive delay, phonologic delay, receptive and expressive language delays, etc.). I have seen 5 year old children who have been given a diagnosis of apraxia when they were younger (e.g., 3 years old) and by the time I see them at age 5, they are very intelligible, only have a residual /r/ distortion, and may break down slightly when they're doing something more linguistically complex, like telling a story. I have also seen 5 year olds who have very poor intelligibility and have difficulty producing a simple CVC in imitation. Obviously, these two case scenarios warrant different amounts of therapy time. The children in the first case scenario may be fine with speech therapy one or two times a week, where children with severe apraxia of speech need more frequent sessions (e.g., up to four or five times a week for 30-45 minutes each session).
From what we know about motor learning, frequent therapy is needed to learn the motor skills necessary for speech. Children with delayed speech due to a phonologic delay only will not generally need as many sessions as a child who has apraxia. However, these two types of deficits can co-occur. Thus, the relative contribution needs to be taken into account. In other words, if the child only has a mild apraxic component and a moderate phonologic delay, therapy may be warranted for two to three times a week with the majority of the time spent working on the phonological processes and a little bit of the time focusing on motor planning. Again, it always comes back to the severity of the disorder and the relative contribution of motor planning to the speech disorder.
For more information on this topic go to: http://www.apraxia-kids.org/definitions/frequency.html.
Dr. Amy Skinder-Meredith is an Associate Professor of Communication Sciences and Disorders at the University of Minnesota-Duluth. She has been a speech language pathologist for 12 years. She has presented at workshops around the country on assessment and treatment of childhood apraxia of speech. She has published articles and has presented at many conferences about the nature of childhood apraxia of speech.