The Intensity of Treatment for Articulation

The intensity of treatment is an essential aspect of pediatric speech therapy. A child may be unable to handle long treatment sessions many days in a row. This post pulls evidence-based research as to how the intensity of treatment is recommended to be handled.

The intensity of treatment takes into account the length of the treatment and session and how many times per week the treatment is given. There are two common approaches to treatment: the high-structure drill-and-practice or an activity-based approach. An activity-based approach provides fewer doses of treatment, or the number of teaching episodes during a session. The research concluded that generalization and retention improve through distributed rather than massed treatments.¹ This applies to both treatment dose and intervention session frequency. All children react to treatment differently, such as those with conditions such as apraxia or down syndrome. So treatment intensity and type should be monitored and adjusted based on the child’s condition.

Childhood Apraxia of Speech and Intensity of Treatment

As mentioned above, each child reacts to treatment differently. Some children, like those with CAS, need a different treatment intensity than those with an expressive language disorder.

Childhood Apraxia of Speech (CAS) is defined as a “speech disorder in which a child has difficulty making accurate movements when speaking,” or, in other words, “the brain struggles to develop plans for speech movement.”²

Those children with apraxia seem to benefit from interventions provided 2-3 times per week, up to 60 minutes per session, with at least 60 doses (treatment episodes) per session.³

The systematic review also determined that two motor treatments and one linguistic treatment were the most effective. This included Integral Stimulation/DTTC (motor), ReST (motor), and Integrated Phonological Awareness Intervention (linguistic).⁴ Since this article focuses on treatment intensity, we won’t discuss these treatments. However, see below for more information on them.

To learn more about integral stimulation/DTTC click here.

To learn more about ReST click here.

To learn more about Integrated Phonological Awareness Intervention click here.

Key Points

·      Generalization and retention improve through distributed rather than massed treatments.

·      Those children with apraxia benefit from interventions provided 2-3 times per week, up to 60 minutes per session, with at least 60 doses (treatment episodes) per session.

• In-Text Citations

  1. Yoder et al., p. 413.

  2. “Childhood Apraxia of Speech,” Mayo Clinic.

  3. Murray, McCabe, and Ballard, p. 501.

  4. Murray, McCabe, and Ballard, p. 502.

• Sources

  “Childhood Apraxia of Speech,” Mayo Clinic, 8 June 2021, https://www.mayoclinic.org/diseases-conditions/childhood-apraxia-of-speech/symptoms-causes/syc-20352045.

  Murray, Elizabeth, Patricia McCabe, and Kirrie J. Ballard. “A Systematic Review of Treatment Outcomes for Children with Childhood Apraxia of Speech,” American Journal of Speech-Language Pathology. 23, no. 3 (2014): 486-504. https://doi.org/10.1044/2014_AJSLP-13-0035

  Yoder, Paul et al. “Studying the impact of intensity is important but complicated.” International journal of speech-language pathology vol. 14,5 (2012): 410-413. doi:10.3109/17549507.2012.685890