Rapid Syllable Transition treatment for Childhood Apraxia of Speech: exploring treatment efficacy in three service-delivery contexts

Abstract

Many children are unable to access speech pathology treatment at the recommended intensity. To address this problem, clinicians use a range of strategies: modifying treatment intensity, mode or delivery agent. Accessing sufficient speech pathology treatment for children with childhood apraxia of speech (CAS) is particularly difficult because treatment should be delivered face-to-face, by a clinician, 3–5 times per week. One relatively new treatment for CAS, rapid syllable transition (ReST) treatment has demonstrated significant acquisition and generalisation effects when delivered intensively, face-to-face, by a clinician. This thesis uses three separate single-case experimental studies to investigate the efficacy of ReST treatment when provided via alternative service-delivery approaches. Lower dose-frequency, telehealth delivery, and a combined clinician–parent delivery model were explored. The studies showed that both lower dose-frequency and telehealth delivery were efficacious. Combined clinician–parent delivery was efficacious for fewer than half the children. Parental experiences of telehealth and of the combined clinician–parent delivery models were investigated qualitatively. The parents reported positive experiences of telehealth, finding it convenient and time-efficient. They had concerns about the combined clinician-parent delivery model, reporting discomfort in the role of therapist, and low levels of confidence and competence in delivering treatment. This thesis supports implementation of both lower dose-frequency and telehealth delivery of ReST treatment. Despite the intuitive appeal of parent-delivered treatment for overcoming access barriers, this thesis does not support clinical application of parent-delivered ReST treatment. This thesis argues for further investigation of intensity variables in CAS treatment and methods for improving parent-delivered treatment efficacy, and the need to ensure clients receive sufficient service provision