Review question
What treatments help to improve the speech and language of children and adolescents with childhood apraxia of speech (CAS).

Background
Children with CAS find it difficult to produce sounds and syllables consistently and precisely in order to speak words and sentences with clarity and correct speech rhythm. As a result, children with CAS can be hard to understand with potential for negative impacts on school achievement and peer friendships. CAS affects around 0.1% of the general population. This review collates the research evidence to identify the most effective therapies for children with CAS.

Search date
The evidence is current to 6 April 2017.

Study characteristics
We found one study with 26 children aged 4 to 12 years with CAS. The children had mild to severe CAS without a known cause. Children were allocated randomly (using a method like coin tossing) to one of two treatments: the Nuffield Dyspraxia Programme – Third Edition (NDP-3); and the Rapid Syllable Transition treatment (ReST). Both therapies were delivered intensively in one-hour sessions, four days a week for three weeks. The treatments were delivered by speech pathology students in a university clinic. Outcomes were assessed before therapy, immediately after therapy, at one month and four months post-therapy. Our review looked at one-month post-therapy outcomes only.

Study funding sources
The included study was funded by the Australian Research Council; the University of Sydney International Development Fund; Douglas & Lola Douglas Scholarship on Child and Adolescent Health; Nadia Verrall Memorial Scholarship; and a James Kentley Memorial Fellowship.

Key results
Further studies replicating these findings would strengthen available evidence.

The study provides limited evidence that the NDP-3 may improve the accuracy of production on treated items and the accuracy of connected speech. There is limited evidence that the NDP-3 has a negligible effect on speech production consistency, and the ReST a negligible effect on accuracy of production on non-treated words. The study did not measure functional communication.

Quality of the evidence
The included study was a randomised controlled trial with an overall low risk of bias. We downgraded the quality of the evidence by one level to moderate, due to imprecision, given that only one RCT was identified.

Recommendations
There is limited evidence that the NDP-3 or ReST may be helpful for children with CAS of unknown origin, aged 4 to 12 years, without other co-occurring conditions. We were not able to find out whether one of these treatment was better than the other, or whether either was better than no treatment or treatment as usual. There is currently no available evidence for other treatments.

Further RCTs — including studies comparing treatments to a no-treatment (wait-list) control group — would strengthen the evidence base. Further research is also needed for children with CAS and other disorders or diagnoses.