Motor-based Intervention for Childhood Apraxia of Speech: DTTC-Connect

NCT07526246 | Not Yet Recruiting DMC

• 2 other identifiers: 2R01DC018581R01DC018581
• Study Type: interventional
• Target: 68
• Locations: 0 countries
• Sites: N/A

Brief Summary

Childhood apraxia of speech (CAS) is a complex motor speech disorder that significantly limits a child's ability to communicate in daily activities, with difficulties often persisting into adolescence and adulthood. There is solid evidence that motor-based interventions, such as Dynamic Temporal and Tactile Cueing (DTTC), improve word production in children with CAS. Building on this strong foundation, the next critical step is to extend this work to support functional communication in connected speech, where children with CAS often continue to struggle. There is a critical need for a systematic bridge within the context of treatment from word-level practice to connected speech, as robust word-level gains often fail to generalize to other speaking contexts. This work addresses this gap by transitioning children from word- to phrase-level practice using Dynamic Temporal and Tactile Cueing-Connect (DTTC-Connect), a novel, structured adaptation of DTTC that targets connected speech production. Our approach builds on established DTTC principles while incorporating progression to more complex utterances, offering a developmentally appropriate, research-informed pathway to functional communication. This study is a Phase II randomized controlled trial (RCT) designed to examine the efficacy of DTTC-Connect, a motor-based treatment that includes phrase-level practice to refine connected speech and support communicative participation for children with CAS. The overall objectives of this work are to test the efficacy of DTTC-Connect and document changes in speech motor control at the connected speech level in 68 children with CAS (3;6 - 12;11 years of age) who receive treatment twice a week for 8 weeks (16 sessions). The central hypothesis is that DTTC-Connect will lead to lasting improvements in phrase accuracy, speech intelligibility and speech motor control, ultimately enhancing a child's communicative participation.

Conditions

Childhood Apraxia of Speech

Keywords

Pediatric Motor Speech Disorder; Speech Motor Control; Communicative Participation

Outcome Measures

Primary Outcomes (1)

• Phrase Accuracy

  The primary outcome measure will be untreated phrase accuracy, quantified using the adapted Multilevel word Accuracy Composite Score (MACS) ratings for phrase-level stimuli. This composite score reflects the accuracy of four key areas: (I) segments (consonant \& vowel accuracy within-word and across-word boundaries); (II) phrase structure (maintenance of structures across the phrase); (III) movement transitions (smoothness and fluency across sounds, syllable, or words); and (IV) prosody (lexical \& phrasal stress). Each component receives a binary rating (0/1). Ratings will consider co-articulatory effects that naturally occur between words within connected speech.

  Immediate Group: Pre-Treatment Baseline; 1-week Post-Treatment; 8-week Post-Treatment; 16-weeks Post-Treatment; Delayed Group: Pre-Delay Baseline; Pre-Treatment Baseline (8-weeks post Pre-Delay Baseline); 1-week Post-Treatment; 8-weeks Post-Treatment;

Secondary Outcomes (3)

• Speech Intelligibility

  Immediate Group: Pre-Treatment Baseline; 1-week Post-Treatment; 8-week Post-Treatment; 16-weeks Post-Treatment; Delayed Group: Pre-Delay Baseline; Pre-Treatment Baseline (8-weeks post Pre-Delay Baseline); 1-week Post-Treatment; 8-weeks Post-Treatment;

• Variability

  Immediate Group: Pre-Treatment Baseline; 1-week Post-Treatment; 8-week Post-Treatment; 16-weeks Post-Treatment; Delayed Group: Pre-Delay Baseline; Pre-Treatment Baseline (8-weeks post Pre-Delay Baseline); 1-week Post-Treatment; 8-weeks Post-Treatment;

• Communicative Participation

  Immediate Group: Pre-Treatment Baseline; 1-week Post-Treatment; 8-week Post-Treatment; 16-weeks Post-Treatment; Delayed Group: Pre-Delay Baseline; Pre-Treatment Baseline (8-weeks post Pre-Delay Baseline); 1-week Post-Treatment; 8-weeks Post-Treatment;

Study Arms (2)

Immediate Treatment

EXPERIMENTAL

Participants in the Immediate Treatment Group will receive Dynamic Temporal and Tactile Cueing-Connect (DTTC-Connect) Treatment two times per week (45-minute sessions each) for 8 weeks. Total duration will be 90 minutes/week over 16 sessions. Treatment will begin following the diagnostic evaluation.

Behavioral: Dynamic Temporal and Tactile Cueing - Connect (DTTC-Connect)

Delayed Treatment

EXPERIMENTAL

The Delayed Treatment Group serves as a control during the period in which participants are waiting to begin treatment. A delayed treatment onset is employed to control for maturation effects. Participants in the Delayed Treatment Group will receive Dynamic Temporal and Tactile Cueing-Connect (DTTC-Connect) Treatment two times per week (45-minute sessions each) for 8 weeks. Total duration will be 90 minutes/week over 16 sessions. Treatment will begin after an 8-week delay following the diagnostic evaluation.

Behavioral: Dynamic Temporal and Tactile Cueing - Connect (DTTC-Connect)

Interventions

Dynamic Temporal and Tactile Cueing - Connect (DTTC-Connect) BEHAVIORAL

DTTC-Connect is a motor-based intervention designed to improve speech accuracy in children with CAS by targeting movement transitions within phrases. Treatment begins with selecting a target phrase identified through dynamic assessment as being within the child's optimal challenge point. Using this initial target, four additional phrases are constructed that systematically build in structural, phonetic, and grammatical complexity to support gradual progression in motor skill. Treatment begins with two-word phrases and follows the first three levels of the DTTC temporal hierarchy: Simultaneous Production → Direct Imitation → Delayed Imitation. The final step is Elicited Production where children produce the target at random intervals in the absence of a prior model. Aligned with standard DTTC, children initially receive maximal support during Simultaneous Production. As accuracy improves, support is faded and the child progresses to less supported levels of production.

Delayed Treatment; Immediate Treatment

Eligibility Criteria

• Age: 3 Years - 12 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Diagnosis of childhood apraxia of speech (CAS). The diagnosis will be made by two speech language pathologists (SLPs) who have extensive experience in the differential diagnosis of CAS.
• Age between 3;6 and 12;11 years.
• Normal structure of the oral-peripheral mechanism as determined by a motor speech examination using established lab protocol.
• Participants must pass a hearing screening conducted at 20 dB SPL at 500, 1000, 2000 and 4000 Hz.
• Not receiving speech treatment elsewhere over the course of this study, although language, augmentative and alternative communication (AAC) treatment, or similar non-speech treatment, would be permitted.
• Language Testing: Receptive Language Index standard score greater than or equal to 70 on the Clinical Evaluation of Language Fundamentals - Preschool 3rd edition (CELF-P3) for children 3;6-5;11 years of age, or the Clinical Evaluation of Language Fundamentals - 5th edition (CELF-5) for children 6;0-12;11 years of age.
• Nonverbal Cognition Testing: Standard score greater than or equal to 70 on the Developmental Assessment of Young Children-2nd edition (DAYC-2) for children 3;6- 5;11 years of age, or the Reynolds Intellectual Assessment Scales- 2nd edition, Remote (RIAS) for children 6;0-12;11 years old.
• Evidence of multi-word spontaneous speech up to five syllables in length.
• English as the primary language.

You may not qualify if:

• Primary dysarthria diagnosis, even if CAS is a secondary diagnosis.
• Abnormal structure of the oral peripheral mechanism.
• Fluency disorder, even if the child meets criteria for CAS.
• Conductive or sensorineural hearing loss, even if the child meets criteria for CAS.
• English is not the primary language.

Sponsors & Collaborators

• National Institute on Deafness and Other Communication Disorders (NIDCD): collaborator
• New York University: lead
• Hofstra University: collaborator

Related Publications (25)

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• Maas E, Butalla CE, Farinella KA. Feedback frequency in treatment for childhood apraxia of speech. Am J Speech Lang Pathol. 2012 Aug;21(3):239-57. doi: 10.1044/1058-0360(2012/11-0119). Epub 2012 Mar 21.

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• Case J, Wang EW, Grigos MI. The Multilevel Word Accuracy Composite Scale: A Novel Measure of Speech Production in Childhood Apraxia of Speech. Am J Speech Lang Pathol. 2023 Aug 17;32(4S):1866-1883. doi: 10.1044/2023_AJSLP-22-00166. Epub 2023 May 17.

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• Wiig, E. H., Secord, W. A., & Semel, E. M. (2020). Clinical Evaluation of Language Fundamentals-Preschool 3 (CELF-Preschool 3). Pearson.

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• Teverovsky EG, Bickel JO, Feldman HM. Functional characteristics of children diagnosed with Childhood Apraxia of Speech. Disabil Rehabil. 2009;31(2):94-102. doi: 10.1080/09638280701795030.

  PMID: 18720114 BACKGROUND

• Strand EA. Dynamic Temporal and Tactile Cueing: A Treatment Strategy for Childhood Apraxia of Speech. Am J Speech Lang Pathol. 2020 Feb 7;29(1):30-48. doi: 10.1044/2019_AJSLP-19-0005. Epub 2019 Dec 17.

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• Maas E, Gildersleeve-Neumann C, Jakielski K, Kovacs N, Stoeckel R, Vradelis H, Welsh M. Bang for Your Buck: A Single-Case Experimental Design Study of Practice Amount and Distribution in Treatment for Childhood Apraxia of Speech. J Speech Lang Hear Res. 2019 Sep 20;62(9):3160-3182. doi: 10.1044/2019_JSLHR-S-18-0212. Epub 2019 Aug 19.

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• Lewis BA, Freebairn LA, Hansen AJ, Iyengar SK, Taylor HG. School-age follow-up of children with childhood apraxia of speech. Lang Speech Hear Serv Sch. 2004 Apr;35(2):122-40. doi: 10.1044/0161-1461(2004/014).

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• Grigos MI, Moss A, Lu Y. Oral Articulatory Control in Childhood Apraxia of Speech. J Speech Lang Hear Res. 2015 Aug;58(4):1103-18. doi: 10.1044/2015_JSLHR-S-13-0221.

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• Grigos MI, Case J, Lu Y, Lyu Z. Dynamic Temporal and Tactile Cueing: Quantifying Speech Motor Changes and Individual Factors That Contribute to Treatment Gains in Childhood Apraxia of Speech. J Speech Lang Hear Res. 2024 Sep 26;67(9S):3359-3376. doi: 10.1044/2023_JSLHR-22-00658. Epub 2023 Jun 28.

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• Grigos MI, Case J, Lu Y, Lyu Z. Dynamic Temporal and Tactile Cueing in Young Children With Childhood Apraxia of Speech: A Multiple Single-Case Design. J Speech Lang Hear Res. 2024 Apr 8;67(4):1042-1071. doi: 10.1044/2024_JSLHR-23-00415. Epub 2024 Mar 21.

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• Brutten, E. J., & Vanryckeghem, M. (2007). BAB: Behavior Assessment Battery for school-age children who stutter. Plural Publishing.

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• American Speech-Language-Hearing Association. (2007). Childhood apraxia of speech [Technical Report] [Technical Report]. www.asha.org/policy

  BACKGROUND

MeSH Terms

Conditions

Apraxias

Condition Hierarchy (Ancestors)

Psychomotor Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Maria I. Grigos, PhD

  New York University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Maria I Grigos, PhD

CONTACT

212.998.5230; maria.grigos@nyu.edu

Julie Case, PhD

CONTACT

julie.case@hofstra.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The outcomes assessors will be blind to Treatment Phase/Session (i.e. Pre-Treatment, Treatment (including session #) and Maintenance), and Group (i.e. Immediate vs. Delayed). They will perform blinded ratings of Phrase Accuracy and Speech Intelligibility, as well as blinded scoring of Variability.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This work will employ a delayed treatment control group design across multiple behaviors. Participants will be seen in two groups: an Immediate Treatment group (treat first) and a Delayed Treatment group (wait first).

Study Record Dates

• First Submitted: April 2, 2026
• First Posted: April 13, 2026
• Study Start (Estimated): September 15, 2026
• Primary Completion (Estimated): September 1, 2030
• Study Completion (Estimated): March 31, 2031
• Last Updated: June 2, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF
• Time Frame: Beginning 6 months following publication. No end date.
• Access Criteria: Researchers and speech language pathologists who provide a methodologically sound proposal. Proposals should be directed to maria.grigos@nyu.edu. To gain access, data requestors will need to complete and sign a data sharing agreement.