The Complexities of CAS: Where Do Parents and Professionals Begin?
For many parents, carers, and teachers, watching a child struggle to form words and communicate effectively can be deeply distressing. Despite a child’s strong desire to speak, the words can remain stubbornly beyond reach, often leaving everyone frustrated and unsure of the best path forward. Recognising that this condition is relatively rare yet life-altering, researchers have long sought to identify the most promising interventions. Now, more clarity has emerged from a 2018 Cochrane systematic review, which suggests that both the Nuffield Dyspraxia Programme-3 and Rapid Syllable Transitions Treatment may provide a much-needed speech breakthrough for children aged 4 to 12 with mild to moderate CAS.
What Is Childhood Apraxia of Speech?
Childhood apraxia of speech is a neurological motor-planning disorder characterised by (1) inconsistent errors in both consonants and vowels, (2) lengthened and impaired coarticulatory transitions between sounds, and (3) inappropriate prosody. In simpler terms, children with CAS know what they want to say but struggle with the complex process of planning the precise, rapid mouth movements required for accurate speech. Contributing factors—such as phonological production impairment, phonemic awareness issues, or oral-motor challenges—can also make speech production even more difficult. Given its rarity and complexity, CAS presents a challenging puzzle for researchers, speech pathologists, and families alike.
What Did This Systematic Review Reveal?
The 2018 review in The Cochrane Database of Systematic Reviews assessed one randomised controlled trial (RCT) of 26 children who received either NDP-3 or ReST therapy. Both groups showed meaningful improvements in their ability to pronounce treated and untreated words, as well as enhanced speech consistency at one-month post-treatment. While the study did not formally compare the two interventions, it offered an encouraging sign that either approach can provoke positive speech changes.
Below is an at-a-glance table summarising these therapies:
| Intervention | Age Range | Efficacy (One RCT) |
|---|---|---|
| Nuffield Dyspraxia Programme-3 | 4–12 yrs | Improvement in word accuracy and speech production consistency |
| Rapid Syllable Transitions (ReST) | 4–12 yrs | Improvement in word accuracy and speech production consistency |
Notably, each treatment was delivered intensively (four sessions per week, one hour each, across three weeks)—an important consideration for families and clinicians when planning therapy timetables.
How Can These Findings Influence Clinical Practice?
In practice, this review underlines the importance of targeted, intensive interventions to address the specific motor-planning deficits in CAS. Often, speech pathologists tailor therapy sessions around a child’s abilities, focusing on carefully selected words and syllables that reinforce accurate sound production. NDP-3 offers structured, step-by-step exercises for building speech sound sequences, while ReST prioritises rapid syllable transitions to strengthen prosody and movement accuracy.
For Australian paediatric speech pathologists, particularly those working in mobile or telehealth contexts such as Speech Clinic, these findings reinforce the practice of prioritising evidence-based interventions for children with CAS. Telehealth delivery can be adapted to model the intensive schedule used in the reviewed research. Additionally, having demonstrated benefits in children with mild-to-moderate CAS over a relatively short therapy window, both programmes could be appealing for families seeking practical, time-efficient strategies.
Are There Next Steps for Researchers, Clinicians, and Families?
Though the evidence is promising, the systematic review highlights the need for more RCTs exploring a broader range of ages, severities, and comorbid conditions. Currently, neither programme has sufficient evidence to be deemed “better” than the other, nor do we know how they compare to no treatment or more traditional therapy. That invites ongoing collaboration between researchers, clinicians, and families, who can document outcomes in different settings, share feedback on child engagement, and track how these therapies integrate with everyday routines.
Furthermore, while word accuracy is vital, real-world communication often hinges on children’s ability to use speech strategies at home or school. Future research could focus on capturing these practical communication outcomes, giving a clearer picture of how therapy translates into daily interactions. As a paediatric speech pathologist, being sensitive to family priorities—like functional language in peer interactions—is key to designing therapy that resonates with a child’s life beyond the treatment room.
Moving Forward Towards Clearer Speech
Although the evidence base remains small, the 2018 Cochrane review offers renewed hope and direction for parents, carers, and health professionals seeking to support children with mild to moderate CAS. Focusing on intensive, evidence-informed approaches such as NDP-3 and ReST can help many children achieve notable gains in word accuracy, enhancing their overall speech production skills. By continuing to adopt best-practice methods and participating in ongoing research, speech pathologists and families can further refine these approaches and ensure that children with CAS receive the best possible intervention.
If you or your child need support or have questions, please contact us at Speech Clinic.
How can I tell if my child really has CAS?
A definitive diagnosis comes from a qualified speech pathologist, who uses detailed assessments of speech sound production, prosody, and consistency across repeated words. If you suspect a problem, prompt evaluation is key.
Are there options beyond the NDP-3 and ReST treatments?
While the reviewed study focused on these two interventions, additional programmes and techniques do exist. Researchers recommend further randomised controlled trials to explore alternative solutions for various age groups and severities.
Does my child’s progress depend on session frequency?
Evidence indicates that intensive therapy can boost results. However, the optimal frequency may vary depending on the child’s specific needs, age, and attention span.
Can telehealth therapy be effective for CAS?
Yes. Telehealth approaches can be adapted to provide structured sessions, real-time feedback, and practice guidance, potentially mirroring the intensity examined in the research.
What if my child also has other learning difficulties?
Many children with CAS have co-occurring conditions. This might necessitate a broader intervention team (e.g., school staff, occupational therapists, psychologists) to strategically support all areas of development.
