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Maas E. Treatment for Childhood Apraxia of Speech: Past, Present, and Future. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024:1-26. [PMID: 38768073 DOI: 10.1044/2024_jslhr-23-00233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
PURPOSE The purposes of this review article were to provide an introduction to and "bird's-eye" overview of the current evidence base for treatment of childhood apraxia of speech (CAS), identify some gaps and trends in this rapidly growing literature, and formulate some future research directions, in order to advance the evidence base and clinical practice for children with CAS. METHOD Following a brief introduction outlining important concepts, a narrative review of the CAS treatment literature is provided, and trends and future directions are identified based on this review. The review is organized around four fundamental treatment research questions: (a) "Does Treatment X work?", (b) "Does Treatment X work better than Treatment Y?", (c) "For whom does Treatment X work?", and (d) "What does 'work' mean, anyway?" RESULTS A wide range of CAS treatments with varying degrees of evidence for efficacy exists. Research is beginning to emerge that compares different treatments and seeks to determine optimal treatment parameters. Few studies to date have explored child-level predictors of treatment response, and the evidence base currently is limited in scope with respect to populations and outcomes studied. CONCLUSIONS A growing evidence base supports the efficacy of a number of treatments for CAS. However, many important gaps in the literature were identified that warrant redoubled and sustained research attention. Research is beginning to emerge that addresses treatment optimization, comparison, candidacy, and outcomes. Suggestions for future research are offered, and the concept of a hypothesized pathway was applied to CAS to illustrate how components of an intervention can effect change in a clinical goal and can help guide development and refinement of treatments for children with CAS.
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Affiliation(s)
- Edwin Maas
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
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Thomas D, Murray E, Williamson E, McCabe P. Weekly Treatment for Childhood Apraxia of Speech With Rapid Syllable Transition Treatment: A Single-Case Experimental Design Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-22. [PMID: 37536463 DOI: 10.1044/2023_jslhr-22-00665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
PURPOSE The aim of this study was to pilot the efficacy of rapid syllable transition (ReST) treatment when provided once per week for a 50-min treatment session for 12 weeks with five children with childhood apraxia of speech. Of central importance was the children's retention and generalization of gains from treatment as indicators of speech motor learning. METHOD A multiple-baseline across-participant design was employed to investigate (a) treatment effect on the 20 treated pseudowords, (b) generalization to 40 untreated real words and 10 untreated polysyllabic word sentences, and (c) maintenance of any treatment and generalization goals to up to 4 months posttreatment. To investigate any difference between in-session performance and retention, a comparison was made between data collected during treatment and probe sessions. RESULTS Treatment data collected during therapy showed all children improving across their 12 treatment sessions. Three of the five children showed a treatment effect on treated pseudowords in the probe sessions, but only one child showed generalization to untreated real words, and no children showed generalization to sentences. CONCLUSIONS ReST treatment delivered at a dose frequency of once per week was efficacious for only one of the five children. In-session treatment data were not a reliable indicator of children's learning. One session per week of ReST therapy is therefore not recommended. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23751018.
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Affiliation(s)
- Donna Thomas
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Elizabeth Murray
- Faculty of Medicine and Health, The University of Sydney, Australia
- Remarkable Speech and Movement, Sydney, Australia
| | - Eliza Williamson
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Patricia McCabe
- Faculty of Medicine and Health, The University of Sydney, Australia
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McCabe P, Preston JL, Evans P, Heard R. A Pilot Randomized Control Trial of Motor-Based Treatments for Childhood Apraxia of Speech: Rapid Syllable Transition Treatment and Ultrasound Biofeedback. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:629-644. [PMID: 36848673 PMCID: PMC10171856 DOI: 10.1044/2022_ajslp-22-00144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/08/2022] [Accepted: 11/29/2022] [Indexed: 05/12/2023]
Abstract
PURPOSE Both Rapid Syllable Transition Treatment (ReST) and ultrasound biofeedback are effective approaches to treating childhood apraxia of speech (CAS). The purpose of the study was to compare outcomes from these two motor-based treatment approaches for school-age children with CAS. METHOD In a single site, single blind randomized control trial, 14 children with CAS ages 6-13 years were randomly assigned to 12 sessions over 6 weeks of either of ultrasound biofeedback treatment (with a speech motor chaining practice structure) or ReST. Treatment was delivered at The University of Sydney by students trained and supervised by certified speech-language pathologists. Transcriptions from blinded assessors were used to compare the two groups on speech sound accuracy (percent phonemes correct) and prosodic severity (lexical stress errors and syllable segregation) in untreated words and sentences at three time points: pretreatment, immediately posttreatment, and 1-month posttreatment (i.e., retention). RESULTS Both groups showed significant improvement on treated items indicating a treatment effect. At no time was there a difference between groups. Both groups showed a significant improvement in speech sound accuracy on untreated words and sentences from pre to post and neither group showed an improvement in prosody pre-post. Changes to speech sound accuracy were retained by both groups at 1-month follow-up. Significant improvement in prosodic accuracy was reported at the 1-month follow-up. CONCLUSIONS ReST and ultrasound biofeedback were equally effective. Either ReST or ultrasound biofeedback may be viable treatment options for school-age children with CAS. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22114661.
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Affiliation(s)
| | | | - Pippa Evans
- The University of Sydney, New South Wales, Australia
- The University of Queensland, Brisbane, Australia
| | - Rob Heard
- The University of Sydney, New South Wales, Australia
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Ng WL, McCabe P, Heard R, Park V, Murray E, Thomas D. Predicting Treatment Outcomes in Rapid Syllable Transition Treatment: An Individual Participant Data Meta-Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1784-1799. [PMID: 35486543 DOI: 10.1044/2022_jslhr-21-00617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The purpose of this study is to identify predictors of treatment outcomes in Rapid Syllable Transition Treatment (ReST) for childhood apraxia of speech through an individual participant data meta-analysis. METHOD A systematic literature search identified nine ReST studies for inclusion. Individual participant data were obtained, and studies were coded for methodological design, baseline participant characteristics, service delivery factors, and treatment outcomes. Bivariate analyses were conducted to identify potential predictor variables. Multiple linear regressions were then performed to identify predictors of treatment outcomes. RESULTS Data for 36 participants from seven studies were included in the statistical analyses. In multivariate modeling, better performance on treated pseudowords posttreatment was predicted by higher baseline expressive language and Goldman-Fristoe Test of Articulation scores, lower speech inconsistency and percentage of vowels correct, and higher pretreatment accuracy on pseudoword targets. Better performance on untreated real words posttreatment was predicted by higher pretreatment accuracy on real words. Gains in performance and retention of gains were not significantly predicted by any individual variable or combination of variables. CONCLUSIONS Baseline speech and expressive language skills and accuracy on pseudowords and real words were significant predictors of absolute posttreatment performance. Regardless of baseline characteristics, all children were statistically as likely to achieve gains during ReST and retain these gains for up to 4 weeks posttreatment. Large-scale prospective research is required to further examine the effects of dose frequency and co-occurring language impairments on treatment outcomes and the complex co-effects of percentage of vowels correct with other potential predictors. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19611714.
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Affiliation(s)
- Wei Lin Ng
- The University of Sydney, New South Wales, Australia
| | | | - Rob Heard
- The University of Sydney, New South Wales, Australia
| | - Veronica Park
- The University of Sydney, New South Wales, Australia
| | | | - Donna Thomas
- The University of Sydney, New South Wales, Australia
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Scarcella I, Michelazzo L, McCabe P. A Pilot Single-Case Experimental Design Study of Rapid Syllable Transition Treatment for Italian Children With Childhood Apraxia of Speech. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1496-1510. [PMID: 33830791 DOI: 10.1044/2021_ajslp-20-00133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background The Rapid Syllable Transition (ReST) treatment is an effective intervention designed to address the planning and programming disorder found in childhood apraxia of speech. To date, no study has considered its use with children who speak languages other than English. Aim This pilot study aimed to examine the use of ReST treatment with Italian children. We hypothesized that the ReST approach would improve the overall accuracy of the targeted behaviors of lexical stress, smoothness, and phonemic accuracy, whereas phonemic and phonetic accuracy of untreated items would remain stable. Method Two monolingual Italian-speaking children with childhood apraxia of speech received therapy in 12 one-hour sessions, 2-3 times per week, using a single-case experimental design. The treatment procedures used in English were replicated in Italian with one change: In English, two stress patterns are treated. Italian commonly uses three stress patterns; therefore, the stimuli were modified accordingly. Accuracy of articulation, lexical stress, and smoothness were assessed at pretreatment and 1 day, 1 week, and 4 months posttreatment in treated and untreated pseudowords and in real words and sentences. Results Both children improved on treated pseudowords and real words with moderate effect sizes, but only one child generalized to untreated pseudowords. Maintenance of treatment results was observed in both participants. Articulation of control phonemes did not change. Conclusions ReST treatment in Italian is feasible, and a treatment effect was found, showing that its use may be valid in languages other than English. Further research is required. Supplemental Material https://doi.org/10.23641/asha.14348060.
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Affiliation(s)
- Ilaria Scarcella
- The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Patricia McCabe
- The University of Sydney, Camperdown, New South Wales, Australia
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Hair A, Ballard KJ, Markoulli C, Monroe P, Mckechnie J, Ahmed B, Gutierrez-Osuna R. A Longitudinal Evaluation of Tablet-Based Child Speech Therapy with Apraxia World. ACM TRANSACTIONS ON ACCESSIBLE COMPUTING 2021. [DOI: 10.1145/3433607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Digital games can make speech therapy exercises more enjoyable for children and increase their motivation during therapy. However, many such games developed to date have not been designed for long-term use. To address this issue, we developed Apraxia World, a speech therapy game specifically intended to be played over extended periods. In this study, we examined pronunciation improvements, child engagement over time, and caregiver and automated pronunciation evaluation accuracy while using our game over a multi-month period. Ten children played Apraxia World at home during two counterbalanced 4-week treatment blocks separated by a 2-week break. In one treatment phase, children received pronunciation feedback from caregivers and in the other treatment phase, utterances were evaluated with an automated framework built into the game. We found that children made therapeutically significant speech improvements while using Apraxia World, and that the game successfully increased engagement during speech therapy practice. Additionally, in offline mispronunciation detection tests, our automated pronunciation evaluation framework outperformed a traditional method based on goodness of pronunciation scoring. Our results suggest that this type of speech therapy game is a valid complement to traditional home practice.
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Affiliation(s)
- Adam Hair
- Texas A&M University, College Station, Texas, USA
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Oliveira AMD, Nunes I, Cruz GSD, Gurgel LG. Métodos de avaliação da apraxia de fala na infância: revisão sistemática. AUDIOLOGY - COMMUNICATION RESEARCH 2021; 26. [DOI: 10.1590/2317-6431-2021-2524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
RESUMO Objetivos Revisar sistematicamente os protocolos e/ou avaliações que contribuem para o diagnóstico de apraxia de fala na infância (AFI) e classificá-los de acordo com a dimensão clínica avaliada. Estratégia de pesquisa Estudo de revisão sistemática da literatura nas bases de dados MEDLINE (acessado via PubMed), LILACS, Scopus e SciELO, com os descritores Apraxias, Childhood apraxia of speech, Evaluation, Assessment, Validation Studies, Evaluation Studies, Language Therapy, Rehabilitation of Speech and Language Disorders, Child e Child, Preschool. Critérios de seleção A busca nas bases de dados foi conduzida por três pesquisadores independentes. Foram incluídos estudos que avaliavam, de forma clara, sujeitos com suspeita ou diagnóstico de AFI. Os revisores realizaram a coleta de dados no que diz respeito às características metodológicas, intervenções e desfechos dos estudos, por meio de planilhas previamente elaboradas especificamente para o presente estudo. O dado principal coletado foi referente aos procedimentos de avaliação da AFI para crianças. Resultados A maior parte dos estudos (14 dos 21 incluídos) realizou a associação entre a avaliação de habilidades motoras e/ou articulatórias e segmentais. Cinco realizaram avaliação de todos os aspectos elencados: motor e/ou articulatória, segmental e suprassegmental e dois realizaram apenas avaliação motora e/ou articulatória. A idade dos sujeitos variou de 3 a 12 anos. Conclusão A maioria das pesquisas considerou a associação entre habilidades motoras e/ou articulatórias e segmentais para avaliação da apraxia de fala na infância. Sugere-se a realização de mais estudos, a fim de buscar evidências de validade.
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McCabe P, Thomas DC, Murray E. Rapid Syllable Transition Treatment—A Treatment for Childhood Apraxia of Speech and Other Pediatric Motor Speech Disorders. ACTA ACUST UNITED AC 2020. [DOI: 10.1044/2020_persp-19-00165] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
Childhood apraxia of speech (CAS) is a speech disorder that many generalist speech-language pathologists feel underqualified to treat. For children with CAS, this may result in ad hoc interventions resulting in slower progress. Research evidence for various CAS treatments is primarily limited to single-case experimental design studies; however, two treatments (Rapid Syllable Transition Treatment [ReST] and the Nuffield Dyspraxia Programme, Third Edition) have been compared in a single randomized controlled trial.
Conclusion
This tutorial describes one of those treatments: ReST which was designed to address the three consensus core features of CAS simultaneously: consistency and accuracy of sounds, sequencing, and prosody. The treatment uses nonwords to help children build and store accurate motor plans and programs using principles of motor learning. Treatment data are described, and commonly reported clinical issues are discussed. Recommendations for which children may be suitable for ReST and for evidence-based practice are described.
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Affiliation(s)
- Patricia McCabe
- Discipline of Speech Pathology, Sydney School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - Donna Claire Thomas
- Discipline of Speech Pathology, Sydney School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth Murray
- Discipline of Speech Pathology, Sydney School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia
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Namasivayam AK, Pukonen M, Goshulak D, Granata F, Le DJ, Kroll R, van Lieshout P. Investigating intervention dose frequency for children with speech sound disorders and motor speech involvement. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:673-686. [PMID: 30941860 DOI: 10.1111/1460-6984.12472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Treatment outcome data for children with severe speech sound disorders with motor speech involvement (SSD-MSI) are derived from Phase I clinical research studies. These studies have demonstrated positive improvements in speech production. Currently there is no research examining the optimal treatment dose frequency for this population. The results of this study, which is the first of its kind, will inform the delivery of effective services for this population. AIMS To investigate optimal treatment dose frequency for the Motor Speech Treatment Protocol (MSTP) for children with SSD-MSI. METHODS & PROCEDURES A total of 48 children (aged 43-47 months) with SSD-MSI participated in the study. Participants received 45-min MSTP intervention sessions either once per week (lower dose frequency) or twice per week (higher dose frequency) for a 10-week period. Blinded outcome assessments were carried out at pre- and post-intervention. OUTCOMES & RESULTS Treatment-related change was assessed at body structures, functions and activities participation level as per the World Health Organization's International Classification of Functioning framework: Children and Youth Version (ICF-CY) framework WHO (2007). These measures are related to articulation, functional communication and speech intelligibility. One-way analysis of variance (ANOVA) revealed that for all variables the baseline scores were not statistically different (p > 0.05) between the two dose-frequency groups. Overall, there was a significant main effect of Time (pre-post) across all variables (p < 0.01). However, repeated-measures ANOVA did not result in any statistical interactions (Time × Dose frequency) for any of the variables tested (p > 0.05). Only marginal clinical advantages (< 4% change in intelligibility) were noted with the 10 extra sessions. CONCLUSIONS & IMPLICATIONS Overall, the MSTP intervention approach in conjunction with home practice led to significant positive changes for all measures in children with SSD-MSI. No statistical differences between high- and low-dose-frequency groups were observed for any of the variables. Clinical effects were examined using effect sizes, as well as changes in articulation, speech intelligibility and functional communication; these differed marginally between the two dose frequencies. This suggests limited benefits of 10 additional sessions per block. Thus, it is recommended that caregivers, speech-language therapists and policy-makers perform a cost-benefit analysis before determining the dose frequency, when considering additional sessions per block.
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Affiliation(s)
- Aravind K Namasivayam
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Margit Pukonen
- The Speech and Stuttering Institute, Toronto, ON, Canada
| | - Debra Goshulak
- The Speech and Stuttering Institute, Toronto, ON, Canada
| | - Francesca Granata
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | - D James Le
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | - Robert Kroll
- The Speech and Stuttering Institute, Toronto, ON, Canada
| | - Pascal van Lieshout
- Oral Dynamics Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, Toronto, ON, Canada
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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Gomez M, McCabe P, Purcell A. Clinical management of childhood apraxia of speech: A survey of speech-language pathologists in Australia and New Zealand. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:295-304. [PMID: 31122069 DOI: 10.1080/17549507.2019.1608301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 03/14/2019] [Accepted: 04/11/2019] [Indexed: 06/09/2023]
Abstract
Purpose: A number of studies have been published that have investigated the practices of speech-language pathologists in relation to speech sound disorder intervention; however, specific research about the treatment of childhood apraxia of speech is not available. This study aimed to describe the treatment approaches being used by speech-language pathologists, explore their perspectives of evidence-based practice and identify perceived barriers to implementing empirical research recommendations. Method: An online survey was distributed to speech-language pathologists in Australia and New Zealand. In total, 109 valid surveys were completed by participants who answered a series of multiple choice, yes/no, short answer and Likert-scaled questions. Result: Speech-language pathologists demonstrated a strong preference for eclectic interventions to treat childhood apraxia of speech. When asked to identify the primary treatment approach they used (whether as a stand-alone; or as the primary approach within an eclectic intervention), the most frequently used intervention was the Nuffield Dyspraxia Programme. Many speech-language pathologists reported valuing empirical research evidence, despite identifying a range of barriers that impact their ability to implement evidence-based practice in childhood apraxia of speech treatment. Conclusion: Although many speech-language pathologists use the Nuffield Dyspraxia Programme as their primary intervention, most clinicians use it as part of an eclectic/hybrid intervention. The effectiveness of eclectic interventions for childhood apraxia of speech has not been empirically evaluated.
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Affiliation(s)
- Maryane Gomez
- a Faculty of Health Sciences , University of Sydney, Lidcombe, NSW , Australia
| | - Patricia McCabe
- a Faculty of Health Sciences , University of Sydney, Lidcombe, NSW , Australia
| | - Alison Purcell
- a Faculty of Health Sciences , University of Sydney, Lidcombe, NSW , Australia
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Murray E, Thomas D, McKechnie J. Comorbid morphological disorder apparent in some children aged 4-5 years with childhood apraxia of speech: findings from standardised testing. CLINICAL LINGUISTICS & PHONETICS 2018; 33:42-59. [PMID: 30199280 DOI: 10.1080/02699206.2018.1513565] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 06/08/2023]
Abstract
There is continuing debate about the origins of productive morphological errors in children with speech sound disorders. This is the case for children with theorised phonetic and motor disorders, such as children with childhood apraxia of speech (CAS, e.g., Ekelman & Aram, 1983; McNeill & Gillon, 2013 ). The morphological skills of children with CAS remain relatively unexplored in pre-schoolers. We investigated English morphology in a retrospective, cross-sectional design of 26 children aged 4-5 years who completed the Clinical Evaluation of Language Fundamentals-Preschool (2nd edition; Wiig, Secord & Semel, 2006). The research aims were to determine: (1) the language profile of the children, (2) the accuracy of each morpheme type produced, and (3) how many of those morphological errors are explained by speech errors (clusters, late developing phonemes, central vowels or weak syllable stress)? The results indicate the group of children with CAS had poorer expressive language skills than receptive skills and 48% demonstrated difficulties with morphology in word structure and recalling sentences subtests. The children had poor accuracy and inconsistent production of a range of morphemes and despite many errors due to the speech characteristics of the stimuli on the CELF-P2, motor speech concerns could not explain all the child's morphological errors. The results suggest morphological difficulties are co-morbid to CAS and when this occurs, treatment for morphosyntax is indicated. There are also significant clinical implications in the assessment of morphosyntax for children with CAS which are discussed.
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Affiliation(s)
| | - Donna Thomas
- a Speech Pathology , The University of Sydney , Australia
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