How To Use Dynamic Temporal and Tactile Cueing (DTTC) for CAS

If you’re a Speech-Language Pathologist curious about how to implement Dynamic Temporal and Tactile Cueing (DTTC) for childhood apraxia of speech (aka, CAS), this article is your get-started guide. My goal is to break Dynamic Temporal and Tactile Cueing, or DTTC, down in clear, concise language- so you have the tools you need to understand the basics and the confidence to dig deeper into this effective motor speech treatment approach. We’ll discuss what DTTC is and explain its principles. This article does not replace formal training– I highly recommend you still take the recommended course. I’ll explain how to obtain DTTC training in this article. So without further ado- let’s get right into it!

Why Treating CAS (and using Dynamic Temporal and Tactile Cueing, or DTTC) Can Feel Overwhelming

Okay, let’s acknowledge some things first.

There’s immense pressure- at least, I think so- on social media to be “the MVP” of all SLPs.

There’s always someone who knows more about one approach or another. And sometimes it can leave you feeling… like you’re not enough.

Not true.

It’s okay to feel that learning how to treat CAS (childhood apraxia of speech) is overwhelming.

It can be.

It’s a completely different therapy approach, and that can make SLP need to stop and take a deep breath.

I promise, however, that this is absolutely a treatment area that you can learn to treat effectively, sooner than you think.

I have often found that if I don’t understand something, I just need to find the right person- or video, or visual, or text- to explain it. I’m hoping that this article provides that for you, but I’ll link to several additional websites to help you grow your knowledge.

School SLPs, in particular, may feel like implementing the DTTC approach can be nearly impossible. However, I have found that even incorporating the basics of a motor-based approach whenever possible can make a huge impact. We’ll get into that soon.

How To Complete Dynamic Temporal and Tactile Cueing Training: DTTC Training for Apraxia

Dynamic Temporal and Tactile Cueing, or DTTC, was developed by Dr. Edythe Strand.

And it’s important to note that DTTC isn’t some social media trend in the SLP world- it’s grounded in decades of motor speech research.

SLPs should know that Dr. Strand’s CAS lectures are available, free of charge, on Youtube.

However, to earn CEU credits, please visit childapraxiatreatment.org for more information.

CAS (Childhood Apraxia of Speech) Treatment: What Research Recommends

The most important thing to know about apraxia treatment is that it is based on movement.

This differs from phonological therapy, where SLPs focus on patterns, and articulation therapy, where we’re more concerned about individual sounds.

CAS treatment is most effective when it is structured, intensive, and focused on movement, rather than individual sounds.

I highly recommend this article from The Informed SLP, about “getting the most bang for your buck” when it comes to apraxia treatment.

In that article I referenced above, they explain that practice amount (the number of trials and sessions) and practice distribution (how practice is divided over time) really matter.

Massed practice was determined to be the most effective. This would involve choosing a small set of target words (such as five target words), practicing them often, and sticking to it for at least 4 weeks. THEN, you could move on to a new set of five words.

This is different than distributed practice, which would be like taking that set of ten words, and just practicing all of them, at the same time, for 8 weeks.

But you don’t need to panic about remembering textbook terms. Just remember this: target fewer words, more often. This leads to more consistent speech movements.

Focus, improve those few targets, then add some more.

Listen To the DTTC Episode on The Pedi Speechie Podcast

In case you missed it, I recently recorded a podcast episode discussing this exact topic: getting started with using a DTTC approach in speech therapy.

You can listen here, or on Apple Podcasts or Spotify.

Why Dynamic Temporal and Tactile Cueing (DTTC) Follows the Research

Dynamic Temporal and Tactile Cueing, or DTTC, aligns well with what research tells us matters when treating childhood apraxia.

It focuses on repeated practice, movement accuracy, and gradual fading of cues.

DTTC is an example of an integral stimulation approach. Um, what?

To say that more simply: you’re having the student watch you, listen to you, and say it with you- and when you can, you fade support.

DTTC isn’t talking about sounds or breaking words into pieces first. It isn’t an articulation drill without support.

Instead, the SLP teaches speech by saying it together, helping as much as needed, and then slowly helping less.

The SLP could model the word first, making sure the child is watching.

Then, have the child say it with you at the same time (“Watch me! Let’s say it together.”).

After that, have the child say it again. Provide visual, verbal, or tactile help as needed- and reduce that support when you can.

An integral stimulation approach focuses on how speech feels and the movement associated with it.

This type of approach is perfect for motor-based speech disorders- because the child knows what he wants to say, but he struggles with planning the movements to say it.

DTTC Hierarchy: Just the Basics

As I mentioned before, I highly recommend taking the CEU course for the “big picture” of implementing DTTC.

That said, I still want to discuss the essentials of the DTTC hierarchy- so you can feel more confident using this treatment approach. This will likely enhance your understanding as you take the course.

The most important thing to understand: the hierarchy describes how the SLP adjusts support based on the child’s accuracy in the moment.

When moving through the DTTC hierarchy, consider factors such as timing (saying the word together or saying the word after a model), the amount of cueing (visual, verbal, tactile), and the level of independence.

We also vary the prosody (soft, loud, happy, mad, etc,) and rate (slow, regular).

The highest level of support involves the SLP saying the word with the child, providing a clear model, and offering as many supports (such as gestural, visual, verbal, tactile) as needed.

The SLP gradually reduces support when possible, increases the time between the model and the child’s attempt, and encourages those independent productions- when it’s appropriate.

These terms are officially called “simultaneous”, “direct imitation”, “delayed imitation”, and “spontaneous”.

The idea right now is to understand the purpose of the hierarchy, not to panic about having it memorized on day one.

DTTC Target Selection: What Should I Target When Implementing Dynamic Temporal and Tactile Cueing?

Great question!

The good news is that you don’t need to run out and purchase therapy cards or word lists.

DTTC is individualized- so you’ll want to choose words that are meaningful and relevant for your student.

This involves looking at what your student can already do, with assistance.

You want to start close to success, with achievable targets.

Consider the shapes that a child can say first- maybe “pa”, a CV shape.

You might expand on that by changing the vowel, changing the consonant, adding a final syllable to make a CVC word, or even adding another syllable (to build a CVCV target).

I have also targeted a child’s first name, or other relevant names or words, to that child.

Check out this article from childapraxiatreatment.org for more ideas on selecting targets.

In Conclusion: DTTC Speech Therapy

To sum things up: DTTC is an evidence-based approach to treating childhood apraxia of speech.

SLPs are able to take the DTTC course and watch Dr. Strand’s video lectures on YouTube.

Dynamic Temporal and Tactile Cueing, DTTC, involves using an approach based on movement, as opposed to patterns or individual speech sounds.

I recommend visiting childapraxiatreatment.org for more detailed information about this effective approach.

A Little More on CAS Evaluation

Oh, and just a little bit more on a related topic.

If you’re exploring DTTC, chances are, you might be interested in learning a little bit more about the assessment piece.

Check out this article, where I explain in more detail what an apraxia of speech evaluation entails.

I hope you feel a bit more comfortable now about DTTC. Please let me know in the comments if this is an approach you’ll look into further!

References

Maas, Edwin, et al. “Getting the Most ‘Bang for Your Buck’ with CAS Treatment (With a Bonus Review of DTTC!).” The Informed SLP, 2019, www.theinformedslp.com/review/getting-the-most-bang-for-your-buck-with-cas-treatment-with-a-bonus-review-of-dttc

The author of this article has completed DTTC training and taken several CEUs on this topic.