A survey study of clinical management of childhood apraxia of speech in Hong Kong

Introduction
Childhood apraxia of speech (CAS) is a type of motor speech disorder in children, but there is limited understanding of its clinical manifestations in Cantonese (and other tone languages). Previous survey studies of CAS have demonstrated their value in informing research and clinical practice. The purpose of this study was to obtain information about clinical practice from speech-language pathologists (SLPs) in Hong Kong.

Methods
An online questionnaire was designed with 48 questions regarding the knowledge and experience of CAS among Hong Kong SLPs, as well as their assessment methods, diagnostic criteria, and treatment of Cantonese speakers with CAS. Both descriptive and inferential statistics were used to analyse the data.

Results
Seventy-seven responses were received from practicing SLPs in Hong Kong. Their average years of clinical experience was 5.77 years (standard deviation = 6.16). Most of the respondents commented that they had ‘a little’ (41.6%) or ‘fair’ (41.6%) understanding of CAS. Their understanding was attributed to previous CAS training, including professional degrees (47.3%), self-education (26.2%), continuing education programs (21.6%), and peer sharing (4.9%).

Respondents who had suspected or diagnosed children with CAS (n = 32) reported their assessment and diagnosis processes. No standardized assessment or objective measures were used clinically; instead, speech and language samples and imitation of polysyllabic words were used by all of the respondents. Most respondents (87.5%) diagnosed or suspected CAS using existing and/or their own clinical checklists. Twenty different checklists were reported by 20 respondents.

Respondents who had provided intervention to children with CAS (n = 41) reported information regarding their treatment strategies. Most of the respondents provided treatment less than once a week (43.9%), followed by once a week (41.5%). The most common duration (46.3%) was 35 to 50 minutes per session. Most of the respondents provided within-session block treatment (85.4%), meaning that the sessions included speech production practice and other tasks. These tasks focused primarily on language, speech perception, and/or nonspeech oral motor abilities. The most common approach used by the respondents was traditional articulation therapy (64.3%), followed by Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) therapy (56.1%), and Talktool® Oral Placement Therapy (48.8%) respectively, but none of them fully implemented these approaches.

Conclusion
This study aimed to examine CAS clinical practice in Hong Kong. The results suggested that the understanding of CAS in Cantonese speakers regarding assessment, diagnosis, and treatment is still limited. Regarding assessment, there are no standardized assessment tools for Cantonese speakers with CAS. Current clinical practices are based on the SLPs’ own clinical checklists and diagnostic criteria, which are varied. Regarding treatment, the SLPs in Hong Kong provide treatment less frequently than the literature suggests and no full implementation of evidence-based treatment approaches was reported. Future investigations of clinical features, assessment, diagnostic criteria, and treatment efficacy and effectiveness are urgently needed to inform evidence-based clinical practice for Cantonese-speaking children with CAS.