Dynamic Temporal and Tactile Cueing (DTTC): A Motor Learning Approach to Treating Childhood Apraxia of Speech

Dynamic temporal and tactile cueing (DTTC) is an evidence-based treatment approach designed to help children with childhood apraxia of speech (CAS) develop accurate and functional speech. Grounded in principles of motor learning, DTTC uses intensive practice and individualized cueing to support the development of speech movement patterns—not just sound production.

As the approach gains broader recognition in pediatric speech-language pathology, especially for children with severe CAS, clinicians are seeking clear guidance on how to implement it effectively. In this article, we explore the principles behind DTTC, how it differs from other CAS treatments, and how to determine whether a child is an appropriate candidate.

Understanding DTTC and motor learning

Throughout my clinical work with children who presented with severe speech sound disorders—particularly those who weren’t progressing through traditional therapy—I began developing what is now known as dynamic temporal and tactile cueing. Many of these children had very limited speech, yet during dynamic motor speech assessment, they demonstrated the capacity to improve when given appropriate support. That clinical experience led me to design a treatment approach that could directly target the core deficits in motor planning and programming.

DTTC is based on the premise that the primary difficulty in childhood apraxia of speech lies not in producing individual phonemes, but in planning and sequencing the movement gestures required for speech. Rather than isolating sounds, the approach emphasizes whole-word and syllable-level movements, supporting the development and refinement of motor programs for speech.

The method is grounded in motor learning principles, a framework widely used in physical and occupational therapy. In DTTC, we apply these principles through intensive, high-frequency practice, carefully calibrated feedback, and fading levels of cueing as the child gains skill. The aim is not just short-term accuracy but generalization, retention, and functional use of speech.¹

By helping children form stable internal representations of accurate speech movements, DTTC provides a path forward for those who may have struggled with other treatment methods—and supports the development of intelligible, meaningful communication.

Principles of motor learning in DTTC

Dynamic temporal and tactile cueing is structured around core principles of motor learning that guide how therapy is delivered—not just what is practiced, but how, when, and with what level of support. 

1. Frequent, high-quality practice

As clinicians, we understand that repetition and intensity are essential for building new motor skills. DTTC applies this principle by recommending shorter, more frequent therapy sessions that include a high number of practice trials. Early in treatment, you’ll focus on just a few targets—selected not by phoneme but by syllable shape, vowel content, and movement complexity. These factors directly influence motor planning and allow you to dynamically shape and refine the child’s movement patterns in real time.

2. Cueing and feedback: scaffolding to independence

DTTC relies on a hierarchy of cueing strategies that provides maximum support at the outset and systematically fades as the child gains accuracy. This might begin with slowed, simultaneous production alongside the clinician, combined with visual models, tactile cues, and gestural prompts.

Your feedback will also evolve throughout therapy. Early in treatment, the focus is on guiding accurate movement execution; later, the goal is to promote independence and retention. Specifically:

• Knowledge of performance (KP): Used early to provide direct feedback on how the movement is performed. For example: “Move your lips more.” This helps the child understand how to produce the target gesture.

• Knowledge of results (KR): Introduced as accuracy improves. This type of feedback shifts the focus to the outcome, helping the child self-monitor and internalize correct productions without relying on constant input.

This structured approach to cueing and feedback supports motor learning while gradually building the child’s autonomy in speech production.

3. Variable practice and randomization

Motor learning research shows that variability supports generalization. In dynamic temporal and tactile cueing, you’ll typically start with blocked practice—repeating consistent targets to establish accuracy—especially for children with severe CAS. As performance improves, you’ll move toward randomized target practice, encouraging flexibility and promoting skills transfer across different contexts and utterances.¹

4. Attention to proprioception and sensory feedback

A distinguishing feature of DTTC is its emphasis on proprioception—the child’s internal awareness of articulatory movement. You’ll help children focus on how it feels to move correctly, not just how it sounds or looks. To support this, you might:

• Slow speech rate to allow time for sensory processing

• Hold target positions briefly to enhance motor awareness

• Encourage consistent visual attention to your face during imitation

These strategies help the brain form accurate internal models of speech movements, supporting more stable and generalizable productions.

5. Minimizing segmentation

Whereas traditional approaches often isolate phonemes, dynamic temporal and tactile cueing emphasizes smooth transitions between sounds, especially at the syllable level. This movement-based approach helps children develop natural, connected speech patterns and avoids reinforcing disjointed or robotic productions.

For instance, instead of segmenting the word “boy” into /b/ and /ɔɪ/, you’ll model and practice it as one fluid gesture. This better reflects the nature of real-world speech, which is inherently continuous rather than segmented.

How is DTTC different from other speech sound disorders (SSDs) treatment methods?

Dynamic temporal and tactile cueing differs from other speech sound disorder interventions in a fundamental way: It prioritizes movement gestures over phonemes and is grounded in the principles of motor learning. While traditional approaches often emphasize sound production or phonological patterns, DTTC addresses the core deficit in CAS—difficulty with motor planning and programming. As clinicians, this distinction invites us to rethink how we approach therapy for children with severe speech sound disorders.

This is more than a shift in technique; it’s a shift in treatment philosophy. Instead of “Let’s work on your sounds,” DTTC reframes the goal as “Let’s work on how you move so you can talk better.” That mindset influences every aspect of intervention, from target selection to session structure. For example:²

• Stimuli are chosen based on syllable shape, vowel content, and articulatory transitions, not just based on phoneme accuracy.

• Practice emphasizes motor complexity, with targeted opportunities to build and refine the movement transitions required for connected speech.

• Feedback evolves parallel with the child’s progress, shifting from detailed movement guidance to outcome-based support, reinforcing motor learning while fostering independence.

Dynamic temporal and tactile cueing also integrates sensory-motor components often underemphasized in other treatments. Its emphasis on proprioceptive awareness, sustained visual attention, and continuous movement—especially at the syllable level—makes it well suited for building the precise, fluid motor patterns needed for intelligible, functional speech.

Who is a candidate for DTTC?

Dynamic temporal and tactile cueing is most appropriate for children with severe childhood apraxia of speech who have not made significant progress using other interventions. As clinicians, we must assess readiness before initiating DTTC to set appropriate expectations and ensure the approach aligns with the child’s developmental profile.

Children are more likely to benefit from DTTC when they:²

• Can focus on the clinician’s face for at least short periods.

• Can attempt direct imitation, even if productions are highly inaccurate.

These readiness markers guide your initial decision-making. A dynamic motor speech assessment—such as the Dynamic Evaluation of Motor Speech Skills (DEMSS)—is key in confirming candidacy. It allows you to observe how the child responds to different types of cueing, identify CAS characteristics, and gauge prognosis based on cueing responsiveness. These insights inform your plan for target selection, cueing intensity, and overall treatment structure.

While DTTC is designed primarily for children with severe motor speech challenges, it may also be used selectively with children presenting with milder impairments or persistent difficulty with complex speech movements.

Implementing DTTC in clinical practice

Effectively implementing dynamic temporal and tactile cueing requires clinicians to think not only as speech-language pathologists but also as motor learning facilitators. The success of DTTC lies in selecting the most appropriate treatment targets and structuring therapy in ways that align with motor learning principles, specifically through strategic cueing, feedback adjustment, and practice design.¹

As discussed earlier, children who meet basic readiness criteria—such as visual attention and imitation capacity—will most likely benefit from dynamic temporal and tactile cueing. Before treatment begins, a dynamic motor speech assessment should be used to confirm candidacy, observe cueing responsiveness, and guide initial treatment planning.

These assessments provide critical insights into prognosis and allow you to tailor treatment based on how the child responds to different types of support. For example, a child who demonstrates measurable improvement with cueing may have a more favorable prognosis and be a strong candidate for intensive, motor-based intervention. This information also helps determine the number and type of targets to introduce, as well as the optimal cueing strategies.

To support optimal learning within DTTC sessions, consider the following clinical strategies:

1. Start with strong scaffolding: Begin with maximum support and fade cues as the child gains accuracy to promote independence over time.

2. Balance intensity with capacity: Choose a manageable number of practice targets that fit the child’s cognitive and attention limits.

3. Enhance proprioceptive feedback: Use slow speech movements early on to build internal awareness of articulatory patterns.

4. Transition to variable practice: Move from blocked to randomized practice to support generalization across speech contexts.

5. Make practice meaningful: Integrate motor practice into real communication tasks to boost engagement and functional carryover.

Bringing DTTC into practice

Dynamic temporal and tactile cueing offers clinicians a robust, evidence-based framework for treating the motor planning deficits that underlie childhood apraxia of speech. By focusing on movement over phonemes, integrating principles of motor learning, and using systematic, multisensory cueing, DTTC enables children with CAS to develop clearer, more functional speech.

Whether you're new to motor-based treatment or looking to deepen your expertise, my Medbridge course series offers the clinical foundation and practical tools you need to deliver impactful, evidence-based care.

Start with the introductory course, Dynamic Temporal and Tactile Cueing: Introduction, which lays the groundwork for understanding how DTTC differs from phonological approaches—and why that distinction matters for successful outcomes. Then, continue through the complete four-part series:

• Dynamic Temporal and Tactile Cueing: The Hierarchy

• Dynamic Temporal and Tactile Cueing: Principles of Motor Learning

• Dynamic Temporal and Tactile Cueing: Cueing and Common Errors
  

This series is essential for any speech-language pathologist committed to improving outcomes for children with CAS.

References

1. Strand E. A. (2020). Dynamic Temporal and Tactile Cueing: A Treatment Strategy for Childhood Apraxia of Speech. American journal of speech-language pathology, 29(1), 30–48. https://pubs.asha.org/doi/10.1044/2019_AJSLP-19-0005

2. Child Apraxia Treatment. (n.d.). Dynamic Temporal and Tactile Cueing (DTTC). https://childapraxiatreatment.org/dttc/