Just as communication therapy for children with apraxia of speech presents unique challenges, it certainly is a challenge to present my views on treatment in a few paragraphs. There are many complexities involved when we discuss therapy strategies due to the wide range of children whom we service. These include, but certainly are not limited to, the maturation level of the child, the child’s general cognitive abilities, possible dual diagnoses, other deficit areas such as fine motor skills, and parent motivation. When we discuss intervention strategies, we must take into account individual strengths as we develop a multi-sensory, multi-modality communication therapy course of action.
For children who have the cognitive capacity to understand picture stimuli, I find that an essential component to early therapy is the development of a “core vocabulary” book. This involves the inclusion of photographic pictures into a “Grandma’s Brag Book” (small photo album). The photos should consist of meaningful people, toys, and objects in the child’s life as well as words that contain initially targeted sound sequences. This book often serves as a child’s first success at expansion of functional communication interactions with significant others. The use of sign language has proven to enhance vocal output, reduce frustration, and provide differentiation for words that “sound the same” in the early course of treatment.
Touch cueing and physical prompting are also critical elements of my treatment approach. Each of these techniques is modified to fit the particular needs and tolerance level of the child. An ongoing goal is to fade all cues as soon as possible to allow for the child to develop the oral/verbal movement and sequencing patterns necessary for intelligible speech. Oral-motor work is never done without a sound production goal in mind. Sounds are not taught in isolation for any length of time with almost immediate progression to consonant-vowel or vowel consonant forms. Focus on suprasegmental features (e.g. rhythm, stress, intonation, etc.) should be ongoing from the start of therapy to enable the most naturalistic speech production possible.
If we begin intensive individual intervention in the optimal age range, the challenges in therapy are: (1) to discover ways to motivate toddlers and preschool-age children into repetitive practice of sound sequences while having fun at the same time (2) to let the child seemingly set the stage for the sessions while, at the same time, achieving therapy goals and (3) to make sure that optimal practice of speech sound production is accomplished so that speech motor patterns become more automatic. These are not impossible tasks if we remain creative thinkers, flexible therapists, and great listeners to the children and their parents. I can’t stress enough the importance of family involvement (including siblings attending treatment sessions), and close collaboration with all professionals involved in the child’s programming. This ensures consistent encouragement and feedback which “nudges” the child with apraxia of speech in the direction of self-motivated speech practice.