When a child is diagnosed with a speech problem such as CAS, their parents enter a world of therapists and services that is new and unfamiliar to most of them. The process of evaluation and development of an intervention plan can be intimidating. It may be tempting for parents to rely on the therapist to “fix” the problem. However, when parents make an effort to understand their child’s diagnosis and become active participants in the intervention process, there are benefits not just for the child but for the parents and therapists as well.
Therapy for CAS is intensive and requires focus and participation on the part of both child and therapist. Parents can share information with the therapist about the child’s personality and preferences that can be used to motivate the child. They can help the therapist understand how the child responds in frustrating situations and how they manage challenging behaviors at home. This information can help the therapist and parents provide consistency in working with the child in therapy sessions and at home.
The need for multiple repetitions to develop motor skills to an automatic level is well established and forms a basis for treatment of CAS. Given the number of hours per day a child spends with family versus therapist, opportunities for practice are multiplied when parents encourage speech practice outside of therapy sessions. Extending therapy targets into the child’s home environment promotes motor learning that goes beyond acquisition of motor skills. *Motor skills* are established through many repetitions of a movement. *Motor learning* is established when the motor skills are carried over to a functional task. For example, a child can produce multiple repetitions of a target phrase such as “More, please” in therapy, demonstrating intelligible production of that phrase in practice. Using the phrase in therapy to request more time with a toy is the beginning of motor learning. Having opportunities to ask for “More, please” many times during the day at mealtime and snacktime brings the motor learning into the “real world” where a child experiences the power of using his or her voice.
The therapy process affects the entire family, not just the child with CAS. Parents and other family members who are actively involved in the therapy process are more likely to be comfortable giving valuable feedback to the therapist. Such feedback can help the therapist determine the next steps in the continuing evolution of therapy goals. It may also help the therapist recognize what they do that works well for the child and their family and what they do that is not as effective. As a young clinician who had no children, I was eager to assign parents “homework” sheets for speech practice at home with their children. Many times the sheets were taken home and forgotten. As an older and (hopefully) wiser clinician, I have learned to request feedback rather than wait for it to be offered. And I have learned the value of teaching parents ways to insert speech practice into daily interactions.
(Dr. Ruth Stoeckel has worked in a variety of settings, including schools, private practice and clinic. She is currently employed at Mayo Clinic in Rochester, Minnesota. Her clinical interests include childhood apraxia/severe phonological disorders, autism, cochlear implants and early language development. She frequently presents at workshops and conferences on childhood apraxia of speech and has published CAS treatment efficacy research. Ms. Stoeckel is a member of the Childhood Apraxia of Speech Association’s Professional Advisory Board.)