During the school year, I work full-time at a middle school where I have a caseload of students. On the side, through my private practice, I conduct comprehensive speech evaluations, including specialized assessments for children who have difficulty with speech motor planning. In the summer, I offer intensive therapy programs specifically designed for children with Childhood Apraxia of Speech (CAS).

My Summer Intensive Program:
I work with up to 5 children during my summer program, providing two 30-minute sessions each day (with at least an hour break between sessions) for 2-3 days per week over 5-6 weeks. This intensive schedule helps children make faster progress than motor speech therapy 1x to 2x per week.

How Sessions Work:
Each child sits in a supportive chair where they can focus comfortably. I keep their favorite motivating items nearby - things like stickers, toys, or activities they enjoy - to keep them engaged and celebrate their hard work.
Before we start, I explain what we'll be doing in a way that makes sense for each child. Some children work well with a token or sticker system, while others are motivated by praise and encouragement throughout the session.

The DTTC Approach:
I use a specialized technique called Dynamic Temporal and Tactile Cueing (DTTC), which is specifically designed for children with CAS. This approach is "dynamic" because I constantly adjust the type and amount of help I provide based on how your child responds in real-time.

The Three Types of Cueing:

1. Temporal Cueing -
This refers to the timing of when I provide support. I might:
- Say the word at the exact same time as your child (simultaneous production)
- Say the word first and have your child immediately repeat it (direct imitation)
- Say the word and wait a few seconds before asking your child to repeat it (delayed imitation)
- Eventually, just show a picture or give a prompt and let your child say the word independently

2. Touch Cues or Tactile-Kinesthetic Cueing (i.e., PROMPT cues) -
For children who need that extra sensory feedback to help their muscles learn the correct speech movements, I use specialized touch techniques. This might include:
- Gently touching their lips to help them feel when to close for sounds like "p" or "b"
- Lightly guiding their jaw movement to help with mouth opening and closing for jaw excursion for vowels
- Providing gentle pressure on their cheeks or under their chin to support proper muscle coordination
- Using touch cues on their throat to help them feel vibration for voiced sounds
- Guiding their tongue placement with gentle tactile support

This sensory input helps children with CAS develop the muscle memory and motor planning skills they need for clear speech production.

3. Visual Cueing - I provide visual support through:
- Exaggerated mouth movements so your child can see how to make the sound
- Hand gestures that match the speech pattern
- Visual cues like pictures or symbols
- Mouthing the word without saying it (mirroring)

How the Levels Work:
I start with the level of support your child needs to be successful - this might be saying the word together while I provide tactile-kinesthetic cues to help their muscles feel the correct movements. As your child improves, I gradually reduce my support. For example, I might move from providing direct touch cues to just pointing to the area where they should feel the movement, then to just showing the word's rhythm with my hands, and finally to letting them produce the word completely on their own.

The beauty of DTTC is that it's completely individualized - if your child needs more support on a particular day or with a challenging word, I immediately provide it. If they're doing well, I challenge them by reducing my cues. This flexibility helps ensure your child experiences success while being appropriately challenged to grow.

Target Words and Practice:
After an initial assessment, I carefully choose 3-5+ target words that are meaningful and useful for your child. We practice each word about 50 times during each session (I try to make this happen naturally with favorite items, e.g., practicing "in" when putting pieces into a puzzle). Once your child can consistently copy a target word during our sessions, I'll guide you on how to practice it at home - typically about 20 repetitions that same day.

Tracking Progress:
At the beginning of each week, I check how well your child can produce their target words without any help from me. This helps me know exactly where to focus our work and when to add new, more challenging words.

My Philosophy:
I believe in making therapy enjoyable while maintaining high expectations. We start working right away because I know these children are capable of amazing progress when given the right support and intensive practice.