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Establish Functional Communication and Early Success

Many children with CAS struggle so significantly and are so severely affected that they have difficulty attaining any semblance of a functional vocabulary. Thus, one initial goal for treatment of such children should be to aid in establishing such a vocabulary. A careful inventory of the child’s current consonant and vowel inventory may provide a clue as to beginning words (or approximations) that may be possible. Word choices should take into account words and functions that a child would want to communicate. One method of therapy, “successive approximations” (also see the Kaufman method), may help to establish functional verbal communication. Word approximations are shaped and molded, with the assistance of cuing and input from the SLP, until there is independent accuracy in the word production.

A core vocabulary book can also be constructed in order to identify and pictorially illustrate such vocabulary targets and equally serve as a practice tool for families to use at home. The parent can use the core vocabulary book at home to engage the child in practice of target words. Such books are inexpensive and simple to construct with everyday materials and photographs. (see information on David Hammer’s approach)

Once a core vocabulary has been established, it may be useful to incorporate “carrier phrases”, i.e., short sentence constructions in which core vocabulary can be inserted. For example, “I see _____”, “Where is _________”, “I want ______”. Additionally, “power phrases” may be introduced as therapy targets. These are short phrases that may serve high utility to the child (“No way”, “Get out”, “Me too”) and provide the child with functional communication.

Systematic and Hierarchical Structure for Early Success

Many methods employed for successful speech therapy for children with CAS are both systematic and hierarchical. A strong emphasis is placed on understanding the current level on which the child is successful and then incrementally building and shaping improved articulation accuracy and movement sequencing through systematically altering the phonetic length, articulatory adjustment, contexts, type of external cues and so on. Clinicians need to be careful to insure that children with apraxia have early success in their speech therapy sessions. One way to enhance this probability is to make sure that starting work is focused at the level at which the child can be successful and then incrementally begin to build new CVC forms, new speech movement patterns, new contexts, etc. (see information on Shelley Velleman’s approach)