17 Feb Kristen Bernarducci
Posted at 09:51h in Uncategorized
Credentials: M.S., CCC-SLP
Hours of Operation: 8:00 AM- 7:00 PM
Treatment locations: Office/Clinic
Arlington, Virginia 22203
Overall Treatment Approach:
My overall treatment approach when working with kids with CAS is completely individualized! I value treatment that is both functional to the child's day-to-day life, as well as fun. It is important to consider motor planning and execution cannot happen in a vacuum (aka in the speech therapy room only) so I like to incorporate as much play-based therapy as possible, as a child's greatest strengths in communication tend to be routed in play. I primarily use the cueing hierarchy set forth by Dynamic Temporal and Tactile Cueing (DTTC) while incorporating motor planning principles. To me, it is more powerful to target the kids family member names, favorite toys, pets names, etc. while considering core vocabulary research, versus a set of words we may suspect to be useful. I strive to target between 5 and 10 functional words at a time depending on the severity of the diagnosis. When word targets are acquired, they move from an acquisition to a retention phase.
Percent of CAS cases: 15
I strive to work with the child's parents in order to establish words that are most functional in the child's home environment within their phonemic inventory. Parents are an enormous aspect to my CAS therapy sessions, as they are key players in their child's success! As early as the assessment date I work to provide parent eduction on the nature of CAS, DTTC, and what treatment sessions will look like. I warn them that although it is intensive speech therapy, it is extremely rewarding and each new word their child gains should be celebrated. I strive to work with the child's parents in order to establish words that are most functional in the child's home environment within their phonemic inventory. I provide parents with a core vocabulary development sheet so the most functional stimuli can be identified. Parents are invited into the therapy room to observe the type of cueing and therapy taking place. I conduct an 8-10 minute "home program," at the end of each session where activities of carryover are discussed and how they can fit into home routines. I keep parents very involved in my treatment, as generalization is key in the treatment of children with CAS!
Childhood Apraxia of Speech is a motor-based speech disorder which is only identified when a child begins to learn to speak. When I say "motor," I mean the difficulty programming and planning speech movements. For example, if you had difficulty planning and executing the movement of your legs and feet simultaneously, walking would take a lot of practice. Therefore, to treat childhood apraxia of speech, we need a lot of movement based practice of the articulators (tongue, lips, jaw, etc.) When you think about speech, it is a highly coordinated movement. You need your brain and multiple muscles to coordinate together to convey a message. Therefore, it is not just a difficulty with one or a few sounds (e.g., a kid that has difficulty saying their /r/) however; it is movement based. So, it is treated with word shapes and motor movements versus structured articulation therapy. Hallmark characteristics in CAS are distorted and imprecise vowels, inconsistent productions of words and articulatory groping (your mouth searching for the correct placement of a word). Know that there is nothing you did "wrong" to "cause" this diagnosis. I know it is confusing but with intensive speech therapy (the right type of therapy) your child can make huge gains. I encourage parents to ask any questions, and then point parents to the Apraxia Kids website and Facebook support groups for our area to provide them a network with parents in a similar situation.
I have experience evaluating/treating children with CAS and refer families to the Apraxia-Kids website to gain additional information. I assisted in organizing a team for the Apraxia Kids walk in DC in October 2018. I correspond with other professionals including school speech-language pathologists that the children on my caseload work with, and seek out continuing education opportunities related to CAS to continue to refine my clinical skills with this population.
Professional consultation/collaboration: Yes
Min Age Treated: 1
Insurance Accepted: Yes