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- Box 209 35 Stone Church Road, Ancaster
- Amy O'Connell SLP Services
My overall approach to the treatment of CAS is both multi-sensory and based heavily in the principles of motor learning. I don’t believe that one approach fits all, therefore I tend to borrow elements from the Kaufman Speech to Language Protocol (K-SLP), Moving Across Syllables Approach and, as required, PROMPT techniques. For most children that I meet, the first step is to establish a list of functional vocabulary items. This may include specific nouns, verbs, family/pet names, and power words (i.e.: no, go, stop etc.) that the child needs in order to communicate more independently in his/her home and/or school setting. From there, I like to work to build movement patterns and word shapes. Using the Kaufman Speech to Language Protocol (K-SLP) or Moving Across Syllables Approach, sessions focus on building sound sequencing skills and expanding the range of movement patterns that the child is able to complete successfully. At the same time, we are working to achieve consonant and vowel sounds that the child may not yet have in his/her sound repertoire. This work involves tactile (as accepted by the child), verbal, and visual cueing. As soon as possible, I work to reduce the level of cueing while maintaining production success. For all clients in my practice, I strive to target multiple goals within a single task. With respect to CAS, as appropriate, I try to pull in elements of early literacy teaching or phonological awareness skill building as exposure therapy. Recognizing that children with CAS are at increased risk for early literacy delays, my goal is to help build in some of these skills while working with speech sounds. This might involve pulling my Lively Letters resources, playing with some early phonological awareness tools, or just generally guiding the child’s attention to the fact that the sounds we are practicing can also be represented in print.
In addition to being an SLP for the past 15 years, I have been mom to a child with CAS for the past 8. In this time, my involvement with the Apraxia Community has grown beyond simple service provision to advocacy, education, and awareness building. Since attending a workshop presented by Dave Hammer in 2015, I have become increasingly aware of the Apraxia Community and have sought to extend my involvement both personally and professionally. As a family, we attend our local Walk for Apraxia yearly and are proud to add new members to our team each year. Professionally, I have accessed and shared resources and social marketing materials from Apraxia Kids and other sources to help build awareness and support early identification in the children with whom I work. I am excited to be attending my first Apraxia Kids National Conference this July in Pittsburgh, Pennsylvania.
My clinical practice is based heavily in parental involvement and competency building. Whether I am working with a child with CAS or a child with a reading delay, my goal is to help equip the family with specific skills and strategies that they can use to support, extend, and maintain skill development beyond the therapy session. Parents are always welcome and encouraged to participate in session. However, I acknowledge that there are times when this is neither possible (i.e.: other siblings to look after) nor ideal (i.e.: child is better one-on-one with clinician). In these instances, parents receive video clips from session to assist with learning the cues and strategies that were helpful in achieving session targets. My goal is to provide parents with multi-sensory cueing strategies and then teach them how to fade these cues as the child achieves success. In the other direction, I seek as much information as possible from parents to help develop meaningful and functional vocabulary and communication targets for therapy. I want to better understand what daily life looks like, so that I can develop home practice strategies that are meaningful and achievable. Given the amount of therapeutic support that children with CAS require, optimizing parent confidence and competence is a primary way of ensuring ongoing, practical, and context-varied practice between therapy sessions. Working with the family, I want to find ways to make practice part of what the family is already doing, rather than something more to add to their list. The type of work sent home, really depends on the parent’s level of comfort with cueing and modelling.
Too often, the ability of a child with CAS to independently communicate a message is tied to the context of their message being known by their communication partner. While this works for talking about the “here and now”, it does not allow the child with CAS to independently talk about past or future events, thoughts, feelings, ideas, and interests. This can significantly limit a child with CAS’ ability to socialize and share in the language of their peers. I have used both low-tech and high-tech options to help bridge this gap. For instance, we have used an “about me” book to help the child with CAS communicate specific interests or facts about themselves on the first day of school. Similarly, my son uses the Pictello app to document vacations, important events, or family outings so that he can independently share these events with his peers. When the context is provided via AAC, conversation can ensue. For children with very limited verbal skills, the use of low-tech AAC visuals can be helpful in communicating very basic wants and needs such as “I need a break” or enabling the child to refer to important family members, pets, or items not physically present. Higher tech AAC can be helpful for the child working to expand phrases and improve the grammatical accuracy of their spoken utterances through immediate auditory feedback. These devices can also be helpful for programming specific functional phrases, such as my son’s Santa request when he was 5 and unable to ask for a camera independently. I have used all of the above both personally, and professionally. I have experience with the basic functioning of various AAC applications including Aacorn/Aacorn+, Lamp Words for Life, Proloquo 2 Go, and Touch Chat.