Every child is beautiful and unique in their own way. I celebrate individualized differences and adapt my therapy strategies to meet each child's needs. My initial priorities change depending on the child's age and development. If the child is within the early intervention age (birth - 3 years) and / or with a suspected diagnosis, then I feel parent training and education is most important. Parents need to understand foundations to communication and how to encourage speech exploration in fun ways that can be incorporated into naturally occurring routines. It is important for parents to understand they shouldn't put demands or pressure on their child to talk but allow opportunities for them to explore sounds in a fun way. With older children, I feel gaining rapport is necessary to help establish a trusting and safe relationship. Speech is hard for many children with CAS so they need to feel supported. I'll often make sure the child has the opportunity to do something they feel good and successful with before asking them to do something harder. I also feel it is important for children to understand why they are receiving therapy. Motivation is also a key component for success. Activities need to be chosen based upon the child's attention, interest and abilities. I use a variety of therapy strategies depending on each child's needs. In the younger ones, I use a play-based and routine-based approach to work on developing sounds. Once words begin to develop we can use integral stimulation and encourage the child to look and imitate a verbal model. Dynamic Temporal and Tactile Curing (DTTC) strategies are also used. Some children benefit with tactile facilitation and PROMPT cues.
My therapy approaches have remained the same through teletherapy. Parent training and education is crucial in early intervention ages and during early speech development. Because the focus is on family learning, your child does not need to be able to sit in front of a screen to benefit from teletherapy. Many young children or children with different sensory needs are running or swinging during the session. Parents are guided on how to support their child’s communication development during various activities. Older children who have more speech, might have a hybrid approach – where they work directly with their parents and the clinician during the session. And some children who are more independent might be able to do the session on their own.
I am on Apraxia Kids Facebook groups and I created my own Facebook community specifically for speech language pathologists to help further their knowledge of CAS. I post on the groups and I help support families as much as I can. I am passionate about continuing education and I'm always seeing out learning more to further develop my clinical skills. I'm trained in PROMPT, and I attend study groups led by a PROMPT instructor when available. I'm always seeking new knowledge and finding ways to share it with others.
I have always had a strong focus on family involvement in my practice. For early intervention and beginning communicators, I require parents or caregivers to be involved. Research shows young children learn best in their natural environments with their familiar caregivers. This also gives the family an option to provide therapeutic strategies multiple hours throughout the week instead of just 1-3 hours a week of direct speech therapy. It is my goal to teach parents, nannies, siblings or anyone involved in the child’s life to learn and practice the strategies.
I try to honor different learning styles and provide options such as reading handouts, verbal instruction, watching a model and through directly practicing. A combination of approaches is used during learning while the goal is to see family members using the new skills during therapy sessions. If the child is unable to be present during therapy sessions, then family members can still demonstrate their use of the learned skills through video. Family members can take short videos of them using the skills during the week during different activities. These videos are watched and reflected on. What went well? What challenges came up? What new strategies can be tried next time?
When COVID-19 pandemic began and sessions transitioned from in-person to teletherapy. A lot was unknown at this time. As a speech therapist, I was concerned some children wouldn’t make the same progress as in person. Some parents had the same fear and discontinued therapy, while many families decided to give teletherapy a try. I was pleasantly surprised when I saw how parent involvement changed. When I was in-person, I had some families who were involved parents however they preferred to have their child engage in direct therapy with me while they asked questions at the end. When I tried to encourage more direct involvement during sessions, they assured they were listening and continued to practice at home.
During teletherapy, they had to be there so I was able to directly see how the home practice was going. I often saw the parents doing a good job but often forgot some key strategies. I was able to coach them in the moment and suggest using strategies. After a few sessions of using the skills together and talking through things, the parents speech practice with their children went from good to excellent. Instead of lack of progress, I was seeing a huge growth in many children. That was because parents were more involved during the sessions, so they were able to practice and refine the use of their skills. So when they did practice outside of therapy, they had more efficient use of the tools to help their child.
Through offering teletherapy, I’m able to focus more on parent education and training. And now I’m able to offer services all over California and not just in Los Angeles area!
I can explain different forms of alternative communication along with the benefits and drawbacks of each. I provide training and materials for low tech systems. I can support learning some sign language. I can establish a picture exchange system and help families and children learn to use it. I can explore beginning use of high tech AAC communication systems during my sessions. When a child demonstrates a high-tech system would be the best system, then I support them by finding a referral for an AAC specialist to join their team. A specialist would have more experience in vocabulary selection, organization, programing and training the different communication systems.