When targeting speech production, I often provide tactile cues following the PROMPT model, along with various visual, gestural, and verbal prompts. Additionally, I incorporate motor learning theory, DTTC, ReST, and some of the K-SLP approach when developing appropriate targets. I provide intensive and repetitive practice of motor speech targets throughout the session, but am careful to watch the child's motivation and emotional state as a whole and balance between blocked practice and random targets. I see it as teetering on the line of pushing them in new ways in order to make progress, while not pushing too hard to where they shut down and don't want to communicate. Following the session, I will provide the family with a list or workbook of specific targets practiced, strategies that were successful and/or showed potential, and discuss with them a frequency of which they should be practiced. I work diligently to keep the families involved in treatment by being present throughout sessions, keeping an open dialogue regarding home practice successes and areas of weakness, and providing consistent feedback regarding various prompting strategies/ techniques and targets. For children with more moderate to mild CAS, I take a similar approach with regard to their interests and shaping motor speech targets; however, I typically incorporate more blocked practice and incorporate a more structured approach to the session.
I have previously participated in the Los Angeles and Chico Apraxia walks, and have presented basic information regarding "red flag" characteristics and differential diagnosis during staff meetings. Although I have not participated a lot in the "Apraxia community," I am interested in becoming more involved and look forward to this new period of learning and professional development.
I keep parents very involved throughout the therapy process. I help them develop a list of reinforcing items/ words to target, have them present throughout each treatment session, teach them prompting strategies, provide them with research to support various treatment approaches/ techniques, observe them working with their child and providing the various prompts while providing immediate feedback, provide visuals, and work with them to determine an appropriate frequency and intensity in which to target speech production each day. I find that if we begin with topics/ vocabulary that are motivating for the child that they are more willing to participate in blocked, intensive practice, and they are more frequently targeted and generalized across environments. Although I am the one guiding sessions, breaking down targets, and providing the direct treatment, I keep open communication with the families to ensure buy-in, carryover, and generalization of the targeted motor plans.
Most, if not all, of the clients I have serviced with a diagnosis or suspected diagnosis of CAS have presented with severely impacted speech and exhibited a lot of behaviors as means of communication. Thus, my first goal is to reduce behaviors through the introduction of AAC (whether sign language, PECS, core board, dynamic device, AAC app). I begin by following the child's lead and observing what motivates them to communicate in both a positive and negative manner. I also take time to discuss reinforcing items/ activities with the family prior to starting, in order to target augmentative communication and begin to shape verbal production for the motivating target(s). I then begin to shape communication through their interests, while building their confidence via AAC and in their attempts at verbal communication, and establishing rapport. Within the reinforcing activities, I take a multimodality approach to communication, combining the use of AAC with speech production targets that align with challenging motor plans.