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- 7185 Navajo Road, Suite D
- Lake Murray Speech & Language
My approach is intensive and usually involves shorter sessions several times a week for maximum progress. I find the least amount of prompting that a child needs to produce the most complex type of utterance and then to use less prompting over time while increasing the complexity of utterances. For example, if a child already produces V, C, CV and VC combinations but does not yet produce CVC combinations, I would do stimulability testing to see if they are able to produce a CVC combination with tactile prompts, visual or auditory cues (such as simultaneous production with "voice on" or "voice off"), direct imitation, and then delayed imitation. Some children vary in the amount of cueing they need, based on the context and their level of fatigue. This is very important for me to pay attention to so that the child does not become frustrated. Each time we practice a word, I like to get as many repetitions as I can. Some children have the attention span for 3 repetitions only, but if a child will repeat 10-15 times, I know that we will make much progress much more quickly. Thus, I give rewards and incentives throughout therapy that are interesting and fun for the child. Over time, I like to see the child mastering the combinations and then moving onto new combinations and new sounds (e.g. CVCC or CCVC, then multisyllabic words, then phrases, and then sentences).
I like to use Kaufman cards to help children develop new combinations and also to provide the cards as a home program for parents to follow. Additionally, depending on the age and motivation of the child, I like to choose 5-15 novel words or phrases that the child can practice in therapy (with the cues they need) and also at home with their parents. We add on a few new sounds, words, or phrases once they have mastered about half of their word/phrase/sentence list.
For those with a very small speech sound repertoire, I have seen new speech sounds emerge with some exposure to tactile and visual cueing as well as with an increase in the child's level of confidence when communicating. Therefore, it is very important to incorporate AAC into therapy to make sure that frustration is kept at bay. I am fluent in American Sign Language, so I will generally teach simple signs (in play) that the child can use if they seem to be interested in this form of communication. I am also PECS certified, which is another system of communication that has been effective for kids with CAS. I encourage the family to maintain AAC while setting aside specific time for speech, often with a reward at the end of practice to keep their child motivated.
Lastly, if there are difficulties with prosody, I will wait until we are at the phrase level to work on this. I have found that working on sustained phonation and then completing glides (high to low and low to high) in an exaggerated way can help a child speaking in a monotone to vary pitch. We can then choose continuant consonants, /m, n/ and do the same glides, eventually moving onto gliding on a vowel with CV and VC combinations, then gliding throughout a short 2-3 word phrase. Depending on the child, we may focus a lot on prosody if they are very stimulable, or we may work on intelligibility more if this is the main area of concern.
I have been involved insofar as it has affected my patients and their family. I have educated the families that have been referred to me and have attended continued education for the purpose of serving them better. I have encouraged all of my families to become involved in Apraxia Kids and Apraxia Kids. I have also been successful in educating the hospital staff where I worked and my patient's insurance company that children with CAS need more intensive therapy (shorter sessions several times a week is better than long sessions infrequently).
I like to have parents in all sessions if possible, unless for some reason they are a source of distraction. I like for parents to think of the new word and sentence lists because they will choose the most functional utterances for their child to practice. I teach to do simultaneous production with their child and encourage them to do this at home if it helps their child to be more accurate. I also teach them how to use their smart phone to record the mouth area saying the target words so the child can practice this way if it motivates them. The parent reports any new words or sounds at the beginning of each session. I also like to see how the parent and child interact when they do not understand each other so that we can implement AAC (sign, using pictures with a high tech device, or PECS) and the parent will be comfortable carrying this on into the home environment.
I am fluent in American Sign Language and I have taught children with CAS and their families simple signs (nouns and verbs) to use when they are not understood. Many patients and families respond very well to this and can quickly build their sign vocabulary. I have also used PECS and picture boards with children with CAS. This provides more of an opportunity for speech practice, as the child will often say the word along with their parent if they are ready. However, when using AAC, I encourage parents not to pressure their child to speak every time they use signs or pictures.
I have used high tech speech generating devices when working with children with the diagnosis of both autism and apraxia of speech. These devices allow children who tend to become very frustrated to begin putting together words and sentences with confidence, and my experience with them has been positive.