Every child with CAS is different, and I firmly believe in individual treatment planning for each client I treat. I take into consideration age, interests, personality, confidence level with speaking, and more when planning treatment for each child. I do not use any one, “canned,” treatment approach, but rather use a variety of strategies that have been proven effective for children with CAS.
For children with little to no vocalizations or words, I implement an alternative-augmentative communication (AAC) system to help build expressive language success. This can include the use of manual hand signs, pictures, or higher-tech options like using an iPad. Using AAC ensures that the child has an avenue to expand their expressive language skills and communicate effectively, while we are organizing their motor speech system to develop their verbal speech skills.
My treatment is then focused on maximizing success with verbal speech. Many of my clients with CAS have had many failed speech attempts and their confidence to speak can be low. I establish early success by doing a thorough evaluation to determine what level the child is already successful at and starting there. I also look at what sounds a child currently has in their inventory and build words from those sounds to increase the chances of success. I use aspects of Nancy Kaufman’s success approximations and David Hammer’s core vocabulary approaches to build an initial functional vocabulary of words that are important to that child or family, as well as including “power words and phrases” for younger children like, “mine,” or “me too.” I find that establishing a functional vocabulary early can be powerful in increasing success and confidence with verbal speech for children with CAS.
Throughout my treatment I incorporate principles of motor-programming and motor learning theory, since CAS is a disorder of the motor speech system. These principles include frequent, intensive practice of focused speech targets; using multi-sensory cues to help trigger motor memories; and providing feedback on both results and performance. I individually tailor the activities we do in therapy sessions to each child to make them fun and engaging to increase the likelihood that the child will participate in mass practice of a speech target.
To help my clients build successful motor plans, I use auditory, visual, tactile, and other multi-sensory cues. I am PROMPT Level 1 trained, and I implement this tactile-based cueing method for children that benefit from and tolerate hands-on tactile cues for speech production. Most sessions, however, I use Dr. Edythe Strand’s Dynamic Temporal and Tactile Cueing (DTTC) method, fading from simultaneous production to direct imitation to spontaneous production while adding or fading multi-sensory cues as needed for success, like auditory cues (listening to my verbal model), touch cues, and visual cues (watching me or using a hand cue).
Parent/caregiver coaching and involvement is an important step in my therapy process. I encourage caregivers to sit in on our sessions and always spend the last 5-10 minutes of our session coaching the caregiver on our therapy targets and multi-sensory cues. I create tailor-made home programs, that focus on intensive practice of speech targets that parents can incorporate into their everyday activities.
I am involved in the Apraxia community as a speech-language pathologist that provides a successful, evidenced-based practice approach to evaluating and treating CAS. I regularly partner with teachers, daycares, school SLPs, and preschools in my local community to coordinate carry-over strategies and to advocate for the children that I treat with CAS. I have attended in-person CAS trainings and participated in Apraxia Kids webinars to ensure that I’m up to date with best practices in CAS. I am an avid follower of Apraxia Kids and Apraxia Kids on social media, and I regularly direct parents to the Apraxia Kids/Apraxia Kids website to help them find the most accurate information and an active support community. I look forward to increasing my involvement in the Apraxia community in the future. I plan to participate in our local Greater Hartford Area Walk for Apraxia next year and to continue to attend Apraxia Kids trainings to further my education on evaluating and treating children with CAS.
Parent/caregiver coaching and involvement is always an important step in my therapy process. To begin with, parents know their children best, and I sit down and have a conversation them to get to know they’re child better so that therapy is successful. Parents provide me with key insights on comfort level, past communication failures, what works for encouragement, and how to make therapy fun and engaging for their child. They also know what words are going to be most important to their child and family to target first, which helps me target a truly functional vocabulary. I encourage caregivers to sit in on our sessions so that they can watch, participate and learn, and I always spend the last 10 minutes of our session coaching the caregiver on our therapy targets and multi-sensory cues. I create tailor-made home programs that focus on intensive practice of speech targets that parents can easily incorporate into their everyday activities and that are fun and engaging for my clients. The easier to implement and the more engaging, the more successful families will be with their home program. I see the best results with a successful home program, and encourage collaboration with nannies, daycare teachers, school SLPs and more to help my clients make the most progress.