My overall treatment approach is to increase the number of intelligible words and increase overall communication. I begin with parent/family education of the specific therapy approaches to CAS. I encourage frequent home practice and emphasize the importance of frequent imitation/repetition of words. I begin therapy with a list of current words, current syllable shapes, and list of motivating/core words. I will start by building current syllable shapes and increasing the variety of the patients phonetic repertoire in a variety of syllable shapes. I usually start with early developing sounds or sounds that the patient is stimulable for. I will progress from CV and VC words to CVCV (repeating) to CVCV (alternating). I start with early developing sounds and sounds the child is stimulable for. I will work on simple vowels and move to vowel dipthongs and complex consonants (w and y). I start with a list of motivating/core words and I will make pictures (and simplify the words if necessary) for home practice. I use principles from David Hammer and core words, principles from Nancy Kaufman's Speech to Language Protocol and cueing from PROMPT. Depending on the patient, I individualize therapy according to progress with each method. I consider the patient's cognitive level, parental support, and co-existing impairments. I always provide homework with words that the child has been stimulable for in therapy or at least provide 2-3 "power words" for home practice. I incorporate carrier phrases frequently in to therapy. I focus on frequency of word practice and incorporate drill in to therapy sessions. Sounds are given names (e.g., "lip sounds, popping sounds, tongue tappers, etc) that are appropriate for the child and age/cognitive level and names are used in therapy sessions and provided for home use.
I have supported local Childhood Apraxia of Speech groups by attending various fundraising campaigns. I am a member of local Apraxia Facebook groups. I am a member of the Apraxia Kids list serve and have individually reached out to a few parents with questions. I would love to attend the Apraxia Kids training in July!
Parents are directly involved in all therapy sessions. Parents incorporate their child in therapy and are actively involved in the session. Parents are provided with information about CAS and given handouts/resources. I encourage parents to use the Apraxia Kids website. Parents are provided with homework every session. Parents are also encouraged to track progress and bring in ideas for core words for practice. Parents are given progress notes every 90 days and progress is discussed each week. Parents are actively involved in "naming" the sounds (e.g., "lip sounds, tongue sounds, etc) and encouraged to use these words at home.
I believe in using AAC to support children with CAS. I have secured dedicated communication devices for several patients who have had CAS. I have also used high tech applications with several other patients whom I believed would progress quickly in speech therapy (families already had iPads). My main goal in therapy is increasing overall communication and AAC is a great tool to use when enhancing language. In therapy, I will model the word (verbally), provide a tactile cue (on patient), then model on the communication device. This gives the child the opportunity to attempt to verbally imitate or use the communication device to express himself/herself. This has now given the child the power of communication and they are now motivated to try it again the next time. I have also used some sign language with very young children. I am thrilled to say that the majority of my patients whom have used SGD's are now fully verbal and no longer need their AAC system.