When I first begin working with a child who has CAS, my number one priority is to decrease frustration. This looks different for every child and family, but often involves making a list of the child's speech sound inventory and creating a list of word approximations the family can immediately begin using during daily routines. For example, a child who is able to produce the "p" and "m" sound might be able to approximate the following words: up, papa/grandpa, mama, my, me, mo/more. I then add to that list by moving on to the speech sounds with the most similar characteristics to the ones in the child's inventory. That would add the following target words: baba/bye, bubba/brother, bebe/baby, booboo/injury, ba/ball, buhbuh/bubbles, etc. Once we add these sounds to the child's vocabulary, he/she typically becomes more confident and more likely to attempt more difficult sounds. I simultaneously introduce additional methods of communication at this time if it is necessary for the child's communication. Sign language and AAC are typically used in order to decrease frustration and increase communication effectiveness while the child is learning to verbally communicate. Throughout the process of building a robust vocabulary for children with CAS, I provide a variety of cues, including visual, verbal, and PROMPT tactile cues. These provide additional reference points for the child to make accurate speech sounds. New speech sounds are then added in familiar syllable shapes (ex: ba to da/ta/ma) and familiar speech sounds are attempted in new syllable shapes (ex: mama to mommy).
At this time, my involvement is limited to providing therapy services for children with CAS as well as resources for their families. I am participate in my local Walk for Apraxia for the first time this year, and helped to secure a location for the event.
At Family First Therapy, the name is truly indicative of our approach with families. I believe in a total team effort, and feel that my clients' progress depends on the coaching I do with parents. From the beginning, I ask for feedback regarding the family's goals for their child, as well as the names of important people/objects/activities that are specific to the family. This ensures that our first target words are useful and functional to the child, and will in turn be practiced frequently during daily activities and routines. When we choose words that work for families, it ensures natural carryover and an increase in the number of times it is practiced throughout the week. I also educate parents throughout the process about ways to assist their children, including the use of visual hand cues and verbal cues that assist with the correct production of sounds. While I use research-based treatment approaches, I recognize the need for flexibility in families. For example, while frequent speech therapy sessions are best practice, that is not always realistic for all families and I will provide specific instructions for home carryover to encourage as much progress as possible.
I have used a wide range of AAC for children with CAS ranging from picture communication boards, to binders full of photos, to iPad apps, and speech generating devices. AAC is an important part of the therapy process with children who have CAS specifically because they often have a good understanding of language and what they would like to say, but there is a large gap in the ability to express that in spoken communication. AAC devices help to decrease frustration and increase the child’s ability to express himself.