My therapy approach for CAS puts the individual child at the center of all of my planning. I want motivation and engagement to stay high throughout sessions, so I carefully plan targets to encourage maximum success and help increase functional communication. This starts by identifying skills that children already have, and then expanding to target a related skill that they have not yet mastered. I also see goal setting as collaborative with parents and caregivers--what are the key areas of difficulty at home and how can I use my knowledge and skills as an SLP to help troubleshoot those communication barriers and work towards easing struggles through our goals in sessions? Because CAS involves motor planning deficits, I aim for high repetition in sessions. Strategies such as shaping targets, using multi-sensory cueing and feedback, and providing opportunities for large numbers of repetitions are a large part of my treatment. I don't take a one-size-fits-all treatment approach because kids are so unique! In my 10 years of experience, I've found that a combination of methods and approaches is important to address the needs of each child. My practice also utilizes technology to help improve speech skills, and I work with a team of computer developers who have created games that allow for home practice in order for kids with intensive practice needs to engage more easily with home practice between sessions.
I have been a pediatric speech-language pathologist for 10 years and have had the opportunity to work with a number of children with CAS--additionally, I became an SLP because CAS runs in my family. I engage with a number of apraxia awareness initiatives through my social media account verbosospeech. I would like to increase my efforts in apraxia awareness and advocacy, as I've found that SLPs are sometimes unsure of the diagnosis and as a result, kids may not get appropriately intensive therapy until they are closer to 6 or 7 years old. My own son, who is now 3 years old, has demonstrated motor planning symptoms since he began babbling at 5 months old (groping behavior when trying to speak, inconsistency, etc), so I suspect that there is a lot of room for research and awareness of how to identify precursors to some of the speech behaviors we use for differential diagnosis. Early diagnosis is key and I would like to help advocate for this!
I view parents as a critical partner in therapy for kids with CAS. I deliver services via teletherapy, and as such, making sure parents are comfortable as facilitators is one of the first steps in the process. In fact, I've found that one key benefit of teletherapy services is that parents are present and participating for the duration of sessions. This is invaluable, as it provides opportunities for collaboration and teaching regarding feedback and recommended practice. Because of the underlying motor planning issues present in CAS, the need for high numbers of repetitions is important, but can be challenging to achieve due to all of the scheduling conflicts that arise for busy families. When parents are empowered to confidently oversee home practice, this can make a world of difference in helping kids achieve enough repetition to facilitate motor learning.
I do not consider myself an AAC expert and refer out for high tech AAC needs. I do advocate for early sign and picture support for functional communication when moderate/severe CAS is present early on, and incorporate this into sessions and parent instruction, although tend to focus the bulk of my therapy time on speech production goals.