When working with children with CAS, I use a multimodal approach to treatment that incorporates a range of cueing strategies, including visual cues (look to my mouth, look at their own mouth in the mirror), verbal cues (regarding placement of articulators, degree of accuracy), and tactile cues (touch cues to guide placement of articulators across speech movement gestures). I carefully select my treatment targets based on the child's current abilities, areas of weakness, and stimulability of a targeted skill. I select targets according to movement gestures (opening, rounding, retraction movement in the context of different consonants and vowels and/or syllable shapes) and create words that would be functional and meaningful to the child and their family/community. I also address prosody from the very beginning of treatment. I begin sessions with a motor warm-up appropriate to the targeted gesture using mass practice with targets presented in a randomized order and with faded cues. I then incorporate targets within play-based activities, shared book reading, or other semi-structured tasks. I also incorporate principles of motor learning to facilitate learning of a skill + retention and generalization (e.g., mass practice of a skill, randomized practice, delayed feedback, faded feedback). Finally, I believe strongly in communication amongst the family and therapeutic team as a key element to success. I let the family know targets that are being address in treatment and how they can be carried over and targeted at home. I also make sure to have regular contact with the therapeutic team to ensure that goals are in line across therapists.
As a doctoral student, I have been involved in research on CAS for the past 6 years. I have extensively reviewed the literature and written papers related to CAS during my studies. I have also attended the Apraxia Kids national conference and been awarded two research grants with my advisor, Dr. Maria Grigos. We have presented at a number of conferences on CAS including the Apraxia Kids conference, the Motor Speech Conference, and the ASHA conference. I have a published paper on speech motor control in CAS (Case & Grigos, 2016) and a second paper under review (Grigos & Case, under review). At NYU, we also sponsored Dr. Strand's course on the assessment and treatment of CAS and a parent workshop led by Dr. Strand.
I typically see children in their homes and always invite parents into our sessions, if it does not impact the child's ability to attend to treatment. If they are not in the home, I contact them after the session to let them know how their child performed during our session and what was targeted. I also let them what they can work on at home, or areas where they have concerns that can be addressed in treatment.
Incorporate gestures/sign from an early age and use of picture symbols to facilitate communicate during our sessions and at home/school.