I use a multisensory, eclectic approach based on integral stimulation that incorporates the principles of motor learning. Sometimes this is described as a “watch me, listen to me, do as I do/do it with me” approach. The approach I take depends on the severity level of the child and the child’s needs. For more severe needs or earlier in therapy, I might use the Dynamic Temporal and Tactile Cueing (DTTC) approach. For a less severe case or a child that is further along in treatment, I might use more of an eclectic approach, but always focusing on movement pattern and syllable/word/phrase shapes rather than isolated sounds. I love to use motivating materials that help us to incorporate literacy, pragmatics, and language skills. I use hierarchical cueing strategies such as simultaneous speaking, teaching the child to watch my mouth, whispering, tactile cueing, performance feedback, results feedback, cognitive cueing, and visual cueing. Depending on the needs of a child, for reinforcement I have used simple token boards (first we work, then we get a reinforcer), or a more complex bean-and-rocks-in-a-cup system that “marks” each response with a bean (to reinforce practice) and rewards actions such as self-monitoring or concentrated efforts with a green rock. Red rocks imply slow down/stop and are given to extinguish negative behaviors.
I have worked and volunteered at Apraxia Austin’s Ranch Camp in 2016, 2017, 2018, and 2019. As I have my own child with severe autism and CAS, I understand the parent’s side of CAS and autism as well.
As parental/caregiver involvement is an important aspect of therapeutic remediation, especially for CAS, I prefer to involve the parents/caregivers whenever possible, asking them to attend sessions and to take notes or record information so that they can practice at home. At the end of each session, I like to discuss ideas for home practice and answer questions to make sure the parent feels comfortable with practicing. I am open to other significant persons attending therapy, such as grandparents and siblings who might be caregivers or play partners. As the parent of a child with severe CAS myself, I have seen how my other child has been empowered and encouraged by understanding how to help her sibling with speech. Depending on the needs of the child and if it will target their current goals, I prefer to incorporate the family members into activities. I enjoy having the parent’s input and working as a team to help each child find their voice.
I love incorporating AAC into sessions. I have used pictures, picture symbols, written words, signs, coreboards, and devices ("Talkers" with LAMP and Proloquo2go). Within our sessions, we tend to use AAC in the same manner in which we might use verbal words in between targets. Naming toys, requesting, commenting on books and play activities, expanding expressive and receptive language, and expanding the mean length of utterances.