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- 6399 Fishtrap Road
- The Heart of Behavior
First and foremost, I work to establish rapport. Working on any speech is often hard and incredibly effortful for the child, so it is even more important to keep the value of engagement high.
Depending on motivation and behavior, I strive for frequent and intensive practice of highly specified and limited speech targets with the recommended 100-200 trials within a 30 minute session. These are initially rapidly mass trialed and consistently presented (“blocked practice”) to give sufficient practice for learning the specific speech motor planning for the targeted speech movements.
It is important to note that all sessions are conducted as individual speech therapy, 1:1 direct. Depending on scheduling, funding, and availability, sessions occur multiple times per week.
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All of relevant areas are integrated into parent/family training and involvement. These include motivation, practice intensity, individual targets, and descriptive feedback. Parent training is required and it occurs as the parent/family are able to participate. Parent education is a vital piece of teaching the importance of how to continue to teach and generalize taught skills. Recommendations for treatment intensity are provided to support parent carryover. Parents are required to complete practice sessions outside of the time the patient comes for direct intervention. Also, therapy materials (i.e. books, games, crafts, toys/prizes) are specified for home sessions to prevent satiation and to provide consistent implementation.
Apraxia-Kids’ tagline “Every Child Deserves a Voice” is a concise and meaningful way to talk about AAC and CAS. Children with CAS are often unable to effectively communicate, but they still have important things to share and they have a basic human right to communicate those thoughts. The fundamental right to effective communication does not start at a specific age nor is it limited to a specific amount of natural speech. Bearing those two key points in mind, I consider AAC options immediately if a patient presents with barriers to communication (which is usually the case if the family is seeking intervention). For very early learners and barring any significant motor deficits, I often investigate the use of sign language because of its portability, allowance for prompting, and the multi-sensory input it provides. For patients with significant motor deficits, I may probe PECS or another form of picture exchange. I have also used a multitude of high tech AAC devices depending on the patient’s specific profile. The bottom line is that we owe it to our patients to provide functional communication while we target speech motor planning. It is not fair to wait until their natural speech develops until it is strong enough to support their communicative needs. These patients need to communicate now, and they have a right to effective communication.