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- 4225 West Parker Road
- Lori Sekhon Speech & Language Services
My treatment approach to working with children with apraxia of speech is evidenced-based, as I am guided by the principles of motor learning. While I feel that it is extremely important to individualize treatment and treatment approaches according to those that a particular child will respond best to, I primarily use the Dynamic Temporal and Tactile Cuing approach. Using cuing techniques such as tactile/kinesthetic, visual, and/or verbal cues allows me to help the child initially produce the sound, syllable shape, word, or phrase. The therapy process gradually allows the fading and reduction of cues until the child is able to retrieve the motor plan for the speech target independently. I will also use the "scaffolding" approach (Nancy Kaufman), where words are "built" with successive approximations as the child's phonemic repertoire and motor planning ability increases. The principles of motor learning research shows that repetitive practice is important for children with CAS, so getting in as many sessions per week is important. Getting the maximum number of responses per session is always a priority as well. Mass practice is used for new targets, whereas distributed (varied) practice is used for targets that are nearing mastery (motor learning/generalization). The child is taught to rely more and more on self/internal monitoring of speech as they progress, because that's what we do when we use conversational speech. I strive to keep each child motivated to "work" by incorporating games, books, toys, and movement that each child chooses. What's fun for one child may not be considered fun to another! I have significant experience working with children with autism, as well using behavior principles and sensory processing strategies for optimal regulation. This experience allows me to help prevent and/or handle behavior problems and maintain motivation for the hard work I am asking the child to do. Early success in therapy is important. It motivates the child and enables them to see themselves as a competent communicator and allows for them to be praised and socially reinforced. For pre-verbal or minimally verbal children, many times I will incorporate sign language or AAC (augmentative and alternative communication) with early verbal attempts as a way to increase communication, decrease frustration, and facilitate the spoken word. Later on, I might use sign language as a cueing strategy for sentence structure. I will choose meaningful and functional words as targets as much as possible so the child can be an active communicator in their environment as soon as possible.
I have been practicing speech-language pathology with the pediatric population since 1985 and have been in private practice since the early 1990s. I have worked with may children with apraxia since 2000, and have become known in my community and amongst my peers as specializing in childhood apraxia of speech. I attend and participate in the Apraxia Kids workshops as much as I can, and I also participated in David Hammer's Critical Thinking in Childhood Apraxia of Speech Treatment Advanced Webinar in 2014. I consult with my clients' teachers and ABA therapists with the idea of educating them on what apraxia looks like and how it's different that traditional articulation disorders. I have co-treated with behavior analysts, occupational therapists, and physical therapists to show them how to accept verbal approximations as part of the "scaffolding" process, which ultimately enables them to be successful communicators in their environment. I would love to someday collaborate with other professionals in a private preschool setting for kids with CAS.
I encourage parents to come to sessions at least weekly so they can keep up with what their child is working on, but more importantly so they can see how their child responds to the cueing I am giving. The type and amount of cueing changes, so the best way a parent can ensure that they are providing the right type of practice at home is to come to our sessions and learn the techniques used. I feel like parent training sessions also allow the parent to see how to use cueing techniques in the natural environment (not necessarily just for the speech targets). I will give parents structured activities to do at home with their child. I take as much time (and not always within the session) to explain to the parent the therapeutic approach and rationale. In addition, I include the parents' input into choosing meaningful words/goals. I have also worked with siblings within the session to help them understand what is going on with their brother or sister's speech and how they can be a "helper".
Using AAC (alternative and augmentative communication) is an effective and often necessary way for a child to be able to communicate and continue to learn expressive language while he/she is working on improving/expanding speech. In addition, using AAC can also decrease problem behaviors and facilitate the spoken word.
I regularly incorporate sign language into the treatment of pre-verbal or minimally verbal children. For some children, the use of an AAC app on an iPad will be more effective. I have experience with Proloquo2Go and LAMP Words for Life primarily, and am continually updating and expanding my knowledge of other AAC applications.