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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. I feel that it is extremely important to individualize treatment and treatment approaches according to those that a particular child will respond best to, although 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 he/she progresses. I strive to keep each child motivated to "work" by incorporating into the sessions 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 as a background in using behavior principles (ABA) and knowledge of sensory processing disorders. 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 non-verbal or minimally verbal children, many times I will incorporate sign language with early verbal attempts as a way to increase communication, decrease frustration, and facilitate the spoken word. Later on, I 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 his/her 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 began particular interest in childhood apraxia of speech in 2000. I have worked with children with CAS since 2000, but have become known in my community and amongst my peers as specializing in CAS for the past 10 years. 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 such as picture cards with a written description of the child's targets and specific cueing strategies to use. 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".
As mentioned above, I regularly incorporate sign language in the treatment plans of non-verbal or minimally verbal children to increase communication, decrease problem behaviors, and facilitate the spoken word. I have also used low-tech picture selection books utilizing photos of the child's reinforcers velcroed to pages in a notebook where the child gives the therapist the object or activity he wants. In addition, I have had several children who have used Proloquo2Go on Ipads, varying from single words to sentences with carrier phrases. I have also used a combination of talking, signing, and a communication device (Proloquo2Go). I have had a brief exposure to L.A.M.P. Words for Life , but am not proficient in this system. The idea of using AAC with a child with CAS is to give the child an opportunity to express ideas, wants, needs he would not otherwise be able to say verbally, and at the same time build some expressive language while he is working on his verbal output.