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- 1487 Chain Bridge Road, Suite #102
- Skill Builders LLC
My overall treatment approach follows the principles of motor learning, which are implemented to the degree necessary depending on the severity of CAS. The focus of treatment with CAS is on the movement gesture, rather than a specific sound, which is an important distinction from other speech sound disorder treatments. Initial stimuli are chosen following the motor speech exam and begin with the child's current phonemic repertoire. These initial targets are selected to be as functional as possible, and are determined with parent input. I use a treatment method called Dynamic Temporal and Tactile Cueing (DTTC), which emphasizes the shaping of movement gestures for speech production. This approach encourages the use of multi-sensory cues (e.g. PROMPT) and includes a nonlinear hierarchy of cueing which constantly changes depending on the child's productions. Short (e.g. 30 mins), frequent (e.g. 4-5 times per week) sessions are recommended based on motor learning research. I have also used an evidence-based treatment method known as Rapid Syllable Transition Treatment (ReST), which uses the principles of motor learning in order to promote learning and generalization. ReST uses nonsense words and focuses on prosody and sounds simultaneously in order to improve motor planning and programming for speech. There are multiple factors to consider before beginning ReST, such as age and any additional developmental diagnoses. ReST therapy is recommended 4 times per week for 3 weeks followed by a 6 week break to allow for continued therapeutic effects.
I have participated in the Walk for Apraxia since 2013 and have served on the board for the DC Walk for Apraxia for two years. My main goal through this involvement has been to connect families and build the Apraxia community.
I believe that collaboration with families is crucial throughout the therapy process. First and foremost, I make sure that parents understand the approach I am using and the underlying principles. When selecting initial targets for therapy, I always encourage parents to share their child's high frequency words, as these targets are typically incredibly motivating for their child. While target selection is dependent on a number of factors, if a child has a limited number of words, we want the targets to be as functional as possible. For example, I once worked on the target "umizoomi", because it was the child's favorite TV show, and a great target word at that point in therapy. I never would have thought to include that word as a target if I didn't encourage input from parents! Homework is dependent on both the child's success with targets and the parent's ability to provide feedback. Although parents may not observe every session, if homework is provided, I always encourage the parent to observe prior to working on the target at home. I am always available by email or phone to discuss any questions or concerns with parents as well.
As children with CAS can present with few words, I always consider AAC options at the beginning of treatment. While therapy for CAS should result in continued progress toward verbal speech, AAC can reduce frustration, encourage typical language development, and most importantly provide a functional form of communication. I have incorporated sign language into my sessions with younger children and also use Words for Life and the Language Acquisition through Motor Planning (LAMP) approach with children.