My treatment approach is play-based, child lead and adult directed. We have loads of fun, but we work HARD! I implement Dynamic Tactile and Temporal Cueing Hierarchy (DTTC) in all sessions for my children with moderate to severe CAS. For more mild CAS cases, I always use a principles of motor learning approach while implementing elements of DTTC and my individual clinical expertise. In the beginning of therapy, I take time initially to establish rapport with each individual child. I am a firm believer that every child learns differently, therefore, therapy cannot be a one size fits all model. I am constantly adapting and being mindful of children’s nonverbal and verbal cues to ensure each treatment session maximizes on their strengths and boosts their growth mindset!
During a therapy session, parents should expect that we will mask our hard work in fun, functional, and playful scenarios. Although we have a lot of fun in therapy, therapy is still hard work, so I ensure that I am always in control of my materials as it is imperative we get a high number of practice trials during each session. It takes time to build trust between the child and their new therapist, so I always follow a child's lead while building up their confidence through growth mindset feedback. I empower children to be resilient through praise for hard work and recognition that speech can be hard, but I am here to help. I use multi-sensory cues during therapy sessions to ensure the child is successful in their productions to include simultaneous productions, visual speech sound cues, tactile-touch cues, and verbal cues. I get to know each individual child to know what cues work best for them as everyone is different.
My current involvement with the Apraxia community includes advocating and educating parents and other SLPs on the imperative role SLPs play in diagnosing and treating CAS. I feel that unfortunately, CAS is often under diagnosed and/or incorrectly diagnosed due to a shortage of education in our field regarding CAS. At my clinic currently, I provide opportunities for other SLPs to learn about treating and diagnosing CAS through spreading word about new trainings or opportunities. I serve as a reference for colleagues to answer questions about CAS and provide coaching opportunities when appropriate. I have participated in the Walk for Apraxia in my local community and spread awareness of CAS in my clinic by involving co-workers of other disciplines (PT/OT/admin, etc.) through creating a team to participate in the walk.
I involve parents in my sessions as much as possible. I love for parents to be in the therapy room and participating in the session. I provide many opportunities for parent involvement and education as possible. I do, however, not provide "homework" in the beginning stages of therapy as it is very important for the child to avoid negative practice. If a parent wants to practice at home, I ensure that I have thoroughly explained what types of cues work best for their child and ensure that they understand how to elicit these cues at home.
I begin using high-tech AAC with my children with severe CAS as soon as possible. Based on prognosis usually determines whether or not I recommend receiving a high-tech device for the child to grow with. For more mild cases of CAS or for children who show rapid progress, I implement a lower tech AAC system to include picture symbol systems or core vocabulary boards. I ensure that the device is a helping tool to advance language development, and we still focus on getting high practice trials of speech during sessions. I have found the best success with using AAC therapy with children with severe CAS as it has helped tremendously with embedding grammatical goals that are often missed due to severity of intelligibility problems.