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- 5604A Virginia Beach Boulevard
- Adler Therapy Group
For a child with moderate to severe CAS, it is important that I spend time creating a plan of care surrounding what sounds (consonants/vowels) a child can already say and in what syllable shape the child can say them in (ex. If the child has the sounds "mmm" and "eee" in his/her spontaneous sound repertoire, and they can say "ma" for "mom" which is in a consonant(m)-vowel(a) syllable shape, I may choose the target "me" to practice in therapy as it includes a syllable shape the child is able to produce and 2 sounds the child is able to produce as well). I follow this protocol similarly for all children who come to me with moderate to severe CAS depending on what vowels and consonants they can already say. In addition to choosing targets based upon what the child can already say, I also take into consideration other information which could be important for the child to say. For example, if the Child's name is Cici, yet the /s/ sound is not in his/her repertoire, and they cannot produce CVCV syllable shapes (Cici=CVCV), I may still pick functional targets that include /s/ within a syllable shape that child can produce with cueing because it is important that the child eventually be able to say his/her name or at least an approximation of it. I may choose the target word "see" as the child does not have the sound/s/ but does have the /ee/ sound and can produce CV syllable shapes. I may also choose the target "peepee" if the child can produce /p/ and /ee/ in order to word on producing a CVCV syllable shape!
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. I use a clicker during my sessions and typically require a child to produce their target word/words 5-10 times before taking a turn with a game. Of course, all children are different, so if we are not able to reach high number of trials at first, we always work up to it. 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 his/her 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 diagnosisng CAS through spreading word about new trainings or opportunities. I currently and mentoring a clinical fellow who has a child with CAS on her caseload. We completed the evaluation together and I have the opportunity to coach her during her therapy sessions. I plan to continue advocating and becoming more involved in the Apraxia community with this role and being listed as a provider. I would love to attend fundraisers in my community if they are available this year.
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.
Three children currently on my caseload with with severe CAS have received high-tech speech generating devices to assist their speech and language needs. We use their AAC device during every therapy session. I model on their device and direct them to the device when communication breakdowns occur. 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.