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- 506 West 2nd Avenue
- Early Life Speech & Language
"I focus on attaining specific oral-motor movements for speech production, and on teaching parents and child this intent (and the difference between this and, say, a phonological focus). I use motor-learning principles to guide my therapeutic decision-making, including how many targets to use, whether to use mass or distributed practice, random or blocked practice, and which feedback to use at which stage of treatment.
I select targets that are either within the child's sound repertoire, or syllable structure, and that are meaningful to the child. Some targets may include high frequency or POWER words/phrases (i.e., words or phrases that can be used in several contexts, are important, and/or specifically meaningful or carry high communicative power for the specific individual). For children presenting with more severe CAS, I choose fewer targets (e.g., 5), and more for children with more oral-motor skill. I immediately train my clients to a) watch me, and b) imitate my movements (starting with large motor movements, if necessary, down to more precise oral-motor movements for a speech sequence). I use multi-sensory cuing approaches to teach speech targets and attain accuracy, and fade them appropriately. Introduction of intonation is an important component of my speech training, to introduce variability in practice for improved motor learning. We utilize 2-3 weekly sessions (currently, most often twice weekly at 60 minutes; but prefer 3 times weekly for 30-45 minute sessions). I use a modified-block practice for training speech targets - I train 5-10 targets, in varying numbers of frequent repeated trials - e.g., 10-20 trials."
Our clinic has been acknowledged in the community as a referral clinic for children with severe speech sound disorders, including apraxia of speech. My primary involvement has been directly with clients who are referred to our clinic. I plan to collaborate more with the local university (Eastern WA University and Washington State collaborative communication disorders program), both for supervision/mentorship and to participate and help supervise at the annual apraxia summer camp (Camp Candoo) hosted by the university and led by Amy Meredith, PhD. Dr. Meredith is well known for her expertise in CAS in the local community. She has run this summer program for several years and this year invited me to participate. (I will actively participate next year - 2021- after the birth of my daughter this summer). I also would like to become more involved with local CAS support, advocacy, and professional organizations/community, and would be willing and excited for the opportunity to participate in research.
I always have my parents observe therapy. I train parents how to aid in generalization of an acquired target (that has been more or less mastered in my speech session FIRST) at home; I also train parents in session how to promote functional communication in the home, and how to advocate for their child/teach their child to advocate for themselves. Even if my parents are not directly working on a target or skill that I am, I like my parents to be on the same page and, as clearly as possible, understand what I am doing and my rationale for it.
I have used simple low-tech AAC including simple phrase strips for children to use at home for functional requests, specific fringe vocabulary listed for preferred items/requests (e.g., snack choices, out-of-reach toys or play activities), low-tech communication boards with CORE and fringe vocabulary, and with communication systems (e.g., Proloquo 2 Go or Tobii Dynavox). I have also previously applied for and been granted iPads for children diagnosed with CAS to use for augmentative communication purposes.