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- 319 South Cedar Street
- Stepping Stones Pediatric Therapy
When a child walks into our clinic, often the doctor decided to take the “wait and see approach” and I’m beginning the journey to treat a minimally verbal to nonverbal 2-year-old child with suspected mod-severe CAS.
Family involvement and parent coaching is key to any treatment session I have. In the world of working with insurance companies, I often get to treat these children 2x a week for 30min sessions. I always take the child’s phoneme repertoire and sit down with the family to create functional target words. I look at what sounds the child already possesses and often create some successive approximations (e.g. “bubba” for “brother) and try to create words with a variety of simple syllable shapes (CV- “no”, VC-“up”, CVCV- “momma”) etc. I make sure family is in agreement to the list and what target word (s) we start with.
If the child is nonverbal, we play with LOTS of sounds. I talk with the family about making sounds fun and our sessions are all play-based and focus on making big movements paired with big sounds. I have found with experience, the more fun and sillier the session is, the more the child will play with sounds themselves. When demands to communicate are taken away and I focus on modeling, I’ve noticed an increase in the child wanting to imitate me. I am thankful to work in an environment where we have big gym equipment, games, trampolines, sensory toys to all assist in engagement and buy-in with the child. If in home, I often utilize daily routines to create opportunities for high repetitions of target words (the car, snack time, or floor time w/caregivers are my personal favorites).
Once I build imitation skills, sessions start with one (maybe 2) functional target words from target word list. I mainly use the DTTC hierarchy and successive approximation approach. I build trust w/ the child by having them watch my mouth, giving a variety of prompts (tactile/visual/physical) and finding where they are successful. Once I find success with a word we play games with high repetitions and always start in unison. Eventually I fade my voice/cueing as sessions progress. I choose therapy activities based on the child’s regulation and how to make the activity most functional to the target word. For example, I once placed token pieces on the child’s stairs and we practiced “up” all the way up the stairs. I send home only successful targets and want parents to feel comfortable implementing our target word (s) in their daily routines.
I have always worked in a collaborative setting with multiple SLPs, OTs, and PTs. I've learned to communicate with my peers about best practices and look to several online resources to better my therapy sessions and activities. If listed in the directory, I would love to collaborate more with clinicians outside of my current work place. I would utilize Apraxia Kids as a resource for my families and colleagues to reference when needing the most current information. When Apraxia Kids Conference can happen in person I would love to attend!
Parents are involved in the therapy process from first appointment. They provide information I need to collect a thorough case history and give me the opportunity to observe the parent-child relationship. Parents are also involved in creating the functional target word list with SLP. I only get to see the child 2 maybe 3x a week, therefore parents implement home program throughout daily activities. Throughout my clinical experience, children with suspected CAS or CAS make significant gains when parents are following home program targets and are educated in the principles of motor learning.
AAC (both low and high tech) is implemented very early on with my children w/ sCAS or CAS. I truly believe in giving the child a functional way to communicate their wants/needs during session and in home to build a language system. My goals and time spent are primarily verbal speech practice, but the device or low tech board is always present to reference or discuss language concepts in longer utterances (matching receptive/cognitive abilities). Most families/teachers in the community find value in AAC when the child is having a communication breakdown. I am there to assist in set up, caregiver education, and implementing the device successfully in activities.