A few weeks ago, I was speaking with a mother of a two-year-old working on expressive language needs. She comes with her child twice a week for speech-language therapy. This, really, was not something particularly different from my day-to-day as an SLP. In this moment, however, I confessed that I was wrong.
You see, as the child was gaining more words, I started to notice a few things: inconsistent utterances for the same word attempts (e.g., “more” would be moe, ba, aaa), difficulty combining sounds and a smaller repertoire of consonants and vowels. Couple these indicators with the child’s eating challenges and expressive language needs, and my brain-search landed on childhood apraxia of speech (CAS).
Truth be told, other than hearing these words in graduate school, childhood apraxia of speech was not an area of expertise for my decade and half as a professional. I wanted to be the best SLP for the family (because all families deserve this), and I felt so incompetent moving forward. So, I got to work.
First, I know that trust and transparency are important. So, I let the family know that I would begin searching for information that would be fruitful for our sessions. Initially, I scoured the internet for information, and my efforts gave me a starting point. Since our SLP-village is large, I reached out to peers who were more well-versed in motor speech disorders. Thank goodness for Joan Kuta, an SLP in the Round Rock Independent School District and Marcus Neal, the owner of MLee Therapy. Both are PROMPT certified SLPs. Below are the five pieces of information that has yielded the most outcomes for my efforts with my client and his family:
5 Tips for Working with Childhood Apraxia of Speech
- Interactive awareness for oral communication. It’s important to bring attention to the focus of the speech therapy session. “Today we are going to work on the /m/ sound. For the /m/ sound, our lips come together and air comes out of our nose.” Then, you work on the sound in salient, meaningful ways. For example, working on the word “mama” would be meaningful for my client. So, we may play a game with a ball, and the child needs to say “me” when it’s his turn or “mama” when it is Mom’s turn.
- Integrate multi-sensory approach. This means that we are going to use visual, auditory and tactile-kinesthetic approaches. So, for example, when working on the /b/ sound, you would model the sound by bringing your lips together (visual), producing the “buh” sound (auditory) and placing your fingers on the child’s lips to give feedback for bringing lips together to produce the sound (tactile).
- Intensive service delivery. Research shows the children with CAS are more successful when they receive frequent (3-5 times per week) and intensive treatment. This means speech therapy 3-5 times per week. Also, individual treatment sessions yield better results. Group therapy may be a better as the child improves. In saying this, I will be the first to say that school service delivery models and insurance jurisdictions may not necessarily allow for this. As a result, for my client, at this time, I provide functional homework for parents to do at home to maximize efforts.
- Support speech intonation and melody. At times, children with CAS will demonstrate atypical pitch, pauses and stress. Activities, such as singing songs with the target sound, are helpful.
- Seek out Resources
PROMPT Institute: PROMPT, an acronym for PROMPTS for Restructuring Oral Muscular Phonetic Targets, is a multidimensional approach to speech production disorders. It is a program to develop motor skill in the development of language for interaction.
Stay tuned for our next post on speech therapy and apraxia. I will provide you a complete routine that has yielded more progress in two weeks than the traditional play-based speech therapy I was doing for the last five months. Here’s to continual learning.