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Speech Therapy Mistakes: Childhood Apraxia of Speech (Part 1)

There are some common speech therapy mistakes when treating Childhood Apraxia of Speech (CAS). Last blog post covered what to do in speech therapy for children with CAS. Today’s post focuses on what not to do.

If you are just joining us, and want to know what Childhood Apraxia of Speech (CAS) is, visit part 1 of this series.

Mistakes. We all make them.

Maybe they aren’t actually mistakes. We come up with an idea and try something new and…it falls flat. Should we call it an “oops”? A “whoopsie”?

There are some specific ways that speech therapy for children with Childhood Apraxia of Speech may look a bit different from traditional articulation therapy. New clinicians sometimes struggle with how to provide intervention for children who have CAS and often learn from experience. Parents might work with their child based on what they’ve read online online to find that it doesn’t really seem to be working as well as hoped.

So, what if we could skip all that? That would be pretty awesome, right?

I’ve got more than one common mistake in mind, but today I’ll focus on the most common one I’ve seen. Of course, the purpose of this post is to take a (hopefully) gentle approach to a common mistake and to spend plenty of time on what to do instead. This is a mistake often made with students with more significant articulation (speech sound development) challenges, including Childhood Apraxia of Speech.

As a new clinician, I made this mistake. Most of the parents I work with tell me they find themselves making this mistake. You aren’t perfect, I’m not perfect. But, if you can learn what not to do ahead of time, maybe the time you spend at home practicing your speech words can be better spent. That is a win for you, for your speech language pathologist, and for your child.

So, let’s get to work. What is it? How can we avoid it? How can we learn from it? What should we do instead?

The Pitfall

Spending too long at the isolation, syllable and word level.

Remember when we talked about Childhood Apraxia of Speech being a motor planning disorder?

That means it is very different for a child to say a word in isolation than to say the same word in conversation.

What do I mean?

As we speak, we anticipate the words which come next. When speaking in conversation, we also have to coordinate the specific target sound using the coarticulation, the way the brain sends messages to the tongue, jaw, lips (and so on) to form words from different starting places.

For example, say the word “sweet.”

Easy, huh? You had time to start with that tricky /sw/ blend and start that word moving from a neutral position.

Now say “I ate a sweet candy yesterday” and “my sweet candy was broken.”

Your mouth had to move from the “a” sound to the /sw/ sound for the first phrase, and from the “y” sound to the /sw/ sound for the second phrase; that is coarticulation. As you can imagine, speaking at the sentence and conversation level involves a lot of motor planning from different mouth positions, instead of (like at the word level) perhaps starting at a neutral position. Coarticulation involves some tricky movements and motor planning as the starting positions vary.

Try This Instead

So, what to do instead? It is still a great idea to start learning new sounds in isolation, syllables and words. However, when working with a child with CAS, let’s not spend too long there! Your speech language pathologist will be able to share with you when a good time for this might be.

Activity Suggestions

Here are a few activity suggestions that will target practicing a targeted speech sound where the child will need to speak in longer utterances, thereby practicing targeted sounds using the added challenge of coarticulation.

A caveat: I’m assuming here your child already is speaking in full sentences. Your child shouldn’t be expected to use specific words in long sentences if he or she is only speaking in phrases. If your child’s speech language pathologist has shared it’s time to move on from the word level, below are some activity suggestions to target speech sounds in longer sentences.

Wordless Picture Books

A wordless picture book allows a child to make up sentences about a story. Another way to approach these books is for an adult to tell the story and then have the child retell the story. This typically works best for younger children if it is done one page at a time, since it’s difficult to remember the whole story.

The books I use most often are Frog, Where are You and Flotsam.

If you’d like a list of more ideas, visit the children’s book guide here.

Pictures

These pictures could be cut out of a magazine, taken from Google Images, or taken from snapshots on your phone or Instagram feed. The photos can be of anything you’d like – preferably something that will interest a child and get them talking! Practice – with a slowed rate if needed – telling 2-3 things about each picture.

Answering Questions

This can be done in a shared reading activity, while driving in the car or in an interview with your child. Your child can practice answering your questions in a full sentence. The questions can be factual or silly, as long as the answers are in a sentence and use the child’s best speech sounds!

If you’d like some suggestions of fun questions to ask, here is a fun list.

Making Predictions

Making predictions can be a fun way to use full sentences using targeted speech sounds. Find a funny picture or You Tube video. You’ll know what types of videos your child likes watching, but a fun clip to practice prediction (and telling why you made your prediction) is a segment from the Ellen show “Epic or Fail.” Of course, watch clips on your own first to make sure they meet your acceptability standards.

Activity Summary

In conclusion, there many activities you can do with your child to practice speech sounds in sentences. However, it is important to keep in mind a few specific tips. One: make sure your child can already say these sounds in words and phrases. Two: make sure your speech language pathologist has recommended working on speech sounds in structured activities. Once you’ve got those pieces in place, you’re ready to get started with some of the ideas in this blog post.

 

I hope this blog post has given you some ideas on how to incorporate using speech sounds once your child is past the word and phrase level. I hope you – and your child – have fun practicing your “new sound” in engaging activities. Next week, we’ll have another common therapy mistake made with children with Childhood Apraxia of Speech. Stay tuned!

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