Apraxia Series: Speech Therapy

Apraxia Series: Speech Therapy Considerations Explained

If your child has been diagnosed with Childhood Apraxia of Speech (CAS), you may have questions about speech therapy.

What does speech therapy look like for a child with Childhood Apraxia of Speech (CAS)?

How can I help make speech therapy successful for my child with Childhood Apraxia of Speech (CAS)?

This article will review the essential factors (such as frequency and building confidence) needed for successful speech therapy sessions. I’ll also throw in a brilliant tried-and-true tip I got from a parent last week that’ll make your home practice run more smoothly.

If you are just joining us, please visit our Apraxia Series: Apraxia 101 article, which will give you more information about this series and about Childhood Apraxia of Speech (CAS).

Parents: Considerations for Sucessful Speech Therapy for Children with CAS

1 | Frequency

Firstly, your child may need frequent speech therapy. Some experts recommend 3-5 thirty-minute speech therapy sessions per week. In addition, experts recommend three ten-minute home practice times per day. Since this schedule is intense, please make sure it is recommended by a speech language pathologist before trying this. Because CAS is a motor planning disorder, frequent practice is needed to establish a new motor pattern.

2 | Building Confidence

We may alternate easier and harder tasks, because we want to build your child’s confidence. Have you ever tried to do something really difficult for a long block of time? It can get exhausting! This method allows children to review old skills (and feel successful) while building new skills (without feeling too frustrated!).

3 | Cues

There are lots of cues we can give for children learning speech sounds. Some cues are: visual models, verbal models, and touch cues. I may model how to produce a speech sound using a hand cue. If you are curious about what this may look like, check out this video.

There are many different ways of doing hand cues for sounds. Ultimately, as long as the cues you use are consistent, I haven’t found any particular hand cues more effective than others. Some hand cues I use are my thumb and index finger tapping one another for the /p/ sound. Another cueis a flat (vertical) hand under my the back of my chin (where my neck begins) for the /k/ sound. These sounds give a visual representation for the sound and act as a cue to help with speech sound production.

4 | Keep the Faith

As we start to work on phrases and sentences, tasks will get harder. One of the defining characteristics of CAS is that repeating longer phrases and sentences is more difficult. Progress may seem quicker at the word level, and slower at the phrase or sentence level. Most importantly, don’t get discouranged, improvement comes from consistent practice.

5 | Choose functional and meaningful targets

We may work on functional words. This means choosing words to practice that your child frequently says at home. Some examples of frequent words could be a child’s favorite snack, movie character, or the names of family members.

Imagine a child is five years old. When meeting new people, and asked how old he is, he says “bib.” Due to the importance of this word, we’d work on a functional word (the child’s age), even if we weren’t working on the /f/ sound specifically.

As a parent, you are a speech language pathologist’s best resource for words your child frequently says. Please share common words your child uses so we can work on them in speech.

6 | Consistency

There will be many repetitions of target words. Remember earlier when I mentioned CAS is a motor planning disorder? The only way to make those brain to mouth connections to produce speech sounds the “new way” is lots of repetition and practice in words, phrases and sentences. The more practice, the more automatic it’ll get. So, get ready to work hard in speech!

Making Sense of the Key Considerations

In conclusion, speech therapy for a child with CAS will need to be frequent. Because CAS is a motor planning disorder, there will be many, many repetitions of functional and meaningful targets. Speech therapy should provide just enough challenge for your child while also building his or her confidence by alternating harder and easier tasks. Your child’s speech language pathologist may use a variety of cues (including hand cues), depending on what types of cues help your child the most. Keep the faith and keep speech therapy and home practice consistent, and you will see results.

Home Practice Considerations

A brilliant strategy a parent shared with me a few weeks ago:

Choose one word.

Instead of overwhelming your child at home, choose a word you will work on saying correctly. When that word comes up, practice saying it together. Try this one word strategy until saying that word becomes easier. This strategy works because it is a way to take a bite-sized, manageable task for a child to complete at home.

Frequently Asked Question

Parents often ask: Will it get better?

The answer I give when parents of young children come into my clinic and ask this question is a resounding YES.

Your child’s speech will improve with age. Your child’s speech will improve with consistent speech therapy.

Again, it’s easy to get overwhelmed because often children with CAS have many errors. Start with one or two speech sound targets. Ask for help from your speech language pathologist. Most importantly, stay the course.

If you live in Ashland, Oregon (or the surrounding area) and have a child with Childhood Apraxia of Speech or other speech sound challenges, feel free to contact me for more information.

Apraxia Series: Apraxia 101

This is part one of a series on Childhood Apraxia of Speech (CAS). This blog post will give basic information on the definition of CAS and signs of CAS. Future blog posts will dive deeper into what speech therapy can look like for a child with severe articulation needs.

What is Childhood Apraxia of Speech (CAS?)

“Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g. lips jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words”

~American Speech and Hearing Association

My first client with CAS

I remember my first client with diagnosed Childhood Apraxia of Speech (CAS). He was a verbal boy with difficulty coordinating his mouth movements for sounds. This little boy knew exactly what he wanted to say, but others could understand less than half of the words he said. He often left out syllables in words (television sounded more like “uh-viz”) and many sounds were left out or substituted. As he spoke, his tongue and jaw seemed unstable. His mouth would move and overcompensate to try and make the sounds he wanted. His brain knew what he wanted to say, but there was a lack of coordination between his brain and his mouth for the movements needed to produce the speech sounds he wanted to say.

Since my first client with Childhood Apraxia of Speech many years ago, I have worked with many other children with CAS and done my own research on how to best help clients with severe articulation needs speak clearly. This is one of my interest areas, and is one of my clinical passions. I am encouraged and energized when I can see children with CAS make progress with effective techniques.

What are the signs of CAS?

CAS is an impairment in planning or programming the movements necessary to produce speech sounds.

Some signs in Childhood Apraxia of Speech are:

– making inconsistent sound errors (using sounds one way in a word and then producing those same words differently later on)

– inconsistent consonant and/or vowel errors when repeating words

– difficulty sequencing longer words and longer utterances (tends to break down)

– even though imitation may be difficult, it is still clearer than conversational speech

– speech may have excess or equal stress, sound monotone

– may be difficulties regulating voicing, rate, pitch, loudness, nasality

– you may see groping in the lips, tongue and jaw as the child tries to produce speech sounds (but not always)

A child with CAS may be very difficult to understand to those who don’t hear his or her speech frequently.

Considerations for CAS diagnosis

I personally do not diagnose very young children with CAS. When very young children have few words, it is difficult to distinguish CAS from another speech and language disorder (like articulation delay or expressive language delay).

Remember every child with CAS will present with different motor challenges. It is important to remember that CAS in several different children can look pretty different.

If you are wondering if your child might struggle with CAS, your first step would be to schedule an evaluation with a Speech Language Pathologist. If you are looking for more information about CAS, the Apraxia Kids website has more information and resources.

Communication Bill of Rights

Introducing the Communication Bill of Rights

Do you have a child who struggles to communicate?
If you are reading this article, chances are communication is important to you. Maybe you know someone (or work with someone) with a communication difficulty. If you care about someone with a communication disability, chances are it is important to you that your loved one has a voice they can use to express themselves.

When navigating (and educating) the communication community of a loved one, you may need resources. Do people tend to talk for your child or loved one? Are there times you feel your loved one is excluded from conversation or social events? Maybe you’d just like to educate yourself and your communication community for the sake of your loved one. If so, the Communication Bill of Rights is an excellent place to start. This document outlines communication rights for people with communication challenges. These rights include being listened to and being included in social activities, among other suggestions. In today’s post I’ll review the rights that really stuck out for me. In addition, I’ll give you some resources to continue your research if you’d like to learn more.

The Communication Bill of Rights

The following rights, written in first person, include the right to:

• Make choices

• Express my feelings

• Learn about life

• Learn about myself

• Involvement in social interaction

• Have a voice that others listen to

• Access aids, services, and resources

• Communication that is respectful and dignified.

• Access to information.

• Request information

• Use communication to reject things I don’t like

• Understand communications

Communication is a basic human right for all. Everyone deserves a voice.

Key Points in the Bill of Communication Rights

Below, I’ve made a graphic of some of the rights that stuck out for me. Also, other options are either here or here. Because these documents are visual, they are an excellent way to familiarize yourself with this topic. While you continue to learn more, these documents can help you identify your own key points.

Key Considerations

First, Listen. Second, Give time to respond. Most important, respect the personhood of the person who is communicating with you.

After all, isn’t this just plain good advice for communicating with anyone? Consider what would happen if we used these suggestions in our everyday lives. How would it impact our own communication? In addition to that, how would it impact the lives of others with communication challenges?

In conclusion, may our communication partners all the dignity and respect they deserve.

What from the Communication Bill of Rights struck you the most?

Tips to Build Imitation Skills in Toddlers

Imitation skills in toddlers are building blocks for future language use.

Do you have a toddler who is a late talker? Do you wonder how to build your child’s language skills?

Maybe you have a child who isn’t a late talker, but you’d like to see more vocabulary growth. How do you do that?

This post will focus on an important, fundamental skill for building language. If you skip this step, you may notice your toddler can become frustrated when you are attempting communication activities at home.

What is the skill? Imitation.

Building imitation builds language. Through imitation, children learn to:

• follow directions

• take turns

• participate in longer play routines (supporting vocabulary development and speaking in longer phrases).

If your young child attends a speech therapy clinic, you may notice that imitation is built into many of your sessions. This “I do, you do” may start with social activities, play activities, structured speech therapy activities, or movement activities (or all of the above).

Imitation skills are building blocks for successful communication. When children have a strong foundation in imitation skills, you will see reduced frustration and increased communication.

Four Speech Language Pathologist Approved Tips for Building Imitation Skills

1. Trust

There is a reason trust is number one. You know your toddler needs a relationship built on trust to truly be at ease and learn. Trust comes first.

An expert in the field once shared this: you have to “woo” toddlers and preschoolers.

This means you need to play games they like and learn their interest areas. In addition, you need to let children choose communication activities before they will do anything for you. This trust relationship is essential for moving forward.

As the parent, you already have that trust. As speech language pathologists, we need to work on building that trust before expecting your young child to imitate.

2. Play

Play in young children is associated with building cognitive skills as well as speech and language skills. This is also an important part of speech therapy for children who do not yet imitate.

In speech therapy, we may work on playing with a variety of toys and maintaining attention to this task. We may also work on imitating sounds (like vroom) or movements with toys.

Play routines support cognitive skills, social skills, and language skills. Imitation and play are foundational skills for language development.

3. Movement

Movement is essential for learning and imitation!

Because we may be working on gross motor imitation or movement in speech for children who are not yet imitating, we want to teach children that we are focusing on movement and imitation in speech. We may imitate gross motor movements like jumping, clapping, and skipping. This builds a back-and-forth relationship and builds imitation skills.

Jump. Kick. Move. When we move (and take turns with movement), we learn and build language!

4. Following Directions

We learn to follow directions in speech. Following directions (in games like Simon Says) gives further practice to the “I do, you do” back and forth relationship of speech therapy and works on listening skills, which are helpful to moving on to imitation skills.

Imitate your child, and have your child imitate you. Through this, you are building the imitation skills that support language.

What is the most important consideration?

Have fun. Play. Seek speech therapy if you think your child may need some extra help building his or her language skills.

Considering Milestones

Finally, let’s do a quick list of language milestones for toddlers. These are especially relevant because they give information acquired skills for toddlers who are developing language. The skills mentioned below are milestones, or skills children typically achieve by the age mentioned.

At 12-26 months, children use one-word utterances and begin using two-word phrases, use intonation to ask yes and no questions, and use limited wh-questions (what, where)

At 27-30 months, children use phrases that are about 2 words long, and will use some grammatical concepts (in, on)

At 31-30 months, children use phrases that are about 3 words long, children begin using is/are, and use of wh questions (what, where) increases

At 35-40 months, children use phrases that are an average of 3-3.75 words long (which means some 3-word phrases and some 4-word phrases)

I hope this blog post has helped you visualize what speech therapy might look like for your child who may not yet imitate in speech therapy. Most of all, I hope this has given you information which will be helpful in building language skills for your toddler. If you are in the Rogue Valley area and are interested in speech therapy for your child – whether your child is imitating or not – please visit my contact page. I’d love to help!

I Want You to Love Your Speech Homework

Does your child receive speech therapy at school or at a clinic?

Do you have speech words to practice at home?

If practicing your speech words has become more of a challenge than it seems it should be, take heart. As a speech language pathologist (SLP), I want you to love your speech homework. Read on for 5 SLP approved tips for keeping speech time fun at home. These tips are designed for children ages 4-8, and are ideas to increase fun while practicing your speech words. Let’s get started as I aim to help you make your speech homework fun!

First, a Caveat…

Let’s start with an important note (bear with me). In speech therapy clinic, we do more than just work on speech sounds. We help children with a wide variety of skills. In fact, SLP’s scope of practice includes a variety areas. SLPs can help with vocabulary, grammar, listening skills, social skills, voice, swallowing, and more. Many people know SLPs work on developing speech sounds (articulation). However, our area of focus doesn’t stop there.

That said, articulation work is an important part of this work. Speech sound work (articulation skills) help children be better understood. In addition, when children speak with clarity, they can share their thoughts. Articulation practice is rewarding, and can be fun for children, parents, and clinicians!

Make Speech Homework Fun – Love Your Speech Homework!

When children are working on saying specific sounds, (for example, a child says the “b” sound for the “v” sound) your speech language pathologist may give you some homework to continue practicing the skills you practice in speech clinic. This articulation homework may be given as lists of words, phrases, or sentences. This homework can also be sounds to practice in story retell or in conversation. If you are looking for a good resource for articulation word lists, Mommy Speech Therapy has some great worksheets here.

How To Make Speech Homework Fun

Now that you’ve got your homework, read on for five tips to make articulation homework more fun for preschool and early elementary school students:

1 | Use Humor

Use humor. “Don’t say _______ (word or sentence)!” or “I can’t hear you say ________ (word or sentence)!” Make a big deal of pretending to be upset (Oh no! I can’t believe you said it!), with a smile on your face in a playful manner (so your child knows you are kidding). This doesn’t work for all children (some children may not get the humor), but this trick is worth mentioning because for a many children, this game will result in laughter.

2 | Use Movement

Children often learn best with movement in play. Try: “Touch the couch and say _______!” “Hop to the kitchen and say __________!”

3 | Earn Puzzle Pieces

If your children like to do puzzles (most of my clients do!), earn one piece of a puzzle for each speech word or sentence.

4 | Pair with a Preferred Activity

This doesn’t work for all children, but sometimes a child can do a preferred activity (like coloring), and say their speech homework quite well at the same time. This works well for seated work and less well for distracting activities (you can’t say your speech words well and watch TV, of course!).

5 | Take a Break

If you need it, take a break. Yes, I said it! Sometimes, if speech homework really is causing frustration, take a break and come back to it. Remember, speech homework should be enjoyable (and not a battle of wills). If you are a client of mine, I really do want you to love your speech homework. Sometimes, that means cutting yourself some slack and skipping a week of homework. We’ll survive.

If all else fails, talk to your SLP.

If you have speech homework and it’s going well (or isn’t), make sure to connect with your speech language pathologist. As an SLP, I want clients and families to have a good experience building your child’s communication skills both inside my clinic (for speech sessions) and outside my clinic (for homework practice).

Finally, get out there and give these tips a try! Here’s to hoping you and your child have a fun and enjoyable time in your articulation practice.

I hope this blog post has helped you come up with ideas to make your child’s articulation homework more fun.