Speech-language pathologists know that working with preschool students means constantly thinking on your feet, moving around, and being creative! If you’re a speech therapist treating childhood apraxia of speech (also known as CAS), then you know it can be challenging to target motor speech objectives while pulling out all the stops just to maintain the student’s attention. Keep on reading to find out my best ideas for keeping those preschoolers engaged during a speech therapy session while also effectively targeting apraxia of speech goals and objectives!
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What is Childhood Apraxia of Speech?
Childhood apraxia of speech (also known as CAS) is a neurological motor speech disorder that involves difficulty with planning and sequencing the motor movements necessary for speech. It is important to note that CAS is not a result of muscle weakness or paralysis.
Apraxia of Speech. (2017). Retrieved 12 June 2023, from https://www.nidcd.nih.gov/health/apraxia-speech#:~:text=Apraxia%20of%20speech%20(AOS)%E2%80%94,to%20say%20correctly%20and%20consistently.
Childhood Apraxia of Speech. (2023). Retrieved 12 June 2023, from https://www.asha.org/public/speech/disorders/childhood-apraxia-of-speech/
Getting Started with Apraxia of Speech
The purpose of this article is to specifically provide some therapy intervention ideas for your fast-moving preschoolers. But before speech therapists even get to the therapy side of things, there are a whole bunch of other considerations. SLPs might also enjoy reading about completing the childhood apraxia of speech evaluation.
How To Complete a Childhood Apraxia of Speech Evaluation
It is essential to learn how to properly diagnose childhood apraxia of speech. And, don’t worry- there’s no need to panic. I think this is one of those areas in the field of pediatric speech language pathology that can feel a little overwhelming- but I promise, with the right information it will click.
To get started, I recommend taking this DTTC CEU course, developed by Dr. Edythe Strand. DTTC stands for Dynamic Temporal and Tactile Cueing. I took part one (which is free and available online). I’m hoping to take her advanced course at some point in the near future!
After taking this course, you will want to look into a dynamic motor speech assessment, such as the DEMSS.
There is a pretty big difference between your everyday articulation assessment and a dynamic motor speech assessment. The DEMSS, for example, looks into different areas based on syllable structure (such as VC, CV, and CVC words). There are no pictures; instead, the child needs to look at the SLP’s mouth to watch and then imitate the production.
Scoring is very different than a typical articulation test, too. SLPs will also be scoring vowel accuracy, consistency, and prosodic accuracy, in addition to articulatory accuracy.
Learn more about child apraxia of speech evaluation.
What Apraxia of Speech Goals Should You Target?
I remember just staring at the screen, wondering what to type when writing my first apraxia of speech goals and objectives! If you are a speech pathologist that feels that way too, you are not alone.
You’ll want to carefully consider what goals and objectives to target for apraxia of speech. Of course, the overall goal of speech therapy is to help increase intelligibility.
The main consideration is that speech therapy goals for childhood apraxia of speech should be based on movement. Therefore, goal writing is very different than it would be for articulation.
Younger children may need to start with imitation tasks. Communication involves having the ability to imitate! This could include imitating gross motor movements, sounds, noises, or exclamations. One can also model varied prosody during sound play!
Establishing a form of AAC is also an important consideration. This is important to help reduce frustration when communicating.
Carefully choosing targeted words is very important. This will greatly depend on the child. For example, it may be very important for a preschooler to practice functional words like “mine!” or “no!”. It is important to note: several CEU courses I have attended have cautioned staying away from “more” and “please”!
SLPs may also write objectives that encourage the development of vowels or dipthongs, prosody, and specific syllable structures. Additionally, I also state that multisensory cues are provided in my objective.
For detailed apraxia of speech goal writing ideas, I highly recommend speech therapists check out Cari Ebert’s SLP’s Guide to Treating Childhood Apraxia of Speech.
Childhood Apraxia of Speech. (2023). Retrieved 13 June 2023, from https://www.asha.org/practice-portal/clinical-topics/childhood-apraxia-of-speech/#collapse_2
Baker, Sarah. Differential Diagnosis of Childhood Apraxia of Speech. SpeechTherapyPD. https://www.speechtherapypd.com/courses/Assessment-and-Treatment-of-Childhood-Apraxia-of-Speech
Gillmer, Melissa. In the Trenches: Practical CAS Applications. SpeechTherapyPD. https://www.speechtherapypd.com/courses/Assessment-and-Treatment-of-Childhood-Apraxia-of-Speech
Graham, Amy. Practical Tips for Treatment of Childhood Apraxia of Speech. SpeechTherapyPD. https://www.speechtherapypd.com/courses/Practical-Tips-for-Treatment-of-Childhood-Apraxia-of-Spe-275
Hammer, D., & Ebert, C. (2021). The SLP’s guide to treating childhood apraxia of speech: Effective therapy strategies for toddlers, preschoolers, and early school-aged children. Speech Corner.
Marshalla, P. (2019). Chapter 21- Teaching Vowels and Dipthongs. In The Marshalla Guide: A topical anthology of Speech Movement techniques for Motor Speech Disorders & articulation deficits. essay, Marshalla Speech and Language.
5 Tips for Running a Childhood Apraxia of Speech Therapy Session
Here are 5 tips that speech pathologists can try while running an apraxia of speech therapy session with younger students! These tips are based on my clinical experience working with preschoolers!
These tips are not for kids who will sit at a table and do a worksheet.
Because I could pull out a stock photo of a child sitting quietly at a table, watching your mouth, and getting the full benefit of your immaculately-planned therapy session.
But as we all know, life doesn’t always happen quite so perfectly!
A lot of my experience has been working with 4th and 5th graders in speech therapy. I had to really shift my expectations when I started working with preschoolers.
It’s very defeating to feel like you’re running around the room, chasing after a kid, and getting nowhere.
So I took a step back to see what I could do that would make apraxia of speech therapy sessions meaningful.
My main objectives for the session became:
- I want to keep my student engaged
- I want my student to watch my mouth as much as possible
- I want my student to practice a few target words, as many times as possible
And that’s it.
So here are my best tips for running your apraxia of speech therapy session with preschoolers.
Less is More
It’s a good idea to know exactly what words or objectives you’ll be targeting in that therapy session. I say this as an SLP who likes to live my (therapy) life on the fly.
My advice for this age group? The fewer target words practiced the better.
I have spent entire sessions working on saying only 3-5 words if my students are on the go and have short attention spans. Go for more reps and zone in on just a few targets.
Clear the Clutter
I consider myself a “creative messy” person. My husband would tell you that I struggle with paper organization (which is why he gets to sort through our mail).
That said, if you have a million toys around your therapy area paired with a child who is constantly on-the-go and moving from one thing to the next, you’re setting yourself up for failure. I learned this the hard way.
Turns out our OT friends preaching about sensory regulation and a calming room know what they’re talking about.
I typically only have a few selected toys or activities in cabinets or in view on my table that I’ll let my students “find”.
For example, one of my students loved sharks.
Pair a Toy with a Target Word
Think quick and fun.
If I’m working on trying to establish final consonants at the ends of CVC words, I might try practicing the word “pop” on repeat while using a popper toy.
My student just has to practice WATCHING and SAYING the target word with me, then we’ll take a turn popping that popper.
Move Around Often
Plan on moving around often.
We spent our speech therapy sessions on the floor, under the table, standing at the table, or looking out the window while watching cars (and simultaneously practicing the word ‘beep’)…. you get the idea.
Once you get moving, you’ll be surprised at how easy it is to pair a target word or objective with that movement. For example, you could practice the word ‘hop’ (a CVC word), ‘up’ (a VC word), or exclamations and vowel or dipthongs (woah! no! oh boy!).
Try a Sensory Bin
If there’s something preschool students like to do, it’s pulling things out of things.
And also putting things into things, hence all of those ‘feed the’ activities.
So, make a simple sensory bin. You’ll just need a clear plastic container and some filler. This doesn’t need to be fancy. You could even use shredded paper.
When working with childhood apraxia of speech, I often am practicing the same small set of target words on repeat. So if we’re working on the dipthong ‘oi’, I might have multiple pictures depicting a ‘boy’ or a ‘toy’ hidden in that sensory bin.
In summary, running a speech therapy session while targeting childhood apraxia of speech objectives can be challenging! Most young children aren’t able to sit still and complete a structured activity or worksheet.
Scroll up to read 5 tips that speech pathologists can try using to keep things on track during a therapy session with three year olds, four year olds, and five year olds!
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