Jake's Journey with Apraxia

by Katie, SLP and Contributing Writer

I want to join the celebration and give a Hip Hip Hooray for Nancy Kaufman’s Speech to Language Protocol (and accompanying treatment materials). I am currently in the process of watching the three-part Instructional Training Video for the K-SLP provided through Northern Speech Services. While I have used the picture cards in Nancy’s Treatment Kits for years, I have been excited to increase my understanding of the bigger picture. Let me share some of my takeaways so far!

First of all, I found it interesting and am in total agreement with this idea expressed by Nancy: Although a child may have difficulty imitating oral movements (e.g., sticking tongue out, puckering lips), these movements will not be addressed separately in therapy. Instead, the focus of therapy will be on achieving imitation of specific consonant and vowel sounds in isolation and within various syllable shapes. In other words, movement of the oral structures (e.g., jaw, lips, tongue) will be addressed only within speech sound production and not outside of speech production.

Next, I loved Nancy’s tips for using the K-SLP with children on the autism spectrum: It may be best NOT to start with the simple reduplicated consonant-vowel-consonant-vowel words (e.g. Mama, BaaBaa) so we do not inadvertently teach these children that all words are produced twice. Additionally, parents and therapists should be careful not to overuse the word “say” as children with ASD may begin adding this word prior to all words they are taught.

Another important mention is that a child with suspected or diagnosed CAS who is not yet able to imitate any vocalizations could be trained FIRST using the K & K Sign to Talk program which bridges sign language to vocal imitation.

It was comforting to hear Nancy suggest that it is sometimes appropriate to move away from targeting specific sounds (especially when working with older children who have become resistant to sound training) and move toward functional language targets. These target words and phrases would be of high interest to the child as well as maximally useful in communicating needed messages for effectively functioning in their daily routines.

Something of which I was not previously aware is that Nancy’s Workout Book includes activities for moving beyond single word production into higher level expressive language tasks. Expressing the function of objects, retelling stories, and improving simple grammar are a few examples. The cool thing about using Nancy’s book is that these skills can be addressed while simultaneously controlling the motor complexity of all words within the target phrases/sentences.

Underlying Nancy’s treatment method is the idea that we as therapists should aim to teach children with CAS simple approximations of words based on their current repertoire of sounds and syllable shapes. As their skill levels increase, these approximations will gradually move to more intelligible productions. Nancy is not afraid to temporarily use “incorrect” productions of words, thus moving children more quickly to a place of true communication versus a place of continual frustration (resulting from working too hard to perfect each word). This last point was a welcome reminder and something I will immediately put into practice with one of my clients.

Speaking of this sweet client, allow me to conclude today by imparting some knowledge I’ve gained through experience (outside of technical, theoretical, and educational knowledge). Sometimes we try to implement specific programs and methods to no avail. Then we do something silly and spontaneous, and BAM a new word or sound combination pops out of that sweet little mouth prompting us to do cartwheels and scream with excitement!

This client, a three-year old little girl we’ll call Suzy Q, has lots of individual consonants and vowels in her spontaneous repertoire. However, she struggles to produce even simple consonants in a variety of CV combinations. For some reason, she has particular difficulty producing CVs containing “ee” (e.g., bee, dee, tee). Her attempts usually sound like “ee” without an initial consonant sound. Suzy’s mother and I have unsuccessfully tried various tricks to help her achieve this skill.

Trying to stay true to the principles I’ve learned about speech sound development and CAS, I often stick to working strictly on CVs containing simple consonants during much of Suzy’s therapy sessions. However, I also try to honor Suzy’s mother’s intuition and use a portion of each therapy session to work on more difficult words, such as CVCVs or other highly motivating words.

Despite Suzy’s difficulty producing “tee” or “dee,” we were running through the C1V1C2V2 pictures in Nancy’s Kit 1. Lo and behold, we heard Suzy say DEE as we broke down a two-syllable word into smaller parts. I wish you all could have seen the look of surprise and excitement her mother and I shared! In that moment, Suzy added “dee” to her repertoire of syllables and it STUCK even a week later. We were also able to transition to “tee!” SLPs and moms alike know that small steps are HUGE VICTORIES.

Similarly, Suzy was able to break out of motor limitations exhibited when producing sounds in varied syllable shapes to quickly add a very close approximation of “Bubble Room” to her spontaneous vocabulary. She is highly motivated by a bubble tower in our sensory gym and initiates communication by frequently requesting this activity.

So I will continue to LIVE and LEARN through both experience and continuing education as I surge forward to help as many sweet Suzies as I am able.

Bio: Katie is a speech-language pathologist who has been serving children of all ages for 15 years in home, daycare/preschool, school, and clinic settings. She earned her Bachelor of Science degree in Psychology from Presbyterian College in Clinton, SC, in 1996 and her Master of Education degree in Communication Sciences and Disorders from the University of Georgia in Athens, GA, in 1999. In her free time, she enjoys working out and running.