Which Words to Work On? Choosing Treatment Targets in Toddlers with Suspected CAS

From the 2 year old who only says “mama” to the 3 year old with severe unintelligibility, we all have children on our caseload that we’re just not sure about. Do they have childhood apraxia of speech? Should I implement a motor-based approach? What words should I work on? This session will explore the many factors to consider and provide guidance for these tricky clinical situations.

We know from recent research that characteristics of Childhood Apraxia of Speech (CAS) can emerge in infancy and early toddlerhood (Overby et.al. 2019), but those characteristics are not necessarily diagnostic, and so we are still often left with questions. Does this child have CAS? What treatment strategy should I use? Whether we’re working with a toddler with very few words, a preschooler with very poor intelligibility, or a young child who hasn’t progressed in therapy, a most critical question comes to mind: what should I be working on?

There is a substantial amount of literature on selecting targets for traditional or phonologically-based treatment methods (Strand 2020) but little evidence exists in the literature on CAS, and even less guidance is provided for “suspected CAS” (sCAS). The only direction given to clinicians to aid in treatment planning is to focus on the movement, rather than specific phonemes. However that requires a shift in mindset that many clinicians find challenging. Additionally, the need to utilize different cueing methods, to understand and apply principles of motor learning, and the often initial slow progress seen with these children can lead to feelings of being overwhelmed and frustrated. All of this often results in clinicians drifting back to writing goals or progressing treatment from a more familiar traditional articulation or phonological approach.

This session will provide a framework for treating children with sCAS, addressing initial target selection as well as selecting later targets as the child progresses through treatment. This will center on principles of motor learning, and guide clinicians to focus on movement when teaching functional words and phrases. It will take into account a child’s phonemic repertoire, but more importantly consider syllable structure inventory as a starting place for target selection. The following concepts will be covered: child readiness for structured motor-based therapy, such as DTTC; consideration of current phonemes and syllable structures produced; functional vocabulary needs and parent goals; and motoric and phonemic complexity of early vocabulary targets.

Following this Course participants will be able to:

1. Contrast target selection methods for traditional articulation vs. motor based therapies.
2. List the syllable structure hierarchy from simplest to most motorically complex.
3. Select 3 treatment targets for a child based on their current syllable and phoneme repertoire.

Note: This course meets the requirement for Professional Development hours towards your ASHA renewal since it is approved by TSHA! You can count these hours towards ASHA renewal when you submit your Compliance Form.