What will therapy look like?
Therapy for your child should be individualized to meet your child’s needs. However, there are some common features you should see for a child with severe CAS. As your child progresses, their therapy should change and evolve, too, but generally, therapy for severe CAS includes things like:
Watching the SLP's Mouth
Your child with CAS will need more cueing/help than other children to learn new movement patterns for speech. It is important for your child to look at the SLP’s mouth so that they not only hear the sounds but see how the mouth moves when talking.
Engage in Integral Stimulation
Children typically learn in imitation, meaning that the adult does an action and the child follows/copies. Integral stimulation means that the adult/SLP does the movement, then the child and the SLP do the movement together at the same time. This is important because the child first sees the movement (so they know what they are trying to do), then they do the movement at the same time so they can see the adult’s model again while the child is trying to make the movement. Integral stimulation is an important strategy/cueing technique that will be used frequently throughout a child’s treatment.
Move in Different Ways
Since CAS is a motor-based disorder, your child’s focus should be on movement and different types of movement. Your child should be learning to move in different ways, like moving their arms in a big motion versus a small motion. You child should also be learning to move their mouth in these ways, such as when we open our mouth big to say “ah” or open it little to say “eat.”
Language
Your child should be continuing to build their receptive language (understanding) and also increasing their expressive language. Their target words for speech and AAC should include nouns (favorite toys or foods, family names), verbs (action words) and social greetings (e.g. "hi" and "bye").
Augmentative and Alternative Communication (AAC)
Your child should be learning how to communicate, which includes speech but also other forms of communication, like gestures, signs, pictures or a device. These other forms of communication are called AAC. The SLP should be working with your child on AAC so that they have a consistent, reliable way to communicate while they are learning to talk. Using AAC will help your child to express their wants and needs, increase their language, and decrease frustration and anxiety.
New Movements Patterns for Words
Your child should be working on a few (5-10) carefully chosen words that are useful and attainable (they can produce the word with help) for the child with lots of repetition. They will be practicing each of these words hundreds of times with the SLP's help. The SLP should be using as much cueing (tactile/touch, visual, auditory cues) as needed for your child to succeed, then repeating the word many, many times for your child to learn it. As your child gets better at moving their mouth to produce the word, the SLP should help them less and less.
Functional Words and Phrases
The words and phrases your child is learning should be functional/useful. Words like family names (Mama/Mommy, Dada/Daddy), your child's name or nickname, yes/yeah and no, favorite foods or toys, action words (go, want, put, do), and social greeting words (hi and bye) are often early targets. "Power" phrases are also frequently targeted. These are phrases such as "me too," "no way," "go away" that your child can use with big impact. Your child should be learning to say these words and phrases with different prosody (rhythm, rate, inflection and smoothness) so that it sounds natural and interesting.
