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Don’t Just Teach the Speech

by Laura Smith
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Co-articulation. Prosody.

These are key terms when treating childhood apraxia of speech (CAS). A child with CAS exhibits three main criteria:

  1. Inconsistent productions with sounds and/or words.
  2. Difficulty with co-articulatory transitions.
  3. Errors with prosody (stress, intonation, pitch, rate, volume).

SLPs who treat apraxia use principles of motor learning and focus on movement gestures or sound sequences. Recently, I’ve noticed an increase in information about CAS. I think ASHA’s addition of apraxia to its Practice Portal helped. The site states, “the majority of treatment approaches for CAS emphasize movement patterns versus sound patterns.”

I’m thrilled with this statement, because I find this step alone often takes a child with CAS from nonverbal to verbal. Common approaches for implementing the process include the Kaufman Speech to Language Protocol and PROMPT training.

However, I still don’t see a lot of emphasis on co-articulatory transitions or prosody. Kids with apraxia struggle with these elements, but as with speech, SLPs can address them in treatment. In working with CAS clients, we should also focus on helping the child “sound” more natural in their speech.

Here’s the thing about apraxia. When kids with apraxia learn a certain motor plan, they learn it well and they consistently say it the same way. This works well in terms of learning the appropriate sound sequences, but we should also consider prosody and co-articulation, so clients don’t sound robotic, staccato and/or monotone.

Okay, so how do we incorporate co-articulation and prosody?

I really enjoy incorporating prosody into treatment. It works with both structured and unstructured tasks, which makes it dynamic and versatile in terms of weaving it into sessions. Make sure—even when doing the direct and structured work of ensuring a child articulates every sound in a word—to vary intonation. Some direct activities I use include having the child say target words like various favorite characters or say words using different emotions. This way, they practice articulatory accuracy and variation at the suprasegmental level. And the kids love it!

Other activities I use include singing songs with changing volume. Recently, I just had a child sing “Bingo” with me where we shouted the first letter and stayed quiet for the remaining letters. Obviously, this child is more verbal and in a later stage of apraxia resolution. However, even in early treatment, the SLP can ask a client to say a target word loudly versus softtly. Including prosody in session plans creates fun activities for you and the client.

Co-articulation can be tricky for CAS clients. Kids with apraxia already experience difficulty sequencing longer syllables or putting words together. When children with apraxia do start combining words, they articulate every single sound. That’s what we want, right?

If I may, let me take a moment to mention phonetics class—some of you just cringed and some of you perked up! Anyway, when we were taught to transcribe, we also learned co-articulation because people don’t talk in connected speech by articulating every single sound. Many times we have to do this when teaching kids with apraxia how to speak, but we can also teach co-articulation at the connected speech level so our clients with apraxia speak naturally.

Childhood apraxia of speech is a rare and complex disorder. However, every SLP can ensure children with the disorder find their voice and also a voice that sounds as natural as possible. We should keep working on movement gestures and sound sequences as the first and most important approach. But as apraxia expert Dee Fish pointed out at the Apraxia National Conference, “Don’t just ‘teach the speech,’ when it comes to treatment for childhood apraxia of speech.”


Laura Smith, MA, CCC-SLP, is a school-based and private clinician in the Denver metro area specializing in childhood apraxia of speech. She often speaks at conferences and consults for school districts or other professionals. Like her on Facebook, follow her on Pinterest, or visit her website at SLPMommyofApraxia.comlauraslpmommy@gmail.com

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Anette Olivier November 11, 2016 - 12:54 am

Can’t agree more!

hbslp November 11, 2016 - 12:33 pm

Wonderful ideas, Laura! Thank you for the reminder to devote time to working on coarticulation at the connected speech level rather than simply honing in on single sounds or words. Sometimes I get stuck in that rut, and I so appreciate your suggestions!

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