I understand how frustrating it is to have a child with Apraxia of Speech on your caseload and not know how to best serve them. Just like you, I didn't learn a lot about Apraxia of Speech during grad school. I want to share with you the knowledge I have gained through reading textbooks, journal articles, and during my professional experience over the past 14 years.
A very important factor in treating children with Apraxia of Speech is using multi-sensory cueing to help them build their motor plans.
What is multi-sensory cueing? It simply means providing cues that involve more than just one of the senses.
Types of Multisensory cues you can use with your students in your speech therapy sessions include:
Visual Cues (a model or image of how the mouth looks when saying the target)
Auditory Cues (a spoken model of the target)
Tactile Cues (cues of what the child feels when saying the target)
Metacognitive Cues (an associative cue, such as a nickname of a sound, that helps the child remember specific features of the target)
There are many ways to use these multisensory cues in therapy. Often, a single cue is engaging two sensory systems. Here is a list of suggestions taken from Fish (2016):
Visual Cues &
Auditory Cues:
Simultaneous Production: The SLP and child say the word at the same time, while the child watches the SLP's mouth, either at a slower or normal rate. This cue should be faded quickly and replaced with a less salient cue (e.g. miming or direct imitation).
Direct Imitation and Delayed Imitation: The SLP models the target before the child says it. In direct imitation, the child immediately repeats the SLP. In delayed imitation, the child repeats the target after a pause up 1-3 seconds.
Mirror: The child looks in the mirror while saying the word.
Backward Chaining: The child begins at the end of the word and works their way to the beginning. For example, ti -> get -> spaghetti. This cue is particularly helpful when teaching multisyllabic words. It is important to practice these words smoothly - this means no pauses between syllables!
Forward Chaining: The child begins at the beginning of a word, and adds more syllables to the work systematically. For example, snow ->snowman.
Visual Cues:
Mouth pictures and videos: Pictures and videos of the mouth to show the child how a specific sound is made.
Ultrasound Biofeedback: An ultrasound probe is used so the child can see the shape and placement of their tongue.
Mime: The child watching the SLP say the target without a voice. This takes the auditory cue away, making the task more difficult, while continuing to provide some support.
Metacognitive Cues:
Hand cues for place, manner, and voicing: The SLP uses specific hand and finger positions to represent specific placement, manner, and voicing. The exact cue doesn't matter - consistency does!
Manual Signs: The SLP signs the target before the child says it.
Graphic Cues: The SLP uses letter and words to denote sounds. This is appropriate for emergent readers and fluent readers. This is a great way to incorporate literacy into your sessions!
Blocks/chips: The SLP/child point to blocks/chips to depict the number of syllables in a word/phrase. You can use lego, pieces of paper - anything that you have handy!
Metaphors: The SLP chooses a 'nickname' for a sound, based on the features of a spound. For example, the 'z' sound could be called the 'buzzy bee sound'.
Visual Syllable words: This is a great cue to teach the pronunciation of compound words. Simply use the picture for each of the words (e.g. snow (picture of snow) + man (picture of a man). You would use this when the child is able to say each word on its own.
Phonetic Placement Cues: The SLP tells the child exactly what to do with their articulators to make a sound. For example, if teaching the 't' phoneme, you could say, "put your tongue behind your teeth and tap it down".
Tactile Cues:
Tactile Cues: These cues can be used with other cues. Both DTTC and PROMPT use Tactile Cues. Learn more about DTTC here and PROMPT here.
Auditory Cues and
Tactile Cues:
Rate Reduction: Slowing down the rate in which the target is said. Prolonging the vowels in a word is a great way to do this. Slowing down the rate allows the child to have extra time to proces exactly what they should be doing.
Ready to Start using Multi-Sensory Cues in your
Speech Therapy Sessions?
Make sure to check out my Speech Sound Cue Cards. Each of the 36 phoneme cards includes:
Phonetic Placement Cues as soon as the child no longer requires them to be accurate. You can fade cues by shifting from using combined sensory cues to single sensory cues and transitioning to less salient cues.
A metaphor (and picture)
A Graphic Cue
Hand Cue.
You can print them full size, or card size and you are free to send them to parents to promote carryover! Click here for a closer look!
Want a visual for Multisensory cues? Check out my Apraxia Homework Packet, which includes this visual and three other handouts!
Quick Reminders:
SLPs need to choose a cue that helps the child at the level of breakdown. For example, if the child is having difficulty using two syllable words, it would be important for the SLP to give cues to remind the child to use both syllables (e.g. a visual cue of two fingers or two blocks).
There is no 'one size fits all' when it comes to cues! Each child will respond to cues differently. SLPs must use their clinical judgment to choose the cues that are most suitable for their students. This can even change moment to moment with the same student!
Using appropriate cues is SO important in order to for children with Apraxia of Speech to progress with their skills. It is also very important to fade the cues as soon as the child no longer requires them to be accurate. You can fade cue by shifting from using combined sensory cues to single sensory cues and transitioning to less salient cues.
Quite often, you may use more than one of these cues at any given time! It is important to be flexible during therapy and provide the cues that are helpful to your student.
**This information is not a substitute for therapy that is delivered by a qualified Speech-Language Pathologist. Any clinical decisions regarding treatment approach are the sole responsibility of the Speech-Language Pathologist.**
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Fish, M. (2016). Here’s how to treat childhood apraxia of speech., (2nd ed.). San Diego, CA: Plural Publishing.