5 FUNctional Ways to Combat Suspected CAS in Toddlers and Preschoolers

Working with busy toddlers and preschoolers takes patience, energy, and creativity. This is most evident when young clients present with severe speech sound disorders like suspected Childhood Apraxia of Speech (CAS). It can be challenging to make speech sound disorder intervention feel like play.

Common Signs of CAS¹

We may recognize some of the following symptoms as early as one or two years old:

1. Receptive ability exceeds expressive ability
2. Characterized as a “quiet baby” with limited babbling/sound play
3. Limited number of consonant sounds and/or vowel errors and distortions
4. Communicates with gestures or other non-verbal actions
5. Connected speech is more unintelligible
6. Voicing errors
7. Groping
8. Prosodic disturbances

As children grow and mature, their neurological systems develop, and the signs and symptoms of CAS may disappear. However, we do not know which kids will just progress out of this stage on their own, and which will require assistance from targeted intervention. This means we should incorporate techniques into our play-based and routines-based therapy to help these kids develop speech skills and become competent communicators.

The 5 FUNctional Strategies

Because we know how sounds are produced and how to help clients develop better speech, SLP’s can develop methods which help kids learn to speak proficiently at an early age. I’ve found success using the following strategies:

1. Instruments – Teaching a child how to control the airflow we use for all speech is a great way to move them into more volitional speech. By incorporating harmonicas, whistles, recorders, etc. into therapy we can appeal to what kids like to do (be loud) and teach them to control their airflow. We move from random blowing to specific patterns. Eventually, kazoos can be introduced to pair breath support with intentional phonation.
2. Interactive Play and Movement – Encourage distinguishable vowel production by suggesting play with toys and books that use animal and vehicle sounds. We can also draw simple scribbles as we vocalize a variety of vowel sounds pairing movement with sound play. Another idea is to model exclamatory sounds as we play outdoors swinging and sliding.
3. Singing – Songs teach children to connect words while building intonation and prosody skills. Any songs will do. I like to build songs into daily routines like hand washing or putting on shoes. Be creative and feel free to make-up songs!
4. Loud vs. Soft Talking – Playing games that encourage kids to be loud and then quiet will build the control of their loudness level, supporting their overall control of the suprasegmentals of speech.
5. Gestures – Gestures and simple sign language create a functional communication system until a child can speak spontaneously.

Over the years, I have found great success in building pre-speech skills with young children presenting with CAS signs and symptoms. The outlined strategies are easily incorporated into play-based or routines-based activities that young children enjoy. This gives them the opportunity to have fun while building their expressive speech. When parents see how much their kids enjoy the activities, they might be more likely to do them with their kids after you leave. We all know that practice makes perfect – it is a win/win!