First and foremost, establish trust and rapport with the child. The work they will be asked to do is hard, and they can't work and learn if they don't feel safe.

I simultaneously target mulitmodal expressive communication skills (use of conventional gestures, sign language, picture communication boards, speech generating devices and vocalizations) while working toward increasing vocalizations.

All communication attempts are honored. The child is encouraged to watch my face and body to observe how I can express the same idea they expressed at the "next step" to foster an aim of refining expressive communication skills. A core set of words/word approximations are identified early in the course of therapy based on their speech productions to give the child as much functional verbal communication as possible in addition to other modes of communication.

Once rapport and trust are established, focused work sessions are incorporated into therapy sessions where the child is asked to work on speech production at a level that is appropriate for them based on their phonetic inventory, phonological development and stimulability for production. If the child cannot yet imitate, they are encouraged to look and listen as the sounds/oral movements are modeled for them. Initially, I focus intensely on correct production of vowels at a level that is appropriate for the child to improve speech intelligibility.

Ideally, therapy is scheduled for 3-4 times per week. Realistically, many families cannot support this schedule. So, therapy is often scheduled for 2 times per week with the parent involved to observe and participate. Then successful activities are sent home. Parents are encouraged to use the therapy activities at home once to twice daily for 10-15 minutes per work session. Emphasis is placed on correct practice versus number of trials.