Depending upon the severity of the child's needs, treatment approaches will vary. For very young children with limited output, imitation of vowel sounds and environmental sounds within a play format is appropriate. For children who are ready for more structured interventions, many trials at the appropriate level (vowel to vowel, consonant vowel, consonant vowel consonant, consonant vowel consonant vowel etc). are practiced in imitation with multi-sensory cues in a highly reinforcing play therapy environment. As a child's verbal output increases, further strategies such as pacing, video modeling etc are utilized. For children who have limited communication skills, motor speech practice is the primary focus with functional communication strategies such as use of Picture Exchange Communication System to express basic needs and wants and to minimize frustration. AAC is also utilized when appropriate.