My treatment approaches when working with children with CAS are created using methodology and strategies from my training in PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets)and DTTC (Dynamic Temporal and Tactile Cueing). When working with children with CAS I have three main goals that I begin with during treatment. These include determining the child's skill level/needs, collaborating with the family to choose at least 4-5 functional target words, and developing an alternative augmentative communication system (as appropriate). Upon determining the child's repertoire of syllable shapes, vowel repertoire, and consonant repertoire, I identify the 'level' at which we will begin speech practice. I determine the 'level' in part by using the 'Motor Speech Hierarchy' from the PROMPT Institute. Each level represents a different speech motor plan ranging from simple to increasingly complex. Once two 'levels' are chosen, I work closely with the family to determine functional target words that are close to the targeted syllable shapes. For example, If the child was working at the 'Mandibular Control' level we may choose words including VC, CV, and CVC shapes such as 'Up,' 'Pa,' and 'Mom.' Based on the individual child, we will target nonsense words and functional words, or functional words only to begin treatment. We begin with blocked practice by practicing speech targets with high frequency and intensity. Generally, we begin with simultaneous productions, followed by direct imitation, production after a time delay, and spontaneous production. Random practice is implemented as child achieves success and moves into spontaneous productions and production after time delay. The timeline of movement from blocked to random practice is tailored individually to each child. Multi-sensory cues are provided at each level and faded with success at each level. It is important that cues are faded appropriately. Parent practice of chosen speech targets at home is strongly encouraged to ensure carryover and generalization of target words. Parents are trained to practice with the child as appropriate during speech sessions to learn facilitation methods. Homework programs are individualized and provided to each child and family. Alternative Augmentative Communication programs (high and low tech) are created with families and implemented early on in treatment in conjunction with speech program.