First, I do everything I can to get them in a 1:1 or 1:2 group. In a school setting with a high caseload that requires sacrifice on my part but I know may CAS students need this small size in order to get mass practice and trials. I have studied and like to use the Dynamic Temporal and Tactile Cueing (DTTC) Approach but my sessions look different depending on the age of the child and the severity of CAS.
My sessions begin where the breakdown occurs although I always try to begin and end a session with success to keep the child invested in the activity. My therapy sessions are play based or literacy based - or what ever the child is interested based. My targets are FUNCTIONAL and MEANINGFUL to the child in order to give the child power through communication at a very basic level. When kids need prompting, I find out what works best for them and use that as often as possible. It might be physical or gestural such as using a straw/bite block or hand signal. It could be visual/verbal such as simultaneous productions with or without voice or using a mirror with a sound cue card attached. Sometimes a child only needs a metalinguistic or placement cue. I use what prompts and cues I need and then fade quickly when no longer needed. The goal is always 100%. Practice at the beginning is massed and blocked and and I let the student know how he or she did on a particular trial using performance based feedback - for example, ""I heard you say doe!"" or ""Where is that /s/ sound?"" As a child begins to master a syllable shape or word, I begin to randomize and make the trials more varied followed up by providing results based feedback (Good Work!) to encourage generalization before moving on to a new syllable shape target, always keeping the movement sequence at the front of my brain. NO SEGMENTING! Coarticulation teaches the most natural movement sequences so that speech sound natural. I use core words to create meaningful pivot phrases, eg, Go daddy, Go see, Go up. I use visuals to teach ""stretching"" the sound such as rubber bands, cars moving, whatever might keep the interest of the child. I like to involve whole body movement when possible for younger children. AAC if needed is a good idea to give the child some type of functional communication.