For a child with moderate to severe CAS, a treatment approach will be determined for the child that is a "best fit" based on their needs. For those children who have very limited verbal communication, I am most likely to employ the use of Dynamic Temporal and Tactile Cuing (DTTC) as the primary treatment approach. When using the DTTC approach, I work with the child and family to determine highly functional/meaningful target words or phrases to practice with the child. All targets are selected based on the child's current speech sound and phonotactic abilities as well as what new movement (sounds) and/or syllable shapes the child is able to produce given cuing. Our practice during sessions is intensive, with the child producing new targets through blocked/mass practice (many repetitions in a row) and provided with visual, verbal, and tactile cues to correctly produce the target. A small number of targets are selected for practice, in order to allow for more intensive practice during the session. I look for totally correct production of targets during treatment, meaning all the sounds are correct, the movement between sounds and syllables is smooth, and the syllable stress and/or overall prosody is correct. We vary productions, making sure the child can produce each target with varied volume, speed, and intonation. Cuing is reduced and increased, as needed, to ensure that the child is as often as possible only producing the target perfectly correct. Systematic use of the DTTC cuing hierarchy supports the child in taking increasingly more responsibility for the motor planning of the target. As the child learns to produce a target correctly, practice with the target become more distributed and random to ensure that they are able to "call up" the motor plan for the target independently. As learned targets are mastered and moved into random practice, new targets are introduced through blocked/massed practice.

For some children, another evidence-based motor speech approach may be appropriate in addition to or instead of DTTC. This may include the use of Rapid Syllable Transition Treatment (ReST) for children with more mild-moderate CAS, wherein children practice nonsense syllables with a focus on self-monitoring for correct production of target utterances. Children are taught to attend to the sounds, beats, and smoothness of their productions compared to the models provided.

For those children who present with a mixed speech sound disorder (such as CAS plus phonological patterns of errors, articulation errors and/or dysarthria) a hybridized treatment approach would be developed to address the child's overarching needs, with a focus on the aspects of their speech sound disorder that are most significantly impacting their intelligibility and participation.