My approach is intensive and usually involves shorter sessions several times a week for maximum progress. I find the least amount of prompting that a child needs to produce the most complex type of utterance and then to use less prompting over time while increasing the complexity of utterances. For example, if a child already produces V, C, CV and VC combinations but does not yet produce CVC combinations, I would do stimulability testing to see if they are able to produce a CVC combination with tactile prompts, visual or auditory cues (such as simultaneous production with "voice on" or "voice off"), direct imitation, and then delayed imitation. Some children vary in the amount of cueing they need, based on the context and their level of fatigue. This is very important for me to pay attention to so that the child does not become frustrated. Each time we practice a word, I like to get as many repetitions as I can. Some children have the attention span for 3 repetitions only, but if a child will repeat 10-15 times, I know that we will make much progress much more quickly. Thus, I give rewards and incentives throughout therapy that are interesting and fun for the child. Over time, I like to see the child mastering the combinations and then moving onto new combinations and new sounds (e.g. CVCC or CCVC, then multisyllabic words, then phrases, and then sentences).

I like to use Kaufman cards to help children develop new combinations and also to provide the cards as a home program for parents to follow. Additionally, depending on the age and motivation of the child, I like to choose 5-15 novel words or phrases that the child can practice in therapy (with the cues they need) and also at home with their parents. We add on a few new sounds, words, or phrases once they have mastered about half of their word/phrase/sentence list.

For those with a very small speech sound repertoire, I have seen new speech sounds emerge with some exposure to tactile and visual cueing as well as with an increase in the child's level of confidence when communicating. Therefore, it is very important to incorporate AAC into therapy to make sure that frustration is kept at bay. I am fluent in American Sign Language, so I will generally teach simple signs (in play) that the child can use if they seem to be interested in this form of communication. I am also PECS certified, which is another system of communication that has been effective for kids with CAS. I encourage the family to maintain AAC while setting aside specific time for speech, often with a reward at the end of practice to keep their child motivated.

Lastly, if there are difficulties with prosody, I will wait until we are at the phrase level to work on this. I have found that working on sustained phonation and then completing glides (high to low and low to high) in an exaggerated way can help a child speaking in a monotone to vary pitch. We can then choose continuant consonants, /m, n/ and do the same glides, eventually moving onto gliding on a vowel with CV and VC combinations, then gliding throughout a short 2-3 word phrase. Depending on the child, we may focus a lot on prosody if they are very stimulable, or we may work on intelligibility more if this is the main area of concern.