I have found that children with CAS benefit from highly dynamic therapy approaches. We need to engage our whole system to really see how the motor planning is affected for each specific child. For this reason, our clinic has a weekly theme upon which all therapeutic activities are built. We try to engage all the senses in therapy sessions while maintaining strict control over distractions. We have found that having a theme provides a cohesive set of activities that makes carryover easier for parents at home and allows me as a therapist to choose very specific targets for the child based upon both ability and interest that are still highly functional. My goal for treatment of CAS is always the most functional change possible in the shortest amount of time. I begin the treatment plan at the level where is the child is beginning to breakdown to ensure challenge with some sense of success. We choose syllables and/or words of importance based on successful spontaneous consonants and vowels, frequently used words in the family, core vocabulary, and needed power words. We begin with the DTTC approach - simultaneous production moving to direct imitation, delayed imitation and finally spontaneous production. We work on stretching sounds rather than bouncing and have found backward chaining helpful for many children. Additionally, I focus on prosody and pitch for natural sounding speech early on. I always use a multi-modality approach - although the target itself remains consistent, how we engage the functionality of the target may change. I have found that if even very young children can see a sound, syllable or word is useful in many contexts, they are more willing to work hard to attain it. I use a cueing hierarchy as we move through targets. We utilize tactile, verbal/auditory, visual and metacognitive cues and fade cues and move from mass to distributed practice and from blocked to random targets as skills increase. We progress through targets as appropriate to develop functional, spontaneous and intelligible verbal expression