Once a thorough evaluation is completed, therapy targets are identified. Targets are chosen based on stimulability and sounds within child's repertoire, core functional vocabulary, present levels of performance, ease of production, and targets that impact intelligibility the most. THere is no "one size fits all" because each child has different traits AND different needs. Sounds, syllables, multisyllables are practiced with successive approximations using a variety of strategies: backward chaining, multi-modal cueing with visual, tactile, proprioceptive stimuli - high frequency of repetition and fading the cues needed for success. Targets are built around a functional vocabulary that maximizes child's ability to communicate effectively. SIgns / gestures / assistive communication is used as needed for a 'bridge' to allow success in communicating with others. Syllable chains are practiced initially with reduplicated phonemes, then progressing to differentiated phonemes. Therapy targets progress from words to functional phrases and sentences. Natural routines are built into sessions to facilitate easier transition / carryover. Family keeps notebook with practice work; phonemes always have a visual cue and a visual picture for association (ie 'K' is the coughing man). Sessions always begin with a 'drill' that child can be very successful with. Verbal routines are always built into sessions - something that child can routinely say at home and in multiple environments. Building it in to the sessions allows for numerous repetitions and success prior to going home. Examples of this might be "counting to 5" or "I can do it."