When treating children with suspected CAS, I always try to keep in mind the relative role of articulation, phonology and motor planning errors. I always have my eye on the vowels as they carry so much information which adds to clarity. I also look for function. Within the child's repertoire what can we quickly shape towards meaningful speech? What can we do to minimize frustration for the child, parent and teachers? What are the child's interests.? What are their important words? What kind of practice will the parents be motivated to integrate into their daily life? These are always important questions and may guide treatment in ways which I sometimes cannot anticipate. I'm also always looking for those surprise targets that emerge out of expected sequence. These might also push the treatment in unplanned directions.

Beyond the factors listed above, for the child who has a speech pattern that looks to be largely impacted by CAS, the treatment is pretty organized and sequenced. I think of classes of sounds the syllable positions. Start where they have success and build syllable shapes ( V, CV, VC, CVC.....CCVC, CVCC). As this process progresses, I would look to build clarity of 2-3 word phrases and sentences with controlled motor sequences. Clarity of vowels remains at least as important as consonant production as do the prosodic elements of sound sequences at the multisyllabic word and phrase levels.

Important elements of treatment include using motor skills (sweeping techniques) to facilitate sound blending. Touch cues also help to foster and support speech sound sequences. To reduce frustration around communication attempts, we might introduce some basic signs or picture cue system.

I always have my eye on risk factors for early literacy. Establishing understanding of sound-symbol relationships can enhance the speech therapy process. Explicit teaching of phonological awareness skills is important for all children but perhaps even more important for children with CAS. As the children grow, we continue to evaluate the prosodic elements of oral reading.