My treatment involves multimodality cuing methods used at different levels as necessary. I use touch cues to help shape movements for sounds, gross motor cues (ex: easy does it vowels), talk about how sounds are made (ex: lips together), encourage self cues, give descriptive/fun names to sounds (tongue tapper /t/), and feedback on what specifically was correct/incorrect. I use signs to decrease frustration and to help facilitate speech. I always let the child and family guide selection of targets in treatment. I may modify what the actual label becomes to make it achievable (ex: a brother named "Sebastian" may be called "bubba" for brother). If something is important for that child to be able to communicate then it becomes core target for treatment. I discuss the need for the family to accept appropriate approximations within the child's capability and each stage. I will address vowels in isolation and then build into CV and VC shapes within the same task. I use backward chaining frequently to assist with shaping targets. All of my therapy is play based drill working to get at least 50+ trials of each target. I use "friends" like stuffed animals or cars to gave the child tell each the target to get several trials in a row; I also have kids say it in set of 5 with me putting 1 finger up for each to build of high five and then 5 more times to count down and make a fist pump/pound. Whatever the child chooses is what we do and our core vocabulary becomes embedded repeatedly in the activity. I use a lot of gross motor play like bouncing, swinging, scooters, etc. to get bodies moving which helps more severe children get voicing and motivates almost all kids to talk! The child's level determines the number of targets addressed in a visit. I give cues to support whatever the child has to say in a session combining verbal and nonverbal methods but I focus specifically on our target words and patterns/shapes to maximize motor learning. I fade cues as quickly as possible using the Dynamic Temporal and Tactile Cueing hierarchy and move between blocked and random practice varying targets. For many of our kids, the family and I have created small picture books to practice their core vocabulary and include pictures of hard to say things as well so the child can point to request these items. Some of our kids have AAC in place and we incorporate verbal trials in conjunction with the device.