Depending on the level of severity of the child and age, I start with the very basics of communication such as, getting the child to engage in play, turn-taking and following directions. I reward any attempt at communicating at first and usually start with simple signs to learn imitation and the need to communicate to get the item they desire. It is impossible to force a sound/word out of a child, but with signing I am able to do hand over hand signing with them in order for them to understand the cause and effect of communication. As a child begins to learn communication is necessary to obtain items I then reward any verbal attempt to imitate the words I am producing. I slowly start to refine words as the child's level of frustration decreases and they are able to engage and allow me to cue them more without shutting down. My treatment session is generally play-based for younger children while I embed simple CV/VC words throughout the activity in context. As my children progress in age and level of difficulty of words I have them sitting at the table working on a variety of syllable shapes utilizing the Kaufman cards while earning pieces to a toy or a turn with a game we are playing. I use Dynamic Temporal and Tactile Cueing with a multi-sensory approach which structures levels of heirarchies of cueing the children to increase accuracy of a word beginning with saying the word in unison to mouthing the word with them and then letting them attempt spontaneously. In addition, I am trained in PROMPT which is physical manipulation of the face to contract the muscles needed for each sound to help map the pathway their mouth needs to take to produce a word correctly.