For children with moderate to severe CAS, I use the child's evaluation to guide my clinical decisions. I have found that frequent shorter sessions are more productive and use a variety of reinforcement techniques to keep the child motivated while working (throwing a ball through a hoop, blowing bubbles), so that we get a large amount of practice in each session. Therapy focuses on helping the child plan and program motor movements from one sound or syllable to another without unnatural pauses. Clinical decisions are made rapidly within each session to determine the level of cueing the child needs to be successful, with the ultimate goal of accurate spontaneous productions from the child.