Therapy for children with CAS first focuses on establishing rapport between the patient and the therapist. This can be accomplished through child-led, play-based therapy, which allows for authentic connection and is motivating for the child. After rapport is established, sessions may begin targeting specific speech production goals. These are centered around "movement shapes", and may focus on syllable shapes, length, and phonetic complexity rather than traditional articulation therapy, which focuses on phoneme production according to developmental norms. After 5-6 target words or shapes are selected, I most often use a "blocked set", which involves principles of motor learning. Using fewer targets allows for more massed practice, which is proven to work best for children with CAS. I also like to develop a child's "power list", which may include important family, place, or item names, actions, or phrases. This may also be used when establishing targets for treatment. Sessions use Dynamic Temporal and Tactile Cueing (DTTC), which involves a hierarchy of simultaneous production, direct imitation, imitation after a delay, and spontaneous production for each of these targeted words/shapes. I use multi-modal cueing including visual cues (attention to my mouth), verbal cues with "pictures" of the sound with semantic cues, i.e. "tick tock sound" with a clock for /t/, gestural and tactile cues (showing the child where the sound is being produced with my finger and/or feeling throat for voiced vs. unvoiced consonants. Feedback may be immediate, delayed, or variable depending on the patient's accuracy. After these targets are mastered with constant practice, variable practice will be introduced by varying phonetic context, prosody, and other aspects of nonverbal communication including volume, rate, etc. all while also tapering feedback. After a blocked set is completely mastered, the above steps will be repeated to add additional syllable shapes, phonetic complexities, words, and/or phrases to continue to improve your child's speech and overall intelligibility.