When a child walks into our clinic, often the doctor decided to take the “wait and see approach” and I’m beginning the journey to treat a minimally verbal to nonverbal 2-year-old child with suspected mod-severe CAS.

Family involvement and parent coaching is key to any treatment session I have. In the world of working with insurance companies, I often get to treat these children 2x a week for 30min sessions. I always take the child’s phoneme repertoire and sit down with the family to create functional target words. I look at what sounds the child already possesses and often create some successive approximations (e.g. “bubba” for “brother) and try to create words with a variety of simple syllable shapes (CV- “no”, VC-“up”, CVCV- “momma”) etc. I make sure family is in agreement to the list and what target word (s) we start with.

If the child is nonverbal, we play with LOTS of sounds. I talk with the family about making sounds fun and our sessions are all play-based and focus on making big movements paired with big sounds. I have found with experience, the more fun and sillier the session is, the more the child will play with sounds themselves. When demands to communicate are taken away and I focus on modeling, I’ve noticed an increase in the child wanting to imitate me. I am thankful to work in an environment where we have big gym equipment, games, trampolines, sensory toys to all assist in engagement and buy-in with the child. If in home, I often utilize daily routines to create opportunities for high repetitions of target words (the car, snack time, or floor time w/caregivers are my personal favorites).

Once I build imitation skills, sessions start with one (maybe 2) functional target words from target word list. I mainly use the DTTC hierarchy and successive approximation approach. I build trust w/ the child by having them watch my mouth, giving a variety of prompts (tactile/visual/physical) and finding where they are successful. Once I find success with a word we play games with high repetitions and always start in unison. Eventually I fade my voice/cueing as sessions progress. I choose therapy activities based on the child’s regulation and how to make the activity most functional to the target word. For example, I once placed token pieces on the child’s stairs and we practiced “up” all the way up the stairs. I send home only successful targets and want parents to feel comfortable implementing our target word (s) in their daily routines.