Monday, September 16, 2013

Apraxia Treatment (1st in a 4 part series): Establishing a Core Vocabulary

This is an area that is so very near and dear to my heart.  If I could treat preschoolers with Apraxia all day long, I’d be in Heaven.   This is an area of speech therapy that I just love!   I feel like these kids *really* need me-- I know everyone on my caseload ‘needs’ me, but I feel like it’s a different level of need with the apraxic kiddos!  

With apraxia, I feel like it’s really up to me-- I’m the individual that’s key to unlocking their communication by getting to know the very detailed ins and outs of their speech production strengths and needs, and figuring out exactly how to use their strengths to facilitate the other areas of need.  I can then, in turn, teach parents and teachers how to model, cue, and simplify words/sentences as needed.  That’s not to say I don’t do parent education like that with the rest of my caseload, but it’s different with Apraxia.  It’s not the same as educating parents on how to read books to their child to build vocabulary and work on answering questions, making predictions, learning basic concepts, etc…  Apraxia is much more intricate, more involved, more detailed than a lot of other areas.  It’s a challenge that keeps my SLP ear fine-tuned and keeps me on my toes!  

Many kids with apraxia (around the age I see them-- preschool) have a very limited expressive vocabulary.  They often use just a few words to convey many other words and ideas.  I have a little girl with apraxia on my caseload, who, when we first started out, used “my mommy” for ev-er-y-thing.  Everything.  Coupled with a head nod “yes” or “no.”  For instance, I’d tell her I liked her hair or her outfit, and she’d respond with “my mommy” to tell me her mom did her hair or got the outfit for her.  We’d be reading a story, and she’d point to things in the book and say “my mommy” with a head nod “no,” trying to convey they didn’t have that particular item at home or they had never done those activities.  One day she even ran across the playground at recess, to the swings, yelling “my mommy!!” That was her automatic that came out, and she didn’t have much more beyond that, spontaneously… which brings me to the point of this blog post:  Establishing a core vocabulary in kids with apraxia.

The first step in establishing a core vocabulary in kids with apraxia, for minimally verbal kids, is figuring out the vowels and consonants they can produce in isolation and upon imitation, as well as any syllable shapes they can produce, such as:
*VC (up, out, in, etc)
*CV (me, my, bee, bow, pie, pay, etc)
*VCV (okay, owie, ohno, etc)

*CVCV (reduplicated syllables; same consonant and vowel sounds repeated-- mama, dada, papa)
*CV1CV2 (same consonant sound repeated, different vowel sound in each syllable-- mommy, daddy, mummy, puppy, people (/pipo/), bubble (buh-bo))
*C1V1C2V2 (both consonant and vowel change in 2nd syllable-- happy, hippo, money, honey, muddy)
*CVC (hop, nine, bat, etc... Generally the hardest, as it includes a final consonant sound)

This is what SLPs are great at-- list-making!! (Does anyone else ever add new things to their to-do list that they’ve already done, just so they can cross them out?? I'm not the only one, right?!)

List 1:  Motor Coordination
The purpose of this first list you’ll want to make is for motor coordination-- practicing syllable shapes/words that have sounds the child already has in their repertoire.  Use what they have and build on those strengths!  If they only have /p, b, m, uh, ee, ah, oh/ sounds, you can teach words like mama, mommy, papa, mo (“more”), “muh” (as an approximation for “more”), me, pop, bubble (buh-bo), puppy, mop, etc.  

Write down their consonants and vowel sounds they are able to produce, and create words from them-- any word you can think of, even if it’s not necessarily a “functional” word for them.  Functional is your second step-- These words on the first list are just for practicing different syllable shapes and practicing a variety of consonant/vowel combinations to increase motor coordination skills.

List 2:  Functional Word List (General)
These are words that are used for either social purposes (i.e. greetings), or to manipulate their environment in some way.  Examples of these types of words are open, on, off, in, out, up, down, hi, bye, no, go, put, etc…  These are also words that you can use for pivot phrases when working on combining words together (more on pivot words/phrases in another post in the series!).

List 3: Functional Word List (Specific)
This is where you’ll make a list of words that are functional to that child specifically.  Favorite foods, toys, books, games, family members’ names, etc… can all go on this list.  In most cases, you’ll have to simplify these words and make them into simpler approximations for the child to imitate.  

Lots and lots of practice and repetition is key in treatment of Apraxia! Shorter, more frequent sessions have been found to be of more benefit to children with Apraxia than longer sessions across fewer days (i.e. 15 minutes 4x/week vs 30 minutes 2x/week).

Additionally, if you don’t already have something with visuals (like the Kaufman Kit) to represent the syllable shapes/words in lists 1 and 2, create some of your own.  Visuals are key when teaching these words, because eventually you’ll want to decrease your cuing and have them to be able to see the picture and produce the word spontaneously!  I'll be doing another post in this series that includes some of my favorite apraxia materials, so keep an eye out for that! It'll include both free and paid materials, both hard goods and printables.  Even some DIY ideas!

That concludes the first part in my 4 part series on Apraxia treatment!  The other three parts of this series will include using pivot words/phrases in therapy, cuing techniques, and a collection of Apraxia materials.  Hope you'll come back to join me for the other posts in the series! If there's any other topics re: Apraxia that you'd like to see covered in this series, please let me know-- I'm open to ideas!


  1. Thank you for your posts on apraxia! I stumbled across your blog while doing a google search for apraxia resources. Small world--I am a K-state graduate (Go Wildcats!) and I got my masters from Wichita State (Go Shockers!)! I am a new grad with my first SLP job and I just so happen to have a kiddo with pretty severe apraxia. I am looking forward to reading your future posts about apraxia!!!

    1. Thank you so much for your comment, Stephanie! That is a small world! Speaking of WSU.. Dr Hodson just came last Fri to present to a group of about 40 of us in the area from a few different districts. One of her previous WSU grad students got her to come and do an inservice for us. I'm glad you found this post helpful-- I'm hoping to get another post in the series up this week, or early next week at the latest! Feel free to email me if you have any specific questions on apraxia and I'll try to help-- I love this area!!

  2. I really like your posts on apraxia. I have a few children on my preschool caseload with CAS. I own the Kaufman Treatment kit and also use The Source for Apraxia as a reference. These two resources differ though on the direction of therapy. Kaufman really targets a variety of sound syllable sequences (new, two, bye, whoa, etc.), where The Source suggests targeting specific consonants in syllables (me, ma, mi, mo, etc.). What do you prefer? Also, do you pick certain functional words and "drill"/practice those until mastered. Example, the word "me" is produced as "nee...." Do you work on that until mastered and would it be best to work on other initial /m/ vowel sequences at that time, or is it ok to mix in other CV syllables, for example "bye" and "day?" Thanks for your input!


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