Children with CAS need to exert a great deal of their cognitive and attention resources to the speech task, especially during the early phases of speech therapy as they build volitional control over their speech motor system. SLPs need to assess consistently their environment and the potential distracters for the child that will reduce the child’s ability to put forth the necessary attention and intrinsic resources to their speech practice. For example, noise and visual distracters or movement can reduce the child’s ability to put forth their greatest allocation of attention to the speech production practice. As children develop their speech motor skills, these issues may become less important.
Attention is a key skill for children who require the type of multisensory strategies described for children with apraxia of speech. In particular, for a child to benefit from increased sensory input like visual cueing, they must be able to provide eye contact and attend to the SLP’s face when instructed to do so. Children who are unable to give even the most basic level of attention to the SLPs face may need preliminary work to increase their ability to do so in order that they may benefit from an intensive speech motor-programming based approach.
Children with CAS have likely experienced a great deal of failure in their communication attempts. Many either withdraw from communication interactions or develop behaviors related to their frustrating situation. Additionally, many children have experienced a lack of success at previous speech therapy attempts. Thus, the SLP needs to provide special care and concern to actively engage such youngsters and insure that they experience early success in therapy – even during the first session. Experienced clinicians pay attention to:
- Understanding the child’s personality as well as their history of communication failure and success
- Demonstrate understanding directly to the child by validating their experience and sharing the desire to help speech become easier for them.
- Remember that each child is different in what motivates them and what interests them. By including such interests in therapy, children may be enticed to participate with more willingness.
- Work with caregivers to communicate a safe environment for the child and to create trust in the process.