Tuesday, May 17, 2011

Childhood Apraxia of Speech Therapy Fundamentals: Part 2 - Types and Variability of Practice

Childhood Apraxia of Speech (CAS) is neurological speech disorder that causes children to have difficulty with the motor planning, sequencing, and programming necessary to produce volitional speech. Therapy needs to address the core problem of motor planning for speech in the most effective way possible. Every child is different, so therapy must be customized. Therapy for a young child who is nonverbal will be different from therapy for an older child who is using multi-word sentences, but the speech is hard to understand. However, the basic underlying fundamentals of therapy for apraxia are going to be similar. These underlying fundamentals are based on current research and professional consensus.

How is therapy for Childhood Apraxia of Speech structured?

We've already discussed the fact that therapy for a motor planning problem needs to involve lots and lots of practice. The next question is how to structure that practice in order to get the best results.

Blocked versus Random practice

Blocked practice is practicing one target at a time, over and over again. This is where the therapist starts when trying to teach something entirely new. If you have a child who can't make a /b/ sound and you are trying to teach it, you are going to practice /b/ over and over again in blocks until the child experiences some success. A blocked practice structure is great at establishing a new skill, but doesn't carry over well outside of the therapy session. When the child begins to perform well in a blocked structure the therapist will move to a random practice structure.

Random practice is when several targets are practiced during a single activity. Now the therapist will practice that same /b/ sound, but will also throw in one or two other sounds the child can make too. The therapist will switch between the two or three sounds randomly. This increases the motor planning demands of the task because the child has to switch between different targets. It also makes the task a little more like real world speech demands when you are not saying the same sound over and over and over again.

Variability of practice

Therapy practice needs to vary in speech context, social context, and environmental context. Targets need to be practiced in multiple speech contexts. That /b/ needs to be practiced at the beginning, middle and ends of words. It needs to be practiced in multiple syllable structures. It needs to be practiced in phrases, sentences, and in conversation.

Therapy practice needs to vary in social context as well. Practicing a /b/ with the speech therapist is different than practicing it with Mama or Grandpa. Practicing a /b/ in a speech therapy session or during a practice session at home is different than practicing every /b/ word that comes up when reading a bedtime story with Daddy.

Finally, variability can also include environmental variation. The child should be working to improve their production of speech targets in therapy, at home, at the grandparent's house, in the car, at the grocery store, at school or daycare, etc.

The greater the three kinds of practice variability the better the child will internalize the new target and be able to use it spontaneously in a variety of contexts. This is why the participation of the parent is so important. The speech therapist cannot achieve social and environmental variability by him or herself. The practice the parents do at home and out and about during their daily life is an essential part of the therapy picture.


Therapy sessions for Childhood Apraxia of Speech need to involve lots and lots of speech productions. When learning something new, the therapist will used a blocked practice structure and only target that new skill. Once your child learns the new skill, the therapist will switch to a random practice structure and randomly switch between the newly learned skill and some old ones in order to improve performance when the demands of the task are harder. The speech skills also need to be practiced in different speech contexts, social contexts, and environmental contexts. Home practice is essential for this variability in practice.

You just finished Part 2 of a three part series on Childhood Apraxia of Speech Therapy Fundamentals.
Read the other two parts of the series:

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