Thursday, May 22, 2014

Apraxia Therapy: Early Apraxia Therapy (Where to Begin) Part 2

I frequently receive requests for information from parents or therapists of very young children - usually between the ages of 18 and 30 months. The children have very few, if any, words. They make few sounds. They have a history of reduced or absent babbling. They have difficulty imitating and difficulty making volitional utterances. They are beginning to become aware that they are different. They want to communicate and yet struggle. Frustration is increasing on the part of both parents and children. The child may begin to act out in negative ways. What do you do? Where do you start?

You have three immediate goals:
  1. Reduce frustration.
  2. Establish and increase frequency of volitional utterances.
  3. Increase number of daily speech utterances through structured practice.

Early Apraxia Treatment - Reducing frustration.

Read about how to address this goal in part one of my Early Apraxia Therapy (Where to Begin) series.

Early Apraxia Treatment - Establishing and increasing frequency of volitional utterances.

Typically, very young children with apraxia have difficulty producing sounds when they want to. You want to help them be able to intentionally vocalize. If they already can vocalize at will, you want to increase the number of those utterances and the contexts in which they can produce those utterances. Note that for the purpose of this goal, you should not care if the utterance is phonetically accurate. For example, if the child is trying to say, “baby”, and the utterance they make doesn’t sound anything like “baby,” that is all right. If they produce something different each time, that is all right too. You simply want them to be able to reliably produce an utterance in response to a stimulus.

Every time a child with apraxia makes a vocalization (any vocalization) on purpose they are practicing formulating a message in their mind, creating a motor-speech plan, and successfully coordinating breath, phonation, and movement of the speech articulators to produce sound. For these children, that sequence of events is a huge success and a necessary beginning. You need this to happen before you can begin to fine tune the specific sounds that emerge. There are many ways to establish and increase practice opportunities for volitional utterances. I will describe four methods below.
  1. Echoing - One of the simplest ways to establish or increase the number of volitional utterances is to echo any utterances your child does make back at them. Remember that every single time your child deliberately makes a sound to communicate they are coordinating intent with breath, phonation, and movement of speech muscles and structures. This is essential practice in early apraxia therapy. So, if your child happens to make a sound (not a frustration sound, but any other sound) echo it back at them. You want to try to create a fun feedback loop or simple game out of bouncing that word/sound/exclamation/utterance back and forth. For example, there was a time when my daughter's only word was "da?" (for "that?"). She would use it to label items she already knew the name for, to request the name for unknown items, and to request items she couldn't reach. She and I could have an entire conversation consisting of bouncing that one word back and forth. She would point to an unknown item (let's say... a marble, just for the sake of this example). The conversation would unfold as follows:
    • Ava: "Da?" (What's that?)
    • Mama: "Da?" (You mean this?)
    • Ava: "Da!" (Yep!)
    • Mama: "Da?" (You sure you mean this?)
    • Ava: "Da!" (Yep mama. Tell me already!)
    • Mama: "Marble."

    So, instead of her making a single utterance and then receiving either the marble or the label for the marble and being done, Ava practiced making an utterance three times in the context of a true, turn-taking conversation. Over time, this simple technique can result in dozens, or hundreds of extra utterances a day. You can listen to an example of a father using this technique with his 21 month old daughter in the first apraxia speech sample audio clip of this post.
  2. Interactive book reading - Sit down with your child and a picture book. Your goal is to use the book interactively to elicit speech from your child. Read the same book each night so that the child sees the book as a familiar and fun activity. You do not want to read the book to your child, although you can make reading the text on each page part of what you do. You want to engage your child in commenting on the action in the pictures by pointing and asking questions. For example, if a story involves a character who falls, every time you read that page, point to the character and say, “Uh oh!” Then encourage your child to mimic you. Go back and forth several times. Have fun with it. Other utterances that can be worked into reading many children’s books include “hi,” “oh no,” “shhhh,” “bye bye,” “mama,” “daddy,” etc. Again, it doesn’t matter so much that your child mimics those words correctly. You simply want them to experience the turn taking and joint attention that comes with playing the game.

    You can watch a video of this type of interaction in my Case Study of Apraxia – Audio Samples from 21-30 months post. I am reading a book with my 21 month old daughter with apraxia. I also highly recommend the Big Book of Exclamations by Teri K. Peterson. The author is a speech pathologist who designed the book to provide many, many opportunities for interactions and vocalizations. Read my review of The Big Book of Exclamations for more information on this great book.
  3. Pair actions and vocalizations - Often children with apraxia find vocalizing easier when their efforts are paired with motion. Encourage your child to say “whee” while sliding down a slide or swinging on a swing. Play horsie and bounce them on your knee or on an exercise ball while saying “ba bump, ba bump, ba bump”. Blow bubbles and encourage them to say “pop” as they pop each one with their finger. Crash cars together and have them mimic “bam!” Give them a ball of play dough and let them poke holes in it imitating “squish” each time. Line up blocks along the end of a table and have them say “uh oh” each time they push one off. Then they can say “up” each time they put one back up setting up for the next round. Possibilities are endless. Again, it doesn’t so much matter what sound they make. What matters is that they do make a sound. You want them to enjoy making the sound. Making a sound is part of the game. Without a sound, the game isn’t as much fun.
  4. Strategic Withholding - Create speech opportunities in daily life. Structure interactions to require speech. It is so easy with a minimally verbal child to start anticipating their needs and eliminate the need for them to even try to vocalize. Instead, deliberately place a few favorite things out of reach so they have to ask for your help to reach them. Give them a small serving of their favorite food so they’ll need to ask for more. If you are coloring with them, deliberately place the colors just a little out of their reach so they’ll have to ask you to hand them the crayons. These are just a few simple examples, but extend the concept as much as possible during the day. Through this simple technique you can create dozens of opportunities for your child to verbalize each day. Every single utterance adds up to extra practice. A child with apraxia needs as much practice as you can possible squeeze in.

    Do not take this to extremes. You are not trying to be mean, or to deliberately frustrate the child. You are simply intentionally creating opportunities for requests. You want the process to feel natural and not forced. If the child is not able to vocalize a request, respond to nonverbal requests (and signs) as well. You want to avoid increasing frustration. Think “create opportunities” rather than “force practice.”

Trying to write this as one continuous post was simply too long. Look for the continuation of this series the rest of the week. In the meantime, if you need more general information about Childhood Apraxia of Speech, the following posts may be useful:
  1. What is Childhood Apraxia of Speech and How Is It Diagnosed?
  2. What makes Childhood Apraxia of Speech different from other speech disorders?
  3. Childhood Apraxia of Speech Therapy Fundamentals: Part 1 - How Much and How Often?
  4. Childhood Apraxia of Speech Therapy Fundamentals: Part 2 - Types and Variability of Practice
  5. Childhood Apraxia of Speech Therapy Fundamentals: Part 3 - Methods and Content


  1. This is a wonderful series! I have thoroughly enjoyed reading this.

  2. This comment has been removed by the author.

  3. Howdy

    I love this subject. Lots of college classes online are open.

    My best wishes!
    Phillip Scollin

  4. Hello

    Receive some help for your site with WordPress plugin developer.


  5. The ultimate article. Thank you for writing a good article to read.
    Sa gaming สมัคร a

  6. The ultimate article. Thank you for writing a good article to read. uplay365 คาสิโนออนไลน์

  7. FINALLY FREE FROM HERPES VIRUSI thought my life had nothing to offer anymore because lifebecame meaningless to me because I had Herpes virus, thesymptoms became very severe and bold and made my familyrun from and abandoned me so they won't get infected. I gaveup everything, my hope, dreams,vision and job because thedoctor told me there's no cure. I consumed so many drugs butthey never cured me but hid the symptoms inside me makingit worse. I was doing some research online someday when Icame across testimonies of some people of how DR Ebhotacured them from Herpes, I never believed at first and thoughtit was a joke but later decided to contact him on the detailsprovided and when I messaged him we talked and he sent mehis herbal medicine and told me to go for a test after twoweeks. Within 7 days of medication the symptomsdisappeared and when I went for a test Lo and behold I wasNEGATIVE by the Doctor Who tested me earlier. Thank you DREbhota because I forever owe you my life and I'll keep ontelling the world about you. If you are going through samesituation worry no more and contact DR Ebhota viadrebhotasolution@gmail. com or WhatsApp him via +2348089535482.he also special on cureing 1. HIV/AIDS2. HERPES 3. CANCER 4.ALS 5. HEPATITIS B 6.DIABETES 7. HUMAN PAPILOMA VIRUS DISEASE(HPV)8. ALZHEIMER 9. LUPUS (Lupus Vulgaris or LupusErythematosus

  8. My life has changed a lot since I started this online trading, it's called bitcoin it has transformed my life from zero to hero, I wouldn't have made it without the help of a trusted account investor company called skylink technology with their new tech that help double your investment to give you massive profit. i have been withdrawing quite some time now, I have invested in her platform and earned numerous profits, If you're interested contact, is legit.mail:  or  whatsapp: +1(213)785-1553  or website:  or telegram group:

  9. شركة تنظيف شقق فلل كنب مجالس موكيت سجاد خيام فرشات خزانات مكيفات زوليات مدارس مكاتب استراحات شركة تنظيف بالرياض إبداع متناهي في تحقيق كل ما تبية
    شركة غسيل فيلا شقه خيم بيت شعر
    التعقيم التنشيف التجفيف التنظيف المثالي
    شركة تنظيف واجهات بالرياض
    افضل شركة تنظيف شقق بالرياض
    شركة تنظيف سجاد بالرياض
    شركة غسيل كنب بالرياض
    افضل شركة تنظيف مكيفات بالرياض

  10. steam generator for steam bath

    WAJA sauna is specialist manufacturer of top quality sauna products. Products include sauna rooms, steam rooms, barrel saunas, wooden hot tubs, and all kinds of sauna accessories.

  11. Hello, I found a very helpful website for Locksmith Services which is an Australian-based company! For More Details kindly visit our website.

  12. I would like to thank Ultimate Life Clinic for reversing my father's Amyotrophic Lateral Sclerosis (ALS). My father’s ALS condition was fast deteriorating before he started on the ALS Herbal medicine treatment from Ultimate Life Clinic. He was on the treatment for just 6 months and we never thought my father will recover so soon. He has gained some weight in the past months and he is able to walk with no support. You can reach them through there website

  13. شركة تنظيف واجهات زجاج بالرياض
    The best glass facade cleaning company in Riyadh relies on the latest advanced machinery and equipment that are used to clean large facades, and the cleaning and polishing process takes place in a short time, so that the place does not hang for a long time. The company provides the service of a large team of customer service personnel, who are present throughout the day in Serving the company's valued customers.

  14. Thanks you for sharing this testy blog.
    You can visit our cafeteria(ThePizzaHotSpot) is open for all the times with tasty and yummy food & friendly service.
    best pizza in Melbourne | best pizza near me | pizza places nearest me | pizza restaurants near me | vegetarian pizzas near me

  15. I panicked when I saw the first sore. The medicines could not heal the sores completely, my whole life I was entirely desperate. Till I found the natural permanent cure for herpes through Nze Njoku Herbal Home, I felt like I was born-again. You can get rid of herpes from now on, too
    Reach Nze Njoku Herbal Home on

  16. I’d recommend using Dr. Utu Herbal Cure topically for instant pain and itch relief as well as accelerated healing of lesions and permanently stopping oral and genital herpes virus outbreaks. I have tried just about everything from acyclovir suppressive therapy to different natural oils, extracts, and other natural methods, some of which are EXTREMELY painful and exacerbate the problem (i.e. apple cider vinegar!). While vitamin E oil and suppressive therapy worked well for me, when I became pregnant I went back to trying to find a herbal cure. I was using vitamin E oil topically for a while but it was thin and difficult to use and only seemed to prevent further outbreaks rather than getting rid of it. I contacted Dr. Utu Herbal Cure through my friend. To my surprise, I could tell my outbreak was starting to heal within only a few hours! No more itching or pain! Dr. Utu Herbal Cure that I used was liquid herbs in bottles, so it was very easy to use. It simply whiffs, but it works so I don’t care! The best part is I successfully delivered a herpes-free beautiful daughter without further medication. Anyone who’s tried Dr. Utu Herbal Cure knows just how quickly those treatments can add up. So hand it a try! Anyone can reach Dr. Utu through

  17. Nice blog. Jaipur Hearing Solution is the Speech Therapist in Jaipur. We do the assessment and management of speech and hearing problems of all age groups.

    Best Speech Therapist in Jaipur

  18. Greetings of the day, my name is Jude Thaoms and I’m from Atlanta Georgia USA. Let me share a little on how I got cured from Genital Herpes. When I stumbled upon a website, while I was looking for cure my genital Herpes on a forum that I frequently visited, the first thing that I noticed was that most persons there was testifying and thanking Herbal Doctor Kham and i went through the write up and i read about how Herbal doctor Kham has cure them and first i went into doubt but i have to see what he can do for me with tears in my eyes because i want to be free from this disease i went to Herbal doctor Kham by contacting him through his email, after speaking him about my problem, he assured me that he will help me get this disease out of me that he is only here to help people and put a smile on their faces. He told me what i will have to do and after going according to herbal doctor Kham instruction and i went back for a medical check up and according to the words he gave to me, Herbal doctor Kham really did it for me, now i believe him and i telling you, if have been infected either with HERPES, HIV,AIDS, CANCER. I assure you that herbal doctor Kham can cure you. I have seen testimonies of people and I’m also one of the living testimony. You can Contact Herbal doctor Kham through Email.. or WhatsApp him through +2348159922297 You can Also Visit his website to know more about him at >

  19. Hi, there. I am Tom Neil and I wish to describe how life had been for my younger brother living with schizophrenia and how he had been forever able to conquer this debilitating disease via a naturopathic, herbal method.

    Maicon - my kid brother was twenty years old when he was brought to the emergency room by the campus police of the college from which he had been suspended several months ago. A professor had called and reported that he had walked into his classroom, accused him of taking his tuition money, and refused to leave.

    Although he had much academic success as a teenager, his behavior had become increasingly odd during the past year. He quit seeing his friends and no longer seemed to care about his appearance or social pursuits. He began wearing the same clothes each day and seldom bathed. He lived with several family members but rarely spoke to any of them. When he did talk to them, he said he had found clues that his college was just a front for an organized crime operation. He had been suspended from college because of missing many classes. My sister said that she had often seen him mumbling quietly to himself and at times he seemed to be talking to people who were not there. He would emerge from my room and ask my family to be quiet even when they were not making any noise.

    My father and sister told the staff that Maicon's great-grandmother had had a serious illness and had lived for 30 years in a state hospital, which they believed was a mental hospital. Our mother left the family when Maicon was very young. She has been out of touch with us, and they thought she might have been treated for mental health problems.

    Maicon agreed to sign himself into the psychiatric unit for treatment. The whole family except I had agreed to have Maicon transferred to a mental asylum. I knew inwardly there was still some plausible means by which my kid brother could overcome this condition. I knew botanical means of treatment will be more favorable than any other type of treatment, and as such, I had taken a keen interest in the research of naturopathic alternative measures suitable for the treatment of schizophrenia. I had pleaded for some little patience from the family in the delay of the transfer, I was looking forward to proving a point to the entire family, of a positive botanical remedy for this condition.

    It was during my ceaseless search on the internet I had been fortunate enough to come across Dr. Utu Herbal Cure: an African herbalist and witch doctor whose professional works had majored on the eradication of certain viral conditions, especially schizophrenia, ( improving the memory capacity positively), via a traditional, naturopathic process and distinguished diet plan. It was by the administration of this herbal specialist that my brother had been able to improve his condition for better.

    Before the naturopathic remedy - Maicon's story had reflected a common case, in which a high-functioning young adult goes through a major decline in day-to-day skills. Although family and friends may feel this is a loss of the person they knew, the illness can be treated and a good outcome is possible.

    My brother Maicon is just like many other patients out there suffering from this disease. Although he was able to overcome this condition via a naturopathic herbal remedy administered by this African herbal physician and saved completely thus, rekindling the lost joy which had been experienced by the family members.

    I wish to use this opportunity to reach across to anyone who may happen to be diagnosed with this disastrous condition to spread the hope of an everlasting herbal remedy that is capable of imposing a permanent end to this disease.

    For more information concerning this naturopathic herbal remedy, feel free to contact this African herbal practitioner via email:

  20. spin to get rewards with torches, pg 888th
    swords and shields. In 10 free spins, winning moves pg 888th

  21. เข้าเล่นสล็อตแมชชีน 2022 เว็บสล็อตออนไลน์ที่ดีที่สุด pg slot ที่มาแรงที่สุดในปี 2022 นี้ กับความสนุกเพลิดเพลินที่คุณจะได้รับจากเว็บของเรา ที่มีความปลอดภัย 100 % มั่นใจได้

  22. I am here to give my testimony about a doctor who saved my life. i was infected with HERPES for more than 2 years, I tried different doctors over a period of time but no one work, but when i came on the Internet i saw great testimony about DR Enato how he was able to cure someone from HERPES virus with the help of herbal medicine I contacted him and he promised to cure my herpes virus.well i decided to give him a try, DR Enato put his best in it and gave me good and effective result just as he has promised. Well after taking all the treatment sent to me by Dr Enato i went back to the Hospital for check up, and now i have been confirmed HERPES Negative. You can contact him if you have any kind of sickness like, HERPES, HIV, CANCER, PILE, HEPATITIS, DIABETES, and alot more you can contact him ON WhatsApp (+2348071351544) or Email His website is

  23. Get rid of all kinds of Herpes with Natural Root and Herbs, I was once infected with Herpes Genital Warts and after using Dr Enato herbal Medicine for a couple of weeks I couldn't trace it anymore, I even went for a checkup and there my test came out Negative. Get Your cure today from his herbal medicine contact him through his Email or WhatsApp {+2348071351544} or his website

  24. To become a Superslot member, you can apply by yourself and apply through the admin. And our team for 24 hours. If you are interested in playing games, web slots, pg, direct websites, we have free trial games to play. without application Open for service in Demo mode, games, free to play, give away lots of credits. Ready to receive many privileges, apply for a trial slot

  25. การีน่า Service เมก้า เกม บริการได้รวมทั้ง บริการใดๆก็ตามที่มีให้ผ่านซอฟท์แวร์เกมบนแพลต์ฟอร์มของ Garena หรือบริการใดๆก็ตามที่เข้าถึงได้ผ่านเกมของ megaslot หรือเว็บ เมก้า เกม ที่น่าสนใจ

  26. Your article has a great deal of value for me. Your blog provides me with insightful. information that expands my understanding. The Custom Box Packaging provides you with long-lasting and visually appealing Custom Subscription boxes Ideas.

  27. วันนี้จะมาแนะนำ ทดลองเล่นสล็อต megagame กับเว็บไซต์เราได้เเล้ววันนี้ที่ MEGA GAME ทุกท่านจะพบ กับเกมสล็อตออนไลน์ รูปแบบใหม่มีมากกว่า 1000 เกมที่เราได้คัดสรรมาให้นักเสี่ยงโชค

  28. roma สล็อต พวกเราได้เลือกสล็อตที่ได้รับความนิยมมาให้แล้วซึ่งก็คือ พีจีสล็อต เกมสล็อตที่ฮอตฮิตที่สุดในเวลานี้ก็คงจะหนีไม่พ้นเกมสล็อต roma ที่ไม่ว่าจะมีทุนน้อยขนาดไหนก็เล่นได้

  29. 918kiss Login to the online slots website is open for service here. Slots that are nice to play can come to use the service. Easily via the website directly to PG, much more than that.

  30. เกมส์ สล็อต สล๊อตออนไลน์ สล็อตเล่นง่ายได้เงินจริง ระบบฝาก-ถอน AUTO 30 วินาทีแค่นั้น สล็อตแจกเครดิตฟรี pg มาแรงที่สุดในชั่วโมงนี้ เนื่องจากว่าระบบของราไม่ต้องโหลด app อะไรให้ยุ่งยาก

  31. chokdee777 slot สำหรับสมาชิกที่ชื่นชอบความง่าย รักความสบายสบาย เพิ่มข้อจำกัดความเพลิดเพลินให้กับเกมพนันออนไลน์แบบขั้นสุดเราขอเสนอ PGSLOT เวอร์ชั่นโทรศัพท์เคลื่อนที่ ให้เสถียร

  32. pg slot99 เกมสล็อต ค่าย พีจี ถือเป็นค่าย เกมสล็อตออนไลน์ มาแรงตลอดหลายปี ที่ผ่านมา เปิดตัวใหม่ มาใน รูปแบบเกมสล็อต 3D มีเกมสล็อต น่าสนุกตื่นเต้น ที่นักเดิมพัน ในการเข้าเล่น

  33. slotpg รูปแบบใหม่ต้องใจผู้เล่น เกมคาสิโนออนไลน์ที่เยี่ยมที่สุด บริการครบวงจรในเรื่องความเพลิดเพลินและก็เงินรางวัลหลายชิ้น สล็อตออนไลน์เล่นไม่ยาก ชำระเงินจริงทุกบาททุกเงิน

  34. ทดลอง เล่นสล็อต PG SLOT สมัคร เกมสล็อต เว็บตรง เกมฟรี สล็อต ทดลองเล่นฟรี ถอนได้ แล้ววันนี้ทางเว็บไซค์ได้รวบรวมเกมสล็อตที่น่าสนใจให้ทุกท่านได้ทดลองเล่นฟรีมากกว่า 100 เกม

  35. This herbal Doctor cured me from herpes virus through herbal means...

    certainly the best online...

    Thank you!! Very well!…………………

  36. เล่นสล็อต สำหรับมือใหม่ อาจจะมีความรู้สึกว่าเป็นเรื่องยาก ที่จะทำเงินสำหรับในการ เล่น สล็อต pg slot แม้ว่าจะทำได้ แต่ว่าก็ทำได้ไม่เท่าไรนัก ได้เงินหลักสำหรับเพื่อการ ทุจริตสล็อต ออนไลน์

  37. pg slot asia สล็อต เป็นเว็บไซต์พนันสล็อตออนไลน์ ลำดับหนึ่ง ที่คนอีกหลายๆคนนั้นต้องเคยได้ฟังชื่อนี่กันมาบ้างแล้วเพราะเว็บไซต์ของพวกเรานั้น PG SLOT เปิดให้บริการโกรธยะหนึ่ง

  38. Pg Slot เครดิตฟรี หรือ มีกิจกรรมที่แจกเครดิตฟรี PG SLOT มีโปรโมชั่นและก็ยังมีแอดมินทำงานที่จะรอเอาใจใส่ดูแลผู้เล่นตลอด 24ชั่วโมง ฝากไม่มีอย่างต่ำที่เว็บของเรา Pg-Slot.Game


Web Analytics