SLP Corner: The Successive Approximation Method for Children with Apraxia of Speech
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Reprinted with the express permission of Apraxia-Kids as originally published on their website.
By: Nancy Kaufman, M.A., CCC-SLP
Children with childhood apraxia of speech cannot easily execute and/or coordinate oral-motor movements to combine the consonants and vowels necessary to form words. Asking children to imitate whole words would be setting them up for failure. Just like any other task that is difficult to master, the task of speaking can be broken down into a more simplified one, in this case word approximations.
By examining how children first learn to speak, we can observe that many of the early vocabulary begins with word approximations such as, baw for ball, or bah for bottle, or even wawa for water. Children with CAS who have performed little babbling or practice as infants, may not be able to change what they hear and understand, into the motor act of speaking those words. By simply offering children with CAS the opportunity to attempt word approximations using the consonants and vowels already in their repertoire, successful attempts at words are achieved, reinforced, and rewarded by the listeners comprehension, and thus their response to the childs needs and desires. Through shaping, cueing, and fading techniques, children with CAS can gradually move into whole words, phrases and sentences.
One can evaluate the consonant and vowel patterns of children by asking them to imitate, moving in a hierarchy from simple to complex vowel and consonant combinations to obtain a profile of the childs motor-speech proficiency. Then, through practice of this hierarchy of consonant and vowel patterns, the children gain verbal praxis skills for the ultimate goal of successful verbal communication.
Beyond the workout of practicing consonant-vowel patterns in real words is the important aspect of functional communication. As soon as the child has any type of an approximation for a word, it should be encouraged and reinforced by the appropriate response of the listener (i.e., giving the child juice for attempting doos or oos for juice). In this approach, however, we do not necessarily wait for the child to use an approximation independently, though that is certainly the optimal goal. We actually assist them with imitation, cues, prompts or any possible way to help them make their best word approximation attempt. We also help to script the children directly into two or three-word combinations almost immediately, even if every word is only approximated, such as in I want .., being scripted as Ah wah
This approach encompasses aspects of behavior modification (shaping, cueing, fading) for successful approximations, as well as our knowledge of phonological processes, which are the way young children tend to simplify adult forms of words. Such phonological concepts as final consonant deletion, cluster reduction, vowel neutralization, to name a few processes, are what we rely upon to decide how a word can be simplified based upon typical speech development. Every word can be reduced to its shell (this concept of word shells was introduced to me by Ms. Carole Goff, M.A., CCC/SLP). For instance, the word bottle, can be broken down like this:
Choosing the childs highest successful imitation and reinforcing it (ideally giving the child the bottle), offers them a chance at successful verbal communication rather than only accepting the full word which may not yet be a possibility. This approach also encompasses techniques gleaned from the research and work accomplished by many speech and language pathologists who work with individuals exhibiting acquired apraxia of speech. These techniques include using melody and gestures to take the pressure off of the volitional muscle control system. Occupational therapy/sensory integration techniques of direct stimulation to the oral musculature and using gross-motor activity to propel the entire motor system to activate verbal-motor skills are also valuable to this approach.
The Kaufman Speech to Language Protocol is also becoming highly successful for children with CAS on the spectrum of autism. Dr. Vincent Carbone, Ed.D., BCBA and Ms. Tamara Kasper, MS/CCC-SLP, BCaBA, are currently researching and adapting the K-SLP techniques specifically through Applied Verbal Behavior, employing methods from B.F. Skinner (1959) and Sundberg and Partington (1998). The changes for children with autism are largely due to the fact that it can be more difficult to move along the hierarchy of word approximations, as there is more work involved in extinguishing and replacing the first learned word approximation and shaping it toward the ultimate goal of the full word. Dr. Carbone also utilizes the method of stimulus-stimulus pairing to move non-verbal (yet vocal) children into the ability to imitate CV patterns, which prepares them for the K-SLP approach.
Through the workout, scripting, and ultimately improving word retrieval, grammatical skill development and general formulation skills, children with CAS can become effective verbal communicators.
Page Last Updated: December 20, 2008
© Apraxia-KIDSSM, a program of The Childhood Apraxia of Speech Association (CASANA). All rights reserved. http://www.apraxia-kids.org
Date Last Modified: 12/20/2008 9:29:08 PM
Featured Organization and Author: Nancy Kaufman, CCC-SLP and The Childhood Apraxia of Speech Association of North America (CASANA)
Nancy R. Kaufman, M.A., CCC/SLP is the owner and Director of the Kaufman Children’s Center for Speech, Language, Sensory-Motor, and Social Connections, Inc. (KCC), located in West Bloomfield, Michigan. She received her B.A. at Michigan State University and M.A. at Wayne State University, having been awarded a graduate assistantship. Nancy has dedicated herself to establishing a treatment approach to help children to become effective vocal communicators since 1979. She is the author of the Kaufman Speech to Language Protocol, (Wayne State University Press, 1995), the Kaufman Speech to Language Protocol Kits for Children (Northern Speech Services, 1998, 2001), the Kaufman (K-SLP)Workout Book (Northern Speech Services, 2005), and co-author of the K&K Sign to Talk: Nouns (Northern Speech Services, 2005) and the K&K Sign to Talk: Verbs (Northern Speech Services, 2009). She lectures locally, nationally, and internationally on the subject of childhood apraxia of speech and other speech sound disorders in children. Families from around the country and the world travel to the KCC to participate in intensive and specialized programs created to meet the needs of their children. Nancy is highly regarded as an expert in her specialized field, and consults with parents and professionals across the globe. Nancy also serves on the Professional Advisory Board of the The Childhood Apraxia of Speech Association of North America (CASANA), and is the recipient of the 2010 Michigan State University College of Communication Arts & Sciences Outstanding Alumni Award. Many specialists in the field of Applied Verbal Behavior (AVB) have adopted the Kaufman Speech to Language Protocol (K-SLP) for children with autism spectrum disorders. A recipient of the Clinical Service Award from the Michigan Speech-Language-Hearing Association, the KCC continues to grow and has earned a reputation for excellence, warmth, and successful outcomes. Nancy has three grown children and resides with her husband in West Bloomfield, Michigan.
We thank CASANA for allowing PediaStaff to reprint their resources. Apraxia-KIDS is the Internet’s largest, most comprehensive and trusted website for information on childhood apraxia of speech (verbal dyspraxia, developmental apraxia of speech) and children’s speech and language topics, including evaluation, speech therapy, research and other childhood communication topics. Invaluable for parents, speech-language pathologists, teachers and all those who care about a child with apraxia. For more information about this organization please visit CASANA