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Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA [email protected] Elaine Dolgin-Lieberman, MA,CCC- SLP [email protected] Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA [email protected]

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Page 1: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Taking Advantage of All Those Teachable Moments

Speech Therapy at Home for Young Children with CAS

Angela Muis, BA

[email protected]

Elaine Dolgin-Lieberman, MA,CCC- SLP

[email protected]

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 2: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Disclosure-

Angela Muis

Apraxia Kids Canadian Ambassador

Chair of a team actively building a national resource organization for Canadian families

Speech-Language Pathologist Assistant / Communication Disorders Assistant

Private Reading Instructor

Parent of a wonderful boy with resolved apraxia

Angela does not have any financial relationships to disclose

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 3: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Disclosure-

Elaine Dolgin - Lieberman

Member of Apraxia Kids Professional Advisory Council (PAC)

Graduate of the CAS Intensive Training 2011, Recognized by Apraxia Kids for Advanced Training and Clinical Expertise in Childhood Apraxia of Speech

Professional Lecturer in the Graduate Speech and Hearing Department at Mercy College in Dobbs Ferry, NY, teaching an annual class on Childhood Apraxia of Speech.

Clinician in private practice with a primary interest in working with children with motor speech disorders.

Elaine does not have any financial relationships to disclose

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 4: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

SPEECH PRACTICE AT HOME IS BENEFICIAL

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 5: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Higher production frequency = faster target acquisition

(Edeal & Gildersleeve-Neumann 2011)

Children with CAS benefit from lots of practice

(Murray, McCabe & Ballard, 2014)

More Practice is Better

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 6: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

“The need for multiple repetitions to develop motor skills to an automatic level is well established and forms a basis for treatment of CAS. Given the number of hours per day a child spends with family versus therapist, opportunities for practice are multiplied when parents encourage speech practice outside of therapy sessions.

Extending therapy targets into the child’s home environment promotes motor learning that goes beyond acquisition of motor skills.”

- Ruth Stoeckel

Practice at home facilitates carryover and generalization

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 7: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

“Many children with childhood apraxia of speech need frequent therapy. Sometimes that’s not possible. At that point it becomes especially important that practice happen at home.”

- Edythe Strand

Practice at home is especially important

when children cannot access

appropriate speech therapy

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 8: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Home practice can be a special time for children and their caregivers

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 9: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

SPEECH PRACTICE AT HOME IS A PARTNERSHIP BETWEEN PARENT AND SLP

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 10: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

“Parents and caregivers are critical to success for children with apraxia of speech. Parents should look to their child’s SLP as a coach, tutor and guide so that the practice they encourage at home is appropriate for their child’s current ability level. ”

- Apraxia Kids

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 11: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

PARENTS ENGAGING IN

SPEECH PRACTICE AT HOME NEED

TO KNOW

●What are my child’s goals?

●What specific targets should we work on?

●How many targets should we work on?

●What activities can we do to encourage practice?

●What cueing strategies are available?

●How should I provide feedback to my child?

●What if I am trying and it’s not working?

● What should I do when my child’s speech is not understood?

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 12: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

PARENTS ENGAGING IN

SPEECH PRACTICE AT HOME NEED

TO KNOW

●Am I doing this well?

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 13: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

A LAUNCHING POINT FOR

PARENTS

“It’s important that, as a parent, you feel comfortable in helping your child with that practice.

Knowing what to listen for, knowing how to help or cue the child if they’re having some problems, having the ability to observe some of the speech pathology sessions is important and it’s really okay to ask your speech pathologist if that can happen.”

- Edythe Strand

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 14: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

AN SLP SUPPORTING

HOME PRACTICE NEEDS TO

KNOW

●What is this family’s capacity for home practice?

●What are the parents’ expectations?

●How much support does the parent need to be successful?

●What type of skill development and encouragement does this parent need to best support their child?

●Is the parent experiencing success using skills that are taught to them?

●How are things going with practice at home?

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 15: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

A LAUNCHING POINT FOR POINT FOR

SLPs

“Especially at the beginning, when they have the least experience, I find that parents benefit most when they clearly understand their role as active “agents” of their child’s learning and are provided with materials and clear models for how to engage the child in appropriate learning activities, as well as lots of support and encouragement when trying these out. Once they experience some success and gain confidence in their abilities, the need for this level of support decreases.”

- Megan Hodge

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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Caregiver as the “agent” of change

It can be challenging to add the new role of being an agent of change for a child with apraxia to the role of parent.

It’s normal for parents to find that adding speech therapy and home practice to an already busy life isdifficult...

because it is.

Page 17: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

How am I going to pull this

off?

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 18: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Parents may find that a dedicated, structured time for speech therapy at home is needed when a child is working on new skill acquisition or while the parent is getting the hang of a new skill, like cueing or providing feedback to their child.

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 19: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Schedule it!

❑ Day planner❑ Calendar ❑ Apps❑ Email to SLP❑ Fill a Jar❑ Visual schedule❑ On the fridge

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 20: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Along with structured time working on skill acquisition, parents/caregivers can layer speech practice for that skill onto activities that are already a part of daily life.

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 21: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

A naturalistic treatment environment is important for facilitating generalization and carryover of skills, and

home practice is essential for helping the child make optimal progress.”

- ASHA’s Childhood Apraxia of Speech Practice Portal

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 22: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

When parents are provided with clear and manageable home practice recommendations, children have an opportunity to practice more frequently and to extend their speech skills across a wider range of settings. This extra practice across settings can help facilitate carryover and generalization of new speech skills.”

- Margaret Fish

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 23: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

TeachableMoments

These are real-life opportunities that can happen at any time and any place or be created to help your child practice their speech targets in a natural setting.

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 24: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

What are my child’s goals?

How often should we practice?

What specific targets should we

work on?

How many targets should we work on

at one time?

What activities can I do with my child

to encourage these targets?

What therapy and cueing strategies

are available?

How should I provide feedback

to my child?

What if I am trying and it’s not working?

What should I do when my child’s

speech is not understood?

QUESTIONS TO CONSIDER

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 25: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

TOOLS AND ACTIVITIES

TOOLS that families can use to take advantage of “Teachable Moments” as they occur in real life.

Creative ACTIVITIES that families can provide that will help the child improve speech accuracy and prosody (rhythm/music of speech) in a natural setting and help them generalize their speech targets in a natural setting.

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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PUTTING TOOLS IN YOUR TOOL BOX

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 27: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

What are my child’s goals ?

Look at the Whole Child

What type of help can we provide to Improve your

child’s speech Intelligibility to allow your child to

Indicate their needs

Convey important

information

Interact socially with their peers.

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 28: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

What Are My Child’s Targets

Identify words/phrases that are important to your child, can be used for

social interaction, and occur often!

Identify syllable shapes in my child’s repertoire and increase syllable repertoire

Identify sounds in your child’s sound repertoire and increase sound repertoire

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 29: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Powerful Early Targets

CV: Go, No, Me, Hi, Bye

VC: Up, Eat

VCV: I do, I go

CVC: mine, nope, yum, yuck

CVCV: mommy, daddy, baby, gimme (give me), no more, bye ma, Go now

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 30: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

How Many Targets Should We Work On At One Time?

The more severe the apraxia, the fewer the targets – can even be one target.

The less severe the apraxia, the more targets your child can handle.

Each target should be practiced three to five times during structured activities.

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 31: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

How Often Should We Practice?

The more often you practice,

The sooner the child will learn and acquire new targets.

The more consistently your child with retain/retrieve these new targets.

The more likely your child will generalize targets words throughout a variety of settings,

The more likely your child will generalize to untaught words.

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 32: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Structured Activities and Teachable Moments

•When doing structured work, try five minutes twice a day. Consider scheduling this practice at specific set time.

•Parents can layer speech practice onto activities that are already a part of daily life.

•Teachable Moments occur ALL DAY LONG.

Take Advantage!

Page 33: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

What Therapy and Cueing

Strategies are recommended specifically for

children with CAS

Review the Evidence – Principles of Motor Learning is a treatment that is recommended for child with impaired speech motor planning and programming (Maas, 2008).

Both DTTC (Strand, 1999, Maas, 2008, Strand 2019) and ReST (McCabe, Murray, Thomas, Bejani, and Ballard) have the strongest evidence and are based on the PML.

Add many practice amounts for a child who is less verbal and distribute these repetitions (e.g., read a book and add in the target) for a child who is becoming increasingly verbal.

Make the practice variable – vary your prosody, rate of speech, intensity.

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 34: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Cueing Strategies

Start with “Watch Me” to fire up Mirror Neurons

Provide a verbal model - give the sound a name and explain how the child should move his/her articulators. (Hammer, 2014)

Add a visual cue – Fran Santore’s Sounds in Motion or Lynn Carahaly’s Speech EZ cues

If needed, provide a tactile-kinesthetic- proprioceptive cue – Deborah Hayden’s PROMPT.Most Recent evidence (2020) supports effectiveness with severe Speech Motor Disorders, although not specifically CAS

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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REPETITION, REPETITION, REPETITION, REPETITION

Murray, McCabe & Ballard (2014) reported that studies on approaches for CAS typically involved 60 to 120 trials per session (high frequency of repetition), whereas studies on approaches for phonological disorders typically involved 10 to 30 trials per session.

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 36: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

How Should I Provide Feedback to My Child?

When a child does not produce the target correctly, blame the muscles, not the child.

The less verbal, the more direct feedback is necessary.

KP: Let your child know how to move their muscles. You closed your lips and made your popping sound when you said “up” (along with a visual cue).

KR: “That was very good!” or “That wasn’t quite right, Let’s try that again?”

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 37: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Self - Esteem

Our most important “job” is to love and support our children and increase their self-esteem by helping them be successful in their speech.

At no time should home practice or feedback be painful for your child.

Praise your child’s correct attempts, but acknowledge all their efforts. **

By taking advantage of Teachable Moments, you take away the “work” in “homework” and allow the child the opportunity to practice in the natural setting.

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 38: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

What Should I

Do When I

Don’t

Understand

my

Child’s

Speech?

How many times have you pretended to understand your child’s production?

There are times when you may not understand what your child is saying.

Honor the words that you were able to understand.

Repeat back closely as possible and say, “I heard you say…., but I am not sure what “….....” means, Can you show me, or maybe you mean...”

**

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 39: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

What if I Am Trying and It

Isn’t Working?

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 40: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Start Where Your Child Is!!

Honor all vocalizations and engage in reciprocal vocalizations.

If you child says “baba,” associate it with communication (e.g., “bye bye”).

Let the child know how the sound was made.

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 41: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Start Prosody Early

Model language with exaggerated intonation and slowed tempo.

Extend the duration of vowels on the stressed syllable and use a shorter duration on weak syllable. HAAA ppe “happy”

Use lots of intonation in your voice “More?”

Produce targets with different pitches “Let’s say it like an elephant, say it like a

mouse.”

Produce with varying intensities “Whisper, Loud, Angry, Happy”

___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________

PA.

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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BE A GOOD MODEL

Use

Use a slower rate of speech.

Think “Mr. Rogers.”

Give

Give time to process,

Add pauses and

Increase the melody of your speech.

Allow

Allow time for your child to formulate their response.

Encourage

Encourage your child to look at your face as a strategy to excite “mirror neurons.”You can model “please” (CCVC) and “thank you (CVCCCV),” but don’t ask for it back!

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 43: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

SPEECH MODELS TO AVOID

● Avoid overemphasis of the final sounds of words to reduce the risk of schwa insertion.

● Avoid breaking up words unnaturally

● Avoid Using Equal Syllable Stress

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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TEACHABLE MOMENTS

ACTIVITIES

Children may not want to look at pictures when they are home! But there are many fun ways to get practice in!

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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TEACHABLE MOMENTS

❏ Play!!!!❏ Book Sharing❏ photo books / core vocabulary books.

(start with pictures of family)❏ Bathtime❏ Shopping cart – Food Shopping❏ Taking a walk❏ Kitchen – hang target words for the week❏ Car Rides❏ FaceTime with parent!!!

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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Bath time

Face to Face

Captive Audience

Targets:“up”“down”“oh no”“wet,” “bubbles”

- captive audience- “up, p, up, up... Oh oh!”

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 47: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

PlaygroundPlayground

Face to face

Lots of movement to make your Targets “variable”

Targets: “Up!” “More!” “Down!”“Whee!”

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 48: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Grocery ShoppingGrocery

Shopping

Face to face

Captive audience

“In!”/ “Out!”“Yes!” / “No!”

Target words everywhere!

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 49: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Baking

Targets:“cup”“more”“yum”“my turn”“in”

Pro tip: measure out cup measures by teaspoons to increase reps!

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 50: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Pool / lake / river / pondSwimming

Targets“Go!" “In!“Go in!”“I go”

3 reps then jump in!

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 51: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

PLAY is so important!

● Cognition

● Language development

● Turn taking and imitation – allows for speech imitation

● Joint attention – allows the child to watch me and excite the mirror neurons

● Social Engagement

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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Play and Target Practice

Play is fun and provides the opportunity to practice the target words/phrases in a natural setting.

Identify the target word that you are working on prior to play.

Use toys with multiple pieces to allow for numerous opportunities to practice the targets.

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 53: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Toys, based on the Westby, Symbolic Play Scale(2000)

Pre-symbolic Level I: 8 to 17 months

• Toys that a child can pull

• Hammer- Pound and Roll

• Toy Telephone

• Blocks

• Balls

• Bowling Game

• Turning knobs, levers, buttons

• Nesting Boxes

• Person in car

• Putting objects into the dump truck and then dump it out

Early Symbolic 17 to 24 months

Farm animal

Grooming kit

Doll and bathtub

Kitchen Set

Dolls

Potato Head

Fisher Price Piggy Bank

Symbolic - 2 to 3 years

Doll House

Doctor Kit

Shopping Cart and Cash register

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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Toys based on the Westby, Symbolic Play Scale

Symbolic Play – 3 to 4 years

Represents observed events, i.e., events in which child was not an active participant

Firehouse and Firemen

Pirate Ship and Pirates

Castles and Knights

Police Station and Policemen

Spaceship and Astronauts

Circus

Legos

Zoo

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 55: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

For Older Preschool ChildrenREPETITIVE games

• Select games that support your child’s target word/phrase

• Consider games with short turns to allow for quick turn-over

•More turns = more opportunities to repeat your child’s speech targets

• Don’t forget Prosody! Makes the game that more exciting!

• Ask that all players repeat the speech targets

•Modify the rules to allow for success Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

Page 56: Taking Advantage of All Those Teachable Moments...Taking Advantage of All Those Teachable Moments Speech Therapy at Home for Young Children with CAS Angela Muis, BA angelamuis@gmail.com

Games and Targets

Snail Race (colors) CV- go, two, yea VC / VCV- CVC- red, win, CVCV, yellow, hooray CVCVC+

Pop the Pip(numbers)

More, two Eat, in, out Pop, pig, yum, one, big

Purple, cookie, burger, belly

More cookies

Pop Up Pirate(colors)

Me, Up, oh no! Red, pop , yikes Yellow, Pirate,

Don’t Break the Ice (lots of repetition when putting the ice cubes in)

Ice, icy Hit, wait, hammer Fall down

Honey Bee Tree Bee, two, four In, out, oh no Down, five, buzz

Greedy Gorilla(food)

In, I do Yum, yuck, rice, milk, juice

Yummy, yucky, water

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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FAVORITE GAMES AND TOYS!

❏ Domino Train❏ Funny Bunny❏ Pengoloo❏ Dough Smash❏ Bingo Dabbers❏ Uh Oh Hippo❏ Pop-Up Pirate

❑ Seek and Find with a Flashlight

❑ World’s Smallest Hot Wheels

❑ Baa Baa Bubbles❑ I Spy -Dig In❑ Melissa & Doug

Puppy School

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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“The impaired development of speech has disrupted the development of reading, spelling and writing skills (e.g. learning letter-sound relationships for deciphering new words.” -Murray and McCabe (2014)

Focus on phonological awareness as early as two!

❏ Sound-letter association - YouTube Phonics Song

❏ Rhyming Books

Read two Books Every Evening

❏ One book for the target sound and ❏ One book for prosody (Dave Hammer)

CAS and Language /

Literacy

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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Storytime

“Hug” by Jez Alborough

“Beep Beep” & “Choo Choo” by Petr Horácek

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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Repetitive Books

Book Title, Author Target Word

More Spaghetti I Say, Rita Goldman Gellman

CV - More, CVCV - Minnie

Moo!, David LaRochelle CV- MOO! With Varying Prosody

If You Give a Mouse a Cookie, Laura Joffe Numeroff

CVC – need, want

Brown Bear, Brown Bear, Eric Carle CV – See, Me, VCCV – at me

The Very Hungry Caterpillar, Eric Carle VC- Eat, Ate

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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Apraxia Specific Apps Speech Stickers

Simply Speech Therapy for Apraxia (NACD)• Syllable Words• Words

Apraxia Picture Cards (Linguisystems) – Lite and full version

Apps Listed on Apraxia-Kids.org

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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Apps to Practice Target Words

Toca Boca Doctor

Peek – A- Boo Barn

My Play Home

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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The Importance of Parent Involvement

Parents are the experts who know what works for your child.

SLP’s are the experts who know how to teach communication.

Together we can work to maximize your child’s communication.

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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Where to Access

Support

SLP

Your SLP can be your BIGGEST ally!

Education

Apraxia Kids webinars

National Conference sessions

Articles on the Apraxia Kids Website

Books

Family & Friends

spouse

siblings

grandparents

friends

anyone you trust who wants to help

You can find home practice specific education in the resources below.

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP

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Thank you!!!

Angela Muis and Elaine Dolgin Lieberman, MA,CCC-SLP