Let's Talk! Article Overviews and Discussion
Childhood Apraxia of Speech (CAS)
Valuable information on: How to diagnose, what we should be looking for as clinicians, and NEW research study findings regarding CAS!
How to Navigate an Out-of-State CF
Thinking of moving for your Clinical Fellowship? Read our tips for the process from personal experience! We provide information on how to navigate the licensing procedures as a Clinical Fellow moving to a different state.
SLP Cheat Sheets - Pediatric THerapy Procedures
Cycles Approach
This cheat sheet outlines the steps of Cycles Approach, which targets phonological processes.
EBP is provided, as well as visuals the clinician can use to keep track of the procedure steps, and ones that can be used as a visual schedule for the client!
SLP CHEAT SHEETS - Adult THERAPY PROCEDURES
Integral Stimulation
This cheat sheet describes the steps of Integral Stimulation, a therapy procedure based on Rosenbeck's 8-Step Continuum. Integral Stim is designed to treat apraxia of speech.
EBP is provided, as well as easy-to-use visuals for tracking progress during sessions
PEDIATRIC TREATMENT AND ASSESSMENT MATERIALS
There Was an Old Lady Who Swallowed a Fly: Book Companion Set 1
Book List and Online Resources for Language Learners- Caregiver Handout
There Was an Old Lady Who Swallowed a Fly: Book Companion Set 1
This product is meant to be used with the book "There was an Old Lady Who Swallowed a Fly" by Lucille Colandro. It is meant for early language learners to help comprehension of simple wh-questions, increase sentence length through carrier phrases, and work on beginning/emerging literacy concepts.
Following Directions with Snuggle Bugs!
Book List and Online Resources for Language Learners- Caregiver Handout
There Was an Old Lady Who Swallowed a Fly: Book Companion Set 1
This easy printable worksheet targets receptive language skills for your students! This product integrates prepositions (in, on top, next to, around, in, beside) with following directions in a fun, engaging activity.
Book List and Online Resources for Language Learners- Caregiver Handout
Book List and Online Resources for Language Learners- Caregiver Handout
Book List and Online Resources for Language Learners- Caregiver Handout
This caregiver handout is intended to provide book recommendations and online resources for language learners. Books on this list contain simple, repetitive language which helps students learn sentence frames, new vocabulary, and more!
Pumpkin Smash! NO PREP Articulation Activity (STOPS)
Fluency for Younger Preschoolers 1:5 - 3:5, Caregiver Handouts
Book List and Online Resources for Language Learners- Caregiver Handout
This NO PREP packet includes /b, p, t, d, k, g/ phonemes in the initial, medial, and final positions. These sheets are in color (to print, laminate, and SMASH! with play dough), and black and white (ink saving and allows clients to color each target as they complete it).
Fluency for Younger Preschoolers 1:5 - 3:5, Caregiver Handouts
Fluency for Younger Preschoolers 1:5 - 3:5, Caregiver Handouts
Fluency for Younger Preschoolers 1:5 - 3:5, Caregiver Handouts
These caregiver handouts focus on fluency for early intervention/younger preschooler clients! This packet includes a breakdown comparison of typical disfluency versus borderline true stuttering, indirect strategies, direct strategies, a severity rating scale, and web addresses for additional information and resources for families.
Fluency for Older Preschoolers 3:5 - 6:0, Caregiver Handouts
Fluency for Younger Preschoolers 1:5 - 3:5, Caregiver Handouts
Fluency for Younger Preschoolers 1:5 - 3:5, Caregiver Handouts
These caregiver handouts focused on fluency for older preschooler clients! Included is a breakdown comparison of typical disfluency versus beginning stuttering, indirect strategies, direct strategies, strategies for home practice, a hierarchy of difficulty, a severity rating scale, and web addresses for additional information and resources for families.
Adult Treatment and Assessment Materials
Coming soon!
Keep an eye on this space for products in the near future!
Materials for Any Age
Coming Soon!
Keep an eye on this space for products in the near future!
Childhood Apraxia of Speech (CAS)
Vowel errors, inconsistent productions, increased errors with increased complexity, sounds like Childhood Apraxia of Speech (CAS), right? CAS has many speech characteristics that are associated with the diagnosis based on a variety of studies. These include:
- Vowel errors
- Presence of oral groping or struggle within oral musculature
- Prosodic disturbances
- Inconsistent productions, and inconsistent errors
- Increased number of errors with increased length or complexity of productions
- Omission errors dominate the child’s articulation errors, but articulation errors of distortions, additions, prolongations, and substitutions are still present
- Syllable segregation
- Decreased ability to sequence phonemes, especially during diadochokinetic (or DDK) tasks
- Small and restricted phonemic repertoire
- Receptive language abilities that exceed expressive language abilities
So does my client, need to have ALL these errors to have CAS?
NOPE! That leaves the question of how do we diagnose it. Typically a diagnosis of CAS is given after the child is 3 years of age or older; prior to this you can state the child has “patterns commonly associated with CAS, which cannot be ruled out at this time,” or simply has “an articulation delay/disorder with suspected CAS.” In Izzini-Seigel’s (2019) study the researchers used the presence of five or more features of CAS, inconsistency with productions, and a score of 85 or lower on the Goldman Fristoe Test of Articulation- Third Edition to differentiate participants with CAS from those with a Speech Sound Disorder. ASHA (2007) explained that some investigators noted that children with CAS typically demonstrate the following features, but all are not required to be the necessary and sufficient signs of CAS:
- Inconsistent errors
- Lengthened/Disrupted coarticulatory transitions
- Inappropriate prosody
Roth and Worthington (2011) also noted that vowel distortions, along with inconsistent errors and prosodic disturbances, are hallmarks for CAS.
Some informal assessment tools can be used include:
- Language sample
- Oral Motor Examination
- Look for oral groping during this!
- DDK
- Assessment of single word production with increasing complexity
- Assessment of connected speech with increasing complexity
- Assessment of intelligibility
- This can be done during the language sample by using a Percentage of Syllables Stuttered (PCC) measurement!
Guibani, Pagliarin, and Keske-Soares (2015) noted that some options for standardized assessments of CAS can include:
Recent Research:
- Izzini-Seigel (2019)
- Researchers investigated children with CAS and other Speech Sound Disorders (SSD) and typically developing children and their performance on a standardized motor assessment to find differences between the populations. They also investigated whether comorbid language impairments would influence the group differences. They had a relatively small sample size with 3 children with CAS alone, 7 children with CAS and language impairment (LI), 10 children with SSD alone, 6 children with SSD and LI, and 14 typically developing children. The children were given standardized assessments examining language, articulation, and motor skills. The children with CAS had significant difficulties with balance and aiming and catching components of the tests (gross motor), but did not perform significantly worse than the other groups on Manual Dexterity (fine motor) tasks. In fact, all 7 of the participants with CAS and LI had gross motor difficulties. The researchers concluded that there was a high rate of comorbid speech, language, and motor impairments in the participants who had CAS, and that further research on this is needed. Although we as SLPs cannot diagnose or treat children with motor or balance difficulties, we can educate parents on what milestones their child should be reaching and encourage them to seek evaluations from appropriate professionals (such as Occupational Therapists, and Physical Therapists). Since motor impairments can directly influence the risk of academic, social, and vocational challenges we can advocate for our clients better by understanding the risks associated with their diagnosis and the potential comorbidities that go with it. The earlier these clients receive interventions and evaluations, the better their quality of life will be!
- Lim, McCabe, & Purcell (2019)
- Researchers investigated the delivery of Dynamic Temporal and Tactile Cueing (DTTC) by school teaching assistants and whether it provided increased success for children diagnosed with CAS. They also investigated the teaching assistants fidelity and experience with training and delivery of DTTC. This study was structured as two case studies, and both participants showed steady improvements with percent phonemes correct measurements at the end of the trial. In order to provide DTTC for the students, teaching assistants were given four weekly training sessions that lasted 1-1.5 hours, which provided instruction on CAS in general, how to use DTTC, role playing and production practice activities, and practice using DTTC. Both teaching assistants had positive remarks about using DTTC, felt that the program was helpful to the children, and felt comfortable with the procedures, especially by the end of the trial. As school SLPs, high caseloads are a continuing issue making high frequency service delivery models, such as those used in DTTC, very difficult (if not, impossible) to attain. By training teaching assistants, therapy assistants, or SLPA’s this approach may become more effective for the children, improving their therapeutic success. The researchers noted as well to be cognizant of the needs of others when training them to carry out our therapy programs, as it can be new and multifaceted. They appropriately concluded that, “we may add another tool to someone’s toolbox, but we do still need to make sure they are supported using it” (Lim, McCabe, & Purcell, 2019, p. 254).
- Overby, Caspari, & Schreiber (2019)
- Researchers investigated the speech and language skills of 17 children aged 3.5-8.8 years old to explore the volubility, syllable structure, and consonant emergence from children who were later diagnosed as typically developing (TD), with childhood apraxia of speech (CAS), and those who were later diagnosed with a speech sound disorder (SSD). This study examined the speech samples gathered in home videos of the participants to assess their linguistic skills at younger ages. The researchers used both standardized and nonstandardized assessments to evaluate the participants. The researchers found that the participants that were later diagnosed with CAS had the lowest mean rate of resonant consonants per minute, and mainly used bilabials and alveolars as infants and toddlers. The participants that were later diagnosed with CAS also demonstrated fewer stops and fewer voiceless sounds than the other two groups. No significant differences across groups were found regarding when the first resonant consonants and utterance perceived to first appear. Altogether the researchers found the following potential ‘red flags’ to watch for with young children during evaluations in order to identify the potential risk of CAS through a later diagnosis:
- Limited vocalizations
- Lack of resonant consonants by 12 months of age
- Three or fewer resonant consonants acquired between 8-16 months
- Scarcity of velar productions before 2 years
- Possibility that LCAS infants and toddlers may have less difficulty with anterior visually salient placement than posterior nonvisual velar placements
- Favoritism of stops and nasals
- Productions of largely vowels and little use of consonant vowel sequences (e.g. CV, CVC) between 13-18 months.
- Researchers investigated the speech and language skills of 17 children aged 3.5-8.8 years old to explore the volubility, syllable structure, and consonant emergence from children who were later diagnosed as typically developing (TD), with childhood apraxia of speech (CAS), and those who were later diagnosed with a speech sound disorder (SSD). This study examined the speech samples gathered in home videos of the participants to assess their linguistic skills at younger ages. The researchers used both standardized and nonstandardized assessments to evaluate the participants. The researchers found that the participants that were later diagnosed with CAS had the lowest mean rate of resonant consonants per minute, and mainly used bilabials and alveolars as infants and toddlers. The participants that were later diagnosed with CAS also demonstrated fewer stops and fewer voiceless sounds than the other two groups. No significant differences across groups were found regarding when the first resonant consonants and utterance perceived to first appear. Altogether the researchers found the following potential ‘red flags’ to watch for with young children during evaluations in order to identify the potential risk of CAS through a later diagnosis:
References
ASHA (2007). Summary of the Practice Policy Childhood Apraxia of Speech [Technical Report]. Retrieved from: https://www.asha.org/articlesummary.aspx?id=8589947136
Blakely, R. W. (2001). Screening Test for Developmental Apraxia of Speech - Second Edition. Austin, TX: Pro-Ed.
Gubiani, M. B., Pagliarin, K. C., & Keske-Soares, M. (2015). Tools for the assessment of childhood apraxia of speech. Sociedade Brasileira de Fonoaudiologia.
Izzini-Seigel, J. (2019). Motor performance in children with childhood apraxia of speech and speech sound disorders. Journal of Speech, Language, and Hearing Research, 62, 3220-3233. Doi: 10.1044/2019_JSLHR-S-18-0380
Terband, H., Namasivayam, A., Maas, E., Van Brenk, F., Mailend, M. L., Diepeveen, S., . . . Maassen, B. (2012). Assessment of childhood apraxia of speech: a review/tutorial of objective measurement techniques. Journal of Speech, Language, and Hearing Research, 62(8), 2999-3032. Doi: 10.1044/2019_JSLHR-S-CSMC7-19-021
Kaufman, N. (1995). Kaufman Speech Praxis Test for Children. Detroit, MI: Wayne State University Press.
Lim, J., McCabe, P., & Purcell, A. (2019). ‘Another tool in my toolbox’: Training school teaching assistants to use dynamic temporal and tactile cueing with children with childhood apraxia of speech. Child Language, Teaching, and Therapy, 35(3), 241-256. Doi: 10.1177/0265659019874858
Overby, M. S., Caspari, S. S., & Schreiber, J. (2019). Volubility, consonant emergence, and syllabic structure in infants and toddlers later diagnosed with childhood apraxia of speech, speech sound disorder, and typical development: A retrospective video analysis. Journal of Speech, Language, and Hearing Research, 62, 1657-1675. Doi: 10.1044/2019_JSLHR-S-18-0046
Roth, F., & Worthington, K. (2011). Treatment resource manual: For speech-language pathology. Clifton Park, NY: Delmar.
St. Louis, K. O., & Ruscello, D. (2000). Oral Speech Mechanism Screening Examination, Third Edition. Austin, TX: Pro-Ed.
Strand, E. A., & McCauley R. J. (2019). Dynamic Evaluation of Motor Speech Skill (DEMMS) Manual. Baltimore, MD: Brookes Publishing Co. Inc.
How to Navigate an Out-of-State CF
Adventures are great! New career, new state, and… NEW STANDARDS. SLP standards in states vary to some extent, but to make a new move/career less of a headache it’s best to try to do the research before making that big jump.
FIRST…..
Talk with your clinical director. Make a meeting with him/her, and be prepared. It’s nearly impossible to know the standards of each state, so check the ASHA website and any other state licensing body. Here’s the link to check ASHA:
https://www.asha.org/advocacy/state/
Some important things to look at when reviewing the ASHA standards in different states are:
- Clinical Supervised hours
- Some states need 300, others may require more so doing your research and notifying your clinical director is VERY important to make sure you can meet the standards.
- Semester Units needed in your masters program.
- If you require more masters level courses you will need to complete them during your program, and not later. Some states have lower requirements than others, for example, I had a clinical program with 58 credits and I needed 60 for the state I moved to.
- Additional tests needed
- Some states require a jurisprudence exam to be taken. This is simply a test of your state’s laws and rules. Honestly, you should try to review each state's laws and rules as a whole. Your CF supervisor, and wherever you end up employed should help with this during training, however, being more familiar with laws never hurt anyone.
NOW you’ve reviewed ASHA, talked with your clinical director, and you are on track to graduate and head to your DREAM CF destination. The job hunt is stressful when you’re unfamiliar with the area. Looking at job websites is helpful. I suggest using Indeed, Monster, Glassdoor, and the ASHA job portal. If you are interested in working with pediatrics look up children's hospitals, school districts, and local private practices in the area you will be moving. If you are interested in working with adults, research any local programs specializing in your area of interest (aphasia, stuttering, swallowing, etc.), as well as any hospitals or outpatient centers. Contract companies and skilled nursing facilities are great options as well, but make sure to check the average compensation rates for CF’s in the same area and inquire about the benefits for each position if you end up interviewing.
Now the first thing any employer will look at is your contact information, which should include your residence. I received more responses from potential employers when I attached a letter titled “Out of State Explanation” that detailed when I would be moving there and any additional helpful details that would make me a more employable applicant. Another option is to attend ASHA conference closest to the time you are planning to relocate. If you go, talk to employers in the area you plan to relocate to, and then you may have an interview with one. This is an easy way to meet an employer face to face, get a job, or even practice your interviewing skills prior to graduation!
As your cohort is applying for in-state licensure, make sure to apply to your out-of-state licensure to get the process going. You may have to get ink fingerprints, which can take awhile to clear. Other states require additional things dependent on your placement, such as your college prep tests (ACT, SAT, CBEST, ect.), an additional credentials, or letters from your university stating that you have experienced and passed a clinical placements in specific settings. Employers should help you through this, but it can be very confusing either way. You will probably play a waiting game with the credentialing/licensing process at some point which can be very annoying, so it’s best to minimize it as much as possible.
Another way to make this process more clear is calling the state licensing body. Typically they are nice and helpful. Sometimes states have very clear websites outlining the process, while others can be murky. Calling them can clear this up. I always found their contact information and phone numbers by googling “(state) certification for Speech-Language Pathology.” Also don’t be confused by labeling of different state first year experiences on the state websites! In my case, I relocated from Michigan to California where it went from being called a “ limited educational license” to a “required professional experience.”
Please feel free to contact abcsforslps@gmail.com with any questions and we will do our best to help. You can also message us on Facebook, or contact us on Instagram. Don’t forget to rate, review, and subscribe on any of our platforms. Good luck!