Sometimes it can be difficult to know exactly what you should be working on with your children with childhood apraxia of speech.  In this podcast episode, I break down speech sound learning in different levels.  Then, I give practical therapy activities that can be used for each level.  Click the play button below to listen to the entire episode.  Or, scroll down to see the notes below.


Free Therapy Levels Chart:

To get started, download the free PDF of the Skill Set Charts for Childhood Apraxia of Speech.  This will break down a nice order to help you determine what speech skill to work on next with a child with CAS:

Click Here to Download the CAS Levels PDF

Show Notes:

Level 1: Imitating Actions

Start Here For…

  • Children who are unable to imitate speech sounds
  • Children who are not tuned in enough to work on anything during sessions
  • Children who have emotional issues and are not willing to work with you on their speech during sessions

Therapy Activities

  • Do a reinforcer probe and offer those preferred reinforcers if the child imitates a basic action like clapping hands, stomping feet, raising hands, etc.
  • Take pictures that represent the actions you want the child to do and print them on cards.  Have the child draw one card from a bag and do that action.
  • Make a movie on your phone where the child is your shadow and imitates what you do (do it in reverse as well).

Level 2: Functional Sounds, Sound Effects, Vocalizations

Start Here For…

  • Children who are able to imitate actions but unable to imitate or produce sound combinations (like CV, VC)
  • Children who need a little confidence boost before working on sound combinations (this could be mixed in)

Therapy Activities

  • Play with vehicles and make engine sounds (or sirens).
  • Feed puppets or stuffed animals and have them make exaggerated “mmmm” noises.
  • Have the child request pieces to an animal puzzle by making that animal’s noise (reduce complex noises down to one sound, like “eee” for monkey).

Level 3: Sound Combinations (CV, VC)

Start Here For…

  • Children who are able to imitate or produce some sounds but are not yet spontaneously combining 2 sounds, like consonant- vowel or vowel-consonant
  • Children who are doing some sound combinations on their own but can’t say very many (or enough to communicate much)

Therapy Activities

  • Get some sort of a riding toy like a bike or a swing and stop the child until he says “go” again.
  • Throw small objects up onto a higher surface (like a table), each time, have the child say “up” to indicate he wants another thing to throw up.
  • Put coins in a piggy bank and have the child say “in” to get each coin to indicate he wants to put it in.

Level 4: Repeated Strings of CV or VC

Start Here For…

  • Children who are able to combine a vowel and consonant together but are not yet producing longer utterances
  • Children who are doing some CV, VC, and CVCV combinations on their own but can’t say very many (or enough to communicate much)

Therapy Activities

  • Sequence words that the child can do together to work on articulatory transitions (the same word repeatedly or alternating two words together).
  • String together several of a word that the child can say and then add a word that the child can’t say to the end that only varies by one sound (bow, bow, bow, boy).

Level 5: Add a Structure, Add a Sound

Start Here For…

  • Children who are able to say some limited structures (like CV, VC, and CVCV) but struggles to say longer or more complex words
  • Children who are able to use some sounds in CV, VC, and CVCV structures but not very many

Therapy Activities

  • Increase vowels by sequencing pictures together that start with the same consonant and change the vowel, like “boy, bee, bay, bow, bow”, etc. Lay the cards in a row and have the student say the sequence.
  • Increase consonants by using the same vowel and changing the consonant, like “me, tea, key, pea, we, see”.
  • Increase structures by taking a known word and adding a sound like, “key…keep, pea…peep, we…weep”.

Level 6: Sound Accuracy in Phrases and Sentences

Start Here For…

  • Children who are able to produce single words of many structures with good speech sound accuracy but intelligibility decreases in phrases and sentences

Therapy Activities

  • Create worksheets similar to the previous section where you provide the pictures and they glue them on, but this time, build sentences, like “see..(next line)..I see…I see cat…I see the cat”.
  • Use one carrier phrase and fill it with different words that the child has mastered, like “I see bat, I see cat, I see hat, I see mat”.  Use flip books if you have them or make your own.

Level 7: Sound Accuracy in Connected Speech

Start Here For…

  • Children who are able to produce sounds correctly in simple sentences and phrases but intelligibility decreases in connected speech

Therapy Activities (work on speaking clearly in tasks with increasing complexity, don’t move on until the previous level is clear)

  1. Have the child describe pictures using full sentences (“the girl is walking her dog in the park”).
  2. Have the child complete automatic speech tasks like saying the pledge of allegiance or the months of the year.
  3. Have the child answer open-ended questions like “tell me about your last birthday party”.
  4. Have the child read a short paragraph.
  5. Have a conversation with the child about a specific topic with the expectation that you will be listening for his speech sounds.
  6. Listen for correct speech sounds in conversational speech and correct using feedback as needed.
Click Here to Download the CAS Levels PDF

More Resources for Speech-Language Pathologists:

Looking for more therapy ideas and resources to help you provide the BEST services to your clients?  Join us in The SLP Solution, our membership program for speech-language professionals!  Inside the membership, you’ll find:

  • Step-By-Step Guides for teaching a variety of speech/language/communication skills
  • Pre-Made Worksheets and Therapy Activities for hundreds of different topics
  • Training Videos for dealing with difficult disorders or problems
  • Answers to Your Questions in our exclusive SLP community
  • Tools and Resources to help you with your paperwork and admin tasks
  • Continuing Education through our monthly webinars and webinar recordings

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