Reframing “Repetitive Practice” to Address Childhood Apraxia of Speech

Many studies have been published in recent years investigating the application of different principles of motor learning for the treatment of childhood apraxia of speech (CAS), and it can be hard to keep up with the latest research. One consistent finding is that the amount of practice a child gets is important.^1,2

For many of us, what immediately comes to mind when thinking about a high volume of practice is repetitive drill work at a table, often with flashcards, which ultimately diminishes the motivation and cooperation of the child. It may be time to re-frame that idea and think about repetition for acquisition.

Drill work often involves lists of words or phrases practiced for accuracy out of context and yields very little intrinsic reward. Repetition for acquisition, however, involves creativity in developing a practice plan that includes functional targets that can be used in context or in a variety of contexts and potentially yields intrinsic rewards as a result of successful communication.

Here are three practical suggestions for implementing repetition for acquisition:

1. Choose targets thoughtfully.

• What does the child have in their phonetic repertoire? And how can those phonemes be assembled to give the child the power to communicate?
• What does the child want to talk about?
• How can targets be used for pragmatic purposes like initiating social interactions, requesting, refusing, or sharing information?
  • • This means informing our choices based on the WHO model, which looks at activities and participation as well as body structures and function.³

2. Engage the child/student.

• Acknowledge that some things you ask them to try may be difficult, but you are there to help.
• Encourage the child to help make decisions.
  • • What targets do they want to prioritize?
    • Where do they want to sit during the session?
    • What movement activities do they prefer?
    • What activities or reinforcers are motivating for them?
    • When is it OK take a short break?

• Start with fewer repetitions with a high rate of reinforcement to foster confidence and cooperation, then build to a greater number of repetitions and reduced rate of reinforcement.

3. Make use of varied contexts as quickly as possible.

• See if the child can produce the target without a direct model or in a play scenario or game.
• Produce the target with varied prosody/intonation.
• Produce the target for someone other than the SLP in the therapy room.
• Incorporate the target in literacy-building activities, like phonological awareness games or reading repetitive books.⁴
• Vary physical position while producing the target.
• Find opportunities for producing the target outside of the therapy room. Such opportunities can include:
  • • Saying their practice words for their teacher.
    • Using their target with the SLP in activities outside of the therapy room.
    • Using their target with someone other than the SLP in activities outside the therapy room (when the SLP determines they are ready.)

A high volume of practice is critical to gaining proficiency with speech skills, particularly for children with a motor speech disorder like CAS. Thinking about using repetition for the acquisition of communication skills versus decontextualized drills can enliven your therapy sessions for both clinician and child.

For more information, my two MedBridge courses on childhood apraxia of speech offer an introduction to the use of evidence-based therapy for school-aged children with apraxia of speech and how specific interventions such as improving reading skills can enhance overall outcomes.