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Using Multi-Sensory Cueing during Childhood Apraxia of Speech Treatment Sessions

I understand how frustrating it is to have a child with Apraxia of Speech on your caseload and not know how to best serve them. Just like you, I didn't learn a lot about Apraxia of Speech during grad school. I want to share with you the knowledge I have gained through reading textbooks, journal articles, and during my professional experience over the past 14 years.

A very important factor in treating children with Apraxia of Speech is using multi-sensory cueing to help them build their motor plans.

What is multi-sensory cueing? It simply means providing cues that involve more than just one of the senses.

Types of Multisensory cues you can use with your students in your speech therapy sessions include:

  • Visual Cues (a model or image of how the mouth looks when saying the target)

  • Auditory Cues (a spoken model of the target)

  • Tactile Cues (cues of what the child feels when saying the target)

  • Metacognitive Cues (an associative cue, such as a nickname of a sound, that helps the child remember specific features of the target)

There are many ways to use these multisensory cues in therapy. Often, a single cue is engaging two sensory systems. Here is a list of suggestions taken from Fish (2016):

Visual Cues &

Auditory Cues:

  1. Simultaneous Production: The SLP and child say the word at the same time, while the child watches the SLP's mouth, either at a slower or normal rate. This cue should be faded quickly and replaced with a less salient cue (e.g. miming or direct imitation).

  2. Direct Imitation and Delayed Imitation: The SLP models the target before the child says it. In direct imitation, the child immediately repeats the SLP. In delayed imitation, the child repeats the target after a pause up 1-3 seconds.

  3. Mirror: The child looks in the mirror while saying the word.

  4. Backward Chaining: The child begins at the end of the word and works their way to the beginning. For example, ti -> get -> spaghetti. This cue is particularly helpful when teaching multisyllabic words. It is important to practice these words smoothly - this means no pauses between syllables!

  5. Forward Chaining: The child begins at the beginning of a word, and adds more syllables to the work systematically. For example, snow ->snowman.

Visual Cues:

  1. Mouth pictures and videos: Pictures and videos of the mouth to show the child how a specific sound is made.

  2. Ultrasound Biofeedback: An ultrasound probe is used so the child can see the shape and placement of their tongue.