CAS Goals for Older

Students
Kay J Giesecke, MS, CCC-SLP
Childhood Apraxia of Speech Specialist since 1996
 Disclosure Statement

• I am the owner of a private practice called Apraxia Austin,

the creator of the Childhood Apraxia of Speech Checklist,
the provider of Apraxia Ranch Camps, three day intensive,
residential CAS summer camps, and the developer of a set
of in depth training videos on using co-articulation in
apraxia therapy for children.
• I am volunteering my time and talents to record and teach
this complimentary workshop offered by Apraxia-Kids
instead of teaching it at their national conference.
• I have no other relevant financial or nonfinancial
relationships in products or services described, reviewed,
evaluated or compared in this presentation.
 Motor Planning (CAS) Therapy
Features

• Focused attention by child, reinforced by early success

• Intensive, frequent, individual practice

• Multiple repetitions of speech movements

• Memorization of speech movement sequences

• Multi-sensory Input (many types of cueing)

• Slower Rate
Hall et al., 2006, , Haynes, 1985, as cited in Caruso & Strand, 1999
 Motor Planning (CAS) Therapy
Features
• Multi-sensory Feedback
• Systematic progression through hierarchies
• Emphasis on Self-Monitoring
• Compensatory speech and language strategies
• Prosody remediation
• Addressing all aspects of disordered communication
Hall et al., 2006, Haynes, 1985, as cited in Caruso & Strand, 1999
 Many Types of Cueing
Used w/ all speech Additional ones w/
sound disorders CAS
• Auditory • Touch cueing (on SLP, parent, or child)

• Visual • Gestural cueing

• Speech model to imitate
• Integral Stimulation (I say it, you
watch, you say it – add cueing if
• Cognitive (tell what to do) needed, possibly even we say it together)
• Mirror work
• Backward chaining
• Written
• Modeling slower rate
• Graphic (pictures)
• Strong use of fading cues
• Use of tools to assist eliciting sounds
• Claps/taps/counting for multi-syllabic
• 3D objects or toys words
 Individualized?

Consider:
• intellectual, physical, social & academic level of the child
w/ CAS
• severity & influence of overlapping disorders
• severity of CAS diagnosis - officially diagnosed?
• possibility of parental/classroom support & how to
access
• Is student verbal or using AAC?
 Categories of Treatment

• Language

• Intelligibility

• Natural Communication

• Academics
 Language Ideas

• Vocabulary

• Beyond Generic/Functional Language

• Grammar

• Increasing mean length of utterance (MLU)

• Multisyllabic Words
 Vocabulary

Vocabulary

• Mindset of inclusivity of vocab in all activities

• Reading books or conversing, define “new” words

• Have student practice using “new” words in different

contexts

• Make notes of new vocab for reinforcement

• Video of Mindset of Inclusive Vocabulary: amplify
and r’s
Functional/Generic Language

Is student only using generic, nonspecific vocabulary

when capable of more?
• Verbs like put, do, get, make, want instead of place,
practice, receive, construct, would like
• Adjectives like big, pretty, smart, good instead of
large or enormous, beautiful or gorgeous, intelligent
or capable, gifted or obedient
• Non-specific nouns like man, lady, bread instead of
the the principal, the cashier, blueberry muffins
Functional/Generic Language

• Target words with specificity in executing your tx goals.

• Use the teachable moment to suggest unplanned suitable

words to use and practice.

• Work on C-C coarticulation in the new words.

Examples: “I slice the steaming bread” for “I cut the hot

bread”.

“There’s an abundance of beautiful wildflowers” for “there

are lots of pretty flowers”.
 Grammatical Errors

Lewis, et al., (2004) report one of most persistent

deficit areas in older children w/CAS is recep/exp
language.
Velleman’s (2006) order of teaching presents these
grammatical morphemes last to the school-aged child
(note all end with V before adding the morpheme):
plural: tubas, shoes
possessive: Rosa's, Joe's
3rd person singular: goes, tries
past tense: skied, tried
 Grammatical Errors

• If those that end in Vs before adding the endings are

appropriate for the school aged child, then we should
probably follow up with those same morphemes added to
words ending with Cs with the older students.
• In my clinical judgment that is exactly what they are
usually missing as well as the use of contractions.
• Adding the grammatical morphemes to words ending in
Cs requires CC coarticulation.
• Use of these structures need to be practiced in many
contexts using co-articulation in words, phrases, and
sentences, not just written in workbooks.
• Video of past tense in sentences
 Increasing MLU

• Practice different phrases that compose longer

sentences (noun, verb, prepositional, etc.).

• Parse them segmented but in sequential order.

• Combine them using Integral Stimulation (I say it &

you listen; now we say it with appropriate cue –
perhaps repeated trials for reinforcement).

• Fade cueing and have student produce the sentence.

 Examples of simple parsing
Parsed Combined
Practice phrases separately • Do with IS then fade cues
• I drink ---- a coke, the milk, • Work on less/easier points
the juice
of coarticulation
• You have ---- a ticket, a
jacket, a ball. • Work on rate

• We see ---- a game, a toy, a • Work on accents

cap.
• Work on eliminating pauses
• She cut ---- her toe, the meat,
a paper.
 Examples of complex parsing

Parsed Combined
• The man with the BIG hat - • Do with IS then fade cues
- ate lunch on the patio.
• Work on multiple points of
• I do NOT have the time – to coarticulation
practice piano today.
• Work on rate

• Work on accents

• Work on adding gestures

• Work on eliminating pauses

 Multisyllabic Words

Multisyllabic Words

• Target according to their difficulty of construction – not

just # of syllables.

• Teach intentionally with lists, cards, activities.

• Teach as they come up in life and tx.

• Make lists from child’s reading material and practice.

• Practice in different contexts and sentences repeatedly.

 All 3 Syllable Words the
Same?
• NO! Syllables and words that have CC together are harder that
those that have CV constructs alternating. From easiest to
hardest….
banana CVCVCV is easiest
bandana CVCCVCV - CC in same place
balcony CVCCVCV - CC in different places
baptism CVCCVCC – 1st CC has 1 unreleased C
battlefield CVCCCVCC - 1 CCC & 1 CC
• Video of unreleased plosive
 Intelligibility

• Coarticulation - one of the primary characteristics of

CAS (ASHA, 2007)

• Lingering consonantal articulation errors

• Lingering vowel errors – on list of additional

characteristics of CAS (ASHA, 2007)

• Many children with speech sound disorders, (which

includes childhood apraxia of speech), present with
much reduced intelligibility. (Flipsen, 2010)
 Definition of Coarticulation

 The influence that sounds exert on one another is

called coarticulation, which means that the
articulation of any one sound is influenced by a
preceding or following sound.

Bernthal, J. & Bankson, N, 1993

 Definition Cont.

 Coarticulation is the way the brain organizes

sequences of vowels and consonants, interweaving
the individual movements necessary for each into
one smooth whole.

swphonetic.com
 What do we coarticulate?

• Sounds within syllables

• Syllables within words

• Words within phrases and sentences

 Coarticulation: Important for
CAS

• Since a primary characteristic of CAS is

disrupted coarticulatory transitions between
sounds and syllables (ASHA, 2007), correct
coarticulation frequently needs to be targeted to
prevent disjointed, robotic, or unintelligible
speech.
• Rehearsing coarticulation also can help
remediate prosody problems, another primary
characteristic of CAS, especially if we practice
with correct accents & pitch.
 Coarticulation

• There was an abundance of beautiful wildflowers.

Becomes
• There wa-za-nabundan-sov-beautiful wildflowers.
(with unreleased d in wildflowers).

Teach students to talk like real people

both with your pronunciations and your
coarticulation.
 When to Target
Coarticulation?
• As soon as the child with CAS starts putting two
sounds together.

• To produce “me” we must do CV coarticulation

with the m and e.

• Continue as needed to target coarticulation until the

end of therapy when the child can produce all types
in sentences as long & complex as is age appropriate
for the child.
How to avoid obtrusive schwa
(uh)
When learning consonant sounds & consonantal
endings…..
• Never add voicing to a voiceless consonant, releasing the
consonant with “uh” (sss becomes suh)
• Don’t add the “uh" to consonants that are continuents
(mmm becomes muh)
• Release voiced plosives with minimalistic voicing
• Don’t release final consonants at the end of a phrase or
sentences. Ex. Put it on top.
 Different Types of
Coarticulation
Text Book Types Sound Context Types
• Anticipatory • Vowel to Vowel – VV

• Retentive • Vowel to Consonant - VC

• Anticipatory/Retentive • Consonant to Vowel – CV

Combos
• Consonant to Consonant –
CC, CCC, or CCCC

Each can occur within

syllables, words, or between
words in sentences
 Coarticulation Context Types

 Vowel to Vowel (VV): “I”

 Vowel to consonant (VC): “I need”

 Consonant to Vowel (CV): “take a”

 Consonant to Consonant (CC): “bathroom”

 CCC: “contests”

Find other instances and tell what type: “I need to take

a friend to the bathroom before the contests.”
Details - Coarticulation Contexts

Vowel to Vowel (V-V)

• back to front – addition of slight /y/ as in lion or
playing
• rounded to unrounded – addition of slight /w/ as in
snowing or know it
• diphthongs – often one of the easiest places to start
teaching children with CAS to sequence sounds
 Teaching a Diphthong

First the child must have the 2 vowels in it.

• Unblended sequencing of the two vowels
• Blending of the 2 vowels for the diphthong
• Use of the target diphthong in production of CVs: cow,
bow, now
• Use of the diphthong in a CVC production: town, down,
or CCVC - clown, or CVCC – sound.
• Use of diphthong in words in phrases & age appropriate
phrases or sentences
 Details – VC Coarticulation
Contexts
Vowel to Consonant (VC)
 Within 1 syllable word – up, on, in
 Between two syllables or words – mama, baby, a
man, the cup, I go
 At end of syllable or sentence when a final single C
is a plosive (quickly released sound) – the plosive is
unreleased.
Examples: “Put it on the top.” The final p is unreleased;
just posture the lips for p.
When 2 Cs as in “best”, final C is released.
 Details – CV Coartic. Contexts

Consonant to Vowel (CV)

• Within a 1 syllable word – go, my, to.

If you are segmenting and saying g-o or c-at with a

pause in between the C & V, you are not producing a CV
or CVC but a separate C & V or separate C and VC. If
used for training, keep the segmentation practice very,
very brief.
 CV Coarticulation Cont.

Consonant to Vowel CV coarticulation cont.

 Within each syllable of multisyllabic words (CVCV -
mama, CV1CV2 -mommy, C1V1C2V2 – bunny. The
syllables must also connect, not ma---ma, unless
segmented for a brief practice period for training order.

 Between a word that ends in a C and one that begins

with a V – take a man (ta ku man), pop a bubble (po pu
bubble).
 Teaching Articles

English speakers say “uh” for a, “thuh” for the, and “un”
for an unless they are used for emphasis. Do NOT
teach them as they are spelled but how we actually
say them. So…
uh boy,
thuh cat,
and un eagle are correct flowing speech.
 Great Example
Corporate use of a coarticulated
pun to advertise iced coffee.
Have an ice day = Have a nice
day.

This is a good example of how

CV coarticulation actually
works between words. Notice
that is doesn’t work unless both
articles are produced with “uh”
(schwa).
 • Initial clusters within words
like st in stop, br in bread,
gl in glad.
CC Coarticulation • Medial clusters like mp and
Rethink about clusters/blends (2 nz in computer and
or more Cs). chimpanzee
Not just at the beginning of
words; found in the middle & • Final clusters within words
end of words. Especially found like mp in jump & nd in
in between words and are still found.
blended together through
coarticulation. • Final/initial cluster
Since found in all of these connections created
places, usually need to practice
them in therapy for CAS in all
between words like zm in
these places. his man, bsh in grab shoes,
shl in push ladders, nd in
can do
 Coartic. Contexts – CC
Details
• There are many, many variations of production
with CC coarticulation. Following is a list of 12
of them explaining what happens in those on the
list. Each represents a type of CC
coarticulation, not just one combo or only the
examples.
• For example, the addition of s for plurals makes
an s sound in 1000s of nouns ending in voiceless
sounds and makes a z sound in 1000s of nouns
ending in voiced sounds.
 Details – CC Coartic. Contexts

1. Same sound or its cognate (identical movement -

but on 1 sound is made with voice and on 1 is
voiceless like s and z) are back to back between
words, then only say the initial sound in the
second word and we ”hear” it in both words - He
knows Sam, I pet Tabby, I had ten.

2. Two sounds similar in place and manner are back

to back between words & 1 is omitted – s before sh
as in horseshoe & kiss Shauna.
 Details – CC cont.

3. 1 sound influences the place of production of

another sound to a new place of production.
When th sounds are adjacent to t, d, n, or l –
birthday, with Lilly, cutthroat, then the alveolar
sounds become dentalized between the teeth.

4. A sound influences the preceding sound to change

voicing; the features of the 1st sound in a word
always takes precedence – “I have to” becomes “I
haf to” & “hiz turn” becomes “his turn”.
 Details – CC cont.

5. Most American speakers substitute a flap (light touch)

/d/ for /t/ when /t/ is between two vowels and not at
the beginning of a stressed syllable (as in hotel) - either
between words (get it, minute or) or within a word
(water, better).
Rhodes, Clear English Corner, 2017

6. Two Cs back to back are produced in the same place

but vary in manner, voicing or nasality – within a word
(jump, land) or between words (thumb popped, can
do). This is the 1st CC coarticulation type I teach.
 Details – CC cont.

7. When using the conjunction “and”, the production

varies, depending on dialect & whether the “and” is
followed by a V or C.

• Tom and Mary – since Mary starts with a C, the d in

“and” is usually omitted.

• Owls and eagles – since eagles starts with a V, the d

in “and” is usually produced and connected to the 1st
letter in eagles when pronounced: Owls an deagles.
 Details – CC cont.

8. Two C’s are produced back to back but are produced in

different locations in the mouth – Example: an alveolar
(tongue tip sound produced in front) beside a velar (tongue
humped up in back) – within a word (skate, blocks) or
between words (kiss Ken, block Sam).

I usually teach this type after the CC coarticulation that is

produced in the same place in the mouth has been taught and
practiced.
 CC Coarticulation Cont.

9. 1st of two Cs back to back is an unreleased plosive

either within a word (popped, kicked) or between
words (pop two, kick two)

In the above examples, the C at the end of the root

word or 1st word of 2 is unreleased. Articulators are
placed for that C and momentarily held until the next
C is said.
 Details – CC cont.

10. Morphological endings “s” or “ed” are added to

create plurals, 3rd person singular verbs, etc. or past
tense. Voice follows voice; air follows air.

11. Three or more Cs are back to back and are a

mixture of voiced and unvoiced sounds between words;
like chameleons they change in different environments.
(swans feed, swans do; dogs flip, dogs blend in).
 CC cont. – A complex
example
12. In anticipation of adding the past tense ending to
words ending in ch or j (also the second sound of g), the
production of the ch or j is unreleased. Examples:
watched, judged
• Instead the sh or zh is released; retaining the voiceless
or voiced feature of the ch or j but transforming the
ending into a continuant; thus allowing the addition of
the t for the voiceless ch and d for voiced j.
• If these changes did not occur, the words would need to
be two syllables: wa/tched
 Video

Video of multiple contexts of coarticulation

 Lingering Consonant Errors

• Determine level

• Do articulation tx that includes motor learning

features like….
o Multiple repetitions to memorize movements
o Slower rate of speech initially and slower of progression
through therapy
o Multi-sensory Input (many types of cueing)
o Systematic progression through hierarchies
 Hierarchy Ladders
Classic Artic Morphology
Spontaneous C to C w/ one Noun Phrase Contractible
3-Syllable No Cues Regular
Speech unreleased + “be” verb + Auxiliary
Words Rate
Intermittent plosive -walked Adjective
Contractible
Structured Model Natural C to C diff. Sentence + Copula
Conversation
CVCVC Prep Phrase
Coarticulation place of prod. Uncontractible
C1VC2 Imitation in word - lift Prepositional Auxiliary
Story Accented Phrases
Retell 1st Posture Coarticulation C to C same Irregular
CVC place of prod. NP + Action
Only 3rd person
Sentences in word - find verb + N P
Blended
VC Additional Regular 3rd
Posturing Words
C to V between Pronouns Person “s”
Carrier CV1CV2 words - put it
Unblended Simple Past Tense–ed
Phrases Phonemic Words Sentence
Cue V to V between Uncontractible
Simple CVCV words - do it Verb + “a”
Blended Copula
Phrase + Noun
CV Mouthing Syllables V to C Possessive “s”
Word in syll. - up Pronoun “I”
Whispering Unblended Irregular Past
C Syllables C to V Verb Tense Verbs
Syllable in syll. - he
Simultaneous
Prolonged Article “a” Plural “s”
Speaking V to V
Sound V Phonation in syll. - I -ing
Noun

C=Consonant V=Vowel Syll=Syllable Prod=Production Kay Giesecke & Heather MacFadyen, 2005, ed. 2009
 Lingering Consonant Errors

• Practice correct production in the articulation hierarchy, eventually long

sentences that include work on
o Coarticulation
o Prosody
o Inclusion in multisyllabic words, morphology such as past tense & plurals, &
multiple targets per sentence.
o Normal rate

• Though Diedrich and Bangert (1976) found that students with

articulation problems who achieved 75% correct production on word lists
and conversation retained skills as well as clients kept longer, I have not
found that to be true clinically with students with CAS.

• I continue working on generalization until 100% for a couple of weeks to

prevent regression.
 Lingering Vowel Errors

• Determine which vowels/diphthongs errors and

consistency of errors.
• If needed, use hierarchy of difficulty to practice
• Correct all vowel errors, not just during specific
practice of vowels.
• Correct all vowels in longer & longer sentences.
• Continue correcting all vowel errors until child
dismissed/discontinued
 Natural Communication

• Prosody
• Rate
• Unnatural pauses
• Accents
• Volume

• Inclusion of gestural language if needed

 Practice longer and more
sentences
• Intentionally practice long sentences (compound or
embedded phrases) with good intelligibility and
prosody .

• Practice producing sentences in sequences

• Repetitive sequences
• Diverse sequences
• Life stories
• Procedural discourse
• Conversation: talking, listening, & asking questions
• Video on conversation
 Academics

• Special Ed advocate for students with CAS

• Reading

• Spelling

• If student has limb dyspraxia, possible hand writing

• Possible need for social skills training

Reading Disorders and CAS in
the Research
Depends on the definition of a reading disorder as well as the population studied

• 50-70% of children with a language disorder

• 50-75% of children with speech sound disorders
• Children with CAS:
• Have difficulty with rhyming and segmentation (Marion, Sussman, &
Marquardt, 1993; Marquardt, Sussman, Snow, & Jacks, 2002)

• Were poorer spellers than children with normal articulation

who were matched for reading (Snowling and Stackhouse, 1983)
• Had difficulties with reading, especially compared to a group
of children with speech sound disorders, but were more
similar to a group of children with a speech sound disorder
and a language disorder (Lewis, Freebairn,Hansen, Iyengar, & Taylor, 2004)
 Scope of Practice of SLP?

• “SLPs have a variety of roles and responsibilities

with regard to literacy intervention, but in general
they must ensure that students with special needs
receive intervention that builds on and encourages
the reciprocal relationships between spoken and
written language.” (ASHA Practice Portal)

• Should be collaborative in nature, working closely

with teachers and resource personnel
How to teach reading to children with CAS?

• Similar fashion to how to teach them to

speak: based on principles of motor learning
• Children typically learn to read out loud first
• Reading out loud requires sequencing speech
sounds, the core deficit in CAS
 Adapt to CAS characteristics

• Disjointed co-articulation – don’t recommend asking the

students with CAS to do traditional blending for reading
without helping them
• Need for:
• Lots of repetition in order to memorize
• More cueing – including integral stimulation for motor learning
(simultaneous production)
• Reduction and withdrawal cueing as progress
• Slow rate to allow for more time for motor planning

• Tendency to “lose” words and regress without following

hierarchies and progressively building more complex syllable
shapes
 Apps as efficient as a SLP?
• Can’t make judgments about changing goals midstream

• Can’t slow down rate of delivery

• Can’t deal with lack of attention of child

• Can’t give tactile, gestural, cognitive cueing, etc.

• Most done only in repetition instead of other types of cues such as

touch, gestures, mouthing the words or simultaneous speech

• Basically syllable and word lists with matching illustrations and

audio models on an electronic tablet

• SLPs ethically bound to use evidence based therapy techniques

Advantages of current apps

• Can be done at home by a parent

• Provide an alternative to traditional therapy

materials

• Can be used as a reward to motivate a child

• Less expensive than real therapy

• Cut down on planning time for SLP

Disadvantages of current apps

• A cop out in providing quality therapy

• Most only provide auditory input

• No multisensory feedback on responses

• No adjustments to programs as child completes levels

• Poor design in some - complex words mixed with simple

• Verbal communication is interaction between human

beings. Apps take the human connection out.
 Disadvantages of Apps

• Most recipients of speech therapy are young children who

learn best through hands on activities.
• Unable to find research yet to prove efficacy
• All require a parent, teacher, or SLP to administer to be
efficacious
• Parent should be trained to efficaciously administer
• Not individualized to child
• No instruction on prosody or coarticulation
• Most not designed to elicit multiple correct repetitions
 Just a thought……

Study published in the American Speech and Hearing

Leader magazine found that the more children 6 months to
2 years of age use handheld electronics the more likely they
are to have expressive speech delays – each 30 minute
increase daily in screen time = 49% increased risk of delays
ASHA Leader, Aug. 2017

Is using electronic games and apps, even if artificial

intelligence is built in, really good for learning and
preparing children for life and human relationships?
 Thanks!

• Thanks for participating in this webinar. If you

should have any questions, you may contact me at
kaygiesecke3d@gmail.com or on my cell, 214-505-
5041. If you email please write “apraxia question”
on the subject line.
 References
• American Speech-Language-Hearing Association. (2007). Childhood Apraxia of Speech (Ad hoc Position
Statement). Available from www.asha.org/policy.

• American Speech-Language-Hearing Association. Written Language Disorders. Practice Portal.

http://www.asha.org/Practice-Portal/Clinical-Topics/Written-Language-Disorders

• Bernthal, J.E. & Bankson, N.W. (1993). Normal Aspects of Articulation, a chapter in Articulation and Phonology
Disorders, .(pp 38-44). New Jersey: Prentic Hall

• Rhodes, K, SLP & American Accent Coach on Clear English Corner/American Accent Training on Flap /t/.

• Diedrich & Bangert, (1976) as cited in Chapter 2 Research Studies of Generalization and Carryover by Pam
Marshalla in Carryover Techniques in Articulation and Phonological Therapy, 2010, (pp.9-20). Millcreek, WA, Marshalla
Speech and Language.

• Flipsen, P, 2010. Measuring Intelligibility in Children and Why, Idaho State University, article handout on
www.asha.org

• Handheld Screen Time Linked to Delayed Speech Development, The ASHA Leader Research in Brief, Volume 22,
Issue 8, Aug, 2017, (pp.16-16).
 References, cont.
• Hall, P.K. & Jordan, L.S. (2006). Features of Motor-programming Treatment with Children Exhibiting DAS.
Chapter in Developmental Apraxia of Speech, Theory and Clinical Practice, (pp.191-218).Austin: Pro-Ed.

• Haynes, S, Developmental Apraxia of Speech: Symptoms and Treatment, In Clinical Management of Neurogenic
Communication Disorders. (pp-259-266). Boston: Little, Brown & Co. as cited in Clinical Management of Motor
Speech Disorders in Children by Caruso, A.J. & Strand, E.A.. (1999), (PP- 117-117). New York: Thieme

• Lewis, A.L. & Ekelman, Bl.L. (2007). Literacy Problems Associated with Childhood Apraxia of Speech. Language
Learning and Education, 10-17.

• Lewis, B.A., Freebairn, L.A., Hansen, A.J., Iyengar, S.K. & Taylor, H.G. (2004). School- age follow-up of
children with Childhood Apraxia of Speech. Language, Speech, and Hearing Services in Schools 35(2): 122 –140.

• Marion, M. J., Sussman, H. M., & Marquardt, T. P. (1993). The perception and production of rhyme in normal
and developmentally apraxic children. Journal of Communication Disorders, 26, 129-160.

• Marquardt, T. P., Sussman, H. M., Snow, T., & Jacks, A. (2002). The integrity of the syllable in developmental
apraxia of speech. Journal of Communication Disorders, 35, 31-49.
 References cont.
• Marshalla, P in Carryover Techniques in Articulation and Phonological Therapy, 2010, (pp.9-20). Millcreek, WA,
Marshalla Speech and Language.

• Snowling, M., & Stackhouse, J. (1983). Spelling performance of children with developmental apraxia of speech.
Developmental Medicine and Child Neurology, 25, 430-437.

• Strand, E. & Skinder, A. (1999.) Treatment for Developmental Apraxia of Speech: Inte)gral Stimulation Methods.
Chapter in Clinical Management of Motor Speech Disorders in Children,. (pp.109-148).. New York: Thieme.

• Velleman, S.L., Childhood Apraxia of Speech: Assessment/Treatment for the School-Aged Child, Presentation
handout from presentation at ASHA Convention Miami, 11/16/06