CAS Therapy: Attention, Motivation and Other Needs

Keeping kids motivated and successful in speech therapy can be challenging at times. We may be asking kids with childhood apraxia of speech to do things that feel really hard or unsuccessful for them. Creating a positive learning environment, providing motivating activities, and making sure that kids experience success from the start are key pieces to keeping kids engaged and participating in treatment sessions. This article includes ideas to help keep your child engaged in speech therapy and how to manage refusals if they arise.

Set up for success

Set up the speech therapy environment for success. Whether it is at home or in the clinic, shift from thinking “Why won’t my child participate in therapy or speech practice?” to “How can we set up the environment to keep my child engaged and achieving success?” This shift in thinking creates a positive starting point for creating a successful learning environment. The speech therapy environment should be welcoming, free from distractions, and feel safe and comfortable to the child.
Parents can also present a positive attitude and expectations about therapy (vs complaining about the time and effort it takes to get there, or negative comments about the speech-language pathologist (SLP) or the facility, etc.). Including other family members such as siblings in this positive attitude is helpful as well.

Choose activities your child loves

Make a list of your child’s favorite things. Identify their favorite games, activities, books, foods, people, and so on. Does your child love art, music, and/or active games? Does your child enjoy building things, creating things, or playing with a certain type of toy? Perhaps your child is motivated by stickers, bubbles, or turns in a game. Once your list is created, think of ways to use these favorite activities in speech therapy to support your child’s motivation. When speech therapy includes your child’s favorite activities, it helps to make practice motivating and fun. We learn best when we are doing things we enjoy. Ask your child’s SLP if they have suggestions for ways to combine practice and enjoyable activities at home.

Create achievable goals

Your child’s SLP will conduct an evaluation to determine what your child is already able to do successfully and what skills may be more challenging for your child. The SLP will create an inventory of the sounds and syllable structures your child is able to produce successfully. These become the building blocks to start shaping your child’s specific speech goals that will help them learn new skills in achievable ways. You can help by identifying “power” words for your child that the SLP can address right away, or have on a list to get to as soon as possible while maintaining success. The SLP will also look at other skills your child has that might help in learning learn new sounds and words. By finding out what your child can already do, SLPs identify strong skills that can be used to help teach new skills in fun, exciting and successful ways.

Choose cues and prompts that are helpful for supporting success

Your child’s SLP will identify cues and prompts that your child responds well to and that support their success in speech therapy. Cues include verbal cues (cues through telling), visual cues (cues through showing), auditory cues (cues through hearing/listening) and tactile cues (cues through touching). Your child may respond best to specific cues or to a combination of cues/prompts. Your child’s SLP may experiment with different cueing strategies to find out which cues or prompts are most helpful. Be creative working together to come up with fun names for sound targets and cues that your child will connect with. Keep instructions simple, clear and understandable to your child.

Build success quickly into speech therapy

Keep speech therapy successful and enjoyable for your child right from the start. Through strong goal setting, appropriate treatment strategies and cues, creativity, and child-specific motivating activities and rewards kids are set up for success. Your child’s SLP will choose goals, cues, and other treatment strategies that create small steps of success right away. Success builds motivation and motivation builds further success!

Use reinforcement and rewards

Using reinforcement and rewards can be a great way to motivate kids in speech therapy (e.g., sticker charts, rewarding with pieces to a game, praise, etc.). Begin with simple requests asking your child to do things that they are able to do easily and then quickly reinforce participation and success. These may be things that aren’t speech-related (e.g., actions in a game). Then, begin rewarding your child frequently for participation with easy speech tasks and gradually increase the complexity of the tasks and decrease the frequency of the rewards, while maintaining success. This helps us find the place where your child will learn and build new skills with our support and identify the line where it becomes too difficult for their current skill set. Provide positive reinforcement verbally for your child trying, even if they aren’t successful. Continuing to try is very important to making change and learning new skills.

What if your child refuses to take part in speech therapy?

If you and your child’s SLP are using strategies to make speech therapy motivating and successful, but your child is refusing, attempting to escape, or avoiding learning situations, take a closer look at the situation. Observe your child’s behavior and consider any reasons that might be leading to their resistance to practice. We generally tend to enjoy doing things that we’re good at and avoid doing things that we’re not good at. When children have childhood apraxia of speech, we are asking them to do something that is very difficult for them. It is important that they begin to feel successful quickly and know that small successful steps will move them closer to their goal of being able to communicate well with others. Be open with your child when you see that they are frustrated and let them know that you are there to support them and to work together toward their goals. Acknowledge their frustration or anger or whatever they are feeling rather than brushing over it. Give them the words to express that what they are trying to do is hard: “I know that saying this word is really hard work for you. Let me help you say it.” Or “Let’s do a different word and try this one later.”
Notice little cues that might show that your child may be feeling unsuccessful or frustrated and quickly increase use of motivators, choose a simpler task, increase your cuing, move to a new activity, or just take a break. Noticing the little cues of frustration can help steer your child back to success and away from shutting down.
Take a look at how the above strategies are being used and identify any areas that can be improved upon in speech therapy. There may be occasions where the “fit” of SLP and child is just not right. If parents are uncomfortable with what they see, they need to address it with the SLP. If they cannot resolve issues or it is clear that the relationship with the SLP and child is not working well and resulting in refusal, it is OK to change SLPs to assure continued positive progress.
Also, consider what else is going on for your child. Are there other areas of development that may benefit from support? Are there other things going on in their life right now causing stress or fatigue socially, at school, or other areas such as sensory processing? Be open and work with your child’s SLP, other team members, and your child to identify the best ways to support him/her in speech therapy sessions.
Most of all, if your child is refusing speech therapy, attempting to escape, or avoiding a teaching situation, don’t place blame on your child, but instead find ways to work together in positive ways to create a supportive learning environment that helps build your child’s success with communication.

by Sheila Hosain, MSc (A), SLP (C)

November, 2020