Choosing Targets:
The order of phonological patterns within cycles is based on developmental and clinical phonology research findings and on each individual's phonological abilities.  Remember, we are not targeting individual phonemes, but rather entire sound patterns.

The clinician should select the client’s most stimulable sounds or patterns, so that the child can experience immediate success.  Stimulate any non-stimulable sounds for a few minutes during sessions until they become stimulable (& always facilitate liquids if they are not stimulable).

The targeted patterns within the cycle are used to stimulate emergence of a specific sound or pattern in spontaneous language, not mastery of it.  Target only those that are consistent deviations and errors that occur at least 40% of the time.

Primary First Cycle Targets:

• Syllableness: Target omitted segments – compound words, two and three syllable words, equal stress word combinations such as cowboy, cowboy hat, elephant.  Remember the focus is on marking syllables.  If the child says eh-phant for elephant, this is not marking all the syllables.  If the child says "eh-wa-bint", this is correctly marking all three syllables (it doesn't matter that certain phonemes are not produced correctly).
• Word initial singleton consonants (Initial Consonant Deletion): begin with CV words starting with /p,b,m,w/ sounds.
• Word final singleton consonants (Final Consonant Deletion): begin with VC structures starting with /p t k m n/ sounds (don’t target final voiced stops).
• Other word structures CVC and VCV words.
• S clusters (Cluster Reduction): Begin with word initial sp, st, sm, sn and then word final ts, ps if difficulty with all S blend words. Add /s/ to consonants that child already produces, if they produce /b/ or /p/ then target /sp/ blends etc. Incorporate phrases after word level, usually on third cycle. This is only for omissions not for substitutions or distortions of s blends.
• Posterior and anterior contrasts (Fronting and Backing): For children who are fronting, begin with word final /k/, then initial /k/, /g/ and/or /h/ (never final g).  For children who are backing, begin with word final /t/, then initial /t/, /d/ and possibly /n/.
• Liquids (Gliding): If absent, these phonemes should be stimulated during each cycle. Stimulate word initial /l/ first (preceded by week of tongue tip clicking) and then word initial /r/ (suppress gliding and exaggerate and prolong the vowel rather than the /r/). Don't blend initially. Incorporate /kr/ and /gr/ when child has velars, typically by third cycle.

Secondary Target Patterns:

• Reassess and recycle primary patterns as needed before progressing to secondary target patterns.
• Only move to secondary targets after establishment of early-developing phonological patterns, contrastive use of velars/alveolars, emergence of /s/ clusters in conversation and suppression of gliding while producing liquids in carefully selected production practice words.
• Target any secondary patterns that are still consistently lacking and problematic.  Incorporate minimal pairs whenever possible.
• Voicing Contrasts/prevocalic only 
• Palatal /j/ then Palatal Sibilants /sh/
• Singleton Stridents (Anterior) /f/ and /s/
• Consonant Clusters such as glide clusters, medial CC sequences (e.g. Mustard)
• Other Consonant Sequences (e.g. gold, straw)
• Word-Medial Consonants
• Postvocalic/Syllabic /r/
• Assimilations
• Vowel Contrasts
  
• Any remaining idiosyncratic deviations
  

Advanced Target Patterns:

• These are for upper elementary children with intelligibility problems.
• Complex Consonant Sequences (e.g. Pumpkin, Extra).
• Multi-syllabic Words (e.g. Evacuation).​

Session structure:

1. Auditory bombardment with amplification: ~30 seconds or 15-20 words that contain the target pattern for this  session.  Child does not repeat words here, just listens. Child then names a few potential practice words using amplifier with microphone near child’s mouth.
2. Target word cards/familiarize child with the targets for this session: The client draws, colors or pastes pictures of familiar 3-5 target words on large index cards, during this phrase the child repeats the words modeled by the clinician.
3. Production practice through experiential play: Taking turns (5 reps a turn) naming the pictures while clinician provides cues – we want 100% success on the target patterns.
4. Stimulability probes: Child’s stimulability is assessed for potential targets for the next session.  If s clusters are next, child is asked to model several words that contain different s clusters. The most stimulable s cluster is then targeted the next session.
5. *Also include Metaphonological tasks like rhyming, onset, rime, syllable segmentation etc in practice. This is often increased during final cycles. (e.g. Target word: /cap/ -> work on rhyming words by having child choose the correct one from stop, moon, map).
6. Auditory bombardment step: Repeated
7. Home program: 2-5 minutes a day, parent reading the week's listening list and the child names the picture cards of the production practice words. Parent can also read listening list and have four line rhymes. After several readings, the parent pauses so the child can fill in the rhyme word.

Typical Metaphonological Development:
3 & 4 year olds (Rhyming and Alliteration, Segmentation, Blending and Manipulation of words and syllables as well as phoneme and grapheme awareness)
5 & 6 year olds (Onset/Rime and Blending, Segmentation, Blending and Manipulation of phonemes as well as grapheme and phoneme correspondence).

Determine your business structure. Research different business structures and speak to an accountant in your area. Business  structures include a Sole Proprietorship, LLC, Corporation (C-Corp, S-Corp) and Partnerships.  It is important to also be aware of your state rules and see what will work for you.  For example a sole proprietorship costs less money, but comes at an expense of more liability.  Ultimately, I went with a Sole Proprietorship because in the state of California they do not allow a single member LLC.  If I could have, I would have went with an LLC since it is a flexible business structure and separates business and personal liabilities. 

Determine your private practice model.  Your choice for a business structure may also depend on your private practice model - are you only going to be seeing patients in their home? Are you going to open up a clinic and have an office-based practice? How big do you anticipate the clinic being? Is this going to be part or full time job? I chose to do in-home therapy since real estate is so expensive here in CA and I didn’t want to jump right into that. I initially wanted to see children in my own home, however after checking with local Zoning Laws, I found out my city doesn't allow that.  So check Zoning Laws as well!

Get Professional Liability Insurance if you don’t already have it.  Popular companies for SLPs to use are:
 https://www.hpso.com/ and  https://www.proliability.com/

​Insurance or Cash Only? I chose to be a private pay only practice.  Since this was a part-time job for me, I did not feel the need to contract with insurance companies (become an in-network provider) in order to obtain clients.  This decision will also depend on projected scope of business and what disorders you intend to treat, experience (are you an expert in a particular area that families will seek out?  Is your area of expertise typically reimbursed by health plans?), the affluence of your community, and the state of economy.  If you decide to go with a cash only practice, you can provide families with documentation of your services to submit to their insurance companies.  Make sure they sign a form indicating that they understand they are responsible for the payment even if they are not reimbursed by their health plan.  I always require payment on the day of service or I have client's pay in advance for the month.  Families can check with  their insurance companies before beginning therapy services to see if their insurance company will reimburse for out-of-network benefits.  If you choose to become an in-network provider with insurance companies, know that it takes a considerable length of time.  The process of applying can take months.  Submitting claims, determining eligibility, collecting co-payments and tracking payments also takes up a lot of time.  For reimbursement purposes, you need to get an NPI number (National Provider Number) and this will identify you as a provider on claims you submit to insurance.  For tax purposes, you may also need to obtain Tax ID number (EIN - Employer Identification Number) to receive payment from insurance companies to your business.  (Even though I do not contract with insurance companies, I got an EIN number and file my taxes under that instead of using my Social Security number).

Writing a Business Plan.  If you are seeking a bank loan to start up your business, you will need to write a business plan.  Consult with an attorney and accountant to set up your business and write your plan.  Helpful websites include: https://www.sba.gov/ and https://www.score.org/

Determine a name for your practice. You can just use your own name if you choose to be a sole proprietor or decide on a company name as well that is different.  I chose Gate to Communicate Speech Therapy as my business name and in order to do that I needed to get a business license with my city (~$130) and had to file a DBA (doing business as) with my county (~$35).  It's important to research whether the name is already being used by others.  If it is being used by others, you may have a difficult time getting the domain name that you want for your website and may confuse people.  Ideally, choose a name that is not in use.  You may also want to consult with an attorney to ensure whether your state has regulations regarding your name choice and if it needs to be approved.  You can also ask about trademarking your logo or name.  Remember your vision of your practice.  If you open your practice as "Jane Doe, Speech Therapy Services" and then in a few years when the business is growing, you want to add employees you may need/want to rename your business and that can be difficult.  You can check this website to see if a domain name is taken:
https://www.name.com/domain/search

Creating a website.  Your next step is to look into creating a website for your business.  In this day and age, most people find companies with a quick internet search, so a website is important.  You have options of using SquareSpace, Weebly, Wix, Wordpress,  GoDaddy etc. I chose Weebly and found it very easy, great customer service and price was good.  Also make sure you get on Google My Business, so you pop up when customers search your area for speech therapists.

Get a business email. You can get a HIPAA compliant email by signing a BAA through G Suite and this will give you a more professional looking email @yourdomainname such as info@janedoespeech.com.  I also have seen practices who use a typical email at gmail.com as well.  If you are not transmitting personal health information or client information, this may be okay.  You can also look into: Hushmail, and ProtonMail.

Get a business phone number. You can use your personal phone number or get a different business phone number.  I set up a free google voice number with an area code of where my business is.  I did this because my regular phone number is where is grew up in NY and wanted the area code to be in the area I am currently servicing.  You can also look into: Spruce Health, Grasshopper, Sideline and Line2.

Get a business bank account.  Make sure your business income is separate from any other income or money in your bank.  I did not specifically set up a "business bank account", I just changed my second savings account that I already had open to be named "business" and this is where I transfer all business income.

Paper documentation or EMR Software? What are you going to do about documentation?  If you decide on paper reports, SOAP notes, invoices, etc then get a locking file cabinet and place it in a locking room in your household for HIPAA compliance.  If you are looking into EMR softwares for paperwork, scheduling, billing, etc. Look into different choices: Simple Practice, WebPT, Office Ally, TreatWrite, Fusion Web Clinic, TheraNest, ClinicSource, Raintree, Practice Fusion, My Client Plus, Practice Perfect.  I do not have an specific recommendations as I do not use an EMR system.

Create your forms: Client intake forms, case history/developmental history, informed consent/authorization to treat, email/text agreement, payment policy, cancellation policy, video release, release of information, How did you hear about us, HIPAA forms, SOAP note document, Superbill etc.  Attached is ASHA's example of a Superbill for SLPs:
https://www.asha.org/Practice/reimbursement/coding/Superbill-Templates-for-Audiologists-and-Speech-Language-Pathologists/

Set your hourly rate: For your payment policy, you will need to list your hourly rate.  You can look to see what other therapists in your area charge and see what the typical price range is.  Just avoid discussing rates with other providers as it can be construed as price fixing.  This will also vary based on expertise and experience.

Decide on payment method: Will you accept cash and check only or do you want to accept credit cards? For the first two years, I only accepted cash and check.  I now use IvyPay for credit cards since parents definitely prefer to have their card charged then to have cash on hand or writing a check each session.  You can also look into Square, PayPal Business, Zelle, Wave App, Quickbooks, Authorize.net, Freshbooks, Go Card Connect are a few others that I have heard of, but do not use.

Determine your niche.   I believe it's best to focus on a specific area in our field or population and market yourself that way.  Ages, population, disorders, etc. (e.g. children,  preschool age, fluency disorders).  Have a goal of becoming the go-to person in your area for that disorder.

Creating business cards/logo.  I had cards made on Vistaprint and had my friend create my logo.  For business cards check out: Vistaprint, Moo, Zazzle, Staples, Canva or Makr and for Logos check out: Fiverr, Instalogo, Canva, Vistaprint, Etsy, 99 designs.

Buy assessments.  After you determine your population, age range and disorders that you will be working with invest a few assessments.  Look into Q global for online assessments.  Also be sure to look into free assessments such as the Communication Matrix.

Fax options: If you are in need of a way to fax items check out: sFax, Filesanywhere, Faxage, Ring Central Fax, Nextiva Fax, eFax, SRFax, Genius Fax and Smart Fax

Side note: If you are a sole proprietor, you may want to get a P.O Box with a real address for your business so on your paperwork you can put that address instead of your home address.  With getting an NPI, EIN number, and listing on all different websites your address begins to be plastered all over the internet and it's difficult to get rid of.

Marketing:

• Add yourself to the professional directory on ASHA ProFind
• Instagram, Facebook, Yelp, Google Ads, FB Ads, Craigslist, Twitter, Nextdoor, Speechtherapyconnect.com, Care.com, Mom's FB groups, Pinterest Business, Linked In,  Speechbuddys.com, SEO on your website (Search engine optimization- look into Brighter Vision) 
• Make brochures, flyers, ads, pamphlets
• Do free screenings are local day cares/preschools
• Speak with referral coordinators at pediatrician's offices.  Have a five minute meeting with doctors.  Give free books to doctor's offices with a sticker containing your business name and phone number on the back.  Pass out "when to refer" cards and have doctors leave them in their waiting rooms, bring in a bucket of Styrofoam stuffed with lollipops, pens, etc and have the name of your business on the bucket.
• Contact dentists, physical therapists, occupational therapists, psychologists, other SLPs, regional centers (or your states early intervention programs to vendor with them).
• Drop business cards off at local libraries, restaurants.
• Join Rotary Clubs, Kiwanis, Chamber of Commerce
• Look into resource centers in your area and contact them to get listed on their website
• Look into community events and health fairs to rent a booth
• Contact private or charter schools
• Give presentations in your community
• Word of mouth is huge!

Hope that was helpful to get you started!

The Principles of Motor Learning are a set of processes that facilitate the acquisition and retention of motor skills.

Motor Performance - The ability to perform a motor task.  How the movement is performed during training, within a structured session. (Temporary change during the speech session).
Motor Learning - Retention and generalization (transfer) of skills learned including how the movement is performed at another time or in another setting outside of speech therapy.  The process of the learner acquiring a skill and making a movement automatic.

Precursors to motor learning in young children:

1. Joint attention / Sustained Attention
2. Communicative Intent / Motivation
3. Ability to Imitate and pre-practice (including phonetic placement training)

Conditions of Practice

Target Choices/Target Complexity
(Type, length, phonetic complexity)

• Simple Task - Focuses on easier sounds and sequences (what the child can say or what is presumed easier and earlier developing)
• Complex Task - Including sound sequences with increased length and phonetic complexity that are more difficult

*Focus on phonemes already in a child’s repertoire as well syllable structures that he/she is already using and build off of that.

Practice Amount: Small vs Large
Refers to the amount of time spent practicing movements

• Large amount of practice - High number of practice trials
• Small amount of practice - Low number of practice trials

*Large amount of practice provides more opportunity to establish a motor plan.
*Maximum response trials - Attempt 50-200 trials depending on the severity of the disorder.
*Larger number of trials leads to greater retention and generalization (Edeal & Gildersleeve-Neumann, 2011).

Practice Distribution: Mass vs Distributed practice

• Massed practice - Practicing a given number of trials in a short period of time
• Distributed practice - Refers to how the practice is divided over time including spreading practice out over a longer period of time.  

*Massed practice is used to establish a motor plan.  It leads to quicker acquisition of a skill, however less generalization.
*Distributed practice leads to better retention and generalization of a skill (Bahrick & Hall, 2005).
*Typically in children with CAS, distributed practice over time (4 sessions a week for 20 minutes) appears to be more beneficial than massed practice (1x a week for an hour).
*Massed practice may look like working on 3 targets for 4 weeks, and then 3 novel targets for 4 weeks, rather than 6 targets for 8 weeks straight.
 
Practice Schedule: Blocked vs Random practice

• Blocked practice - Practice each stimuli in a block (e.g. you have 6 target words total and you practice target 1 10x, then move on to target 2 and practice 10x, target 3, etc)
• Random Practice – Mixing the practice of each stimuli once or twice across the whole set. Different movement targets are practiced in a random order (e.g. you have those same 6 target words, however you practice them in an unpredictable random order)

*Start with a more blocked practice for acquisition (Shea et al., 2001) then move to random as movement accuracy improves, so the child doesn’t over habituate.  
*Evidence shows random practice leads to better motor learning and generalization (Shea et al., 1990), but for more severe cases, blocked practice may be necessary at first to optimize learning. 
*If you start with random practice then it will take the child longer time to acquire the accurate movement gesture for that target. 
*One study in CAS treatment (~2.5hr tx/week, 2-4 week phases): 2 children showed greater retention with blocked, 1 child showed greater retention with random and 1 child showed no clear improvements with either condition (Maas & Farinella, 2012) .

Practice Variability: Constant vs Variable practice

• Constant practice - Practicing the same target, in the same context (i.e. /p/ in syllable initial position: pie, pa, pee, poe)
• Variable practice - Practicing various targets in different contexts (e.g. /p/ /k/ and /d/ in syllable initial and final position: pa, up, do, ick, key or the target word "do", changing contexts such as having the target word produced in different phrases ("I do", "do it!", "you do")

​*Variable practice is better for retention and facilitates motor learning (Shea et al, 2001).  Having some variability with target choices benefits speech motor learning.
*Constant practice is better for acquisition of a skill and may be better for learning the underlying timing pattern of a motor program (Lai et al., 2000).
*Variability can also include working on prosody to practice more flexibility in motor planning and programming as well changing stimuli (orthographic vs picture), changing carrier phrases or even changing the setting.  

Conditions of Feedback
(Type: Knowledge of Results/Knowledge of Performance, Frequency: High/Low, Timing: Immediate/Delayed)

Feedback Type: Knowledge of Results vs Performance

• Knowledge of Results - Information about the outcome that is binary. You tell the client if they achieved the target or did not. (e.g. saying “good job” or “that’s not right”)
• Knowledge of Performance - Giving more specific feedback regarding the movement performance (e.g. “I like how you pushed your lips out” or "Your jaw needs to open a little more")

*Knowledge of performance has proven to be better with more complex tasks where the goal is unknown or the client does not have the knowledge of how to reach the goal (Newell et al., 1990).  So for early acquisition of a motor skills, begin with knowledge of performance.
*To promote generalization and retention of a motor skill, move to knowledge of results feedback.

Feedback Frequency: High vs Low 

• High - Feedback after every attempt at production regardless of accuracy 
• Low - Feedback only after some attempts at production regardless of accuracy

*Low frequency feedback has been shown to benefit learning (Bruechert et al., 2003) and promotes retention of a skill.
*More frequent feedback might be required initially for learning of complex skills. Begin with more feedback and gradually fade to less, so a child does not rely on this.
*Children may benefit more from more high frequency feedback overall (Sullivan et al., 2008).
*Few studies have examined feedback frequency in speech motor learning.  *One study with children with CAS (Maas, Butalla & Farinella, 2012) showed 2 children with greater retention with low frequency feedback, 1 child with greater retention with high frequency feedback and 1 child with no improvement in either condition. (High frequency feedback meaning feedback given on 100% of trials, low frequency feedback meaning feedback given on 60% of trials).

Feedback Timing: Immediate vs Delayed

• Immediate - Feedback immediately following attempt at production
• Delayed - Feedback provided with a delay (e.g. 5 seconds)

*Delayed feedback enhances learning compared to immediate feedback (Vander Linden et al., 1993, Strand et al., 2006).

References: Maas. et al. (2008). Principles of Motor Learning in Treatment of Motor Speech Disorders. American Journal of Speech-Language Pathology, 17, 277-298.

Lets admit it, toys are sometimes a hassle, you pay a lot of money for a toy and your child doesn't like it or they get bored after one time playing with it.  We've all been there and it's frustrating!  Well the good news is, you don't always need toys to interact and play with your little one! There are several toy free "games" that consist of two people interacting with each other that are just as fun and engaging. The social interaction games listed below are great for building speech, language and of course social skills!  You can focus on making eye contact, joint attention, turn-taking, requesting, imitation of actions/nouns and much more!  As a speech therapist, I work with many children who have a difficult time with social reciprocity and engagement. The child is often lacking those joint attention skills (looking at an object, then at the person, and back to the object) during interaction and play time. I have found that these toy free social interaction "games" work wonders and almost always get the child more engaged with me!  

Some examples of social interaction games include:

• Peek-A-Boo
• This Little Piggy Goes To The Market
• Tickles 
• Leap Frog - Can work on action word "hop" or "jump"
• Chase - Can work on action word "run"
• Patty Cake - Can work on action words such as "roll" "pat" "bake". 
• Airplane - Lie on your back with your feet in the air and have your child rest their tummy on your feet. Pretend they are riding an airplane.  Incorporate sound effects such as "whooosh" "vrooom" 
• Bouncing - Have your child sit on your lap and bounce them up and down.  You can rock back and forth or sway side to side.  You can work on words such as "fast" and "slow"
• Race Car - Sit down with your knees raised up and have your child sit down with their back against your knees.  You begin steering them by leaning side to side.  You can work on sound effects and words such as "go" "crash!" "utoh!" "stop!"
• Horsey Rides - Get down on your hands and knees, have your child climb on your back and pretend they are going on a horsey ride.  Incorporate those horse noises!
• Ahh-Choo Game - Although this toy involves a small object, it's a classic and works wonders.  Place a small toy on top of your head and pretend to sneeze saying "ahh-choo!".  It is a great way to make your child look at you, make eye contact, laugh and engage with you.​

 

• Song Examples
  • Row Row Row your Boat - Sit across from your child, facing each other and hold hands, move back and forth like you are rowing a boat
  • Ring around the Rosie - Work on action word "fall down"
  • Itsy Bitsy Spider - Accompanied by hand motions.  Hopefully your child will attempt to imitate the hand movements he/she sees
  • Wheels on the Bus - Accompanied by hand motions as well

​Children are always craving movement and they are naturally drawn to variations in pitch, intonation, and loudness in our voices, so it is important to move around, be fun, act silly and incorporate sound effects during these games.  This will facilitate the interaction between the two of you!

Enjoy!
 

Hope this blog post sparks some ideas in your head on ways to make your therapy sessions more fun for your students, yet just as engaging!

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https://www.teacherspayteachers.com/Product/Scavenger-Hunt-Targeting-Basic-Concepts-3961151​

 "Before words and sentences emerge, a child needs to possess the ability to imitate.  A child needs to react to events going on in their environment and be able to imitate those various actions/gestures and sounds that he/she sees through out their day.  Other important pre-linguistic skills include joint attention, eye contact and attention.  Exclamatory words quickly draw attention and engage little ones.  They can easily be used during play time and in every day routines for a fun and functional way to build and expand your child's language skills as well as develop a larger repertoire of speech sounds. 

Below is a list of various exclamatory words that can be paired with different objects, which can easily be incorporated into play time with a child.

"mmmm" "yummm" "ick" "ew" "blah"- These can be used when feeding stuffed animals or a baby doll.  Another great activity is using velcro fruit & vegetables and then pretending to eat them.  Pretend the foods are good and say "mmm" also pretend they are yucky, spit it out and say "blah!" - kids love this one!  

"vrooom" "errrr (screaching)" "boom!" "beeep" "crashing noise" "whoa" "choo choo"- Vehicle noises

"weeee" "uhh ohh" "ouchie" "ow" "woohoo" "yippee" "oopsie" "lalala/singing sound" "mwah/kissing sound"  "hmm/thinking sound" "ughh/mad sound" "wow" "nigh-nigh" "yay" "gulp /drinking noise", "shhh" "wahhh/baby crying" "aww" "eek!/scary sound" "aahhh/scary sound" "boo" "tah-dah" "pee-u"- These can be used when playing with toy people and using accompanying items.  Such as saying 'weee' down the slide, 'uhh ohh" when someone falls down and "eek! when making a scared face!"

"ahhh choo" - Kids love fake sneezing! Place toys on top of your head and pretend to sneeze and I'm sure your little one will get a kick out of it.

"popping sound with lips" - Use this with bubbles.

"whoosh" "boing" - Playing with a toy ball.

Animal sounds: "oooh oohh ah ah for monkey" "buzzzz for bee" "moo" "neigh" "oink" "baaa" "ruff ruff" "h-h-h- as panting dog" "meow" "heee/ hissing cat sound" "quack" "cockadoodledooo" "roar"

The book Moo Baa Lalala By Sandra Boynton is a boarded sturdy book that comes in a small size or lap size that is great to use with toddlers to work on animal sounds.

Using all these exclamations with different objects can be used to establish joint attention with your child (shifting the child's focus from you to the toy and back to you) as well as establish eye contact and attention.  It can also be great to build functional play skills and using toys appropriately and facilitate reciprocal play.

When using these exclamation words use a slower rate of speech and vary your pitch and intonation.  Overemphasize vowel sounds and syllables.  Children are naturally drawn to our voices and are more likely to attend to varying intonation with excitement.  Make sure you are really engaging with your child and looking them in the eye.   Always accompany gestures as well with the sounds to facilitate imitation of these actions.

For children with delayed language and late talkers, use toys that are your child's favorites.  Follow your child's lead with which toys they choose and what they want to do with those toys.  From here, pause and wait.  Repeat the exclamation several times for more exposure to the word to facilitate verbal imitation.  Try to avoid telling your child to "say weee!" etc.  Praise any attempts including gestures.

For children with Childhood Apraxia of Speech, hold the objects right next to your mouth when saying the sounds. These individuals often have difficulty with coarticulatory transitions, so placing the object at your mouth will focus their attention there.  This way they can watch your mouth as you make the noises.  Make sure to keep the sounds together and stretch the word out, do not separate them.  With CAS, the focus is on movement. (e.g. cow says "mmmmoooo" - not mmm...oooo.  Also vary prosody - say sounds in a "mommy /daddy/baby voice" "high like a mouse/deep like a lion voice", or excited/sad/mad voice.

For children with severe speech sound disorders and articulation errors, make sure to extend the vowel sounds when using these exclamations.  Vowels sounds contribute more to intelligibility than consonant sounds do.  Prolonging the vowel sounds gives more time for your child to think about the consonant sounds that follow as well.

Children learn through play!  Remember, they don't like to listen to us, they like to imitate us!