Childhood Apraxia of Speech and expanding utterances!

My first year as an SLP (during my clinical fellowship year), I worked with a student with severe Childhood Apraxia of Speech.  This started me down a path of discovery and growth.  A few years ago I was able to attend the CASANA Intensive Training Institute for SLP’s.  The training was taught by some amazing researchers and clinicians.  The training that I received was amazing but also opened a door to continued growth.  My hope is to continue to learn and grow while passing on information to fellow SLP’s, families, and teachers.

I recently started putting to design some of the activities that I have designed (with post-it notes and index cards).  Currently, I have children that are working on early sound and syllable planning and some that are working on expanding their MLU or length of utterance.  So I created some activities and visuals to support expanding utterances.  I think this looks much better than my post-its!

As a new therapist (a few moons ago), I remember getting stuck moving past 2-3 syllables.  An important tool for working with apraxia and with any articulation disorder is prompting and cueing.  Along with this, you increase the utterances methodically according to the skill of the individual.  You can’t just go from word level to a phrase!   Below is the approach that I often use to build the length of utterance.  I use articles such as “a” and “the” to add to the complexity of the utterance.

It is also very important to start expanding utterances early.  It can be as simple as adding an “a” to baby for “a baby”.  The earlier you add in the coarticulation between words, the better.  A few years ago, I started working with an older girl with CAS.  It was very obvious to me that they had worked hard to get sounds in words, but they didn’t teach the coarticulation between words.  Her sentences were choppy and her prosody was distorted.

Below is the approach that I often use to build the length of utterance.  Click for a copy of this chart!

A couple of my kiddos are at the sentence level but need practice expanding their sentences both in length and variety.  I have a few flip books that I have used for early sounds as well as some fun flip cards to create silly articulation sentences.  This gave me the idea to create the Keep Talking:  Expanding length of utterances activities.

While I originally created this activity to work with some students with apraxia, I have found it to be a great tool for many speech and language activities!


I use the Keep Talking Expanding Utterance Activity for the following:

  1. Sentence expansion
  2. Grammar
    1. Articles
    2. Pronouns
    3. Verb Tense
  3. Color codes are a modified Fitzgerald key to coordinate with AAC use.
  4. CAS working from single word utterances to multi-word utterances.
  5. Articulation to build from single word to sentences

How would you use this activity?