Childhood Apraxia of Speech and Expanding Utterances

In 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.  Some fantastic researchers and clinicians taught the training.  The training that I received was terrific but also opened the door to continued growth.  I hope to continue learning and growing while passing on information to fellow SLP’s, families, and teachers.

I recently started to design some of the activities that I have developed (with post-it notes and index cards).  Currently, I have children working on early sound and syllable planning and some 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!

Building Utterances Hierarchy

As a new therapist (a few moons ago), I remember getting stuck moving past 2-3 syllables.  An essential 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 essential 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.  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!

Expanding the Length of Utterances Activities

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

While I created this activity to work with some students with apraxia, it is an excellent 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 a single word to sentences

How would you use this activity?