1. Choose a List of Words: This should be a short list of words that the child can use in a variety of situations (common words).  They should also include sounds that you want to target during your speech practice.
2.  Practice Words in Isolation: At the beginning of your session, have the child practice saying the list of words in isolation.  Use tactile, verbal, and visual cues to encourage correct production of the sounds in the words.  Accept gradually more accurate approximations of the word if the child is not able to produce the word completely correctly at first.
3. Practice Words During Play: Once the child loses interest in the direct drill of the words in isolation, move to some fun play activities.  Choose activities that will allow multiple opportunities to practice the target words.  Each time the word comes up, stop and help the child practice saying that word correctly.  Praise correct productions.
4. Encourage Practice at Home: If the child is able to practice the words in isolation at home, train the parents on how to cue the child to produce the words correctly in isolation.  Then, train the parents on how to encourage these words during everyday situations and show them how to prompt the child to say the word more correctly.

1. Rework Your Schedule: Ok, I admit that this part doesn’t sound as fun as it will require some IEP amendments to inform the parents of the reduction in minutes.   Check out the activities section of the Therapy Activity Database for how this could work.
2.  Assemble Your Materials: For this, you’ll need a simple artic screener, flashcards for each sound, and copies of worksheets you can send home.  Stick all of this in a rolling case and you’re ready to roll (literally)!
3.  Pick a Sound for Each Child: You won’t have much time with each child so pick one sound at a time to work on.  Grab one of my RTI data sheets so you can collect your data for each child.
4.  Do Your Sessions: Go to the activities section in the membership to see how I break down my 5-minute sessions.

1. Take an Inventory: First, let’s find out if the child can say any of the target words without lisping.  Some children will naturally have a facilitating context where they can already say the word.  For this, just have the child say a big long list of words that contain the lisped sounds. 
2.  Sound in Isolation: Help the child produce the any of the lisped sounds in isolation without lisping. You can use any facilitating contexts that you found in the last step or use some elicitation techniques.  Find one that the child is most successful with.
3. Sound in Syllables: Pair the newly discovered sound with vowels to make nonsense syllables
4. Sound in Words: Moving on up!  Time to try that sound in some single words
5. Sound in Sentences: Practice the sound in words in sentences.  Make sure you’re practicing the sound in a variety of word positions.
6. Work on the Other Sound: Now that the child has mastered one of those sounds in sentences, go back and work on the other ones from the start.  If the child was able to do /s/ to begin with, go back and work on /z/ now in isolation and move through the steps again.
7. Sounds in Conversation: Once the child can say all sounds in sentences, time to start working on it in conversation.  Start with structured conversation and then move up to unstructured conversation.

1. Choose a Process, Find Some Pairs: First you’ll need to pick which phonological process you’ll target and find some minimal pairs to go with it.
2. Auditory Discrimination: Student will receptively identify the difference between two minimal pair words where the only sound difference between the two words is the target sound class vs. the replacement sounds (example: key and tea)
3.  Production in Single Words: Student will produce the target sound class in single words
4. Production in Phrases: Student will produce the target sound class in 2-3 word phrases
5. Production in Sentences: Student will produce the target sound class in sentences
6. Production in Structured Conversation: Student will produce the target sound class in structured conversation
7. Production in Unstructured Conversation: Student will produce the target sound class in unstructured conversation in a variety of enviornments

1. Choose Processes to Target: Make a list of the targets that the child is not currently using correctly in conversation but is stimulable for.
2. Set Up Your Cycles: Choose phonemes to target for each pattern on your list.
3. Run Your Sessions: Follow the session agenda below to run each session targeting that phoneme/pattern.

1. Speech Sound Production: Target production of speech sounds to create functional, meaningful spoken communication for the child.
2. Language Development: Help the child develop a full set of language skills, including the ability to build sentences and have conversations.
3. Augmentative-Alternative Communication (AAC): Not all children with CAS will require an AAC device or system, but some will.  This should be at least considered for every child with this diagnosis.
4. Prosody: Help the child learn to use his voice fluidly and functionally to create correct intonation and pausing.

1. Ensure Proper Medical Care: Make sure child is being treated and followed by a cleft palate team 
2. Assessment: Identify limitations of the child’s structures (which sounds is the child physically capable of producing?)
3. Establish Sounds: Correct placement and production for any sounds that the child is physically able to produce (typical articulation therapy) while making sure to teach and establish appropriate intra-oral air flow for these sounds (no air escaping through the nose)
4. Find Approximations: If the child is not physically able to produce a sound, find the closest approximation for that sound that the child is able to do.  Teach the child this compensatory error and work on correct air flow with that sound.  Get it as close as possible to the original sound so that others will have a better chance of understanding the child.
5. Anticipate Future Surgeries: If the child is about to get surgery to correct physical limitations, you can teach correct placement for sounds ahead of time to get a head start on therapy once the surgery is completed.
6. Consider AAC: Use AAC as necessary to aid the child in functional communication with those around him

Note: Non-Speech Oral Motor Exercises are not advised for this population

1. Over-articulate in Words: Student will properly and precisely pronounce every sound in a single word.

2. Over-articulate in Phrases: Student will properly and precisely pronounce every sound in 2-3 word phrases.

3. Over-articulate in Sentences: Student will properly and precisely pronounce every sound in a short sentence.

4. Over-articulate in Structured Conversation: Student will properly and precisely pronounce every sound while answering an open-ended question.

5. Over-articulate when Signaled: Student will begin to properly and precisely pronounce every sound in conversation when he receives a signal from the therapist.

6. Identify Signs of Conversational Breakdown: Student will list 5 ways to know that there has been a conversational breakdown and the other person doesn’t understand.

7. Over-articulate During Conversational Breakdown: Student will begin to properly and precisely pronounce every sound in conversation when his conversational partner shows signs of conversational breakdown.