How do I know if my child’s SLP is qualified to treat CAS?
What if my child’s SLP does not have CAS experience?
How do I know if my child’s SLP is a good fit?
What if my child’s SLP is not a good fit?

How do I know if my child’s SLP is qualified to treat CAS?

Basic qualifications for a speech-language pathologist (SLP) include a Master’s degree (usually MS or MA), licensure/certification from the state in which they practice, and a Certificate of Clinical Competence (CCC) from the American Speech-Language-Hearing Association (ASHA). The speech-language pathologist’s credentials should look like: MS, CCC-SLP or MA, CCC-SLP.

If their credentials are MS, CF-SLP or MA, CF-SLP, this means that they recently finished graduate school and are in their first year of supervised clinical practice.

If their credentials are BA, SLP-A or BS, SLP-A, this means that they are not a speech-language pathologist. They may be a speech-language pathology assistant (SLP-A). Some states license speech-language pathology assistants with a Bachelor’s degree who are able to offer a limited scope of services and typically work under the supervision of a Master’s level clinician. The amount of supervision and services varies state to state. Although SLP-A or Bachelor’s level clinicians do hold a license they have considerably less education and training than a Master’s level clinician.

Most graduate programs for speech-language pathologists provide at most one course/class on childhood motor speech disorders, which is the group of disorders that includes CAS. Much more training is needed to know how to effectively treat CAS.

Consider asking your SLP these 5 questions to determine if they are competent to treat CAS:

1

What is CAS and how is it different from other speech sound disorders?

The SLP's answer should include information about how CAS is a motor-based (not linguistic or language-based) disorder and therefore must be treated with a motoric (not linguistic or language-based) approach. The issue in CAS is difficulties with motor movement/planning/programming, not specific sounds (articulation) or patterns of sound errors (phonological disorder).
2

What type of CAS training have you completed and what approaches do you use?

The SLP should be able to list multiple trainings that they have attended, preferably intensive or advanced trainings (as in multiple days of training, not hours). Ideally the SLP will have attended trainings in evidence-based methodologies such as DTTC. The SLP should indicate that they select the treatment approach based on the child’s current needs and that they are open, comfortable and competent to providing more than one treatment approach to best meet the child’s needs. If a SLP indicates that they only use one treatment approach for all children with CAS, this is not a good sign.
There are several different approaches to treating CAS that are motor based and have varying degrees of research evidence. Different approaches are appropriate for children of different severity levels and most children with CAS benefit from more than one approach during the course of their treatment.
3

What experience do you have treating CAS, including what ages and severity levels?

Ideally the SLP has treated multiple children with CAS. Since CAS is a rare disorder, this might not be the case.The SLP should have completed at least one advanced or intensive training on the treatment of CAS.
There are significant differences in goals and treatment approaches for children with mild versus severe CAS. Ideally, the SLP will have treated other children in a similar age range and/or severity level as your child. If they have not, they should have ideas of how to obtain additional training in how to treat a child in your child’s age range and/or severity.
4

What were the outcomes for the children with CAS that you have treated?

The speech-language pathologist should indicate that the children with CAS that they treated made progress with developing intelligible speech. The outcomes may vary depending on the child and the severity of CAS. Answers that indicate the child was “cured” or progressed extremely rapidly or answers that indicate that the child did not make progress are probably not good indicators. Guarantees of definite long-term outcomes such as “Your child will talk normally in two years” should also be a red flag.
5

How do you include parents and other caregivers in the therapeutic process?

Parents should be included in every step of the therapeutic process, including goal selection and implementing therapy. This means that the speech-language pathologist should seek the parents’/caregivers’ input and approval regarding the goals and treatment approach selected for their child. The speech-language pathologist should be open to parents/caregivers observing therapy sessions either by being in the room, watching through one-way mirrors, or watching videos of therapy. Parents should be fully informed regarding their child’s goals and the approach(es) that are being used with their child. The speech-language pathologist should also be regularly communicating ways that the parents/caregivers can be practicing at home.

Need more information? Learn more about diagnosis and evidence-based treatment.

What if my child’s SLP does not have CAS experience?

The field of speech-language pathology is broad and CAS is a rare disorder, so many SLPs receive little to no training on CAS in graduate school. This is a dilemma many parents experience, often because the therapist that is available in the public school or through an in-network insurance group does not have experience with CAS.  In this case, parents may want to consider the therapist’s commitment to learning, including consulting with SLP mentors with experience in treatment of CAS. Consider sharing the below with your SLP:

  • Information for clinicians on assessment and treatment of CAS on this website (Child Apraxia Treatment)
  • Free online training about CAS offered on this website (click here)
  • ASHA Evidence Map on CAS
  • Ask your SLP to look for an SLP CAS mentor, such as a recognized CAS expert or SLP Recognized by Apraxia Kids for Advanced Training and Expertise in Childhood Apraxia of Speech (found on the Apraxia Kids SLP Directory here)
  • Apraxia Kids webinars
  • Important Research Articles about CAS

How do I know if my child’s SLP is a good fit?

Many factors go into finding an SLP who is a good fit for your child. You probably want to ask the SLP the 5 Questions listed above to determine if they have the knowledge and experience to help your child and to include you in the process, including determining your child’s goals. Once the SLP is working with your child, they should be immediately establishing rapport and a therapy routine with expectations. This means that they are building trust and a relationship with your child but also asking your child to participate in therapy to work on their goals. Overall, you should feel comfortable and confident about your child’s therapy and SLP and your child should, too. Although your child will be working hard in therapy, they should also be motivated to attend. For some children, the activities in therapy might be motivating, while other children will need a reward of some sort. Your SLP should be figuring out what motivates your child to keep them engaged in therapy.

If you have questions about any aspect of your child’s therapy, the SLP should be open to answering them. However, you probably want to schedule a time outside of your child’s therapy session to ask your SLP questions. Otherwise, the SLP probably won’t have time to adequately answer your questions, since SLPs often book clients back-to-back.

Click here for tips on working with your SLP.

What if my child’s SLP is not a good fit?

Regardless of your care in selecting an SLP and the SLP’s experience and qualifications, sometimes it is not the right fit. If your child is not making progress or consistently resisting attending therapy, talk to your SLP about your concerns. You probably want to schedule a time outside of your child’s therapy session for this conversation, so that you and the SLP have sufficient time. Your SLP should discuss changes to implement to improve your child’s progress or better motivate your child to attend therapy. This process may have to be repeated more than once to maximize progress and motivation, depending on your child’s needs. Overall, trust your gut. You’re the expert on your child. If the SLP is not a good fit for your child, seek the services of a different SLP.

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