5 Fun Ways to Mix Prosody into CAS Therapy

Experts agree that disrupted prosody is one potential characteristic differentiating childhood apraxia of speech (CAS) from phonological disorder. Studies suggest difficulty marking stress persists longer in children with CAS versus those with other types of speech delay.¹These children are perceived by listeners as having less accurate stress marking than children with other phonological disorders.²

Supported in Research

Prosody manipulation isan element of variable practice that according to principles of motor learning may enhance a childs ability to adjust movements needed to produce an intelligible utterance.

In 2010, Ballard et al. proposed a treatment for CAS emphasizing prosody.³They found that manipulating prosody in novel and varied three-syllable sequences resulted in generalization to less complex 3-syllable sequences. Contrary to expectations, the intervention also generalized to more complex 4-syllable sequences. A follow-up study in 2014 found generalization of effects to untreated words.⁴

These studies highlightthe value of integrating prosody into therapy as soon as possible.

Activities That Encourage Prosody

1. Songs and Fingerplays

These provide a natural context for manipulating duration, loudness, and pitch. Depending on age, the focus may be limited to one aspect, such as duration, to mark stress. A target word or phrase that the child is working on for accuracy may be embedded in the song, allowing for work on accuracy as well as prosody.

2. Toys that Provide Auditory Feedback

Simple microphones from the novelty toy bin and more sophisticated versions that can be used with an app encourageprosody in children. Tap on drums or bongos to reinforce syllables and loudness.

3. Action Figures, Dolls, and Stuffed Animals

Children can use different voices to pretend to be different characters, varying pitch, loudness, voice quality, etc. as part of imaginative play. Target words and phrases can be integrated into the play theme.

4. Board Games

Imitate different voices or rate of speech as the child moves a game piece around the board. Ask questions using contrastive stress, Is it YOUR turn, or MY turn?, or, Does your character have BLUE eyes?

5. Books

With emerging readers, keep it simple. Have them participate in a cloze activity (complete a sentence) using expression to convey emotion, emphasis, or the characters voice.For example, in theEric CarlebookHave You Seen My Cat?,the child can help by saying, Have YOU seen my cat?, or, THAT is not my cat!

With children who are readers, point out opportunities where prosody can add interest to what they are reading. Use books at a level slightly below their reading level so they can practiceadding in the prosodic variation.

Start using these activities as a fun way to incorporate prosody into therapy and see how direct work on prosody results in improvements that go beyond the practiced targets!