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.1 These children are perceived by listeners as having less accurate stress marking than children with other phonological disorders.2

Supported in Research

Prosody manipulation is an element of variable practice that – according to principles of motor learning  – may enhance a child’s ability to adjust movements needed to produce an intelligible utterance.

In 2010, Ballard et al. proposed a treatment for CAS emphasizing prosody.3 They 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 highlight the 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 encourage prosody 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 character’s voice. For example, in the Eric Carle book Have 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 practice adding 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!

  1. Velleman SL, Shriberg LD. (1999). Metrical analysis of the speech of children with suspected developmental apraxia of speech. JSLHR, 42, 1444-1460
  2. Munson B, Bjorm EM, Windsor J. (2003). Acoustic and perceptual correlates of stress in nonwords produced by children with suspected developmental apraxia of speech and children with phonological disorder. JSLHR, 46, 189-292.
  3. Ballard KJ, Robin D, McCabe P, McDonald J. (2010). A treatment for dysprosody in childhood apraxia of speech. JSLHR, 53, 1227-1245.
  4. Thomas DCMcCabe PBallard KJ (2014). Rapid Syllable Transitions (ReST) treatment for Childhood Apraxia of Speech: the effect of lower dose-frequency. J Commun Disord. Sep-Oct;51:29-42.
  5. American Speech-Language-Hearing Association. (2007). Childhood Apraxia of Speech [Position Statement].  Available from www.asha.org/policy