What words are recommended to practice with a 3-year-old child with apraxia of speech?

Words to Practice with a 3-Year-Old with Apraxia of Speech

For a 3-year-old child with apraxia of speech, prioritize practicing functional, high-frequency words that occur naturally in daily routines—such as "more," "help," "open," "go," "eat," and family member names—while embedding these targets within intensive motor-based speech therapy delivered 20-30 hours per week. 1

Core Word Selection Principles

Functional Communication Targets

• Select words the child needs immediately for daily communication, including requests ("more," "help," "open"), protests ("no," "stop"), social words ("hi," "bye"), and labels for preferred items or activities 1, 2
• Choose words that occur repeatedly throughout the day so the child has multiple natural practice opportunities beyond formal therapy sessions 2
• Prioritize words with early-developing sounds (like /m/, /b/, /p/, /w/, /h/) that are motorically simpler to produce, as children with apraxia struggle with motor planning rather than language comprehension 1

Developmental Appropriateness

• Target vocabulary that typically-developing 2-year-olds use (50+ words by 24 months), including simple nouns, action words, and social phrases, as this represents the developmental foundation 2
• Include words from various categories: people names, food items, toys, body parts, animals, and action words like "go," "up," "down" 2

Treatment Framework for Word Practice

Intensive Structured Therapy

• Implement 20-30 hours per week of intensive behavioral intervention that embeds speech therapy within a comprehensive framework, as children under 3 years demonstrate the most robust responses to this intensity 1
• Deliver therapy through one-hour sessions, four days per week minimum, using structured motor-based approaches like the Nuffield Dyspraxia Programme-3 (NDP-3) or Rapid Syllable Transitions Treatment (ReST), which have moderate-quality evidence for improving word accuracy 3

Parent Training Component

• Include 5 hours per week of parent training to ensure word practice generalizes across home routines, not just therapy sessions 1
• Train parents to respond immediately to the child's communication attempts (even if unintelligible), expand on what the child says, and provide adequate pause time for processing 2
• Teach parents to model correct production without directly correcting errors—simply restate what the child attempted in proper form 2

Augmentative Communication Integration

Simultaneous Multimodal Approach

• Implement sign language or picture-based communication (like Picture Exchange Communication System) simultaneously with speech practice, as augmentative communication does not impede speech development and may accelerate it 1, 4
• Early introduction of sign language by family has been associated with rapid improvement when coupled with intensive speech therapy, with one case report showing progression from no intelligible speech to age-appropriate articulation in 18 months 4
• Train parents in alternative communication modalities as part of the comprehensive treatment plan 1

Practice Strategies During Daily Routines

Environmental Optimization

• Organize the physical environment to support communication: ensure good lighting, minimize distracting backgrounds, position yourself at the child's eye level, and reduce unnecessary noise during word practice 2
• Integrate word practice throughout all daily routines—mealtimes, bath time, play, dressing—not just dedicated "teaching" times 2

Interaction Techniques

• Practice "give and take" conversational strategies where you take turns, even if the child's turn is just an approximation or gesture 2
• Motivate and reinforce all communication attempts, supporting the child's efforts regardless of accuracy 2
• Expose the child to other language models—both adults and peers—so they experience various communication styles 2

Critical Pitfalls to Avoid

What NOT to Do

• Do not use nonspeech oral motor exercises (like blowing bubbles, tongue push-ups, or oral massage) as these lack evidence for apraxia and may waste valuable therapy time that should focus on actual speech production 5
• Do not use compensatory aids or immobilizing devices during active speech therapy, as these impede motor learning 1
• Never abandon communication attempts due to slow progress—children with apraxia require more processing time and consistent practice than typically-developing children 2

Common Misconceptions

• Do not assume the child doesn't understand words they cannot say—apraxia is a motor planning disorder, not a cognitive or language comprehension problem 1
• Do not delay augmentative communication while "waiting to see if speech develops"—multimodal communication supports rather than hinders speech development 1, 4

Monitoring Progress

Assessment Schedule

• Monitor word accuracy on both treated and non-treated words, speech production consistency, and accuracy of connected speech at regular intervals 3
• Coordinate with occupational therapy if there are co-occurring motor planning difficulties affecting non-speech movements 1
• Adjust word targets and intervention intensity based on the child's response, recognizing that some children show rapid improvement while others require sustained intensive intervention 3, 4