Early Intervention and First Impressions
Three years ago, I worked with a little boy named Kamdyn, who had just turned two a couple of months earlier through our state’s early intervention program. At the time, I received general background information, including scores, family goals, and notes about his limited verbal productions. In addition, he had 18 documented ear infections.
Given that history, all signs seemed to point to a typical late-talking boy who had endured one ear infection after another. When he turned three, he began receiving therapy services through his local school district. At that point, I said my goodbyes to this sweet little boy and wished him and his family the best on the journey ahead.
A Surprising Diagnosis
Fourteen months later, everything changed. By then, I had immersed myself in motor speech and feeding therapy and had opened my own private practice. In May 2016, I received an email from Kamdyn’s mom, Ashley, telling me that he had recently been diagnosed with severe Childhood Apraxia of Speech (CAS).
That news caught me completely off guard. Although CAS is very difficult to diagnose before three years of age, I was still dumbfounded and, honestly, disappointed in my clinical skills for not having any inclination earlier. After all, I had worked with this little boy every week for more than a year, and I never once thought CAS was on the radar. Instead, his history of 18 ear infections had seemed like the most obvious explanation.
Even so, there was no time to dwell on that disappointment. Instead, the priority was clear: get Kamdyn into therapy and see what we could do. While I had never worked with a child whose sole diagnosis was severe CAS, I also knew that the training I had completed over the previous year gave me something valuable to bring to the table.
A Different Kind of Evaluation
Kamdyn came to his initial evaluation reluctantly. Understandably, he had already gone through assessment after assessment, and now he was facing even more speech testing. However, my evaluation looked different from the others he had experienced. Rather than focusing only on speech output, I examined his mouth and assessed the motor responses of his tongue, jaw, and lips.
That evaluation revealed several important findings. I noted asymmetry in his jaw strength and stability, poor lip rounding, and reduced lip closure for his /m/, /p/, and /b/ sounds. Additionally, he had a high palate, a moderate tongue tie, and a reverse swallow. Although Kamdyn had no history of feeding difficulty and was not considered a picky eater, he was chewing and manipulating food in a very unorganized way.
Building an Oral Motor Foundation
Based on those findings, we began the TalkTools Straw Hierarchy (straw #2), the bite tube hierarchy, Bite Blocks, the Horn Hierarchy, and bubble blowing. Meanwhile, gum chewing and use of the slow-feed technique were addressed as well. We also began targeting the reverse swallow.
I explained to his mom that, although this approach looked very different from traditional speech therapy, it was essential for him to have a strong oral motor foundation. Without getting his jaw into a stable position, he would inevitably have much more difficulty moving his tongue and lips when he spoke.
In many ways, the concept is similar to a pyramid of cheerleaders. Without a stable base—the strong cheerleaders planted firmly on the ground—the cheerleader at the top cannot perform stunts. Likewise, the tongue, which is responsible for the finest motor movements in speech, depends on that stable base. In Kamdyn’s case, that difference could mean saying “Tam” instead of “Kam.”
Why Muscle Patterns Mattered
Because of Kamdyn’s CAS and reverse swallow, he was not using his muscles in the optimal way for speech. As a result, weakness became part of the picture. It was mild, but it was definitely present. During speech, he remained in a constant state of retraction because he had to clench his jaw so much to create stability and allow his tongue to move more effectively.
Therefore, therapy needed to address not only speech sounds themselves but also the underlying movement patterns supporting those sounds. That shift in focus was critical, because speech is motor-based and depends on efficient coordination.
How We Structured Therapy Sessions
I saw Kamdyn twice a week between May and August, in addition to his traditional speech therapy. Our sessions included approximately 30 minutes of oral placement exercises and 15 minutes of speech drills. However, we did not spend 30 minutes doing all OPT exercises and then shift to 15 minutes of speech work. That approach would not have been effective for generalizing motor patterns.
Instead, I chained each OPT exercise with a functional speech sound or drill. For example, Kamdyn had significant difficulty rounding his lips, so we used the following sequence to target the /o/ “oooo” and /w/ sounds: a sensory-motor warm-up with a Z-Vibe involving cheek activation, fish lip pops, straw drinking, and then mass practice of lip-rounding sounds in CV or CVCV formation.
The key, therefore, was linking OPT exercises from sensory input to feeding and, finally, to speech. In this way, the activities supported one another and helped reinforce more functional motor patterns.
Progress in Just Two Months
Within only two months, Kamdyn’s family noticed a marked improvement not only in his speech but also in his confidence while speaking. The first video below shows Kamdyn during his evaluation, while the second shows him just two months after introducing an OPT-based program. The difference in his ability to move his lips, cheeks, and jaw is astonishing.
Ultimately, it has been an honor to be part of Kamdyn’s therapy team and to see firsthand that OPT is not just for children with feeding difficulties. His progress is living proof that speech is motor-based and that, when sensory work, feeding, and speech are paired together, the possibilities are tremendous.
About Vanessa Anderson-Smith
Vanessa Anderson-Smith is a Speech-Language Pathologist born and raised in South Dakota. She received her Bachelor’s degree from Augustana University and her Master’s degree from The University of South Dakota. In 2013, she founded Anderson-Smith Speech Therapy, LLC. Her practice focuses on the assessment and treatment of motor-based speech and feeding disorders in both children and adults. Vanessa lives in Canton, South Dakota, with her extremely supportive husband, Ryan.