Rapport in Apraxia therapy

Rapport is an extremely important part of Apraxia therapy

Therapists often ask how I achieve a high number of repetitions in apraxia therapy. A strong rapport with the child is key. In fact, I consider rapport essential in apraxia therapy, so much so that in my course, I include it as a prerequisite for effective treatment.

Many children referred to us for apraxia therapy have previously undergone speech therapy without significant progress. This isn’t a reflection on the previous therapist; often, children start with language-based speech therapy around age 2 or 3, and it may take time to recognize that the child has childhood apraxia of speech. By the time they begin motor-based speech therapy, they may feel frustrated and have low self-confidence.

Investing time in building rapport and trust is critical to setting up successful therapy. When the child trusts you, they feel supported and are more willing to make the effort needed to produce sounds accurately.

What are some ways that you can build rapport? 

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• Give the child choices of toys and activities.  This doesn’t mean the session should lack structure. I take out a few selected toys from my closet and let the child choose from them. Offering a choice gives the child a sense of control—something everyone appreciates. Practicing target words within a preferred activity increases engagement and supports more effective learning.
• Choose your target words carefully which will help the child be successful and build their confidence. 
  • Power words.  Meaningful words will keep the child motivated. 
  • At the beginning, it is important to keep the target word list small so that the child can learn to produce some functional words quickly. 
  • Choose words with sounds that the child already has in their repertoire.
  • Provide cueing that helps the child produce the word accurately. 

Remember, maintaining rapport is an ongoing process. As the child's skills develop, it’s important to introduce new words and syllable shapes. However, this can also bring new challenges for the child. What can you do if a particular word proves difficult?

First, acknowledge the child’s effort and recognize that the task is challenging. Then, reassure them that you’re there to help them succeed. Sometimes, it’s okay to set that word aside for the session and focus on words the child is more comfortable with.

One more thing to keep in mind.  The child may be having a difficult day or just tired.  Pushing the child to do more than they can do will set you up for failure. 

Therapy is a marathon, not a sprint.  So take the time to build that relationship and to nurture it along the way.

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