What is Forward and Backward Chaining? How do we use it in Apraxia Therapy?

Chaining is a very effective cueing technique in Apraxia therapy.  It can be used to correct a distorted sound in the word as well as working on omission of initial and final sounds in the word.  Children with childhood apraxia of speech often simplify syllable structures which results in omission of sounds.

These are the steps: 

Pull the error sound / syllable out.

• Have child repeat it correctly a few times.
• Put the sound / syllable back into the word, and use simultaneous productions to chain the word back together. Simultaneous productions is the first step in the DTTC hierarchy.  The clinician and child start the word at the same time and move through the sounds in the word together.

Omission of initial and final sounds:

If the child is omitting an initial sound in the word i.e. "uppy" for "puppy".  Practice the full initial syllable "puh" several times and then practice the full word "puppy".  You can do the same for final sounds but be careful not to add a schwa sound when practicing stop sounds i,e. the final /p/ in up or pop. It is better to work on final sounds that have movement i.e /s/, /f/, /sh/, /m/ and /n/.

There are two types of chaining, forward and backward chaining.  

Forward Chaining:

The initial sound in the word is produced incorrectly.

For example: The word "hæppy" produced as "æppy".  The child is omitting the initial sound /h/. So we practice saying "hæ" a few times and then use simultaneous productions to put the word together.

Backward Chaining:

The final sound in the word is produced incorrectly.

For example: The word "opIn" (open) is produced as "opʌn"(oh-pun).  The child is distorting the vowel.  So we practice "pIn" several times and then use simultaneous productions to put the word together.

Chaining is also very effective for cluster reduction. 

If the child produces "slip" as "sip".  You can teach "lip" and then add the /s/ as teach "slip", "duck" and then "stuck".

Click here to see a therapy video demonstrating Backward Chaining

Click here to see me use Forward Chaining to improve cluster reduction

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