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Early Intervention Speech Therapy

Interview: Sharon Gretz, MEd, on Childhood Apraxia of Speech

Published January 27, 2009 5:02 PM by Stephanie Bruno-Dowling
Sharon Gretz is the founder and current executive director of the Childhood Apraxia of Speech Association of North America (CASANA). She also is the parent of a child diagnosed with apraxia of speech.

Sharon's personal journey with her son, as well as her professional dedication to helping children and families affected by apraxia is both inspiring and incredibly insightful. My hope is that therapists and parents will be moved and motivated by her story, her words and her passion.

Stephanie: Sharon, thank you so much for taking the time to speak with me and complete this interview. Let's start off by hearing about you and your background.

Sharon: I am married with three children, the youngest of which was diagnosed with severe apraxia of speech at age 3. He's now 17 years old and considering colleges to investigate.  I have my Masters Degree in counseling (MEd) and have completed all graduate course work toward my PhD in communication sciences and disorders.  I have a long history of working in disability services and nonprofit program development and this gave me a real advantage when my son was diagnosed with CAS.  I incorporated CASANA in 2000.  Shortly thereafter, CASANA received its 501c3 designation as a public charity from the IRS.  Our organization is governed by an active board of directors, all of which have a personal connection to apraxia.  I am happy to say that just January 1 of this year I became the first full time Executive Director of CASANA, our first full time paid staff position.

Stephanie: Please tell us what it was like to first receive your son's diagnosis. How did it affect your family?

Sharon: Goodness, it affected our family in countless ways!  First of all, once my son was diagnosed we were told both that apraxia is a very challenging speech disorder and that his prognosis was guarded.  As we understood it, with appropriate therapy and enough of it, our son would be able to "improve his intelligible speech" but how much, no one knew.  I felt pretty numb.  You go in thinking your child has a "speech delay" and come out not even sure your child will have fully functioning speech - ever.  Numb is the best word to describe the initial feeling.  Then came the fear.  

Would we "know" appropriate therapy if we saw it? What if we could not find someone who really knew how to help?  What if we let our son down?  In the end, we were connected with a true expert and for that we will always be grateful.  My son started one on one individual private speech therapy four times a week.  It made working full time hard.  I was fortunate that my boss at the time let me change to part time and working from home so that I could take my son to his speech therapy, sit in the observation room and watch his treatment, and spend lots of time with him at home following through on his therapy program.  It felt for some period of time that our lives revolved around speech therapy; both private and at his preschool.  Add occupational therapy (which many of the kids end up needing) and the financial burden and we were very stretched! 

I was very fortunate that our entire extended family rallied around us.  Aunts, uncles, grandparents - everyone became committed to doing whatever it took to provide my son his best shot at speech.  In that way, we were very rich.

Stephanie: Can you tell us more about the specific therapeutic techniques that were instrumental in helping your son?

First of all, let me tell you what did NOT benefit my son's speech production.  For the first year of his speech therapy, prior to any understanding by myself or a professional that he had childhood apraxia of speech (CAS), he received EI speech therapy akin to what you would know as "language stimulation."  He received this type of therapy for one year, first once a week, then twice a week, with no benefit at all to his speech production.  

This was a child who brought many strengths to speech therapy including an extraordinarily good attention span; good cognitive and receptive skills; and a strong intent to communicate.  It was after one year and his transition to preschool services from the birth to three early intervention program that I sought out a private speech-language evaluation at our local children's hospital. That was where he was diagnosed with very severe CAS when he was 3 years old.  In retrospect, that lack of progress in my son, despite treatment being delivered, should never have been acceptable to the professional.

My son immediately, and I mean from the very first day, began to make progress with a new SLP, David Hammer, from his eclectic "multi-sensory" approach.  Specifically, my son's attention and effort were directly brought to his articulators and what he was doing with them.  Visual, tactile, and verbal cueing was used that appeared to help him associate the cue with a particular speech movement.  It was as if the cues sparked a motor memory for what he was being asked to produce. The focus of this treatment was on speech movement and being able to join movements, first, for short functional words and then into longer units such as phrases and multi-syllabic words.

Very early in my son's "new" therapy, he benefited from a core vocabulary approach. I think this is a great strategy for early intervention SLPs.  Basically, the SLP, after getting a complete phonemic inventory, worked with me to identify a small set of functional words with high utility for my son in particular.  So, my son was having some success with bilabials and alveolar stops and amazingly had a final /s/ in his small repertoire.  He had few vowels aside from schwa.  With this in mind we crafted a list like "me, bus, boy, eat, mad, up, pup..." and several others.  We used a small photo book and inserted both a photo of the word/action and the written word.  This became a practice set for us to be able to use at home to reinforce what was happening in the therapy room.  My son could show the book to his father and siblings and was proud to practice "reading" it.  

Once the set of words became more automatic and accurate, new words were added with consideration to the phonemes he could produce, those that were stimulable, and so forth. Eventually, he got so good we dropped the book!

In some cases, my son was directly taught to produce single sounds because his apraxia was so severe. In fact, I think that in his case nearly all consonant sounds were directly taught.  That being said, the focus of therapy was not to perfect those sounds prior to moving on to working on short words.  There was constant shifting between working on the movements needed for words and backing up to fix accuracy of individual phonemes.

My son was asked to produce many, many repetitions of the syllables or words that were targeted.  The SLP was quite creative in setting up fun play scenarios and setting rules for games that made it nearly mandatory that my son make multiple attempts (think "drill play").  It was not uncommon to hear dozens and dozens of productions of the speech targets in a single therapy session.  

Simple sign language was used to not only bridge communication gaps when my son's verbal attempts were not understood but to also serve as visual and tactile cues.  It helped enormously when the sign and verbal attempt were paired as they always were.  The great thing about signs is that you can fade out the cues over time as the child's system becomes more competent.  I found that it also served as motivation early on when speech attempts were unintelligible.  When paired with a sign, if I could not understand my son's verbal attempt I had a good chance of catching the sign and thus could respond appropriately, and reinforce his communication attempts.  Many children can learn simple signs, although for some children it may be too frustrating due to fine motor deficits.  In that case, the SLP can still use signs as visual cues for the child.

Stephanie: As a parent, what advice would you give to other parents who may be hearing the diagnosis of apraxia for the first time?

Sharon: Well, first of all, parents should not blame themselves, as if they did something to "cause" apraxia in their child.  Secondly, they should go ahead and allow themselves to feel sad, mad, and/or sorry for their child and for themselves for a short period of time.  This is understandable and necessary. However, inevitably they must pick themselves up, brush themselves off and get out there and learn as much as they can about this speech problem and how children are best helped.  Becoming an effective advocate is something all parents should strive for and which is critically important to their child.

While it is important to have hope and to know that children can actually do quite well with appropriate help, each child with apraxia is a unique constellation of strengths and needs.  No two of our children are totally alike. So be somewhat cautious comparing children with CAS to one another.

Learn how to critically evaluate and weigh all information and sources of that information and to then apply knowledge vis-√†-vis what they know about their own child's needs.  Treatments recommended should be able to withstand a parent's critical scrutiny. I highly suggest trying to form a team with your child's SLP, physician and others. 

Get connected!  Our online groups are a great way to get valuable information but also personal support available in your home, when you need it.  Our summer conference is immeasurably valuable and inspirational too!

The good news is that with appropriate help and enough of it, many of our children become quite effective speakers, so much so that others could not possibly guess that they once had a severe speech disorder. CASANA will continue to push for research so that we can learn more about all the factors involved.  Hang on and have hope!

Stephanie: Unfortunately, there are many parents out there who are struggling the way you were years ago when your son was first diagnosed. What prompted you to go beyond your experience and begin CASANA?

Sharon: First, when my son was diagnosed, I had not heard of apraxia of speech in children.  There was no information specifically designed for parents.  What I was able to locate was the very sparse professional literature and quite frankly, from my read of it, the future for these kids sounded pretty bleak.  We were fortunate to get connected with a SLP who had years of successful experience treating children with CAS, and so the clinical experience of our SLP did not necessarily match the dire prediction of the professional literature.  

My son struggled through about 5 years of individual speech therapy, and I do mean "struggled".  The amount of time, concentration, and intense effort that was put forth by both my young son and his wonderful SLP was truly something to witness and something I could not forget.  CASANA is a tribute to both of them and to the reality of what this disorder means to children and their families, as well as the professionals who provide help.  

The partnership between our family and our son's SLP was critically important and benefited my son in countless ways.  In my "spare" time, I dedicated myself to learning everything that I could about apraxia, reading and deciphering every text book and journal article that I could locate.   My son's SLP took me under his wing almost like he would a graduate student and provided additional knowledge. I also observed over 200 individual speech therapy sessions. At the end of the day, I had learned a TON about CAS.  The decision for me once that I knew my own son was going to be ok, was... do I walk away and go my merry way?  Or do I have a responsibility to share what I learned and to help other families?

Secondly, back when my son was diagnosed in 1994, the internet was still quite "young". Imagine, there was nothing called a blog!  I had found some online bulletin boards and through that, several parents of children with apraxia.  In 1997, I decided to take the leap and started an email discussion group (listserv) about apraxia. Well, the Apraxia-KIDS listserv was (and still is) wildly successful.   It just grew and grew and then grew more.  

Later, other parents assisted in helping to set up a companion website so more information could be shared.  I was contacted more and more for information and was even offered funding now and then; though at the time I was still a "mom" sitting at my home computer just trying to share what I had learned.  Finally, the whole enterprise of trying to keep up with the needs as well as the time and expense became something that could not be effectively handled by an informal effort.

Third, though out the whole process I began to understand the need for factual information.  In my mind, I felt that not only was relevant and accessible information needed, but also reliable information grounded in facts.  It was clear very early that anyone could basically say anything they wanted to say on the internet.  Who do you trust, really? There is a great responsibility when you are providing help to vulnerable people. I just really hoped that we could create an organization that's information would be trustworthy to families, professionals, and researchers.  

Please join me on Friday for the second half of my interview when Sharon will talk about the services CASANA provides as well as some of the most recent information on apraxia research and treatment techniques.


Denise in Rocky Mount, I know your comment is from almost a yr ago. But in case you are still needing help... I take my daughter to Pediatric Therapy Associates in Cary, NC and she has a wonderful therapist named Kelly. She has made significant progress in the 5 months she's been going 2x a week.  Another friend of mine takes her Apraxic daughter there. She goes to a different therapist, but she also likes them as well! There is also a early education program through the state called Child Find and her daughter gets speech therapy through them 2x a week and private speech therapy 2x a week (so now 4x a week). I'm currently in the process of filling out the paperwork for Child Find. Best of luck!

Cherie September 5, 2014 8:06 PM
Cary NC

A friend of mine, whose son has apraxia is looking to find a place that can train her to help her son with the school work as well as help him deal with emotions.  If you know of training programmes for parents in Pennsylvania, please let me know.

Sam May 7, 2014 12:52 PM

My son is now 6 years old and has been in speech therapy since 18 months.  The initial speech therapy and OT came from the Orange County Regional Center, in California.  We live in San Clemente.  During this time, I can tell you I feel the same as Sharon, in regards to the therapy her son had received prior to her son seeing the Private therapist.  I feel that it was time wasted.  PRECIOUS TIME! What I know now that I can share with others, would be if you believe an iota of any thought that your child has speech issues, don't wait to contact a Private Therapist that is very familiar and treats children with CAS.  You cannot go wrong.  My son had no progress AT ALL during the time he was receiving these services from the Regional Center.  I truly believe that they had no idea what Apraxia was.  Just the fact that they called it speech delay and never spoke of any other possible issues is strange to me.  Although, it is typical that Apraxia isn't diagnosed until 3 or older, I was disheartened by all the testing, but no other mention of other possible problems.  This I know now, from all my research.  You, the parent, are the strongest advocate and must do your due diligence.  I researched the internet and diagnosed him myself!   It wasn't until afterwards that our Private Therapist(s) that I contacted (calling numerous therapists) diagnosed him with Severe Apraxia.  I couldn't believe it.  I'm not even in that field!  He has seen two separate Speech Therapists, in the same office, 4 days a week.   It's only been (maybe 5 YO) that he has been speaking.  And when I say speaking, he is now using multi syllabic words (some still approximations...a lot of approximations) and just starting to use sentences this past year.  He's come a long way...but has a long road ahead.  With the Apraxia comes the fine motor skill issues, as well as sensory type of issues, which is my understanding.  When I say sensory with my son, it would be more of regulating his body.  He seems to jump a lot and run in place.  Have to keep him busy.  Other issues, is eating, which he is getting better.  I have to make sure I have everything in small bites where I know he can't choke.  He can pretty much eat everything, but I don't let him eat alone.  Ugh...SCARY!  Also, if you have your children in Public School with Apraxia, make sure your Speech Therapist is knowledgeable of Apraxia and you receive OT on top of it all.  I am going through a very hard time in my district.  Although, he went through Kindergarten, we didn't push Academics, but the focus was Private Speech Therapy and Socialization with his peers.  My received two 1/2 hour sessions with the school, which I find a joke.   In any event, since we focused on Speech we are having him retained in Kindergarten, but they are no longer having a Special Needs class.  They are trying to put him in a 1st grade environment doing Kindergarten work.   But that's not gonna happen!  Not if I have anything to do with it.  So, I am now hiring an Attorney to help me fight the system so our Children with Apraxia and other severe speech issues are not discriminated against receiving the best education possible.  Having kids bundled up in one classroom learning K, 1st and 2nd Grade work is detrimental.  

Jackie Alves September 4, 2013 1:07 AM
San Clemente CA

My granddaughter has been in speech therapy since two without progress. She is now four. Changed SLP s and now dx with severe childhood aphasia.....who in NC is the most successful in treatment for her? Can anyone help?????

denise August 25, 2013 9:37 PM
rocky mount NC

This arctlie went ahead and made my day.

Kayleigh Kayleigh, suvQCEWrV - sYrFuaAwBYe, lMjoMraNu October 29, 2011 1:21 AM

St. Ritas school for the deaf in Cincinnati, OH started a wonderful program for children with Apraxia.  Cincinnati's children's hospital also has a clinic for the same thing.

Brandi Allam September 10, 2011 10:07 PM
Cincinnati OH

Im a 17 year old female and i have verbal apraxia. Over the childhood years i was told i would not be able to go into general education classes which upsetting my parents and I because the classes i was in were way to easy for me , but they did not want me to get out because of my speech . Currently i am in honors and college level classes in high school ,although i have a speech problem I don't let it take over my life .I mean it defiantly makes it more difficult with talking to people or trying to get a job but  i try to not let it depress me! If  you guys would like i could make a video of me speaking!

Laurel Flax December 9, 2010 1:00 AM

My 13  year old grandson that I help to take care of has autism  He spoke till he was two with the usual baby words, mama dada goal for football etc.  Then at two he stopped talking.  He makes sounds to indicate what he wants and points or goes to whereever the item is.  I was told by a speech therapist  10 years ago that she felt he had apraxia but she said nothing could be done.  Afterf reading these comments, I feel that something may still be able to be done.  We tried signing but his signs were not discernable.  My email  I is

I appreciate any suggestions we live in South Florida.

Lenore Roseman, Retired teacher NYC October 19, 2010 8:41 PM

Way to go Sharon! Our family thinks you are an awesome encourager to all those who have heard "this will take time, and it will be difficult."  Our children are terrific bouncers and they will reach the stars as we encourage them in their unique gifts and secure them a place in society as not only "normal", but excellent!

Sandra Stough, Christian - Nurse,Notary, Counseling, Lighthouse Medical and Notary August 20, 2010 10:58 PM
Bridgeville PA









MARIANNA MEGERLE July 19, 2010 11:15 PM
cincinnati OH

Great info.  I just read an an article on DAS in relation to gluten, malabsorbtion and autism.  Many of these symptoms are exhibited by my son.  He's 3:11 and really not speaking.  He's producing some vowels and consonants.  He's actually produced some very appropriate words in context (acrobat- repeating my husband).  We are seeing an apraxia specialist soon.  Hopefully we'll get some answers.

January 29, 2010 2:20 AM

As some of you veteran blog readers may remember, last year I interviewed Sharon Gretz, the founder and

January 26, 2010 10:01 AM

PingBack from

January 19, 2010 9:01 PM

Thank you for your insight as a parent!

Many of your son's SLP's strategies are very helpful for our SLP's at Chatterboxes, including the idea for the "book" and the multi-sensory approach to sequencing sounds!

Thank you!

Megan Rozantes, M.S., CCC-SLP


Megan Rozantes, , SLP Chatterboxes January 5, 2010 3:28 PM
Newton MA

Every few days or so, I read through recent comments posted throughout the blog and attempt to address

October 23, 2009 11:11 AM

My Daughter  is 2 and 1/2 years old and has been diagnosed with an expressive speech delay through our county infant an toddler program..She has been recieving services for about 8 months 2x a week once with a private speech therapist and once with county slp.... I believe she has severe apraxia because she has made very little progress...I am trying to get her more services through the county and also having her tested at our local pediatric hospital..I want her to have therapy daily and am fighting my county to provide the services she needs.... I am completely overwhelmed as a mother with 3 kids... Any suggestions, websites, books, anything that I can do to help my daughter more...I feel like I need to do more and financially strapped at this point to add more private speech therapy time...

Michele Polk October 18, 2009 5:13 PM
Linthicum MD

Wow - I just discovered the appraxia site and came across this interview and blog.  My daughter was diagnosed at about age 3 with Developmental Apraxia of Speech.  She just turned 10.  She continues to make progress in her speech each year.  Learning to read helped her speech a lot.  She also needs special education services for reading, math, writing, language, and gets some adaptive physical education services.  What information is out there about children with Developmental Cognitive Delay as well as Developmental Apraxia of Speech?  I am so pleased with my child's progress each year - but more and more concerned with her social development.

Cheryl, teacher - kindergarten August 7, 2009 8:10 AM

My seven year old grandsons do not speak.  The speech therapist and doctor have suggested apraxia.  Where do we start?  They are receiving minimal speech through their school but it helped adn we feel they need INTENSIVE assistance?

Sue July 23, 2009 6:05 PM
Corryton TN

My child was diagnosed with apraxia at the age of 2 1/2. When I first heard  that he had this speech disorder I also tried to find out all about this disorder I first went to the Media Library nobody there knew what it was, all I found there was just two books that was about this disorder all I wanted to do is find out more about this disorder. first my child did not speak a word, he would scream because he wanted to speak and he couldn't, so our Speech Pathologist first started to teach him sign language and that worked because he than started to try even more to use his words even if the words did not come out the way he wanted now my son is almost 5 years old, and for the first time asked his first question:"What does that do?" It was the most special words I ever heard and of course answered. I thank you Sharon with all my heart I admire you. I still blame myself alot of times, because I am a working mother I feel I should be there for him all the time and not working. Its like I want to be able to do more but I can't.  

Elisa, Heatlhcare Admin - Medical Sec. July 9, 2009 9:08 PM
Deltona FL

My story is similar.  Except we were told my son had PDD.  We ended up taking Colin to see Dr. Marialan Agan in  June 2002.

We finally got a correct diagnoses then we were told about prompted therapy, we could not locate a therapist  any where with in 100 mile radious of our home.  My husband and I made arrangements to take my son to therapy at our local hospital 5 days aweek.  We did NOT see any improvment untill we discovered a prompted therapist in Austin Texas, which is a 130 mile from our home.  We took him once a week, with in the first year we saw a huge improvment.  He went from have a ten word vocabulary to being able to speach in sentences in a year.  Prompted therapy made a huge impact on my son's life.

sandra Jones, Sp. Ed - Teacher, High School May 3, 2009 11:43 PM
Waco TX

My grandson was just diagnosed with severe Apraxia.  He has an appointment for further evaluation at a facility in Omaha, NE that specializes in speech developmental problems.  After reading through your website, I feel much more hopeful that early intervention will be helpful.  Ari has been using "baby-sign" for quite awhile.  He has also shown a high ability to problem-solve.  I can't imagine the internal frustration he must have at not being able to be understood.

Beth April 1, 2009 9:53 PM
Cold Spring Harbor NY

I agree with your use of a multi-modal approach to learning language, but I have never seen in my years working in early intervention, a child under three years of age who understood how to coordinate his articulators.  Do you think your child would have responded to this before he was three?

Kara, SLP March 13, 2009 9:10 PM

Today's post is a continuation of the one written earlier this week. In that post I highlighted the four

March 13, 2009 11:16 AM

Thank you for a great article!  I also checked out the Apraxia-Kids site and it is wonderful ... very informative and useful.  Each question or thought I had regarding CAS was addressed, even regarding a Spanish-speaking child I work with who has CAS.

Charlotte-Anne Allen, speech/lang. pathology - SLP/CCC, M.A., IPP February 5, 2009 1:11 PM
Ronda NC


I applaud your courage as a parent and your devotion as a practioner and speech and language therapist to develop others' comprehension of CAS.  I worked in early intervention in the early years of the century (2000... and on) and knew that there was not much material on this specific topic even then.  I have to say that many "colleagues" told me I did not know what I was saying, when I complained about the lack of information about this condition, which I was told did not "exist."  Bev M.

Bev, Preschool speech therapist - Speech Pathologist, unemployed at this time February 4, 2009 1:01 PM
Stewartstown PA

Tuesday's post highlighted Sharon Gretz, the Founder and Executive Director of CASANA (Childhood Apraxia

January 30, 2009 12:31 PM

Thank you for this great interview, Stephanie and Sharon!  It is so important for speech-language clinicians to clearly understand that young children who do not get articulation early need to learn what the mouth is for.  I am impressed with my colleague who brought this boy around and the parent who understands how important a topic this is.  I have a client who is now 12 yrs old and in the autism spectrum who just last week "got" cvc words through a process of my coaching him to "voice & whisper"--e.g. in "cat", we voice "ca" and whisper "t"--this yielded a clear "cat"...this boy was not able to stop at the end of cvc words, but always ended with a schwa.  He has a great AAC device and was so thrilled to add his new list of cvc words for his own practice.  We never know how long a child will need to work out the sensory-motor components of their CAS, but it is worth trudging on and teaching how the mouth works along with auditory repetition (AAC).  Our field is so vast and each little component hugely important!  Many thanks...

Susan Nachimson, , Speech Pathologist Private Practice January 30, 2009 12:05 PM
Garberville CA

I am so glad our readers are finding so much value in this interview. I know that I learned a great deal through speaking with Sharon. I have a few children that I am working with right now that are demonstrating the signs of apraxia and this interview and reading the Apraxia-Kids website as inspired my therapy plan.

Please read this Friday's post which will present the second half of our interview!

steph bruno, blog author January 28, 2009 10:36 PM

Wow, that was a really nice thing to say.  I truly appreciate your kind words.  

Sharon Gretz January 28, 2009 6:38 PM

Stephanie,  Thank you for this excellent article.  I hope your interviews with Sharon Gretz will call attention to this widespread disorder.  Those of us who have children or grandchildren with Apraxia of speech are so very thankful to have the support Sharon Gretz.  Her contributions to the  CASANA website and the Apraxia-KIDS Email Listserv are invaluable in our struggle to give these children a voice.  

Martha January 28, 2009 3:28 PM
Dettelbach, Germany


I think what I'd like to suggest is a sit down meeting with your child's SLP and IEP team.  I would ask directly about what the therapist intends to do differently given the new understanding that your child has apraxia of speech.  I don't know what sort of therapy the SLP has been doing with your daughter so I cannot comment on whether or not it would appear to be the type of therapy that would be most appropriate if apraxia is the primary reason for your daughter's speech deficits.  Also, it is important to remember that the AMOUNT of therapy or frequency is just one factor that is important to kids with CAS.  An equally important question is: are the  methods being used in the therapy APPROPRIATE for a child with apraxia?  More of the "wrong" thing, is not going to be helpful either.  So, I hope you have a good relationship with the IEP team and can talk about these issues.  I invite you to our website at where you will find a great deal of information.  One place for you to be sure to visit is "Family Place".  There is a Family Start Guide to Apraxia in the Family Place at  We also have a variety of online groups from which you will benefit.  Look on our website under "e-communities" to read about them and find one that is good for you.  We are here to help!

Sharon Gretz

CASANA - Childhood Apraxia of Speech Association of North America


Sharon Gretz January 28, 2009 12:15 PM

My 4 year old daughter soon to be 5 in March sees a Speech Therapist at her Preschool.  I was told today that she believes my daughter has Apraxia.  What do I do?  I feel like she needs more therapy than just twice a week.   What are some activities that I could do at home with my daughter?  Could you please help me?

Christy Poole January 28, 2009 10:18 AM

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About this Blog

    Stephanie Bruno Dowling, M.S. CCC-SLP
    Occupation: Speech-Language Pathologist
    Setting: Early Intervention in Delaware County, PA
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