Setting Childhood Apraxia of Speech Goals: A Guide For SLPs
May 17, 2022
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For both new and experienced speech-language pathologists, childhood apraxia of speech (CAS) cases are challenging. Because CAS is an uncommon, complex, and variable motor disorder, setting appropriate goals for treatment can be particularly tricky, but it's critical to patient and student success.
With careful assessment, planning, and collaboration with family, you can effectively develop individualized goals to help your patients with CAS succeed in improving their communication skills.
In this guide, we hope to clear the confusion around choosing goals for childhood apraxia of speech. We will outline some key considerations for setting goals for patients with CAS, as well as offer some specific examples. You will also learn how you can use Ambiki's goal bank and builder to make your planning even easier and more effective.
Start With an Accurate Assessment
First, assess the child's current level of functioning. This will help you understand what skills need to be targeted and at what level. Use both formal and informal assessments, as well as parent reports, to get a complete picture.
When setting goals for childhood apraxia of speech, one resource our team of SLPs prefers is the CAS Goal Planning Worksheet by Brie Schindel, MSLP, R.SLP, SLP(C), which advises starting with a summary of your assessment findings for the following:
Sound repertoire - vowels and sounds in the initial and final position of words
Word shapes and combinations
Language functions, e.g., protesting, greeting, getting needs met, labeling, commenting, and questioning
Prosody - phrasing, rate, stress, loudness, and pitch
Visual, tactile, and verbal cues trialed
In an article on apraxia-kids.org, Lori Hickman, M.S., CCC-SLP emphasizes that speech intelligibility and mean length of utterance are often most compromised in children with apraxia of speech. Therefore, they are also the best measures of the child's functional communication deficits and progress in treatment.
Regardless of which assessments you use, it is imperative that you accurately identify all the child's communication abilities and deficits, so you can choose the right goals and interventions that are most likely to result in positive outcomes.
Set The Right Treatment Goals for CAS
After completing a thorough assessment, you can begin to set treatment goals based on your findings.
According to the CAS Worksheet mentioned previously, possible goal areas include:
Precursors to practice, e.g., ability to imitate and attend
Expanding repertoire, e.g., K sound
Expanding word shapes, e.g., CVC word shapes
Expanding language, e.g., combining 2-words, using 'ing' endings
Improving prosody, e.g., correct stress on 3-syllable words, reducing segmentation
Increasing communicative functions, e.g., asking questions, responding with yes/no
Some of these goal areas may not be applicable, but ensure the goals you choose are comprehensive, developmentally appropriate, and expand upon the child's abilities rather than focusing just on deficits.
Based on SMART and other goal-setting frameworks, we recommend writing CAS treatment goals that include each of the following components.
Who: Indicate the student or patient who is working on the goal. Consider what makes this child's case unique.
Skill: Without being vague, provide a clear description of the skill speech or language therapy will address.
Context: Under what conditions or in what context will the goal be measured? Include what cues, assistance, or other kinds of support the child will need.
Measurable: What metrics will you use to show progress and attainment of the goal?
Reason: Why is the child working toward this goal? Consider how the skills you are targeting relate to specific functions in the child's life.
Time Frame: Specify by when the patient is expected to achieve the goal.
Understandable: Is the goal written clearly and free of jargon so that the child, family, staff, and/or other readers can understand it?
Relevant/Realistic: Depending on your clinical judgment, ensure the goal is unique to the child, logical, consistent, and meaningful to the child and family.
Achievable: Using your professional judgment, determine whether the goal is attainable given the child's specific challenges and available time and resources.
The above framework applies to both long-term goals and short-term goals. Remember that long-term goals are those that the child is expected to achieve by the end of the treatment period. Short-term goals are the specific objectives the child will need to meet to progress toward a long-term goal.
Examples of Childhood Apraxia of Speech Goals
Next, we will consider some examples of comprehensive long-term and short-term goals for speech and language therapy.
Notice how the components of the goal-setting framework are incorporated in these examples. Remember that determining whether the goals are understandable, relevant/realistic, and achievable would rely on the SLP's judgment.
Eli will increase ability to spontaneously produce a variety of syllable shapes in words and phrases with 90% accuracy as measured by assessments, therapist observation, and documentation over the course of 1 year to improve overall speech intelligibility and motor planning.
Given high frequency and functional words, Eli will produce CV/VC words first in imitation then moving to spontaneous productions at the word level with 100% accuracy across 3 therapy sessions.
Given high frequency and functional words, Eli will produce CVC words first in imitation then moving to spontaneous productions at the word level with 100% accuracy across 3 therapy sessions.
Given high frequency and functional words, Eli will produce 2-syllable words first in imitation then moving to spontaneous productions at the word level with 100% accuracy across 3 therapy sessions.
Examples of Language Goals for CAS
Long-Term Goal: Expressive Language
Alex will increase expressive language to age-appropriate levels to improve conversational skills, as measured by increases in standard scores on language assessments as well as therapist observation and documentation over the course of 1 year.
Short-Term Goal 1: Expressive Language -> Utterance Expansion
During structured and unstructured activities, Alex will produce 2-word utterances first in imitation then spontaneously for a variety of pragmatic functions in 9/10 opportunities across 3 therapy sessions to expand language.
Short-Term Goal 2: Expressive Language -> Asking Questions
During structured and unstructured activities, Alex will ask simple questions at the word level with appropriate prosody first in imitation then spontaneously with 90% accuracy across 3 therapy sessions to increase communicative functions.
Make CAS Goal Planning Easier With Ambiki's Goal Bank and Builder
If you're looking for more childhood apraxia of speech goals or need more help writing your own, check out Ambiki's Goal Bank and Builder.
You can search the goal bank for both short- and long-term goals created by other SLPs that incorporate the comprehensive framework discussed earlier.
The goal bank is also tagged and organized within an extensive taxonomy, so you can apply filters to your search to target specific CAS goal areas. For example, you can apply filters for discipline (e.g., speech therapy), major focus area (e.g., expressive language), and minor focus area (e.g., utterance expansion).
Image of Ambiki's goal bank filters
Once you click search, you will get a list of goals to choose from. You can use these goals for inspiration or as a template for creating your own.
When you select a goal, you will see that the goal components (e.g. who, skill, measurements, etc.) are color-coded for easy identification. To modify the goal for your patient, you can use the selections and fields on the side of the screen (e.g. patient name, percentages, etc.). You can then copy the goal to your clipboard so you can paste it into your documentation.
Image of a goal for CAS in Ambiki's goal bank
Alternatively, you can easily create your own childhood apraxia of speech goals from scratch using the goal builder. To access the builder, all you need to do is select “Create New Goal” at the top of the screen in the goal bank.
The builder includes features to help you include all the components of the framework so you can ensure you are setting comprehensive CAS goals. You can also set customizable portions of the goal so you can modify them for future sessions or other patients (e.g. patient name, target level, percentage, etc.).
Image of Ambiki's Goal Builder
Visit our goal bank and builder FAQ page to learn more about how to use these tools to create comprehensive childhoold apraxia of speech goals.
Need More Help?
Childhood apraxia of speech can be a difficult disorder to treat, but with a thorough assessment and the right goals in place, success is possible.
Looking for more help with planning for your therapy sessions? Be sure to subscribe to our blog and visit us at ambiki.com for more tips and resources!
