The easy answer to the question, “What type of speech and language goals should be considered when planning an IEP for a child with apraxia?” is that any area of communication deficit that the child with CAS exhibits should be addressed in his/her treatment program. What complicates the answer is that many areas of communication can be affected when a child has CAS, so a clinician must be very observant in order to ascertain which areas of communication are affected for each child. The components of any speech-language treatment program will vary depending on the individual child. But there are a number of general guidelines that should help parents know if their child is getting appropriate services.
- fluency (stuttering)
- voice (volume, hoarseness, etc.)
- vocabulary (understanding and use of words)
- language processing (understanding of other people’s communication to him/her)
- language production (use of age-appropriate word order and language structures, such as verbs, pronouns, etc., which are referred to as syntactical and morphological skills)
- articulation (ability to produce phonemes or sounds in single words)
- co-articulation (ability to produce phonemes or sounds in connected speech)
When a clinician is developing goals for an Individualized Education Plan (IEP), they will look at goals in two ways long-term goals and short-term objectives. The long-term goal(s) should address what the child should be able to do as a result of intervention over a specified period of time (for IEPs, this is generally one year). Short-term objectives include the types of activities that will be used to support and achieve the long-term goal. Both long-term goals and short-term objectives should be objectively measurable. Each should specify WHO will do WHAT under WHICH CIRCUMSTANCES. The long-term goal will often specify how the goal will be measured to ascertain a child’s progress.
One suggestion for speech production long term goals for children with CAS is to write them in terms of the child’s speech intelligibility AND his/her mean length of utterance in morphemes (morphemes are like words, but are a more sensitive measure of a child’s language complexity. For example, if a child said “cat,” that would be counted as one morpheme. But if the child said “cats,” that would be counted as two morphemes, because the pluralization (s) of the word “cat” represents a higher level of language complexity). Speech intelligibility and mean length of utterance are the two features of a child’s communication that are often the most compromised when he/she has childhood apraxia of speech, and as such are the best measures of the child’s functional communication deficits pre-treatment, and of the child’s progress as a result of treatment.
It is essential for the clinician to establish long-term goals that require a true gain in skills rather than gains that would naturally be expected as a result of maturity and/or the clinician’s increased ability to understand the child as a result of becoming familiar with his/her speech. There are expected ranges for both mean length of utterance and speech intelligibility in children. The long-term goal should be written to represent criterion for success that would represent at least one year’s growth (or the amount of time the long term goal is being written for). Remember, however, that statistical differences in children’s utterance length do not occur in an amount of time under three months (Hickman, 1983), so a clinician must be cautious in viewing comparison measurements of utterance length that are taken closer than 6 months to each other. Speech-intelligibility and language complexity, however, are features that can be measured more frequently.
The short term objectives support the long-term goal, or are a representation of some of the means for supporting and achieving the long term goal. Objectives often include benchmarks indicating dates by which a child will have met the objective at a specified level. These objectives should not be all-inclusive. In other words, every single aspect of the child’s treatment program does not have to be listed as an objective, but the objectives and the long term goals should be written in a way that allows measurement of the important factors for each child’s success.
Finally, parents are an important part of the goal development. Goals and objectives should make sense to parents in terms of their child’s needs. It is also important to remember that the most outstanding goals and objectives in the world do not guarantee that the services/intervention provided will be effective. For that reason, I believe it is very important for parents to observe speech therapy sessions as often as possible, and maintain frequent communication with the SLP In this way, parents can be aware of how the goals and objectives developed are actually being addressed therapeutically.
Hickman, L. A., (1983) Sex Differences in the Language Development Rates of Two-Year Olds. Masters Thesis, Portland State University.
(Lori Hickman, M.S., CCC-SLP, has been a practicing speech-language pathologist since 1983, having graduated with her Master’s in Speech Sciences from Portland State University in Oregon. Ms. Hickman has dedicating her career to date to speech-language pathology in the schools, as well as assessment and treatment of children with severe communication disorders such as CAS. Ms. Hickman is the author of The Apraxia Profile, an assessment instrument as well as therapeutic materials for children with CAS. In 2000, she wrote the book Living In My Skin: the Insider’s View of Life With a Special Needs Child, a book based on interviews of hundreds of parents of children with special needs, providing professionals, extended family, friends, and communities with an inside look at the day-to-day challenges that families of children with special needs face. She is also a member of the CASANA Professional Advisory Board and has contributed articles to the Apraxia-KidsSM web site.)