Use these sample goals for CAS as a starting point for writing your own goals based on the child’s level:

1. Imitating Actions: Client will imitate actions from in the therapy setting with at least 80% accuracy on 3 consecutive data collection days.
2. Functional Sounds, Sound Effects, Vocalizations: Client will produce or imitate sounds with his mouth using sound effects and basic vocalizations (like making animal and vehicle noises or saying “mmmm” for a yummy sound) at least 20 times during 15 minutes of play with the speech-language pathologist.
3. Sound Combinations (CV, VC): Client will produce both sounds in consonant-vowel (CV) and vowel-consonant (VC) words (such as, “me”, “no”, “hey”, “hi”, “bye”) to label pictures or for functional communication on at least 80% of observed attempts.
4. Repeated Strings of CV or VC: Client will produce both sounds in reduplicated consonant-vowel-consonant-vowel (CV)  words (such as, “mama”, “dada”, “no no”) to label pictures or for functional communication on at least 80% of observed attempts.
5. Add a Structure, Add a Sound: Client will produce all sounds in CV, VC, CVC, and CVCV words to label pictures or for functional communication on at least 80% of observed attempts (age appropriate sound substitutions will be allowed).
6. Sound Accuracy in Phrases and Sentences: Client will produce all sounds in CV, VC, CVC, and CVCV words in short sentences on at least 80% of observed attempts (age appropriate sound substitutions will be allowed).

The goal of this skill set is to improve a child’s willingness and ability to use speech functionally in the natural environment.  Speech sound accuracy is not the primary goal for this hierarchy (though it is encouraged), so close approximations of words are accepted and encouraged.

Again, here is a sample of how you might step a child through using language for functional communication with a child with childhood apraxia of speech.  Use this as a starting point but customize it to what the child needs.

Use these sample goals as a starting point to helping a child with CAS or Suspected CAS to use spoken language for functional communication.

1. Increasing Vocalizations: No goal for this step, this is a therapy strategy that will be implemented to encourage vocalizations.
2. Functional Vocabulary, First Words: Client will produce spoken single words or word approximations to intentionally communicate with the therapist at least 20 times during a 15-minute therapy session on 3 consecutive data collection days.
3. Functional Phrases and Carrier Phrases: Client will imitate or produce words or word approximations in short carrier phrases (such as “I want ___” or “I see ____”) to intentionally communicate with the therapist at least 20 times during a 15-minute therapy session on 3 consecutive data collection days.
4. Spontaneous Sentences: Client will imitate or produce 4-5 word sentences (sound errors acceptable) at least 20 times during a 15-minute therapy session on 3 consecutive data collection days.
5. Grammatical Markers and Linguistic Components: Client will correctly use the following grammatical marker/linguistic components in sentences while describing pictures in the therapy setting with at least 80% accuracy.
6. Using Complete Sentences in Connected Speech: Client will use grammatically complete utterances during conversation with the therapist with no more than 10 grammatical or word order errors in 15 minutes of therapy on 3 consecutive data collection days.

** Introduce other language concepts as necessary for success or after achieving complete sentences.  Other skills may include following directions, increasing vocabulary, asking and answering questions, etc.  Not all children with CAS will struggle with other language concepts so they are not included here.

The goal of this skill set is to improve prosody skills in children with CAS, including rate, pitch, and volume.  These skills are often impaired in children with childhood apraxia of speech but they won’t look the same in every child.  Analyze what challenges the child is having and choose the skills from the chart below that best fit that client’s needs.

Use these sample goals as a starting point to helping a child with CAS or Suspected CAS improve prosody.

1. Attending to Variations in Pitch, Rate, and Volume: The client will attend to several sounds in the environment (or recorded) and use at least 2-words to describe the sound (e.g. loud [volume], soft [volume], high [pitch], low [pitch], fast [rate], slow [rate] in 8 out of 10 opportunities on 3 out of 4 data collection days.
2. Demonstrating Prosody Variations in Non-Speech: The client will demonstrate a variety of prosodic features (i.e. volume, rate and pitch) when producing non-speech sound (e.g. sound effects) in 8 out of 10 opportunities on 3 out of 4 data collection days.
3. Demonstrating Prosody Variations in Speech: The client will demonstrate a variety of prosodic features (i.e. volume, rate and pitch) when producing single words or nonsense syllables in 8 out of 10 opportunities on 3 out of 4 data collection days.
4. Using Expected Prosody in Single Words: The client will demonstrate expected prosody following a model when saying single words in 8 out of 10 opportunities on 3 out of 4 data collection days.
5. Using Expected Prosody in  Phrases: The client will independently demonstrate expected prosody (i.e. rate, pausing, stress and intonation) when saying phrases in 8 out of 10 opportunities on 3 out of 4 data collection days.
6. Using Expected Prosody in Sentences: The client will independently  demonstrate expected prosody (i.e. rate, pausing, stress and intonation) when saying sentences in 8 out of 10 opportunities on 3 out of 4 data collection days.
7. Using Expected Prosody when Reading: The client will independently demonstrate expected prosody (i.e. rate, pausing, stress and intonation) when reading aloud 80% of the time on 3 out of 4 data collection days.
8. Using Expected Prosody During a Structured Task: The client will demonstrate expected prosody (i.e. rate, pausing, stress and intonation) when completing a structured task 80% of the time with no more than 2 cues on 3 out of 4 data collection days.
9. Using Expected Prosody during Spontaneous Conversation: The client will demonstrate expected prosody (i.e. rate, pausing, stress and intonation) 80% of the time with no more than 2 cues on 3 out of 4 data collection days.

The goal of this skill set is to provide a child an alternative means of communicating to relieve frustration and communicative pressure if speech is not adequate to do this.  If a child’s speech is functional to communicate everything that he wants and needs to communicate in his natural environment, this hierarchy can be skipped.  Or, this hierarchy can be abandoned once functional speech becomes adequate.

Use these sample goals as a starting point to helping a child with CAS or Suspected CAS use AAC to communicate.

1. Non-Standardized Communication/Engagement: Client will communicate intentionally with others using gestures, pointing, eye contact, joint attention, proximity, leading an adult by the hand, non-standard signs, acting out what one wants, etc. at least 10 times during 15 minutes of therapy.
2. Choosing an AAC System
3. Training for AAC System
4. Using AAC System for Functional Needs : Client will use some form of language (spoken speech, sign language, or AAC) to intentionally communicate with others at least 10 times during 15 minutes of speech therapy on 3 consecutive data collection days.
5. Combining Words Using AAC: Client will use some form of language (spoken speech, sign language, or AAC) to produce 2-word utterances at least 20 times during 15 minutes of speech therapy on 3 consecutive data collection days.
6. Teaching Grammatical Markers and Linguistic Components using AAC: Client will correctly use the following grammatical marker/linguistic components in sentences while describing pictures in the therapy setting with at least 80% accuracy (any form of language is accepted: spoken speech, sign language, or AAC).
7. Using AAC for School and Learning: Child is shown how to use AAC to participate in classroom activities and practice language skills learned in the school environment. Additional vocabulary words are added to the system as needed to allow the child opportunities to practice and use the language that is being taught at school.  Additional goals can be written for participation in these classroom activities.

Where to Start:

I know this can seem overwhelming when you’re first starting out so keep in mind that you only need to work on one level from each of these four areas and you can even prioritize it down so that you’re just working on one or two areas at a time.

Also, keep in mind that this should be used as a framework for speech therapy and not a prescribed program or system.  This method has not been tested by research and is just my interpretation of one way that these skills may be broken down.  I have decided on this order based on my clinical experience and what I’ve read in the current CAS literature, but it is not backed by specific research.  This is just an idea to get you started, but you should tweak it and modify it for each individual child.