Mining for Gold: Ten Tips for Finding Motor Speech Targets When Treating CAS

After you diagnose a child with Childhood Apraxia of Speech (CAS), determining their optimal motor speech targets for treatment can be a daunting task. Setting these targets requires a keen eye and resilient creativity – similar to that of a gold miner. The SLP must see the glimmer of a target that could be, or become, a golden nugget. Sometimes these motor speech targets are just under the surface!

So, get out your pick ax, and be the gold miner for your clients with CAS. Here are some mining tools to get you started:

1. Assess your Landscape and Construct a Map

Prior to choosing targets, be certain that you have completed a thorough motor speech assessment. You should assess the child’s vowels and know their phonemic repertoire and phonotactic structures. Dr. Edythe Strand states, “When choosing initial stimuli, I use the results of the motor speech examination to guide me, looking at the phonemic inventory, syllable shapes, and degree of vowel differentiation and accuracy.”10

Maas, Gildersleeve-Neumann, Jakielski, & Stoeckel7 recommend considering the following when choosing motor speech targets:

  • Age
  • CAS severity
  • Language development
  • Cognitive skills
  • Other diagnoses
  • Motivation
  • Prognosis

2. Mine the Repertoire

Once you know what’s in the child’s phonemic and phonotactic repertoire, start to combine phonemes to construct targets within the chosen phonotactic structures. When working on new phonotactic structures, combine firm phonemes that are already in the child’s repertoire. If targeting new phonemes, utilize a child’s firm phonotactic structures to construct the targets.11 Dr. Edythe Strand also recommends choosing a small set of targets at the start.10 This will allow for initial mass practice of targets during acquisition, which follows the principles of the motor learning theory.

After a motor speech target becomes firm, that target can be moved to generalization and maintenance practice within a random practice schedule. This will allow a new target to enter the mass practice set.

3. Meld the Nuggets

Use homorganic phonemes and phonemic context to construct and elicit precise production of targets. Targets that are homorganic in structure minimize the motoric load on the child’s vulnerable motor speech system.1,8

Homorganic phonemes refer to phonemes that are produced with the same place of articulation. Remember, we are working on motor speech movement gestures, not individual sounds. Examples of motor speech targets that are homorganic include:

  • Pairing an alveolar phoneme with a high front vowel (e.g. “eat”, “tea”, “neat”)
  • Pairing a velar phoneme with a high or mid-back vowel (e.g. “goo”, “go”)

Although the use of homorganic phonemes is a helpful strategy, the target’s functionality and the child’s motivation to produce the target must always be considered!

4. Keep Digging

Use the principle of motor learning – motivation! Often a difficult, complex target may be achieved before a less complex one if the child is highly motivated to produce the syllable, word, or phrase. For example, a client surprised me by rapidly achieving the targets “Santa” (CVCCV) and “Elsa” (VCCV) in random practice schedules at the spontaneous level. She acquired these much faster than the target “sit” (CVC) in part due to her level of motivation.

5. Don’t Take the Easy Route

Use your client’s optimal challenge point to improve long-term outcomes.5 In motor learning, this occurs when the child’s learning is expanded without decreasing their performance in the chosen practice schedule. As a result, the child receives the optimal amount of feedback and level of motor difficulty.

Motor speech targets should not be too easy or too hard. All targets should challenge your client. Research has shown that “the decrease in practice performance is the result of the task becoming more challenging… it is precisely this challenge that leads to improved long-term performance.6

6. Dig Beneath the Surface

It may be tempting to use premade, commercially available motor speech target cards, but avoid it. Using these types of stimuli may save you analysis time, but their use will not meet the highly individualized needs of your client.  The principle of task specificity requires that motor practice should replicate the targeted motor skill as closely as possible.7,9 As a result, some researchers believe that it is more effective to use real words versus non-words as motor speech targets.

7. Mine the Gold and the Silver!

Whenever possible, combine your client’s language goals with their motor speech goals and targets. Use morphosyntactics to increase length and complexity of motor speech targets, as well as expressive language skills. One way to increase a target’s phonotactic complexity is to add regular plural, third person singular tense, or past tense morphemes. For example:

  • Hop (CVC) to hopped (CVCC)
  • Pick (CVC) to picks (CVCC)
  • Catch (CVC) to catches (CVCVC)
  • Book (CVC) to books (CVCC)

Motor speech targets can also be phrases, not just syllables or words (e.g. I do (VCV)).  Furthermore, your client’s targets should reflect different parts of speech – such as nouns, verbs, and adjectives – that code various language functions like greeting or requesting.3 Once a few targets are firm, try combining individual targets into small phrases or sentences.

8. GOLD!

Work on various prosodic features from the start. Focus on contrastive, sentential, and lexical stress patterns. Don’t forget to vary rate as well.

Be creative! There are many fun ways of incorporating prosody into your target practice. Some examples include:

  • Prosody wheels
  • Pretend play
  • Use of puppets or action figure toys

9. Cash In

Continuously collect precise data. Start by determining your data collection procedures and time frames. Then, use cumulative accuracy to assess consistent target production across time.2 Collect the other types of data – including the level of Dynamic Temporal Tactile Cueing (DTTC) – needed for your client to produce the target accurately.

10. Roll Up Your Sleeves

Be a persistent gold miner! This work is not easy and takes both time and effort. Consider starting a “Potential Target” list or Google Doc that you share with parents, teachers, caregivers, paraeducators, etc. Keep a running list of possible targets that are personalized, functional, and motivational. Although your client may not be ready for some of these targets right away, he or she may be at later points in treatment.

Although mining and choosing individualized, functional, and motivational motor speech targets is challenging, it can be done. Ensure success at the start by choosing targets that can be achieved more easily. At the core of this work is always considering the whole child and his or her individual needs, overall communicative effectiveness, and personality.

  1. Davis, B.L. & MacNeilage, P. (1995). The articulatory basis of babbling. Journal of Speech and Hearing Research, 38, 1199-1211 .
  2. Deal, J.L. & Florence, C. (1978) Modification of the eight-Step continuum for treatment of apraxia of speech in adults. Journal of Speech and Hearing Disorders, 43, 89-95.
  3. Fish, M., Here’s how to treat childhood apraxia of speech. 2011 Plural Publishing, San Diego, CA.
  4. Fish, M. Speech language pathology corner: 10 suggestions for effective treatment of childhood apraxia of speech.
  5. Guadagnoli, M. & Lee, T. (2004). Challenge point: A framework for conceptualizing the effects of various practice conditions in motor learning. Journal of Motor Behavior, 36, 2, 212-224
  6. Guadagnoli, M., Moran, M., & Dubrowski, A. (2012). The application of the challenge point framework in medical education. Medical Education, 46, 5, 447-453.
  7. Maas, E., Gildersleeve-Neumann, C. E., Jakielski, K. J., & Stoeckel, R. (2014). Motor-based intervention protocols in treatment of childhood apraxia of speech (CAS). Current Developmental Disorders Reports, 1, 197-206.
  8. MacNeilage, P.F. & Davis, B.L. (1990). Acquisition of speech production: Frames, then content. In M. Geannerod (Ed.), Motor representation and control (pp. 453-475). Hillsdale, NJ: Erlbaum.
  9. Schmidt, R.A. & Lee, T.D. Motor control and learning: a behavioral emphasis. 4th ed. Champaign: Human Kinetics; 2005
  10. Strand, E. Choosing stimuli for speech therapy with children who have severe apraxia of speech.
  11. Davis, B.L. & Velleman, S.L. (2000). Differential diagnosis and treatment of DAS in infants and toddlers. Infant-Toddler Intervention, 10, 177-192.