What Kinds of Goals and Strategies are Most Important in Speech and Language Therapy?

Goals and strategies must meet the needs of each individual child. Each set of goals and strategies is based upon the individual assessment completed with the child, on-going observations of the child, and parental input.

Strategies to aid in speech and language development include some "universal" principles for children with fragile X syndrome.  Calming strategies may need to precede therapy. These may include exercises, such as wall push-ups, or deep pressure massage. Visual cues seem to be very helpful across the age -span for boys having fragile X. With young children, these might include pictures of the day's activities in sequence, calendars, pictures of classmates and their weekly jobs, and pictures of vocabulary being taught in a unit.

For older children, visual cues can include signs or signals for proper behavior (e.g., hand over mouth for "quiet mouth"). Pictures and logos provide visual cueing for the linking of language to reading. Visual cues are essential for teaching science and social studies concepts, as discussion alone may be too abstract. 

Such visual cues can take the form of acting out concepts (e.g., for a unit on weather, some children become the wind, while others act out taking off a coat as the temperature climbs, etc.). Dramatization can also help with the comprehension of story sequences and plots.

For boys with fragile X syndrome, goals may be developed in a number of areas. Oral-motor goals are appropriate for most. Receptive language (listening) goals may be developed to increase vocabulary, comprehension of directions, understanding of grammar, and recognition of the role of a listener in a conversation.

Expressive language goals, for both boys and girls, will likely focus on pragmatic skills. Initiating conversations, turn taking, and controlling perseveration and tangential comments are all skills on which the SLP can focus. Children with fragile X seem to benefit most from using real-life situations, such as message delivery, lunchtime conversation, and asking to play a game, to help their conversational speech.  Girls with fragile X often need help with overcoming their shyness and anxiety to participate in conversations and social situations.

Expressive language goals for boys may also focus upon vocabulary development for both functional speech and academic subjects. Syntax goals may center around the development of phrases, sentences, question forms, or other issues with word order. Children with fragile X often have a powerful strength in mimicking or imitating the language on TV shows, videos, or songs. This imitation skill can be used to help them learn whole phrases or sentences and apply them appropriately.

Speech goals often include specific work on intelligibility, with emphasis on sounds in isolation, words, and sentences. Such work may include oral-motor exercises for strengthening lip and tongue control. Speech therapists can also help with cluttering, the tendency to repeat syllables, words, and phrases. Some of the techniques used for stuttering (e.g., slow, easy speech) can be very helpful.

Auditory processing goals should focus on the specific areas of weakness, whether in attention, perception, memory, or conceptualization. SLPs may work with teachers to help them slow their rate of speech and emphasize words clearly with children who have slow processing. Visual cues can be very helpful to focus attention and aid memory. Higher level conceptual goals can be designed around cause and effect, prediction, and problem solving, using stories, academic subjects, and real-life situations.

Parents can contribute to the goal development in speech and language by thinking through and listing speech and language needs at home. They may have specific topics for vocabulary units that they believe will be useful for their child. They may also have valuable information about conversational abilities at home. Goal setting should be a joint project of the professional staff and parents.

Gail Harris-Schmidt, Ph.D., CCC-SLP
Saint Xavier University
Chicago, Illinois

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