Where to Begin: Part 2) Apraxia of Speech Therapy Choosing Targets and Practice

Once an individualised assessment has been completed, the next question in apraxia of speech therapy is often, where do I actually start? Target selection and how practice is structured can strongly influence therapy outcomes, particularly for individuals with more significant motor planning difficulties.

Turning assessment into therapy decisions

After completing an assessment, it can be helpful to pause and reflect before jumping straight into therapy planning. Think to yourself, I have just assessed this client. What have I noticed? What are they able to do right now? Where do the breakdowns occur? Ask practical questions. What targets can they achieve with support? How would I describe the severity of their apraxia of speech? Are speech attempts very limited or highly inconsistent? Is there some emerging control at the syllable or word level? These observations help guide where therapy needs to begin. It is also useful to think about the foundations of speech production. Can the client produce simple oromotor movements on request? Are vowels present? Is there any consistency with CV syllables? For some individuals, this is exactly where therapy needs to start. For others, these skills may already be established, allowing therapy to focus on more complex targets.

Choosing therapy targets in apraxia of speech

In apraxia of speech therapy, targets are not selected based on age expectations or phonological patterns. Instead, target selection is guided by motor planning ability, consistency, and the individual’s capacity to sequence speech movements. Early targets are often simple and highly controlled. This may include vowels, CV syllables, or a small set of consonants that are easier to see, feel, or cue. Starting at this level supports repeated, accurate practice and helps create early success, which is especially important for individuals who may already feel frustrated by communication difficulties. As motor planning improves, targets can be gradually expanded. This might involve moving from syllables to words, from words to short phrases, or increasing the range of sounds once consistency has been established. Progression should always be driven by the individual’s performance rather than by a predetermined hierarchy.

The role of drill based practice

Drill based practice plays an important role in apraxia of speech therapy, particularly in the early stages. Repeated practice of carefully selected targets supports motor learning and helps improve consistency of speech movements. Effective drill work is not about large numbers of repetitions without purpose. Instead, it focuses on accurate production supported by clear models, appropriate cueing, and feedback that helps the client understand how to adjust their speech movements. Over time, cues can be reduced as control and confidence increase. Drill based activities can be adapted across severity levels. For individuals with severe apraxia of speech, practice may focus on a very small number of sounds or syllables. For individuals with moderate apraxia, practice may involve words and short phrases. For mild apraxia, therapy may focus more on connected speech, prosody, and speech naturalness.

Cueing and support in therapy

Cueing is a central part of apraxia of speech therapy. Visual, verbal, tactile, and gestural cues can all support motor planning, particularly when new targets are introduced. The aim is not to remove cues as quickly as possible, but to use them thoughtfully and consistently. Cueing should support accuracy and reduce frustration. For some individuals, longer term cueing is necessary and entirely appropriate.

Balancing drill work with functional communication

While drill based practice is important, it does not replace functional communication. Therapy should also include meaningful words, phrases, and communication opportunities that are relevant to the individual’s everyday life. This may involve combining structured drills with functional vocabulary within the same session, or using AAC and total communication approaches alongside speech practice. The balance will differ for each individual and should always be guided by their communication needs and goals.

Looking ahead to Part 3

In apraxia of speech therapy, assessment tells us where to start, and thoughtful target selection helps us decide how to move forward. In Part 3, we will look more closely at severity of impairment in apraxia of speech and discuss some general suggestions for where therapy might begin based on whether the impairment is severe, moderate, or mild. If you are interested in learning more, and need to save time creating your own therapy materials, you can head to my Apraxia of Speech Therapy Bundle here: 👉