Hi Pamela,
In looking closer at this question, one could make an argument for both A) Realistic and B) Achievable being correct answers (issues with the family’s goals and expectations). Your rationale sounds reasonable. I checked some contemporary resources and found that “achievable” and “realistic” are often used interchangeably in terms of concept, although they obviously start with a different letter. Also in these more contemporary representations of the SMART goal framework, the “R” is “Relevant” to represent what is meaningful to the patient and their unique goals and outcomes. We will update this question for better clarity- thank you for bringing this to our attention.
The scope of the question is to make sure you understand the normal motor trajectories for Down syndrome: the 2001 Palisano, et al article was the first to document this, followed by the Winders 2019 article looking at similar gross motor trends. Based on this research, it would NOT be “realistic” OR “achievable” for a child with DS to walk by typically developing infant ambulation milestones. The research tells us that that ~50% of children with Down syndrome walk by 24-30 months and ~90% walk by 36 months. However, the family’s goal of walking by 12-14 months (typical development) would be “Relevant” because it is meaningful to them.
As you continue your preparation, focus on these most contemporary SMART framework definitions:
S – Specific: Clearly defines the exact skill, behavior, or outcome to be achieved.
M – Measurable: Includes objective criteria or metrics to determine whether the goal has been achieved.
A – Achievable: The goal is realistic given the patient’s current abilities, resources, and clinical condition.
R – Relevant: The goal is meaningful to the patient and linked to functional outcomes or participation goals.
T – Time-bound: Specifies a timeframe for achieving the goal.
Helen