The key finding
A 2024 review of 50 studies found that children with disabilities can meaningfully participate in setting and evaluating their own therapy goals, not just passively receive them from adults. Researchers identified three approaches and four specific tools designed for child-led goal setting, and synthesized these into a six-phase framework called DECIDE. However, none of the studies reported validation data specifically for children answering for themselves, meaning we don’t yet know how reliable or consistent these tools are when kids use them independently. This gap highlights both the promise and the unfinished work in truly centering children’s voices in their own care.
What the study looked like
This scoping review searched six academic databases for studies involving children under 18 years old with disabilities or developmental delays who participated in goal setting during therapy or rehabilitation. The researchers weren’t testing a single intervention—instead, they mapped the landscape of existing tools and approaches that let children lead the goal-setting process rather than having adults decide for them. They analyzed how these tools were used across different phases of goal work, from initial conversations about what matters to the child through to measuring progress after therapy. The review included diverse study types and populations, providing a broad view of current practice rather than testing one specific method.
Why researchers think this happened
The authors propose that children are more engaged and motivated when they have ownership over their therapy goals, which aligns with decades of research showing that autonomy supports better outcomes in learning and rehabilitation. The DECIDE framework emerged from patterns the researchers noticed across studies: children naturally move through distinct phases when setting goals, from understanding what goal-setting means to monitoring their own progress. Each phase serves a purpose—directing children to the concept of goals helps them understand the process, eliciting topics ensures goals reflect what children actually care about, and constructing specific statements makes goals actionable. The framework synthesizes scattered practices into a coherent process, suggesting that effective child-led goal setting isn’t one conversation but an ongoing collaboration.
How to read this carefully
This review found tools and approaches but not strong evidence about whether they work consistently. The absence of clinimetric properties—measures of reliability, validity, and responsiveness—specifically for child self-respondents means we don’t know if children answer consistently over time or if the tools actually measure what they claim to measure. Most validation has likely been done with parent or clinician reports, not children’s own responses. Additionally, scoping reviews map what exists rather than evaluate quality, so the 50 included studies vary widely in rigor. The diversity of disabilities and ages studied makes it hard to know which approaches work best for which children. Correlation between child participation and engagement doesn’t prove that child-led goals cause better therapy outcomes.
What this means for everyday life
If your child receives therapy for a disability or developmental delay, this research suggests it’s worth asking whether they can participate in choosing their own goals. Even young children often know what’s frustrating or what they wish they could do—ride a bike, button their shirt, play with friends at recess. The DECIDE framework offers a vocabulary for conversations with therapists: Is my child being directed to understand goal-setting? Are we eliciting what matters to them, not just what I think they need? When children see therapy addressing goals they chose, they may invest more effort. That said, tools are still developing, and not every child will engage with formal goal-setting the same way. Given this emerging evidence, it might be worth considering your child as a collaborative partner in their therapy planning, asking therapists how they involve children’s voices, and recognizing that meaningful participation looks different at different ages and abilities.