Childhood Apraxia of Speech

Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have difficulty saying sounds, syllables and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts 9 e.g., lips, jaw and tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words when they are trying to communicate.


Not all children with CAS are the same. All the signs and symptoms listed below may not be present in every child.  With a very young child these symptoms include:

  • Does not babble as an infant

  • First words are late and may often be missing sounds

  • Only a few different consonant and vowel sounds

  • Problems combining sounds; may show long pauses between sounds

  • Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia does it more often)

  • May have problems eating.


An older child:

  • Makes inconsistent sound errors that are not the result of immaturity

  • -Can understand language better much better than he or she can talk

  • -Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech.

  • May appear to be groping when attempting to produce sounds or coordinate the lips, tongue, and jaw for purposeful movement

  • -Has more difficulty saying longer words or phrases clearly than shorter ones

  • Appears to have more difficulty when he or she is anxious

  • Is hard to understand, especially for an unfamiliar listener

  • Sounds choppy, monotonous or stresses the wrong syllable or word


How is childhood apraxia diagnosed?

An audiologist should perform a hearing evaluation to rule out hearing loss as a possible cause of the child’s speech difficulties.


A speech therapist with knowledge and experience with CAS conducts an evaluation. This will assess the child’s oral-motor abilities, melody of speech, and speech sound development.


What treatments are available for children with CAS?

Research shows that children with CAS have more success when they receive frequent (3-5) times per week) and intensive treatment. Children seen alone for treatment tend to do better than children seen in groups. As the child improves, they may need treatment less often, and group therapy may be a better alternative.


The focus of intervention for CAS is on improving the planning, sequencing, and coordination of muscle movements for speech production. To improve speech, the child must practice speech. Some clients may be taught to use sign language or an augmentative or alternative communication system if the apraxia makes speaking very difficult. Once the speech production has improved, the need for these systems may lessen, but they can be used to support speech or move the child more quickly to higher levels or language complexity.


Consistent practice and repetition are important and necessary keys to helping children with apraxia achieve their potential for intelligibility and communication. Children with CAS need a supportive environment that helps them feel successful with communication. For children who receive other services, such as physical or occupational therapy, families and professionals need to schedule the services in a way that does not make the child too tired and unable to make the best use of therapy time.