Childhood Apraxia of Speech

Childhood apraxia of speech (CAS) is speech production disorder that causes the child’s speech to be hard to understand. It is usually detected around 2 years of age, when speech development is noted to be delayed.  

Children with CAS may have a hard time putting the tongue, lips and jaw in the right position to make many speech sounds. He or she will have trouble putting speech sounds together (i.e., /b - a - t / for “bat”). Longer sentences or words are more difficult for the child to say, which causes more errors. This makes the child’s speech harder to understand. The child may be able to make a sound or word correctly one time, but not be able to say it another time.  

Usually, the child with CAS does not have difficulty with non-speech movements such as chewing, licking or swallowing. Children with CAS may have problems with other motor skills such as cutting, coloring and writing. The difficulty with speech and later language development may even result in problems with reading and spelling as the child gets older.

CAS is believed to be a neurological speech disorder. Although there is nothing wrong with the strength of the muscles of the mouth, the message from the brain to the muscles is incomplete. This causes problems with coordination and planning of the movements needed to make a sound or word. Some children with CAS have had specific birth or prenatal injuries that have caused minor brain damage. However, the exact cause is often not known.

Three Most Common Characteristics

  • Inconsistent speech sound errors
  • Difficulty moving from one speech sound to another or one syllable to another
  • Abnormal rhythm, stress and intonation during speech

Other Characteristics That May be Seen

  • Difficulty producing many speech sounds
  • Use of only vowel sounds, grunts, or single syllables to communicate
  • Use of only a few speech sounds during speech
  • More errors on longer sentences or longer words than with single sounds or syllables
  • Difficulty and struggle when trying to find the right mouth position to make a sound
  • Difficulty starting a sound
  • Normal receptive language (understanding) skills, but limited expressive language (talking) skills
  • Difficulty imitating mouth movements (in severe cases)

The child with CAS should begin speech therapy as soon as the disorder is identified. A speech-language pathologist will know how much therapy a child will need. Speech therapy helps the brain form new connections to help make the movements for speech.

Frequent practice of speech movements during therapy helps to train new movements for speech sounds and words. The speech-language pathologist may use several different techniques to help the child learn to produce and sequence speech sounds. There is not one program used to treat CAS. Treatment will depend on the child’s speech characteristics, age and ability level. In some cases, sign language or a talking device are used to help the child communicate until the child’s speech is clear to others.

The goal of speech therapy is to teach the child a new motor skill. For this skill to become easy, the child must practice often between speech therapy sessions. The parent should work with the child a few minutes several times each day. Short, frequent sessions are better than occasional long sessions. The more the child practices, the faster the progress will be noticed and the sooner the child will be able to develop clear speech.   Speech therapy will also focus on improving the language system in children with both speech and language deficits; pre-literacy and literacy skills may also be addressed in older children with CAS.

For more information, contact the Division of Speech Pathology, 513-636-4341.


Last Updated 04/2013