What is Childhood Apraxia of Speech?
Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS struggle to make speech sounds and blend sounds together to form words. This can make the child’s speech difficult to understand.
Children with CAS may know what they want to say but have difficulty making the sounds correctly. Someone with childhood apraxia of speech usually does not have problems with muscle tone or strength. Instead, there is an issue where the brain has trouble sending messages to the mouth for speaking. The mouth movements may not happen in the right place, at the right time or with the right force.
Many parents feel confused when their child’s speech is not improving as expected. With most speech sound disorders, children follow expected patterns and often begin making progress after starting traditional therapy. With CAS, children have difficulty planning and coordinating speech movements and need specialized therapy to make progress.
How Common Is Childhood Apraxia of Speech?
Childhood apraxia of speech (CAS) is rare. It affects about 1 in every 1,000 children.
What Causes Childhood Apraxia of Speech?
The cause of childhood apraxia of speech is usually unknown. It is not caused by environmental factors, like daycare or anything a parent does. When the cause is unknown, it is called idiopathic CAS.
In some cases, CAS may be linked to:
- Genetic changes in a single gene
- Syndromes, such as Fragile X syndrome, Klinefelter syndrome and Noonan syndrome
- Brain injury, epilepsy, seizures or stroke
- Neurodevelopmental disorders, such as autism spectrum disorder
Childhood apraxia of speech often runs in families. Children with CAS may have family members with speech, language or learning difficulties.
How Can Childhood Apraxia of Speech Impact My Child?
Childhood apraxia of speech affects how clearly a child speaks. The impact ranges from mild to severe. Children with mild CAS may speak but struggle to plan mouth movements. They need to repeat or rephrase their sentences so others understand them. Children with severe CAS may have limited speech. Their words are hard to understand, even for familiar people like parents. This can result in the child being unable to effectively communicate their wants, needs, thoughts and feelings.
Children with CAS know what they want to say but cannot get the words out. This may cause them to be frustrated. Children with CAS may benefit from supporting speech with other forms of communication, such as signing, using a communication device or using picture symbols.
Childhood apraxia of speech can affect the foundational skills for reading and spelling. Checking a child’s sound skills early can help them learn to read. By catching issues quickly, they can get the special help they need.
What Are the Signs of Childhood Apraxia of Speech?
Signs of apraxia of speech in children can look different at different ages.
Signs of childhood apraxia of speech in toddlers:
- History of limited babbling as a baby or babbling that consisted of mostly vowel sounds like “aa-ee-oo” rather than consonant sounds like “dada”
- Delayed first words and few consistent words that are understood (fewer than 10 words at 18 months)
- Delayed phrase acquisition (no two-word phrases by 24 months)
- Inconsistent productions where the child may say words well once, then struggle to repeat them
Signs of childhood apraxia of speech in preschool and school-age children:
- Inconsistent speech errors
- Errors when saying vowels
- Difficulty turning voice on and off for specific sounds (for example, saying “buy a buppy” instead of “buy a puppy”)
- Difficulty moving between sounds or syllables (for example, saying “banana” as separate units “ba-na-na”)
- Groping or “trial and error” mouth movements where the child seems to be searching for the correct position to make sounds
- Incorrect stress or equal stress on words or syllables (for example, saying “air-PLANE” instead of “AIR-plane”)
- Speech that is hard to understand
How Is Childhood Apraxia of Speech Diagnosed?
A speech-language pathologist diagnoses childhood apraxia of speech. During the evaluation, the speech-language pathologist:
- Listens closely to your child’s speech
- Tests different sounds, words and sentences
- Watches how your child moves their lips, tongue and jaw
- Checks language skills, including how well your child understands and uses words
There is no single medical test for CAS. It does not show up on a brain scan or blood test. Diagnosis takes time and careful evaluation, and more than one visit with the speech-language pathologist is often needed.
A child with suspected CAS may have more than one diagnosis. The speech-language pathologist will also consider other conditions that may be impacting speech, such as hearing loss or a language delay.
The speech-language pathologist will diagnose whether your child has childhood apraxia of speech or a phonological disorder. A phonological disorder is another kind of speech sound disorder where the child makes predictable, rule-based errors that make their speech hard to understand (an example is saying “tat” for “cat” or “boo” for “book”).
The path to diagnosis often involves more than one professional. Your child’s pediatrician often makes a referral to the speech-language pathologist. Audiologists do hearing tests to rule out hearing loss. Neurologists and developmental pediatricians may look for other medical conditions. Doctors, therapists and teachers work with you to understand your child’s needs and create the best treatment plan.
CAS vs. Speech Sound Disorder
Childhood apraxia of speech is a type of speech sound disorder. Children with CAS and children with typical speech sound disorders both have trouble speaking, but there are several key differences:
| Childhood Apraxia of Speech (CAS) | Typical Speech Sound Disorder (SSD) |
|---|---|
| Often makes inconsistent speech errors; the same word may be said differently each time. | Typically makes consistent, predictable errors that follow recognizable patterns. |
| Has difficulty with planning, programming and coordinating movements of the lips, tongue, jaw and mouth for speech. | Usually does not have significant difficulties with speech motor planning or coordination. |
| Needs specialized, motor-based therapy focused on improving the brain’s ability to plan and coordinate speech movements. Progress may be slow if traditional therapy is used. | Often responds well to traditional speech therapy and typically makes steady progress. |
An accurate diagnosis helps guide the right treatment.
How is Childhood Apraxia of Speech Treated?
Early and frequent therapy for childhood apraxia of speech is key. If a child is diagnosed with CAS or is suspected to have CAS, early specialized intervention can help reduce frustration, build communication skills and help the child be understood. Treatment focuses on repeated practice of speech movements with specific support. This helps the brain learn new motor plans.
Therapies may include:
- Dynamic Temporal and Tactile Cueing (DTTC): This is a motor-based therapy that helps children learn meaningful words and phrases through practice and repetition. The speech-language pathologist uses different levels of support and cues to help the child learn movement patterns without errors. DTTC is used to treat children with moderate to severe CAS symptoms.
- Rapid syllable transition treatment (ReST): This is a motor-based therapy that uses made-up words to help children practice speech sounds, word stress and smooth transitions between syllables. It is used for children with CAS and ataxic dysarthria (when your speech sounds “off rhythm” because your brain can’t smoothly control the muscles used for talking).
- Integrated Phonological Awareness (IPA): This is a language-based therapy that teaches speech sounds, sound patterns and letter-sound connections at the same time. IPA was originally designed for preschool children with speech-language impairments. Research shows that young children with CAS also improve their speech production with this approach.
- Nuffield Dyspraxia Program, Third Edition (NDP3): This is a motor-based therapy that builds speech skills step by step, from individual sounds to words and sentences. It is used for children with severe speech sound disorders, including CAS.
Research shows two to four therapy sessions per week can help children with CAS make faster progress. Parents play an important role. Your child’s therapist will show you how to practice at home.
Some children with CAS may benefit from augmentative and alternative communication (AAC) to support their speech and language. AAC can include picture boards, sign language or speech-generating devices. Research shows that using AAC does not stop speech from developing. It supports communication while speech improves.
Can Children with Apraxia Catch Up?
Many children with childhood apraxia of speech make strong progress with therapy. Progress may take time. Some children may continue to have mild speech differences. Others may catch up to their peers.
How Long Does It Take to See Improvement?
Each child is different. Progress depends on how severe their childhood apraxia of speech is, how often they receive therapy and practice at home, and if they have additional diagnoses.
Consistency is key. With regular therapy and practice, speech usually becomes clearer over time. Significant progress often takes one year or more.
Frequently Asked Questions About Childhood Apraxia of Speech
Is childhood apraxia of speech (CAS) the same as a typical speech sound disorder?
No. Childhood apraxia of speech is a motor-based disorder. A typical speech sound disorder follows more predictable patterns and often improves more easily.
Will my child with childhood apraxia of speech (CAS) ever speak clearly?
Many children develop clear speech with early and consistent therapy. Progress takes time, but steady gains are common with specialized therapy.
Can childhood apraxia of speech (CAS) improve without therapy?
Children without therapy rarely make consistent progress. Children with CAS need specialized, frequent speech therapy. Practicing at home also plays an important role.
Can children with apraxia attend regular school?
Yes. Many children attend regular classes with support.
When should I seek an evaluation for my child’s speech?
If your child has few or inconsistent words by 18 months or speech that is hard to understand, talk with your child’s doctor.
