Speech Disorders

Childhood Apraxia of Speech

Childhood Apraxia of Speech (CAS) is a motor speech disorder. Not to be confused with developmental speech delay, CAS is a neurological condition which affects the child’s ability to plan, sequence, and execute the movements necessary to produce sounds, syllables, and words. This is not due to muscle weakness or paralysis. The child may also have difficulty receiving sensory feedback regarding the placement of the articulators for speech.

A child with Childhood Apraxia of Speech may exhibit the following speech behaviors (Kamhi & Pollock, 2005):

  • Inappropriate or abnormal word/sentence stress
  • Variability or inconsistent speech error patterns
  • Reduced sound repertoire (sound bank contained in the brain contains fewer sounds than expected for such a child’s age)
  • Increased speech sound errors with increased word or phrase length and complexity (e.g. spaghetti may be harder to say than pig)
  • Groping when attempting to say a difficulty word or phrase, with several attempts to say it

How do I know if my child has Childhood Apraxia of Speech (CAS)?

All children are different, therefore, CAS manifests differently in each child. This list of possible signs is a guideline of characteristics but not all symptoms need to be present for a child to be diagnosed with CAS.

A Very Young Child

  • Does not coo or babble as an infant
  • First words are late, and there may 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 of speech does so more often)
  • May have problems eating

An Older Child

  • Makes inconsistent sound errors that are not the result of immaturity
  • Can understand language 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 to 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

Potential Other Problems

  • Delayed language development
  • Other expressive language problems like word order confusions and word recall
  • Difficulties with fine motor movement/coordination
  • Over sensitive (hypersensitive) or under sensitive (hyposensitive) inside the mouth (e.g., may not like toothbrushing or crunchy foods, may not be able to identify an object in the mouth through touch)
  • May have problems when learning to read, spell, and write

How can speech therapy help?

The purpose of speech therapy for children with CAS is to improve the planning, sequencing, and coordination of muscles needed for speech production. Treatment sessions for CAS are often short in duration and frequent, often 3-5 times per week. Using multiple repetitions of sounds, syllables, and/or words in play-based therapy is a hallmark of CAS treatment.


Kamhi, Alan G. & Pollock, Karen E. (2005).  Phonological Disorders in Children.  London, England: Paul H. Brooks Publishing Co.

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