Speech and Language Delay

Apraxia of Speech

Childhood Apraxia of Speech (CAS) is a rare speech disorder that impacts children’s ability to say sounds, syllables, and words. Children with CAS are unable to speak with ease because their brains struggle to control the body parts (jaw, lips, tongue, etc.) and muscle movements associated with speech.

Signs and Symptoms

Childhood Apraxia of Speech symptoms will vary in children based on age and the severity of the disorder. In addition to signs of a general speech disorder, symptoms characteristic of CAS include the following:

  • Inability to transition smoothly between sounds or words
  • Incorrect emphasis on syllables when pronouncing words
  • Distortion of or an incorrect use of vowels
  • Uncommon gaps or pauses between syllables when speaking
  • Problems repeating simple words
  • Inconsistency when making errors (i.e. saying the same word wrong in multiple different ways)


Childhood Apraxia of Speech is a motor speech disorder that results from a disability in the brain function that controls the muscles and body parts needed for speech. Normally, the cause behind CAS in a particular child is indeterminable. However, doctors and other experts believe that possible causes of CAS can include:

  • Symptoms of a genetic disorder or condition (CAS does occur more often in children with conditions such as velocardiofacial syndrome and galactosemia)
  • Neurological conditions
  • Traumatic brain injuries or infections
  • Stroke

It is important to note that while CAS is also known as “developmental apraxia,” this does not necessarily mean that children will outgrow the disorder as they get older.


Children suspected of having a language delay such as Childhood Apraxia of Speech are evaluated by a Speech-Language Pathologist (SLP). The evaluation will most likely include a process that reviews your child’s speech abilities, muscles movements, and medical history. It can be particularly difficult to diagnose CAS because the process requires multiple tests and observations and also because it may be difficult for the speech-language pathologist to communicate with your child. Initially, a hearing test may be performed to determine if hearing loss could be causing speech problems. Afterwards, your child’s SLP will conduct an evaluation that involves the following:

  • Oral-motor assessment: Your child’s doctor will test for muscle-weakness or low muscle tone in the jaw, tongue, or lips (a condition known as dysarthria). Children with CAS do not tend to have muscle weaknesses. You child will be evaluated on how they coordinate movements of their mouth in nonspeech activities such as blowing, frowning, or kissing. Also, the SLP will examine muscle movements while your child repeats certain sounds.
  • Melody of speech (intonation) assessment: During this portion of the evaluation, the SLP will check to see if your child correctly puts stress on syllables and words. The doctor will also assess how well your child can mark different types of sentences using pauses and pitch.
  • Speech Sound Assessment: In this part of the assessment, an SLP will look at how well your child sounds out vowels and consonants and how well others understand your child’s speech.


The main form of treatment for Childhood Apraxia of Speech is speech therapy. Therapy for CAS focuses on improving muscle coordination for speech and is often very intensive. Studies have shown that frequent (3-5 days a week) and individual treatment tends to be more successful in improving a child’s speech. Some common characteristics of speech therapy for CAS include:

  • Speech language pathologists will use various feedback cues such as touch and sight to help your child practice and improve their speech.
  • Some children may be taught sign language or other alternative communication systems if the apraxia is severe and makes communication difficult during treatment.
  • Your child will practice syllables and words instead of individual sounds during therapy.

Next Steps

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