Incidence of childhood apraxia of speech (CAS) refers to the number of new cases identified in a specified time period. Prevalence of CAS refers to the number of people who are living with the condition in a given time period.

The population point-prevalence estimate for CAS in children 4–8 years of age is currently estimated to be 1 in 1,000 (Shriberg, Kwiatkowski, & Mabie, 2019). Among children 4–8 years of age with idiopathic speech delay, it has been estimated that the prevalence of CAS falls around 2.4% (Shriberg, Kwiatkowski, & Mabie, 2019). In children with complex neurodevelopmental disorders, estimates are larger, with 4.3% meeting the criteria for CAS alone and an additional 4.9% meeting the criteria for CAS with coexisting childhood dysarthria (Shriberg, Strand, et al., 2019).

CAS was reportedly more prevalent in individuals with the following conditions:

• 22q11.2 deletion syndrome (Shriberg, Strand, et al., 2019)
• CDK13-related disorder (Morison, van Reyk, et al., 2023)
• Down syndrome (Shriberg, Strand, et al., 2019; Wilson et al., 2019)
• galactosemia (Potter et al., 2013; Shriberg, Potter, & Strand, 2011; Shriberg, Strand, et al., 2019)
• heterozygous disruption of FOXP2 (Morison, Meffert, et al., 2023)
• velocardiofacial syndrome (Kummer et al., 2007)

It should be noted that there are no large-scale, population-based studies investigating the prevalence of CAS in children who are on the autism spectrum. Limited evidence from studies showed mixed findings, with some that found a higher prevalence of CAS among individuals on the autism spectrum (Tierney et al., 2015), whereas others indicated that CAS was not more prevalent in individuals who are on the autism spectrum (Shriberg, Strand, et al., 2019). A higher prevalence of children met the criteria for CAS in one study of children on the autism spectrum who are minimally speaking (Chenausky et al., 2019), but another study showed no significant difference in the prevalence of CAS for children on the autism spectrum who have intelligible speech (Shriberg, Paul, et al., 2011). Comorbid autism was not associated with greater risk for severe CAS (Chenausky et al., 2023).

Likewise, there were also mixed findings regarding the prevalence of CAS in individuals with 16p11.2 deletion syndrome (Fedorenko et al., 2016; Mei et al., 2018; Shriberg, Strand, et al., 2019).

Of children diagnosed with CAS, over 95% had comorbid expressive language disorder. Children with comorbid intellectual disability, receptive language disorder, and nonspeech apraxia were significantly more likely to have severe CAS (Chenausky et al., 2023).

Currently, there are no validated diagnostic features that differentiate childhood apraxia of speech (CAS) from other childhood speech sound disorders (Murray et al., 2021). However, the following core features consistent with a deficit in the planning and programming of movements for speech have gained some consensus among researchers (ASHA, 2007b):

• inconsistent errors on consonants and vowels in repeated productions of syllables or words
• lengthened and disrupted coarticulatory transitions between sounds and syllables, including syllable segregation—pauses between sounds, syllables, or words that affect smooth transitions
• inappropriate prosody for their linguistic community, especially in the realization of lexical or phrasal stress

"Importantly, these features are not proposed to be the necessary and sufficient signs of CAS" (ASHA, 2007b, Definitions of CAS section, para. 1). The frequency of these and other signs may change depending on task complexity, age of the child, and severity of symptoms (Iuzzini-Seigel & Murray, 2017; Lewis et al., 2004).

Additional Reported Characteristics

Other characteristics that have been reported in children diagnosed with CAS and that represent difficulty in planning and programming articulatory movements for speech are listed below (Iuzzini-Seigel, Allison, & Stoeckel, 2022; Shriberg, Potter, & Strand, 2011):

• articulatory groping—articulatory searching prior to phonating
• consonant distortions
• increasing difficulty with longer or more complex syllables and word shapes
• schwa additions/insertions—insertion of schwa between consonants or at the word/syllable boundaries
• slower rate of speech than what is expected for age and/or language or dialect
• inconsistent voicing errors—voiceless sounds produced as their voiced cognates or vice versa
• vowel errors—vowel distortions or substitutions

Several of the features above overlap with dysarthria—such as consonant distortions, vowel distortions, slower rate of speech than expected, and voicing errors—and misdiagnosis could occur (Allison et al., 2023; Iuzzini-Seigel, Allison, & Stoeckel, 2022).

See "Differential Diagnosis" in the Assessment section on this page for more information about discriminating CAS characteristics from other speech sound disorders.

Co-Occurring Characteristics/Symptoms

The clinical features reportedly associated with CAS place a child at increased risk for problems in expressive language and weakness in the phonological foundations for literacy (e.g., Chenausky et al., 2023; Chou et al., 2024).

As in children with other speech disorders, the following co-occurring language and literacy problems are commonly present:

• delayed language development
• expressive language problems, such as word order confusion and grammatical errors
• problems learning to read, spell, and write
• problems with social language/pragmatics

The following nonspeech sensory and motor problems commonly co-occur (Davis et al., 1998; Dewey et al., 1988; Iuzzini-Seigel, 2019; Iuzzini-Seigel, Moorer, & Tamplain, 2022; McCabe et al., 1998; Shriberg et al., 1997):

• developmental coordination disorder
• gross and fine motor delays
• motor clumsiness
• oral apraxia
• limb apraxia
• feeding difficulties
• hyper- or hyposensitivity in the oral area (Newmeyer et al., 2009)

Childhood apraxia of speech (CAS) can be congenital or acquired during speech development. CAS can occur in one of the following contexts:

• as an idiopathic neurogenic speech sound disorder (i.e., in children with no observable neurological abnormalities or neurobehavioral disorders or conditions)
• as primary or secondary signs within complex neurobehavioral disorders—for example, autism; epilepsy; and syndromes such as fragile X, Rett syndrome, and Prader–Willi syndrome (Bashina et al., 2002; Boyar et al., 2001; Chenausky et al., 2023; Iuzzini-Seigel, Moorer, & Tamplain, 2022; Scheffer et al., 1995; Spinelli et al., 1995)
• in association with known neurological events—for example, intrauterine or early childhood stroke, infection, trauma, or brain tumor resection (see, e.g., Brown et al., 2000)

The neurological deficits underlying CAS are different from those that underlie dysarthria. Dysarthria is a deficit in motor execution and not in motor planning or programming.

Researchers have investigated possible genetic bases for CAS. Of particular interest are findings from studies of a four-generation London family—the KE family—many of whom have apraxia of speech. Findings suggest that deficits in the FOXP2 gene may negatively affect the development of neural networks involved in the learning and/or planning and execution of speech motor sequences (Lai et al., 2000, 2001; Liégeois et al., 2003; Marcus & Fisher, 2003; Shriberg et al., 2006; Tomblin et al., 2009; Zeesman et al., 2006).

More than 30 genes, including CDK13, EBF3, FOXP2, and SETBP1, account for approximately one third of CAS cases, either as a primary cause or within broader neurodevelopmental syndromes (Morgan et al., 2024).

Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of persons with CAS. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); prevention and advocacy; and education, administration, and research. See ASHA's Scope of Practice in Speech-Language Pathology (ASHA, 2016). See also ASHA's Position Statement on Childhood Apraxia of Speech (ASHA, 2007a).

Appropriate roles for SLPs include, but are not limited to, the following.

Education

• Provide information to people with a higher likelihood of CAS.
• Educate professionals, colleagues, and the public on the needs of people with speech sound disorders and the role of SLPs in diagnosing and managing CAS.

Screening and Assessment

• Screen people who present with possible CAS and determine the need for further assessment and/or referral for other services.
• Conduct a comprehensive assessment of speech, language, and communication that accounts for the influence of culture(s), language(s), and dialect(s) used by the people you assess.
• Diagnose the presence of CAS based on expert clinical judgment.
• Use dynamic assessment to differentially diagnose CAS and to determine severity and prognosis.
• Refer to and collaborate with other professionals to rule out other conditions, determine etiology, and facilitate access to comprehensive services (see ASHA’s resource on interprofessional education/interprofessional practice [IPE/IPP]).

Intervention and Support

• Provide diagnostic intervention to children suspected of having CAS.
• Make decisions about the management (e.g., treatment, service delivery) of CAS.
• Make recommendations for a multi-tiered system of support (e.g., response to intervention) in the schools to support speech and language development and academic progress.
• Make decisions, as part of the individualized education program team, about eligibility for services based on the presence of CAS and any co-occurring conditions.
• Serve as an integral member of an interdisciplinary team working with individuals with CAS and their families/caregivers (see ASHA’s resource on IPE/IPP).
• Develop treatment plans, provide intervention and support services, document progress, and determine appropriate service delivery approaches and dismissal criteria in collaboration with the family to address cultural considerations and honor language varieties.
• Counsel people with CAS and their families regarding communication-related access and provide education aimed at preventing further complications related to CAS.
• Consult and collaborate with family members, caregivers, and care partners to facilitate program development (see ASHA’s resource on focusing care on individuals and their care partners).
• Provide supervision, evaluation, and/or expert testimony, as appropriate.
• Remain informed of research around CAS, help advance the knowledge base related to the nature and treatment of this disorder, and use evidence-based practice to guide intervention.
• Advocate for appropriate speech-language pathology services for individuals with CAS and their families at the local, state, and national levels.

As indicated in the ASHA Code of Ethics (ASHA, 2023), SLPs who serve this population should be specifically educated and appropriately trained to do so. SLPs who diagnose and treat CAS must possess skills in differential diagnosis of childhood motor speech disorders, specialized knowledge in motor learning theory, and experience with appropriate intervention techniques that may include augmentative and alternative communication and assistive technology. SLPs without the required skills should make appropriate referrals or seek supervision from those who do.

Screening

Screening is conducted by a speech-language pathologist (SLP) whenever a speech sound disorder (SSD) is suspected or as part of a comprehensive speech and language evaluation for a child with communication concerns. The purpose of the screening is to identify those who require further speech-language assessment or referral to other professional services. For a more detailed list of screening components, see the Screening section of ASHA's Practice Portal page on Speech Sound Disorders: Articulation and Phonology.

Children who are suspected of having childhood apraxia of speech (CAS) based on the presence of features indicating deficits in motor planning or programming should be given a comprehensive motor speech assessment by an SLP with experience in pediatric motor speech disorders. For information about young children suspected of having CAS, see the "Diagnosis Under 3 Years of Age" section on this page.

To date, there are no available CAS-specific standardized screening tools. However, with an understanding of the symptoms suggestive of CAS, clinicians can adapt multisyllabic word lists for dynamic assessment, use repeated lines from stories, or find other ways to elicit and prompt accurate speech movement.

Comprehensive Assessment

Consistent with the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) framework (WHO, 2001), comprehensive assessment identifies and describes functioning, disability, and contextual factors (ASHA, 2016).

See ASHA's International Classification of Functioning, Disability, and Health (ICF) for examples of assessment data consistent with ICF for various clinical disorders.

Assessment involves a variety of standardized and nonstandardized measures and activities. See ASHA's resource on assessment tools, techniques, and data sources. Keep in mind that standard scores cannot be reported for assessments that are not normed on a group representative of the individual being assessed.

When evaluating an individual’s speech and language skills, SLPs consider how culture, language, and identity shape communication. SLPs choose assessments that account for language variation and cultural influences to ensure accurate interpretations of the results. SLPs consult the latest research and best practices when evaluating SSDs in the language(s) and/or dialect(s) that the person uses (see, e.g., McLeod et al., 2017; Washington et al., 2025). See the “Cultural and Linguistic Considerations During Assessment” section on this page and ASHA’s Practice Portal page on Cultural Responsiveness. See the "Cultural and Linguistic Considerations During Assessment" section on this page and ASHA's Practice Portal page on Cultural Responsiveness.

Comprehensive assessment of SSDs generally includes the following:

• case history
• hearing screening
• oral mechanism examination
• speech sound assessment in multiple contexts (e.g., picture naming like an articulation test, connected speech like a story retell task, dynamic assessment tool)
• language screening and evaluation, if possible

For details, see the "Comprehensive Assessment" section of ASHA's Practice Portal page on Speech Sound Disorders: Articulation and Phonology. See also ASHA's two Practice Portal pages on Spoken Language Disorders and Written Language Disorders.

Motor Speech Assessment

Motor speech assessment is critical for

• differentiating CAS from other SSDs, such as childhood dysarthria and phonological disorder, and
• identifying both oral apraxia and apraxia of speech—either of which may occur in the absence of the other.

See McCauley and Strand (2008) for a discussion of nonverbal oral and speech motor performance assessment tools.

Evaluating movement accuracy is a key consideration in motor speech assessment. The SLP uses various tasks to assess the segmental and suprasegmental features and other clinical characteristics of CAS. These tasks help identify the presence of motor-based planning and speech difficulties (see the “Signs and Symptoms” section on this page).

Examples of tasks include the following (McCabe et al., 2024):

• single words that include all phonemes in languages and/or dialects used across different word positions
• multisyllabic words
• connected speech sample
• repeated productions of single words and nonsense words
• oral motor assessment, including nonspeech tasks (e.g., smile, kiss–smile) and speech tasks
• sequential and alternating movement repetitions (e.g., /pɑpɑpɑ/ and /pʌtʌkʌ/)

Sequencing errors may consist of inaccuracies, inconsistency (i.e., not producing the same sound or syllable in each repetition—whether correct or not), or mis-ordering sounds (Velleman et al., 2012). In preschool children, consistency and accuracy of repetitions are likely to be more useful performance indicators than repetition rate (Williams & Stackhouse, 1998, 2000; Wong et al., 2025). Sound sequencing errors are also sometimes related to difficulty with phonological assembly. SLPs should also consider the stress and/or rhythmicity of a child’s productions as means of investigating movement ability.

Assessment includes performance across multiple contexts since results can vary by context. For example, an SLP would assess speech sound production during spontaneous, elicited, and imitated utterances (McCabe et al., 2024). SLPs monitor any changes in the following five variables within different contexts (e.g., the child’s speech might be smoother when speaking slowly than when speaking rapidly):

1. fluidity (smoothness)
2. rate
3. consistency
4. lexical stress
5. accuracy

The Role of Dynamic Assessment

Dynamic assessment is important for differential diagnosis of CAS and determining severity and prognosis (Strand & McCauley, 2019; Strand et al., 2013). During dynamic assessment, the clinician provides cues and strategies to help improve a child’s productions and better understand a child’s speech production skills. Observations during dynamic assessment inform treatment planning because the clinician understands what prompts, cues, and strategies work best for the person with CAS. It also offers potential starting points for intervention by identifying areas of breakdown.

Comprehensive assessment may result in one or more of the following:

• Identification of a hearing loss
• Diagnosis or provisional diagnosis of CAS or diagnosis of other SSDs (e.g., articulation and/or phonological disorder)
• Description of the characteristics and severity of the disorder
• Identification of factors that might contribute to the SSD
• Diagnosis of a spoken language (listening and speaking) disorder
• Identification of literacy (reading and writing) problems
• Monitoring of literacy learning progress in students whom SLPs and other professionals within the school setting have identified as having SSD
• Recommendations for a multi-tiered system of support (e.g., response to intervention) in the child’s school to support speech and language development and academic progress—if academic, behavioral, and/or socio-emotional concerns arise
• Recommendations for speech and language intervention, including augmentative and alternative communication measures and language(s) of service delivery, as needed
• Referral to the following professionals, as needed:
  • an audiologist for a comprehensive hearing evaluation if the child does not pass a routine hearing screening
  • an ear, nose, and throat doctor (otolaryngologist) if resonance or voice issues are of concern
  • an occupational therapist for nonspeech, sensory motor, or fine motor issues
  • a physical therapist if gross motor skills or overall muscle tone is of concern
  • a pediatric neurologist if neurological indicators (e.g., potential seizure activity, dysarthria symptoms without a prior neurodevelopmental diagnosis, tremors, or imbalance) are present
  • a geneticist if the child’s medical or family history suggests the possibility of a neurobehavioral disorder of genetic origin (e.g., fragile X syndrome, Rett syndrome, dysmorphology)

Cultural and Linguistic Considerations During Assessment

CAS will influence production across all languages in multilingual speakers. However, clinical features may not be the same across languages, and language-specific features may be present. Therefore, SLPs cannot directly apply English diagnostic features or checklists to those who do not speak English.

Shared Features

Studies suggest that the following CAS features are shared across languages (e.g., Lahtein-Kürsa et al., 2025; Malmenholt et al., 2017; Meloni et al., 2020; Shakibayi et al., 2019; Wong et al., 2020):

• inconsistent errors
• articulatory groping
• difficulty with diadochokinetic tasks
• difficulty with increasing syllable complexity and length of utterance
  vowel and/or consonant cluster errors
• differences in prosody, but may manifest differently depending on the language

Language-Specific Features

Phonemic systems. SLPs consider the language-specific features related to the phonemes and the number of vowels within a language. For example, Lithuanian SLPs noted palatalization errors because most Lithuanian consonants differ only in palatalization, and Estonian SLPs noted distorted diphthongs (Lahtein-Kürsa et al., 2025). Cantonese speakers with CAS may de-aspirate typically aspirated sounds, reflecting similar underlying motor planning deficits observed in English speakers with CAS, who often substitute voiced or voiceless sounds (Wong et al., 2020). Visit ASHA’s resources on phonemic inventories across languages for more information about phonemes in specific languages.

Word and syllable structures. Word and syllable structures (e.g., frequency of consonant clusters) in a language may also influence errors. For example, Meloni et al. (2020) reported that intrusive schwas and vowels, a common CAS feature in English, were not demonstrated in French speakers with CAS, but more research was needed.

Prosody. SLPs also consider the variation in prosodic systems across languages, such as lexical stress versus lexical tone. In tonal languages, which rely on changes in pitch within a syllable to change the meaning of a word, CAS can result in communication breakdowns because subtle changes in pitch alter meanings. For example, Cantonese speakers with CAS have difficulty with pitch contrasts and variations (Wong et al., 2024). Conversely, in a nontonal language, such as Hebrew, lexical stress may not be a sensitive enough diagnostic marker for identifying CAS in Hebrew-speaking children (Tubi et al., 2024).

Additional Cultural and Linguistic Considerations

The SLP needs to carefully review the language’s phonology, tone, length, morphology, and prosody when adapting the materials to different cultural and linguistic contexts.

Cultural responsiveness is crucial for multilingual speech assessments because they may involve languages and/or dialects that the SLP does not use. Examples of culturally responsive methods include (McLeod et al., 2017; Washington et al., 2025)

• speech assessments of all the languages that the child uses (e.g., Margetson & McLeod, 2026);
• cross-linguistic analysis;
• strengths-based assessment; and
• collaboration with the family and community to understand the child’s linguistic context.

See also ASHA’s Practice Portal pages on Multilingual Service Delivery in Audiology and Speech-Language Pathology and Cultural Responsiveness.

Diagnosing CAS

Diagnosis Under 3 Years Of Age

If caregivers express communication and hearing concerns, then the family should be referred for a screening and/or evaluation even if the child is younger than 3 years of age. Children younger than 3 years of age can qualify for early intervention services and supports if the child has—or is at risk for—a developmental delay, disability, or health condition.

Challenges to diagnosing infants and toddlers with CAS include the potential presence of a comorbid condition, limited verbal output for a more definitive diagnosis, and potential changes in speech during the first 3 years. However, some studies suggest early indicators of CAS. Early indicators could include (Highman et al., 2024; Overby et al., 2019)

• fewer vocalizations;
• fewer consonants;
• a less diverse phonetic inventory (e.g., early preference for stops and nasals);
• later consonant acquisition; and
• limited syllable/word shapes.

Because of the challenges listed above and the limited data of CAS from infancy, clinicians might provide provisional diagnostic classifications and continue to “treat as if” the child does have CAS. Provisional diagnostic classifications might look like

• “CAS cannot be ruled out”;
• “signs are consistent with problems in planning the movements required for speech”; or
• the child is “suspected to have CAS.”

Differential Diagnosis

Several instruments have been proposed for assessing the speech motor planning and programming skills considered to represent the core deficits in CAS; however, the rigor of their psychometric characteristics has been called into question (see, e.g., McCauley & Strand, 2008).

The SLP can use dynamic assessment as a method for examining both the question of differential diagnosis and the value of particular types of cues (Strand & McCauley, 2019; Strand et al., 2013). The chart below provides a basic comparison between the characteristics of CAS, dysarthria, and nonmotor-based SSD. However, CAS can also co-occur with dysarthria and/or a phonologically based SSD.

*See the section on "CAS Versus Other SSDs" for more information. This chart does not capture all the nuances of differential diagnosis of CAS, which are elaborated below.

CAS Versus Other SSDs

Many of the features associated with CAS are also found in children with more broadly defined SSDs (McCabe et al., 1998; Shriberg et al., 2017). The diagnosis of CAS cannot be based solely on the severity of a child’s SSD, as this may result in overdiagnosis.

The SLP may need to distinguish CAS from a subtype of idiopathic SSDs (e.g., consistent phonological disorder, inconsistent phonological disorder). Although CAS features can overlap with other SSDs, CAS is characterized by weak motor planning and lexical stress errors (Murray et al., 2021; Rvachew & Matthews, 2024). Consistent phonological disorder is characterized by predictable errors and weak phonological processing (Rvachew & Matthews, 2024). Inconsistent phonological disorder is characterized by weak phonological planning and inconsistent whole-word errors (Rvachew & Matthews, 2024). For example, the same person might pronounce “strawberry” as /sɔbi/, /ʃɔbɛwi/, or /tɔbɹi/ during different occasions. Therefore, the SLP needs to look for other symptoms of planning and programming difficulty outside of token-to-token variability to help differentiate challenges with phonological assembly from motoric deficits.

Differentiating CAS from dysarthria presents a significant challenge, especially in mild–moderate presentations, because these disorders can share several speech, prosody, and voice features (Iuzzini-Seigel, Allison, & Stoeckel, 2022). Iuzzini-Seigel, Allison, and Stoeckel (2022) discuss how SLPs can review which features are considered unique to CAS (e.g., syllable segregation, lexical stress errors) and dysarthria (e.g., audible inspiration, loudness decay, imprecise articulatory contacts) and which features overlap both disorders (e.g., vowel errors, consonant distortions, slow rate).

See Iuzzini-Seigel, Allison, and Stoeckel (2022) for a checklist that differentiates diagnosis of CAS and dysarthria in children.

CAS can also co-occur with dysarthria (Braden et al., 2021; Wilson et al., 2019) or, in some cases, fluency disorders. A child’s limited speech sound production skills may mask these other diagnoses or make it difficult to determine the contribution of these different diagnoses to the child’s overall speech profile. See ASHA’s Practice Portal page on Stuttering, Cluttering, and Fluency for more information.

Treatment goals for children with childhood apraxia of speech (CAS) focus on improving overall communication and language skills. These goals are achieved by

• increasing speech production and intelligibility and/or
• using augmentative and alternative communication (when indicated), such as gestures, manual signs, voice output devices, and context-specific communication boards.

See ASHA’s International Classification of Functioning, Disability, and Health (ICF) webpage for examples of functional goals consistent with the ICF framework for various clinical disorders.

Many children with CAS also have phonological impairment and/or language disorder. Speech-language pathologists (SLPs) aim to consider the relative contribution of motoric and linguistic deficits when planning treatment. For example, if a child has mild motoric deficits and significant phonological deficits, then the SLP would prioritize linguistic approaches while also bringing in principles of motor learning (PMLs) to facilitate movement accuracy (Maas et al., 2008, 2014; McCabe et al., 2014; McCauley & Strand, 1999).

Treatment Components and Approaches

Below are brief descriptions of treatment components and approaches that address CAS. Many clinicians combine approaches to meet the needs of their clients, patients, and students. This list is not exhaustive, and the inclusion of any specific treatment approach does not imply endorsement from ASHA. Visit the Treatment section of the Apraxia of Speech (Childhood) Evidence Map for evidence summaries.

General Treatment Components

Effective treatment approaches for CAS emphasize movement gestures versus sound patterns. Many treatment approaches for CAS incorporate the following techniques:

• Shaping the best and most accurate productions possible.
• Sensory cueing approaches involve the child’s senses to teach the movement sequences for speech. Sensory cues can be used separately or in a multisensory approach. These approaches may facilitate speech production by providing additional feedback to the child if they cannot benefit from, or does not receive, sufficient intrinsic sensory feedback. Many treatments for CAS incorporate sensory cueing (e.g., motor-based treatment approaches; Maas, 2024).

Types of Sensory Cueing Approaches

Visual cueing methods provide visual “cues” as to the shape, placement, or movement of the articulators. Visual cues can be gestural (e.g., simple hand signs) or more technologically advanced methods of biofeedback such as

• electropalatography readouts;
• ultrasound images (see, e.g., Preston et al., 2016);
• computerized speech viewing programs; and
• other forms of biofeedback that provide visual cues about speech movement performance.

Verbal/auditory cues provide explicit instruction on how to move the articulators during production attempts to help the child make more accurate movement sequences for speech (e.g., make a circle shape with your lips, push your lips out). Simultaneous productions (Strand, 2020) are often beneficial when supporting a new speech movement, as they provide both auditory and visual cues while the child also receives kinesthetic feedback from their own system.

Tactile facilitation methods provide direct tactile input for correct speech production. Using these methods, the SLP applies pressure or otherwise touches the child’s face, neck, and head to provide a tactile cue for correct production or speech movement gesture. PROMPT© (Prompts for Restructuring Oral Muscular Phonetic Targets) is one tactile method of treatment that is based on touch, pressure, kinesthetic, and proprioceptive cues (Dale & Hayden, 2013; Hayden et al., 2010). The Touch-Cue Method is another tactile approach in which touch cues are given at the same time as auditory and visual cues during the initial stages of therapy (Bashir et al., 1984).

Additional Treatment Components

A core set of child-specific functional stimuli (e.g., words or phrases) is often incorporated into various treatment approaches (Iuzzini & Forrest, 2010; Strand et al., 2006).

Treatment selection depends on factors such as the severity of the disorder and the communication needs of the child. Because symptoms typically vary both from child to child and within the same child with age (Lewis et al., 2004; Shriberg et al., 2003), multiple approaches may be appropriate at a given time or over time.

Apraxia in other systems may also play an important role in treatment. For example, the presence of limb apraxia may make it difficult for the child to use manual signs for functional communication. The presence of oral apraxia may support the need for either more aggressive or alternative approaches to the use of phonetic placement cues in speech treatment.

Motor Programming Approaches

Motor programming approaches typically include PMLs to facilitate the early acquisition of motor skills (e.g., saying a new word) and/or long-term learning and generalization. Clinicians may strategically start with certain practice conditions to promote early acquisition and then transition to other conditions to facilitate the child’s long-term learning, generalization, and independence. Relevant PMLs include the following (Maas et al., 2008):

• frequent and intensive practice of speech targets
• a focus on accurate speech movement
• external sensory input for speech production (e.g., auditory, visual, tactile, and cognitive cues)
• careful consideration of the conditions of practice (e.g., random vs. blocked practice of targets)
• appropriate types and schedules of feedback regarding performance

For a discussion of the PMLs as they apply to CAS and a review of motor-based treatment approaches for CAS, see Maas et al. (2014).

Examples of evidence-based motor programming approaches include the following:

• Dynamic Temporal and Tactile Cueing (DTTC) is a structured approach based on integral stimulation in which the clinician instructs the child to “look, listen, do what I do” (Strand et al., 2006). The key element of this approach is that the SLP is constantly adding or fading auditory, visual, and tactile cues as needed after each practice trial. The SLP uses multisensory cues to elicit the child’s productions along a temporal hierarchy that ranges from simultaneous production, followed by direct imitation, to delayed imitation. Prosodic variation is introduced at each level of this hierarchy to ensure natural-sounding productions all the way through. Finally, words are elicited at the spontaneous level in response to various prompts to ensure the child’s independent and accurate productions (Strand, 2020). Research shows that young children with moderate–severe CAS benefit from this approach (e.g., Grigos et al., 2024). It is not intended for long-term use (Strand, 2020).
• Nuffield Dyspraxia Programme (NDP3®) is a motor programming approach that emphasizes motor programming skills and focuses on speech output. It is designed for children 3–7 years old across the severity range but can be modified for older and younger children. As a “bottom-up” approach, this program aims to “build” accurate speech from core units of phonemes and simple syllables, ultimately building up to multisyllabic words, sentences, and connected speech. New motor programs are established using cues and feedback and through frequent practice and repetitive sequencing exercises. Clinicians can use minimal pairs to incorporate phonological skills into the treatment approach (Williams & Stephens, 2010).
• Rapid Syllable Transition Treatment (ReST) involves the repetition of varied sequences of nonsense syllables to train motor planning flexibility (Ballard et al., 2010; McCabe et al., 2020). It uses intensive practice in (a) producing multisyllabic pseudo-words to improve accuracy of speech sound production, (b) rapid and fluent transitioning from one sound or syllable to the next, and (c) control of syllable stress within words. Pseudo-words allow the development and practice of new speech patterns without interference from existing error speech patterns (Ballard et al., 2010; McCabe et al., 2017, 2020). This approach tends to be used for children with mild–moderate CAS.

Linguistic Approaches

Linguistic approaches for treating CAS focus on the rules for when speech sounds and sound sequences are used in a language. These approaches focus on speech function. They target speech sounds and groups of sounds with similar patterns of error to help the child internalize phonological rules. Linguistic approaches can support co-occurring phonological deficits, but they are often insufficient in addressing the motor speech planning and programming needs of children with CAS.

See ASHA’s Practice Portal page on Speech Sound Disorders: Articulation and Phonology for more specific linguistic approaches.

Prosodic Facilitation

Prosodic facilitation, or rhythmic approaches, use intonation patterns—melody, rhythm, and stress—to improve functional speech production. Melodic intonation therapy (MIT; Albert et al., 1973), initially developed for aphasia, is a prosodic facilitation approach that uses singing, rhythmic speech, and rhythmic hand tapping to train functional phrases and sentences. MIT can be used in combination with other motor programming approaches (Martikainen & Korpilahti, 2011). Research is also emerging on using Speech–Music Therapy for Aphasia—a therapeutic approach that requires collaboration with an SLP and a music therapist—with children with CAS (van Tellingen et al., 2024).

Augmentative and Alternative Communication (AAC)

When a person with CAS cannot effectively communicate through oral communication alone, augmentative and alternative communication (AAC) can provide functional communication that supports and enhances verbal speech production at the same time (Bornman et al., 2001; Cumley & Swanson, 1999; Yorkston et al., 2010). AAC approaches may also stimulate the development of language skills that cannot be practiced orally (Cumley & Swanson, 1999; Murray et al., 2014).

Aided AAC needs some type of transmission device. Examples of aided AAC include picture communication, line drawings, and speech-generating devices. Unaided AAC requires only body movements. Examples of unaided AAC include manual signs, gestures, and finger spelling.

See ASHA’s Practice Portal page on Augmentative and Alternative Communication (AAC) for more information.

Considerations For Bilingual and Multilingual Populations

The following information and treatment considerations are summarized below (Gildersleeve-Neumann et al., 2023):

Importance of Using Multilingual Treatment in CAS

• Bilingual treatment for CAS may encourage improvement in the child’s overall speech sound system, including nontreated phonological error patterns (Gildersleeve-Neumann & Goldstein, 2014).
• Children may appear to prefer one language, but this may reflect a preference for the easier motor task and not necessarily a true preference for that language. This pattern does not justify limiting communication to a single language for the child and family.

Strategic Target Selection

• Targeting errors that are present in only one language is unlikely to improve intelligibility in additional language(s). For example, if final consonants are targeted in English to improve intelligibility but occur rarely in the child’s language(s), intelligibility in additional language(s) may not be positively influenced by targeting final consonant productions in English.
• Beginning treatment by targeting phonemes shared by all languages improves intelligibility across languages (Irizarry-Pérez et al., 2024).
• Addressing patterns with similar error rates in all languages can result in a cross-linguistic transfer of skills (Yavas & Goldstein, 1998).

Language-Specific Considerations

• Goals and targets in each language are chosen based on the properties and word shapes of each language. English has more monosyllabic words with consonant clusters; thus, targets in English should be representative of this word shape.
• Clinicians (a) consider the contexts in which a child uses each language and (b) identify vocabulary words that are likely to facilitate carryover, functional use, and repeated practice and exposure in each language.

Treatment Design and Home Practice

• Treatment incorporates activities that facilitate cross-linguistic transfer of skills and improved intelligibility.
• Home practice activities are provided in the language(s) used by the family.

Monitoring Progress and Adjusting Treatment

• SLPs monitor progress in all languages. They note the consistency of improvements and any generalization across languages.
• If the child is not making progress, then the SLP modifies goals and approaches, as needed.

For general information about treating a bilingual or multilingual child with a speech sound disorder, see the "Treatment" section of ASHA's Practice Portal page on Speech Sound Disorders: Articulation and Phonology. See also ASHA's Practice Portal page on Multilingual Service Delivery in Audiology and Speech-Language Pathology.

Considerations in Schools

The Individuals with Disabilities Education Improvement Act of 2004 (IDEA) details the criteria for eligibility for services in the school setting. In accordance with IDEA, the SLP determines

• if a child has an SSD in all languages or dialects used,
• if there is an adverse effect on educational performance or social interactions resulting from the disability,
• if the child meets eligibility criteria specific to that state, and
• if specially designed instruction and/or related services and supports are needed to help the child make progress in the general education curriculum.

For information about eligibility and dismissal from speech-language pathology services in the schools, see the "Considerations for Treatment in Schools" section of ASHA's Practice Portal page on Speech Sound Disorders: Articulation and Phonology.

See also ASHA's resources on eligibility and dismissal in schools, IDEA Part B Issue Brief: Individualized Education Programs and Eligibility for Services, and 2011 IDEA Part C Final Regulations.

Children With Persisting Speech Difficulties

For some children, speech difficulties persist throughout their school years and sometimes into adulthood. Pascoe, Stackhouse, and Wells (2006) define persisting speech difficulties as "difficulties in the normal development of speech that do not resolve as the child matures or even after they receive specific help for these problems" (p. 2).

Persisting difficulties for children with CAS can include the following (Lewis et al., 2024):

• prosody issues
• speech sound distortions or errors
• ongoing difficulty with handling unfamiliar multisyllabic words
• literacy skills below grade-level expectations

For more detailed information about treatment options for children with persisting speech difficulties, see the "Children With Persisting Speech Difficulties" section of ASHA's Practice Portal page on Speech Sound Disorders: Articulation and Phonology.

Postsecondary Transition Planning

Children with persisting speech difficulties may continue to have problems with oral communication, literacy, and social aspects of life as they transition to postsecondary education and vocational settings (Lewis et al., 2024). The potential impact of persisting speech difficulties highlights the need for continued support to facilitate a successful transition to young adulthood. See ASHA's resource on postsecondary transition planning.

Service Delivery

See the Service Delivery section of the Apraxia of Speech (Childhood) Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective.

Service delivery variables, along with the type of treatment approach, impact treatment outcomes. Thesevariables include dosage, format, provider, timing, and setting.

Dosage

Dosage refers to the frequency, intensity, and duration of service. 

A high treatment dosage for CAS is consistent with PMLs (Maas et al., 2008, 2014; McNeil et al., 1997). Motor speech disorders, including CAS, require repetitive and individualized planning, programming, and production practice. For example, high frequency of trials (100 productions in 15 minutes) showed quicker acquisition of targets and more generalization than 30–40 productions in 15 minutes (Edeal & Gildersleeve-Neumann, 2011). Children with CAS receiving a lower frequency (i.e., twice per week over 12 weeks) can eventually make the same communication gains over time as children receiving a higher frequency (i.e., four times per week); however, the clinician may need to weigh the cost of a slower improvement of the child’s functional communication with a lower frequency and dosage (Iuzzini-Seigel et al., 2025).

Therefore, intensive and individualized treatment of childhood apraxia is often necessary (Hall et al.,1993; Namasivayam et al., 2015; Strand & Skinder, 1999).

Format

Format refers to the structure of the treatment session (e.g., group, individual, telepractice). 

The type of treatment format (individual vs. group vs. both) depends on the primary goal for the child at a particular point in the treatment process. For example, if the primary goal is to improve the motor aspects of speech, individual sessions that emphasize motor practice are the preferred approach. However, once the child has made progress on goals targeting motor speech production, goals might then include generalization, language, and the enhancement of pragmatic skills. At that point, a combination of individual and group treatment may be appropriate.

Audiology and speech-language pathology services can also be delivered via telepractice. There is emerging evidence that children receiving CAS interventions via telepractice make positive gains, but research is limited (Bahar et al., 2022). See ASHA’s Practice Portal page on Telepractice. Visit ASHA State-by-State for state-specific telepractice requirements. Visit ASHA’s resource on coding and payment of communication technology-based services for reimbursement information.

Provider

Provider refers to the person providing the treatment (e.g., SLP, trained volunteer, caregiver).

SLPs treat the speech motor and linguistic aspects of the child’s SSD. Other professionals (e.g., physical therapist or occupational therapist) may also be involved in the treatment of children with apraxia. It is important for SLPs to collaborate with other professionals about treatment alternatives and to participate in co-treatment when appropriate (Davis & Velleman, 2000; Velleman & Strand, 1994).

See ASHA’s resource on interprofessional education/interprofessional practice (IPE/IPP).

Timing

Timing refers to timing of intervention relative to diagnosis.

When a child is diagnosed with CAS, they likely demonstrate a significant speech disorder that warrants immediate intervention. Early treatment is also indicated for children suspected of having CAS or with a provisional diagnosis of CAS. A child’s progress with early intervention can provide more information to make a definitive diagnosis. Early motor-based treatment is critical in maximizing progress and treatment outcomes.

Setting

Setting refers to the location of treatment (e.g., home, community-based).

Whenever possible, treatment takes place in a naturalistic setting and considers the family’s cultural and linguistic needs. A naturalistic treatment environment involves as many important people in the child’s life as possible to facilitate generalization and carryover of skills. Involving caregivers in treatment helps them understand their child’s goals and encourages home and community practice.

ASHA Resources

• Childhood Apraxia of Speech—Position Statement
• Childhood Apraxia of Speech—Technical Report
• Consumer Information: Childhood Apraxia of Speech
• Focusing Care on Individuals and Their Care Partners
• Interprofessional Education/Interprofessional Practice (IPE/IPP)
• Phonemic Inventories Across Languages
• Postsecondary Transition Planning

Other Resources

This list of resources is not exhaustive and the inclusion of any specific resource does not imply endorsement from ASHA.

• Age of Acquisition of English Consonants (Crowe & McLeod 2020) [PDF]
• Apraxia Kids
• Apraxia Kids | Bilinguals With CAS: You’ve Got This
• Child Apraxia Treatment: Once Upon a Time Foundation
• National Institute on Deafness and Other Communication Disorders | Apraxia of Speech
• The University of Iowa | Phonetics: The Sounds of American English
• The University of Sydney | ReST Rapid Syllable Transition Training
• WETA Reading Rockets | The Development of Phonological Skills

Albert, M. L., Sparks, R. W., & Helm, N. A. (1973). Melodic intonation therapy for aphasia. Archives of Neurology, 29(2), 130–131. https://psycnet.apa.org/doi/10.1001/archneur.1973.00490260074018

Allison, K., Stoeckel, R., Olsen, E., Tallman, S., & Iuzzini-Seigel, J. (2023). Motor speech phenotypes in children with epilepsy: Preliminary findings. American Journal of Speech-Language Pathology, 32(4S), 1912–1922. https://doi.org/10.1044/2022_AJSLP-22-00176

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., Text rev.).

American Speech-Language-Hearing Association. (2007a). Childhood apraxia of speech [Position statement]. https://www.asha.org/policy/

American Speech-Language-Hearing Association. (2007b). Childhood apraxia of speech [Technical report]. https://www.asha.org/policy/

American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology [Scope of practice]. https://www.asha.org/policy/

American Speech-Language-Hearing Association. (2023). Code of ethics [Ethics]. https://www.asha.org/policy/

Bahar, N., Namasivayam, A. K., & van Lieshout, P. (2022). Telehealth intervention and childhood apraxia of speech: A scoping review. Speech, Language and Hearing, 25(4), 450–462. https://doi.org/10.1080/2050571X.2021.1947649

Ballard, K. J., Robin, D. A., McCabe, P., & McDonald, J. (2010). A treatment for dysprosody in childhood apraxia of speech. Journal of Speech, Language, and Hearing Research, 53(5), 1227–1245. https://doi.org/10.1044/1092-4388(2010/09-0130)

Bashina, V. M., Simashkova, N. V., Grachev, V. V., & Gorbachevskaya, N. L. (2002). Speech and motor disturbances in Rett syndrome. Neuroscience and Behavioral Physiology, 32, 323–327. https://doi.org/10.1023/A:1015886123480

Bashir, A. S., Grahamjones, F., & Bostwick, R. Y. (1984). A touch-cue method of therapy for developmental verbal apraxia. Seminars in Speech and Language, 5(2), 127–137. https://doi.org/10.1055/s-0028-1082519

Bornman, J., Alant, E., & Meiring, E. (2001). The use of a digital voice output device to facilitate language development in a child with developmental apraxia of speech: A case study. Disability and Rehabilitation, 23(14), 623–634. https://doi.org/10.1080/09638280110036517

Boyar, F. Z., Whitney, M. M., Lossie, A. C., Gray, B. A., Keller, K. L., Stalker, H. J., Zori, R. T., Geffken, G., Mutch, J., Edge, P. J., Voeller, K. S., Williams, C. A., & Driscoll, D. J. (2001). A family with a grand-maternally derived interstitial duplication of proximal 15q. Clinical Genetics, 60(6), 421–430. https://doi.org/10.1034/j.1399-0004.2001.600604.x

Braden, R. O., Amor, D. J., Fisher, S. E., Mei, C., Myers, C. T., Mefford, H., Gill, D., Srivastava, S., Swanson, L. C., Goel, H., Scheffer, I. E., & Morgran, A. T. (2021). Severe speech impairment is a distinguishing feature of FOXP1-related disorder. Developmental Medicine & Child Neurology, 63(12), 1417–1426. https://doi.org/10.1111/dmcn.14955

Brown, T., Cupido, C., Scarfone, H., Pape, K., Galea, V., & McComas, A. (2000). Developmental apraxia arising from neonatal brachial plexus palsy. Neurology, 55(1), 24–30. https://doi.org/10.1212/WNL.55.1.24

Chenausky, K. V., Baas, B., Stoeckel, R., Brown, T., Green, J. R., Runke, C., Schimmenti, L., & Clark, H. (2023). Comorbidity and severity in childhood apraxia of speech: A retrospective chart review. Journal of Speech, Language, and Hearing Research, 66(3), 791–803. https://doi.org/10.1044/2022_JSLHR-22-00436

Chenausky, K., Brignell, A., Morgan, A., & Tager-Flusberg, H. (2019). Motor speech impairment predicts expressive language in minimally verbal, but not low verbal, individuals with autism spectrum disorder. Autism & Developmental Language Impairments, 4. https://doi.org/10.1177/2396941519856333

Chou, S. T. Y., Sutherland, R., & McCabe, P. (2024). A systematic scoping review of the literacy skills of children with childhood apraxia of speech: Recommendations for best practice and further research. International Journal of Speech-Language Pathology, 26(3), 346–366. https://doi.org/10.1080/17549507.2024.2363935

Cumley, G., & Swanson, S. (1999). Augmentative and alternative communication options for children with developmental apraxia of speech: Three case studies. Augmentative and Alternative Communication, 15(2), 110–125. https://doi.org/10.1080/07434619912331278615

Dale, P. S., & Hayden, D. A. (2013). Treating speech subsystems in childhood apraxia of speech with tactual input: The PROMPT approach. American Journal of Speech-Language Pathology, 22(4), 644–661. https://doi.org/10.1044/1058-0360(2013/12-0055)

Davis, B. L., Jakielski, K. J., & Marquardt, T. P. (1998). Developmental apraxia of speech: Determiners of differential diagnosis. Clinical Linguistics & Phonetics, 12(1), 25–45. https://doi.org/10.3109/02699209808985211

Davis, B. L., & Velleman, S. L. (2000). Differential diagnosis and treatment of developmental apraxia of speech in infants and toddlers. Infant-Toddler Intervention: The Transdisciplinary Journal, 10(3), 177–192.

Dewey, D., Roy, E. A., Square-Storer, P. A., & Hayden, D. (1988). Limb and oral praxic abilities of children with verbal sequencing deficits. Developmental Medicine & Child Neurology, 30(6), 743–751. https://doi.org/10.1111/j.1469-8749.1988.tb14636.x

Edeal, D. M., & Gildersleeve-Neumann, C. E. (2011). The importance of production frequency in therapy for childhood apraxia of speech. American Journal of Speech-Language Pathology, 20(2), 95–110. https://doi.org/10.1044/1058-0360(2011/09-0005)

Fedorenko, E., Morgan, A., Murray, E., Cardinaux, A., Mei, C., Tager-Flusberg, H., Fisher, S. E., & Kanwisher, N. (2016). A highly penetrant form of childhood apraxia of speech due to deletion of 16p11.2. European Journal of Human Genetics, 24(2), 302–306. https://doi.org/10.1038/ejhg.2015.149

Gildersleeve-Neumann, C., & Goldstein, B. A. (2014). Cross-linguistic generalization in the treatment of two sequential Spanish–English bilingual children with speech sound disorders. International Journal of Speech-Language Pathology, 17(1), 26–40. https://doi.org/10.3109/17549507.2014.898093

Gildersleeve-Neumann, C., Michel, I., Beltrán, B., & Heath, A. (2023, May 17). Bilinguals with CAS: You’ve got this! https://www.apraxia-kids.org/wp-content/uploads/2023/06/Module-3-Bilinguals-CAS-Handout.pdf [PDF]

Grigos, M. I., Case, J., Lu, Y., & Lyu, Z. (2024). Dynamic Temporal and Tactile Cueing in young children with childhood apraxia of speech: A multiple single-case design. Journal of Speech, Language, and Hearing Research, 67(4), 1042–1071. https://doi.org/10.1044/2024_JSLHR-23-00415

Hall, P. K., Jordan, L. S., & Robin, D. A. (1993). Developmental apraxia of speech: Theory and clinical practice. Pro-Ed.

Hayden, D. A., Eigen, J., Walker, A., & Olsen, L. (2010). PROMPT: A tactually grounded model. In A. L. Williams, S. McLeod, & R. J. McCauley (Eds.), Interventions for speech sound disorders in children (pp. 453–474). Brookes.

Highman, C., Overby, M., Leitão, S., Abbiati, C., & Velleman, S. (2024). Update on identification and treatment of infants and toddlers with suspected childhood apraxia of speech. Journal of Speech, Language, and Hearing Research, 67(9S), 3288–3308. https://doi.org/10.1044/2023_JSLHR-22-00639

Individuals with Disabilities Education Improvement Act of 2004, Pub. L. No. 108-446, 20 U.S.C. § 1400 et seq. https://sites.ed.gov/idea/

Irizarry-Pérez, C. D., Peña, E. D., Bedore, L. M., & Falcomata, T. S. (2024). A cross-linguistic approach to treating speech sound disorders in bilingual children. Clinical Linguistics & Phonetics, 38(5), 433–452. https://doi.org/10.1080/02699206.2023.2219368

Iuzzini, J., & Forrest, K. (2010). Evaluation of a combined treatment approach for childhood apraxia of speech. Clinical Linguistics & Phonetics, 24(4–5), 335–345. https://doi.org/10.3109/02699200903581083

Iuzzini-Seigel, J. (2019). Motor performance in children with childhood apraxia of speech and speech sound disorders. Journal of Speech, Language, and Hearing Research, 62(9), 3220–3233. https://doi.org/10.1044/2019_JSLHR-S-18-0380

Iuzzini-Seigel, J., Allison, K. M., & Stoeckel, R. (2022). A tool for differential diagnosis of childhood apraxia of speech and dysarthria in children: A tutorial. Language, Speech, and Hearing Services in Schools, 53(4), 926–946. https://doi.org/10.1044/2022_LSHSS-21-00164

Iuzzini-Seigel, J., Grigos, M. I., Velleman, S., Thomas, D., Murray, E., Cavanaugh, R., Anumandla, S., & Case, J. (2025, November 20). Is more frequency better? A clinical RCT in 61 children with CAS [Conference session]. American Speech-Language-Hearing Association Convention, Washington, DC, United States.

Iuzzini-Seigel, J., Moorer, L., & Tamplain, P. (2022). An investigation of developmental coordination disorder characteristics in children with childhood apraxia of speech. Language, Speech, and Hearing Services in Schools, 53(4), 1006–1021. https://doi.org/10.1044/2022_LSHSS-21-00163

Iuzzini-Seigel, J., & Murray, E. (2017). Speech assessment in children with childhood apraxia of speech. Perspectives of the ASHA Special Interest Groups, 2(2), 47–60. https://doi.org/10.1044/persp2.SIG2.47

Kummer, A. W., Lee, L., Stutz, L. S., Maroney, A., & Brandt, J. W. (2007). The prevalence of apraxia characteristics in patients with velocardiofacial syndrome as compared with other cleft populations. The Cleft Palate Craniofacial Journal, 44(2), 175–181. https://doi.org/10.1597/05-170.1

Lahtein-Kürsa, M., Padrik, M., Daniutė, S., Kairienė, D., Martikainen, A.-L., Vanhala-Haukijärvi, M., & Mailend, M.-L. (2025). Diagnostic features of childhood apraxia of speech: A survey study of Estonian, Finnish, and Lithuanian speech-language pathologists. American Journal of Speech-Language Pathology, 34(1), 97–117. https://doi.org/10.1044/2024_AJSLP-24-00035

Lai, C. S. L., Fisher, S. E., Hurst, J. A., Levy, E. R., Hodgson, S., Fox, M., Jeremiah, S., Povey, S., Jamison, D. C., Green, E. D., Vargha-Khadem, F., & Monaco, A. P. (2000). The SPCH1 region on human 7q31: Genomic characterization of the critical interval and localization of translocations associated with speech and language disorder. American Journal of Human Genetics, 67(2), 357–368. https://doi.org/10.1086/303011

Lai, C. S. L., Fisher, S. E., Hurst, J. A., Vargha-Khadem, F., & Monaco, A. P. (2001, October 4). A forkhead-domain gene is mutated in a severe speech and language disorder. Nature, 413, 519–523. https://doi.org/10.1038/35097076

Lewis, B. A., Freebairn, L. A., Hansen, A. J., Iyengar, S. K., & Taylor, H. G. (2004). School-age follow-up of children with childhood apraxia of speech. Language, Speech, and Hearing Services in Schools, 35(2), 122–140. https://doi.org/10.1044/0161-1461(2004/014)

Lewis, B. A., Miller, G. J., Iyengar, S. K., Stein, C., & Benchek, P. (2024). Long-term outcomes for individuals with childhood apraxia of speech. Journal of Speech, Language, and Hearing Research, 67(9S), 3463–3479. https://doi.org/10.1044/2023_JSLHR-22-00647

Liégeois, F., Baldeweg, T., Connelly, A., Gadian, D. G., Mishkin, M., & Vargha-Khadem, F. (2003, October 12). Language fMRI abnormalities associated with FOXP2 gene mutation. Nature Neuroscience, 6, 1230–1237. https://doi.org/10.1038/nn1138

Maas, E. (2024). Treatment for childhood apraxia of speech: Past, present, and future. Journal of Speech, Language, and Hearing Research, 67(9S), 3495–3520. https://doi.org/10.1044/2024_JSLHR-23-00233

Maas, E., Gildersleeve-Neumann, C. E., Jakielski, K. J., & Stoeckel, R. (2014). Motor-based intervention protocols in treatment of childhood apraxia of speech (CAS). Current Developmental Disorders Reports, 1, 197–206. https://doi.org/10.1007/s40474-014-0016-4

Maas, E., Robin, D. A., Austermann Hula, S. N., Freedman, S. E., Wulf, G., Ballard, K. J., & Schmidt, R. A. (2008). Principles of motor learning in treatment of motor speech disorders. American Journal of Speech-Language Pathology, 17(3), 277–298. https://doi.org/10.1044/1058-0360(2008/025)

Malmenholt, A., Lohmander, A., & McAllister, A. (2017). Childhood apraxia of speech: A survey of praxis and typical speech characteristics. Logopedics Phoniatrics Vocology, 42(2), 84–92. https://doi.org/10.1080/14015439.2016.1185147

Marcus, G. F., & Fisher, S. E. (2003). FOXP2 in focus: What can genes tell us about speech and language? Trends in Cognitive Sciences, 7(6), 257–262. https://doi.org/10.1016/s1364-6613(03)00104-9

Margetson, K., & McLeod, S. (2026). Multilingual speech assessment: Using an implementation science framework to explore acceptability of the Speech Assessment of Children’s Home Language(s) (SACHL). American Journal of Speech-Language Pathology, 35(1), 226–241. https://doi.org/10.1044/2025_AJSLP-25-00141

Martikainen, A.-L., & Korpilahti, P. (2011). Intervention for childhood apraxia of speech: A single-case study. Child Language Teaching and Therapy, 27(1), 9–20. https://doi.org/10.1177/0265659010369985

McCabe, P., Beiting, M., Hitchcock, E. R., Maas, E., Meredith, A., Morgan, A. T., Potter, N. L., Preston, J. L., Moorer, L., Aggarwal, P., Ballard, K., Smith, L. B., Caballero, N. F., Cabbage, K., Case, J., Caspari, S., Chenausky, K. V., Cook, S., Grzelak, E., . . . Grigos, M. I. (2024). Research priorities for childhood apraxia of speech: A long view. Journal of Speech, Language, and Hearing Research, 67(9S), 3255–3268. https://doi.org/10.1044/2024_JSLHR-24-001

McCabe, P., Macdonald-D’Silva, A. G., van Rees, L. J., Ballard, K. J., & Arciuli, J. (2014). Orthographically sensitive treatment for dysprosody in children with childhood apraxia of speech using ReST intervention. Developmental Neurorehabilitation, 17(2), 137–146. https://doi.org/10.3109/17518423.2014.906002

McCabe, P., Murray, E., Thomas, D., & Evans, P. (2017). Clinician manual for Rapid Syllable Transition Treatment (ReST). The University of Sydney.

McCabe, P., Rosenthal, J. B., & McLeod, S. (1998). Features of developmental dyspraxia in the general speech-impaired population? Clinical Linguistics & Phonetics, 12(2), 105–126. https://doi.org/10.3109/02699209808985216

McCabe, P., Thomas, D. C., & Murray, E. (2020). Rapid Syllable Transition Treatment—A treatment for childhood apraxia of speech and other pediatric motor speech disorders. Perspectives of the ASHA Special Interest Groups, 5(4), 821–830. https://doi.org/10.1044/2020_PERSP-19-00165

McCauley, R. J., & Strand, E. A. (1999). Treatment of children exhibiting phonological disorder with motor speech involvement. In A. J. Caruso & E. A. Strand (Eds.), Clinical management of motor speech disorders in children (pp. 187–208). Thieme.

McCauley, R. J., & Strand, E. A. (2008). A review of standardized tests of nonverbal oral and speech motor performance in children. American Journal of Speech-Language Pathology, 17(1), 81–91. https://doi.org/10.1044/1058-0360(2008/007)

McLeod, S., Verdon, S., & The International Expert Panel on Multilingual Children’s Speech. (2017). Tutorial: Speech assessment for multilingual children who do not speak the same language(s) as the speech-language pathologist. American Journal of Speech-Language Pathology, 26(3), 691–708. https://doi.org/10.1044/2017_AJSLP-15-0161

McNeil, M. R., Robin, D. A., & Schmidt, R. A. (1997). Apraxia of speech: Definition, differentiation, and treatment. In M. R. McNeil (Ed.), Clinical management of sensorimotor speech disorders (pp. 311–344). Thieme.

Mei, C., Fedorenko, E., Amor, D. J., Boys, A., Hoeflin, C., Carew, P., Burgess, T., Fisher, S. E., & Morgan, A. T. (2018). Deep phenotyping of speech and language skills in individuals with 16p11.2 deletion. European Journal of Human Genetics, 26(5), 676–686. https://doi.org/10.1038/s41431-018-0102-x

Meloni, G., Schott-Brua, V., Vilain, A., Lœvenbruck, H., Consortium, E., & MacLeod, A. A. N. (2020). Application of childhood apraxia of speech clinical markers to French-speaking children: A preliminary study. International Journal of Speech-Language Pathology, 22(6), 683–695. https://doi.org/10.1080/17549507.2020.1844799

Morgan, A. T., Amor, D. J., St John, M. D., Scheffer, I. E., & Hildebrand, M. S. (2024). Genetic architecture of childhood speech disorder: A review. Molecular Psychiatry, 29(5), 1281–1292. https://doi.org/10.1038/s41380-024-02409-8

Morison, L. D., Meffert, E., Stampfer, M., Steiner-Wilke, I., Vollmer, B., Schulze, K., Briggs, T., Braden, R., Vogel, A., Thompson-Lake, D., Patel, C., Blair, E., Goel, H., Turner, S., Moog, U., Riess, A., Liegeois, F., Koolen, D. A., Amor, D. J., . . . Morgan, A. T. (2023). In-depth characterisation of a cohort of individuals with missense and loss-of-function variants disrupting FOXP2. Journal of Medical Genetics, 60(6), 597–607. https://doi.org/10.1136/jmg-2022-108734

Morison, L. D., van Reyk, O., Forbes, E., Rouxel, F., Faivre, L., Bruinsma, F., Vincent, M., Jacquemont, M.-L., Dykzeul, N. L., Geneviève, D., Amor, D. J., & Morgan, A. T. (2023). CDK13-related disorder: A deep characterization of speech and language abilities and addition of 33 novel cases. European Journal of Human Genetics, 31(7), 793–804. https://doi.org/10.1038/s41431-022-01275-8

Murray, E., Iuzzini-Seigel, J., Maas, E., Terband, H., & Ballard, K. J. (2021). Differential diagnosis of childhood apraxia of speech compared to other speech sound disorders: A systematic review. American Journal of Speech-Language Pathology, 30(1), 279–300. https://doi.org/10.1044/2020_AJSLP-20-00063

Murray, E., McCabe, P., & Ballard, K. J. (2014). A systematic review of treatment outcomes for children with childhood apraxia of speech. American Journal of Speech-Language Pathology, 23(3), 486–504. https://doi.org/10.1044/2014_AJSLP-13-0035

Namasivayam, A. K., Pukonen, M., Goshulak, D., Hard, J., Rudzicz, F., Rietveld, T., Maassen, B., Kroll, R., & van Lieshout, P. (2015). Treatment intensity and childhood apraxia of speech. International Journal of Language & Communication Disorders, 50(4), 529–546. https://doi.org/10.1111/1460-6984.12154

Newmeyer, A. J., Aylward, C., Akers, R., Ishikawa, K., Grether, S., deGrauw, T., Grasha, C., & White, J. (2009). Results of the Sensory Profile in children with suspected childhood apraxia of speech. Physical & Occupational Therapy in Pediatrics, 29(2), 203–218. https://doi.org/10.1080/01942630902805202

Overby, M. S., Caspari, S. S., & Schreiber, J. (2019). Volubility, consonant emergence, and syllabic structure in infants and toddlers later diagnosed with childhood apraxia of speech, speech sound disorder, and typical development: A retrospective video analysis. Journal of Speech, Language, and Hearing Research, 62(6), 1657–1675. https://doi.org/10.1044/2019_JSLHR-S-18-0046

Pascoe, M., Stackhouse, J., & Wells, B. (2006). Persisting speech difficulties in children: Children’s speech and literacy difficulties, Book 3. Whurr.

Potter, N. L., Nievergelt, Y., & Shriberg, L. D. (2013). Motor and speech disorders in classic galactosemia. In J. Zschocke, K. Gibson, G. Brown, E. Morava, & V. Peters (Eds.), JIMD Reports (Vol. 11, pp. 31–41). Springer. https://doi.org/10.1007/8904_2013_219

Preston, J. L., Leece, M. C., & Maas, E. (2016). Intensive treatment with ultrasound visual feedback for speech sound errors in childhood apraxia. Frontiers in Human Neuroscience, 10, Article 440. http://dx.doi.org/10.3389/fnhum.2016.00440

Rvachew, S., & Matthews, T. (2024). Considerations for identifying subtypes of speech sound disorder. International Journal of Language & Communication Disorders, 59(6), 2146–2157. https://doi.org/10.1111/1460-6984.13108

Scheffer, I. E., Jones, L., Pozzebon, M., Howell, R. A., Saling, M. M., & Berkovic, S. F. (1995). Autosomal dominant rolandic epilepsy and speech dyspraxia: A new syndrome with anticipation. Annals of Neurology, 38(4), 633–642. https://doi.org/10.1002/ana.410380412

Shakibayi, M. I., Zarifian, T., & Zanjari, N. (2019). Speech characteristics of childhood apraxia of speech: A survey research. International Journal of Pediatric Otorhinolaryngology, 126, Article 109609. https://doi.org/10.1016/j.ijporl.2019.109609

Shriberg, L. D., Aram, D. M., & Kwiatkowski, J. (1997). Developmental apraxia of speech: I. Descriptive and theoretical perspectives. Journal of Speech, Language, and Hearing Research, 40(2), 273–285. https://doi.org/10.1044/jslhr.4002.273

Shriberg, L. D., Ballard, K. J., Tomblin, J. B., Duffy, J. R., Odell, K. H., & Williams, C. A. (2006). Speech, prosody, and voice characteristics of a mother and daughter with a 7;13 translocation affecting FOXP2. Journal of Speech, Language, and Hearing Research, 49(3), 500–525. https://doi.org/10.1044/1092-4388(2006/038)

Shriberg, L. D., Campbell, T. F., Karlsson, H. B., Brown, R. L., McSweeny, J. L., & Nadler, C. J. (2003). A diagnostic marker for childhood apraxia of speech: The lexical stress ratio. Clinical Linguistics & Phonetics, 17(7), 549–574. https://doi.org/10.1080/0269920031000138123

Shriberg, L. D., Kwiatkowski, J., & Mabie, H. L. (2019). Estimates of the prevalence of motor speech disorders in children with idiopathic speech delay. Clinical Linguistics & Phonetics, 33(8), 679–706. https://doi.org/10.1080/02699206.2019.1595731

Shriberg, L. D., Paul, R., Black, L. M., & van Santen, J. P. (2011). The hypothesis of apraxia of speech in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 41, 405–426. https://doi.org/10.1007/s10803-010-1117-5

Shriberg, L. D., Potter, N. L., & Strand, E. A. (2011). Prevalence and phenotype of childhood apraxia of speech in youth with galactosemia. Journal of Speech, Language, and Hearing Research, 54(2), 487–519. https://doi.org/10.1044/1092-4388(2010/10-0068)

Shriberg, L. D., Strand, E. A., Fourakis, M., Jakielski, K. J., Hall, S. D., Karlsson, H. B., Mabie, H. L., McSweeny, J. L., Tilkens, C. M., & Wilson, D. L. (2017). A diagnostic marker to discriminate childhood apraxia of speech from speech delay: I. Development and description of the pause marker. Journal of Speech, Language, and Hearing Research, 60(4), S1096–S1117. https://doi.org/10.1044/2016_JSLHR-S-15-0296

Shriberg, L. D., Strand, E. A., Jakielski, K. J., & Mabie, H. L. (2019). Estimates of the prevalence of speech and motor speech disorders in persons with complex neurodevelopmental disorders. Clinical Linguistics & Phonetics, 33(8), 707–736. https://doi.org/10.1080/02699206.2019.1595732

Spinelli, M., Rocha, A. C. D. O., Giacheti, C. M., & Richieri-Costa, A. (1995). Word-finding difficulties, verbal paraphasias, and verbal dyspraxia in ten individuals with fragile X syndrome. American Journal of Medical Genetics, 60(1), 39–43. https://doi.org/10.1002/ajmg.1320600108

Strand, E. A. (2020). Dynamic Temporal and Tactile Cueing: A treatment strategy for childhood apraxia of speech. American Journal of Speech-Language Pathology, 29(1), 30–48. https://doi.org/10.1044/2019_AJSLP-19-0005

Strand, E. A., & McCauley, R. J. (2019). Dynamic Evaluation of Motor Speech Skill (DEMSS) manual. Brookes.

Strand, E. A., McCauley, R. J., Weigand, S. D., Stoeckel, R. E., & Baas, B. S. (2013). A motor speech assessment for children with severe speech disorders: Reliability and validity evidence. Journal of Speech, Language, and Hearing Research, 56(2), 505–520. https://doi.org/10.1044/1092-4388(2012/12-0094)

Strand, E. A., & Skinder, A. (1999). Treatment of developmental apraxia of speech: Integral stimulation methods. In A. J. Caruso & E. A. Strand (Eds.), Clinical management of motor speech disorders in children (pp. 109–148). Thieme.

Strand, E. A., Stoeckel, R., & Baas, B. (2006). Treatment of severe childhood apraxia of speech: A treatment efficacy study. Journal of Medical Speech-Language Pathology, 14(4), 297–307.

Tierney, C., Mayes, S., Lohs, S. R., Black, A., Gisin, E., & Veglia, M. (2015). How valid is the checklist for autism spectrum disorder when a child has apraxia of speech? Journal of Developmental & Behavioral Pediatrics, 36(8), 569–574. https://doi.org/10.1097/DBP.0000000000000189

Tomblin, J. B., O’Brien, M., Shriberg, L. D., Williams, C., Murray, J., Patil, S., Bjork, J., Anderson, S., & Ballard, K. (2009). Language features in a mother and daughter of a chromosome 7;13 translocation involving FOXP2. Journal of Speech, Language, and Hearing Research, 52(5), 1157–1174. https://doi.org/10.1044/1092-4388(2009/07-0162)

Tubi, R., Ben-David, A., & Segal, O. (2024). Characteristics of lexical stress in Hebrew-speaking children with childhood apraxia of speech. Journal of Speech, Language, and Hearing Research, 67(3), 711–728. https://doi.org/10.1044/2023_JSLHR-23-00205

van Tellingen, M., Hurkmans, J., Terband, H., van de Zande, A. M., Maassen, B., & Jonkers, R. (2024). Speech and music therapy in the treatment of childhood apraxia of speech: An introduction and a case study. Journal of Speech, Language, and Hearing Research, 67(9S), 3269–3287. https://doi.org/10.1044/2023_JSLHR-22-00619

Velleman, S. L., Huffman, M. J., & Mervis, C. B. (2012, June). Relations between speech and motor-speech performance in children with 7q11.23 duplication syndrome [Paper presentation]. International Child Phonology Conference, Minneapolis, MN, United States.

Velleman, S. L., & Strand, K. (1994). Developmental verbal dyspraxia. In J. E. Bernthal & N. W. Bankson (Eds.), Child phonology: Characteristics, assessment, and intervention with special populations (pp. 110–139). Thieme.

Washington, K. N., Crowe, K., McLeod, S., Margetson, K., Bazzocchi, N. B. M., Kokotek, L. E., van der Straten Waillet, P., Másdóttir, T., & Volhardt, M. D. S. (2025). Methods of diagnosing speech sound disorders in multilingual children. Language, Speech, and Hearing Services in Schools, 56(3), 469–487. https://doi.org/10.1044/2025_LSHSS-24-00099

Williams, P., & Stackhouse, J. (1998). Diadochokinetic skills: Normal and atypical performance in children aged 3–5 years. International Journal of Language & Communication Disorders, 33(S1), 481–486. https://doi.org/10.3109/13682829809179472

Williams, P., & Stackhouse, J. (2000). Rate, accuracy and consistency: Diadochokinetic performance of young, normally developing children. Clinical Linguistics & Phonetics, 14(4), 267–293. https://doi.org/10.1080/02699200050023985

Williams, P., & Stephens, H. (2010). The Nuffield Center Dyspraxia Programme. In A. L. Williams, S. McLeod, & R. J. McCauley (Eds.), Interventions for speech sound disorders in children (pp. 159–178). Brookes.

Wilson, E. M., Abbeduto, L., Camarata, S. M., & Shriberg, L. D. (2019). Estimates of the prevalence of speech and motor speech disorders in adolescents with Down syndrome. Clinical Linguistics & Phonetics, 33(8), 772–789. https://doi.org/10.1080/02699206.2019.1595735

Wong, E. C. H., Lee, K. Y. S., & Tong, M. C. F. (2020). The applicability of the clinical features of English childhood apraxia of speech to Cantonese: A modified Delphi survey. American Journal of Speech-Language Pathology, 29(2), 652–663. https://doi.org/10.1044/2019_AJSLP-19-00118

Wong, E. C. H., Wong, M. N., & Velleman, S. L. (2024). Acoustic analyses of tone productions in sequencing contexts among Cantonese-speaking preschool children with and without childhood apraxia of speech. Journal of Speech, Language, and Hearing Research, 67(6), 1682–1711. https://doi.org/10.1044/2024_JSLHR-23-00383

Wong, E. C. H., Wong, M. N., Velleman, S. L., & Lai, E. M. C. (2025). Cantonese oral and speech motor assessment for preschool children with and without speech sound disorders. American Journal of Speech-Language Pathology, 34(6), 3216–3237. https://doi.org/10.1044/2025_AJSLP-24-00358

World Health Organization. (2001). International Classification of Functioning, Disability and Health.

Yavas, M., & Goldstein, B. (1998). Phonological assessment and treatment of bilingual speakers. American Journal of Speech-Language Pathology, 7(2), 49–60. https://doi.org/10.1044/1058-0360.0702.49

Yorkston, K. M., Beukelman, D. R., Strand, E. A., & Hakel, M. (2010). Management of motor speech disorders in children and adults. Pro-Ed.

Zeesman, S., Nowaczyk, M. J. M., Teshima, I., Roberts, W., Cardy, J. O., Brian, J., Senman, L., Feuk, L., Osborne, L. R., & Scherer, S. W. (2006). Speech and language impairment and oromotor dyspraxia due to deletion of 7q31 that involves FOXP2. American Journal of Medical Genetics Part A, 140A(5), 509–514. https://doi.org/10.1002/ajmg.a.31110

Acknowledgements

Content for ASHA’s Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review.  ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Childhood Apraxia of Speech page.

Primary Version

• Tom Ehren, MS, CCC-SLP
• Tatyana Elleseff MA, CCC-SLP
• David Hammer, MA CCC-SLP
• Kathy Jakielski, PhD, CCC-SLP
• Nancy Kaufman, MA, CCC-SLP
• Barbara Lewis, PhD, CCC-SLP
• Rebecca McCauley, PhD, CCC-SLP
• Tommie Robinson Jr., PhD, CCC-SLP
• Ruth Stoeckel PhD, CCC-SLP
• Edythe Strand, PhD, CCC-SLP
• Shelley Velleman, PhD, CCC-SLP

Secondary Versions

• Mike Bright, MS, CCC-SLP (2026)
• Susan Caspari, MA, CCC-SLP (2019)
• Jenya Iuzzini-Seigel, PhD, CCC-SLP (2026)
• Edwin Maas, PhD (2019)
• Eddy Wong, PhD (2026)

ASHA seeks input from subject matter experts representing differing perspectives and backgrounds. At times a subject matter expert may request to have their name removed from our acknowledgment. We continue to appreciate their work.

Citing Practice Portal Pages

The recommended citation for this Practice Portal page is:

American Speech-Language-Hearing Association. (n.d.). Childhood apraxia of speech [Practice portal]. www.asha.org/Practice-Portal/Clinical-Topics/Childhood-Apraxia-of-Speech/