Childhood Apraxia of Speech

Apraxia is a motor speech disorder that makes it hard to speak. It can take a lot of work to learn to say sounds and words better. Speech-language pathologists, or SLPs, can help. Visit ASHA ProFind to locate a professional in your area.

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About Childhood Apraxia of Speech (CAS)

In order for speech to occur, messages need to go from your brain to your mouth. These messages tell the muscles how and when to move to make sounds. When a child has apraxia of speech, the messages do not get through correctly. The child might not be able to move their lips or tongue in the right ways, even though their muscles are not weak. Sometimes, the child might not be able to say much at all.

A child with CAS knows what they want to say. The problem is not how the child thinks but how the brain tells the mouth muscles to move.

CAS is sometimes called verbal dyspraxia or developmental apraxia. Even though the word “developmental" is used, CAS is not a problem that children outgrow. A child with CAS will not learn speech sounds in typical order and will not make progress without treatment. It can take a lot of work, but the child’s speech can improve.

Signs and Symptoms

Not all children with CAS are the same. Your child may show some or all of the signs below. You should talk to your doctor and see an SLP if your child is older than 3 years and

  • does not always say words the same way every time;
  • tends to put the stress on the wrong syllable or word;
  • distorts or changes sounds; or
  • can say shorter words more clearly than longer words.

Children with CAS may have other problems, including

  • difficulty with fine motor skills;
  • delayed language; or
  • problems with reading, spelling, and writing.

Causes

Most of the time, the cause of CAS is unknown. In some cases, damage to the brain causes CAS. Damage may be caused by a genetic disorder or syndrome, or by a stroke or traumatic brain injury. 

Seeing a Professional

Testing for CAS

An SLP can test your child’s speech and language skills. Many children with speech sound disorders also have language disorders. Find an ASHA-certified SLP in your area by using ASHA ProFind  .

To test for CAS, the SLP will look at your child’s oral–motor skills, speech melody (intonation), and how they says different sounds. To test how your child says sounds, the SLP will

  • check how well your child says speech sounds alone and combined in syllables or words and
  • check how well others can understand what your child says.

You should also talk to your doctor, who can check for any medical problems. It is important to have your child’s hearing checked by an audiologist. A child with a hearing loss may have more trouble learning to talk.

Treatment for CAS

A child with CAS should work with an SLP. Your child may begin with therapy 3–5 times per week. As speech improves, treatment may be less often. Individual or group therapy may be appropriate at different stages of treatment.

See ASHA’s information for professionals on the Practice Portal’s Childhood Apraxia of Speech page.

Treatment Goals

The goal of treatment is to help your child say sounds, words, and sentences more clearly. Your child will learn how to

  • plan the movements needed to say sounds and
  • make those movements the right way at the right time.

Doing exercises to make the mouth muscles stronger will not help. Mouth muscles are not weak in children with CAS. Working on how to move those muscles to say sounds will help.

Your child must practice speaking to get better at it. It helps to use all the senses when learning how to say sounds. Your child may use

  • “touch” cues, like putting their finger on their lips when saying the “p” sound as a reminder to close the lips;
  • “visual” cues, like looking into a mirror when making sounds; or
  • “listening” cues, like practicing sounds with a recorder and then listening to hear if the sounds were made correctly.

Other Ways to Communicate

In order to communicate, your child may learn sign language or may learn to use picture boards or computers that talk. This is called augmentative and alternative communication (AAC).

Some parents are afraid that their child will only want to use AAC systems and not try to talk. There is no evidence to support this idea. AAC systems support communication and help your child as they work on their speech with the SLP.

Family Support

CAS treatment takes time, and your child will need your support. Practice what your child learns with the SLP to help them make progress. Take breaks when your child is tired and make practice as much fun as possible. Tell your child’s SLP what happens at home so you can all work together to help your child succeed.

Other Resources

This list does not include every website on this topic. ASHA does not endorse the information on these sites.