Childhood Apraxia of Speech

Childhood Apraxia of Speech (CAS) is a motor planning disorder. Children that carry the diagnosis have difficulty planning the motor movements of the tongue, lips, jaw and palate, which are necessary to produce intelligible words and sentences. CAS can be congenital, or it can be acquired during speech development. It can start from birth (congenital) or after an accident (acquired). It can be a singular issue (idiopathic), or it can occur in the context of complex neurodevelopmental disorders or even because of damage after a separate neurological event caused by a variety of issues in the brain, such as a high fever or head trauma (Shriberg, 2010).

Speech is a highly complex system of sounds that requires very precise planning. Speech originates as an idea and is translated into words. As children develop, motor planning for frequently spoken words becomes more automatic. Speech is effortful and a constant struggle.

The first step in determining if a child has apraxia of speech is to rule out normal, but delayed development. An evaluation by an ASHA-certified speech language pathologist (SLP) is the first step in determining a diagnosis of CAS.

Per the American Speech Language and Hearing Association (ASHA), there is currently no validated list of diagnostic features differentiating CAS from other childhood speech sound disorder, including those due to phonological-level delay or neuromuscular disorder (dysarthria). However, three features consistent with a deficit in the planning and programming of movements for speech have gained some consensus among those investigating CAS:

  • Inconsistent errors on consonants and vowels in repeated productions of syllables or words
  • Increased time between the production of individual speech sounds in a word or phrase
  • Awkward stress of sounds and syllables at the word and sentence level. (ASHA, 2007a)

Once a differential diagnosis has been made, the SLP will determine the best course of treatment. Treatment selection depends on a number of factors, including 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, Freebairn, Hansen, Iyengar et al., 2004; Shriberg et al., 2003), multiple approaches may be appropriate at a given time or over time. For more information on CAS, please visit

The most daunting question that parents of children diagnosed with CAS frequently ask is, “Will my child ever speak normally?” Though there is no definitive data, treatment of CAS by a skilled speech language pathologist has shown positive outcomes. Treatment of CAS can be a lengthy and intense process. It is important to be positive—and most of all to be patient—when the words just won’t come out right. After all, our children want to communicate with us; it may just take a little more time.

If you wonder whether your child may have a speech-language disorder, you are welcome to make an appointment to talk with one of our speech pathologists.

—by Keystone staff

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