Childhood Apraxia of Speech

​Childhood Apraxia of Speech (CAS) is a motor speech disorder in which the brain struggles with the planning and coordination of movement for the lips, jaw and tongue when talking. CAS isn't caused by muscle weakness or paralysis. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the necessary muscle movements.

At this time, the causes of CAS are unknown.

Signs and Symptoms

Children may begin exhibiting signs of CAS early on, typically when they begin trying to communicate as infants.  Symptoms can also emerge later, and as the child grows, the signs may evolve.

A very young child may exhibit the following "red flags" for delays in speech and spoken language development:

• Does not coo or babble as an infant
  
• Lack of gestures, or poor use of gestures as an infant and toddler
• First words are late, may be missing sounds
• Makes only a few vowel and consonant sounds
• Has problems combining sounds and may have long pauses between sounds
• Simplifies words by replacing difficult sounds with easier ones or omitting difficult sounds entirely (all children do this to some extent, but children with CAS do it more frequently)
• May have problems while eating due to poor muscle control in the mouth

An older child with a more developed speech pattern may indicate CAS with the following signs:

• Makes inconsistent sound errors
• Can comprehend language much better than he/she can talk
• May appear to be groping when attempting to produce sounds or struggle to intentionally coordinate the jaw, lips or tongue
• Has difficulty imitating speech
• Has difficulty producing speech sounds when saying longer words or phrases
• Is hard to understand, particularly for an unfamiliar listener
• Speech sounds monotonous or choppy ; difficulty with the "rhythm" of speech
• Stresses the wrong part of a word or phrase

There also are additional problems that may arise if a child has CAS. These include:

• Delayed language development
• Additional expressive language problems, such as word recall
• Issues with fine motor movement, imitation, and/or coordination
• Hypersensitivity or hyposensitivity in the mouth, such as not liking to brush teeth or avoiding certain food textures
• Difficulty with social interactions with peers due to communication breakdowns

Diagnosis and treatment of CAS will involve a visit to an audiologist and speech language pathologist who will perform a series of evaluations. ​

Diagnosis and Treatment

If you believe your child is exhibiting the signs and symptoms of Childhood Apraxia of Speech​ (CAS), it is important to reach out to a professional in the field of speech language pathology. Diagnosis of CAS involves a visit to an audiologist and a speech language pathologist.

An audiologist visit will include a hearing test to rule out hearing loss as a cause of the speech issues. Once that has been completed, a speech language pathologist will evaluate the child's oral-motor abilities, melody of speech speech-sound development, and expressive and receptive language skills. It is important to note that because CAS is a speech disorder, the child must actually have speech before it can be diagnosed.

Oral Motor Assessment

An oral motor assessment will check for signs of weakness or low muscle tone in the lips, jaw and tongue (known as dysarthria) versus poor coordination of the lips, jaw and tongue (oral apraxia). Among other tests, the child will be asked to imitate non-speech actions such as smiling, frowning or puckering the lips to test for muscle coordination.   It should be noted that children do NOT need to have oral apraxia for non-speech movements in order to have CAS (apraxia for speech movements).

Melody of Speech (Intonation) Assessment

A melody of speech (intonation) assessment will include listening to the child to ensure he/she can appropriately stress syllables in words and phrases, and use pitch and pauses to mark different types and points of sentences.

Speed Sound Assessment

A speech sound assessment involves evaluating the accuracy of vowel and consonant productions as the child sequences sounds and says words and phrases. The assessment also will determine how well others can understand what the child is saying.

​Expressive and Receptive Language  Assessment

An expressive and receptive language assessment involves the child completing evaluations to demonstrate how he/she uses as well as understands spoken language.  It is common for children with CAS to have a split in their expressive (lower scores) and receptive (higher scores) language. 

Treating CAS requires an approach based on the principles of motor learning.  Treatment takes time, patience and commitment. CAS is a dynamic disorder and speech characteristics can change over time with appropriate therapy and neurological maturation.  Children should receive intensive and frequent intervention, often as much as three to five times per week. It's critical to practice at home as well. CAS may be called a "developmental" speech disorder, but it is not something a child will grow out of. There is no cure, so the focus of intervention should be on improving the planning, sequencing and coordination of the muscles in order to communicate clearly.

Multisensory feedback is very helpful, and children in individual sessions tend to do better than those in group settings because of the high number of repetitions that are required for a motor speech approach. For some children, alternative communication methods, such as using pictures, iPads, computers, writing, or sign language, may be introduced if the child becomes frustrated.   These alternative methods may be phased out as the child progresses through treatment, or they may remain a regular part of the child's communication approach..

The best resource for learning more about CAS is a speech-language pathologist with additional training in CAS.  Two high-quality parent-friendly books on CAS are: The Late Talker by Marilyn Agin and Speaking of Apraxia by Leslie Lindsay.