Childhood Apraxia of Speech

The American Speech and Hearing Association (2007) defines childhood apraxia of speech (CAS) as a "neurological childhood speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits." What appears a straightforward, natural progression toward complex motor movements in speech for the typically developing child is a much more effortful, slow, and inexact process for the child with CAS (also referred to as dyspraxia).

Three specific features differentiate CAS from other speech-sound disorders:

  • Inconsistent errors on consonants and vowels in repeated productions of syllables and words
  • Lengthened co-articulatory transitions between sounds and syllables
  • Inappropriate prosody
    (ASHA, 2007)

CAS is a complex speech deficit: signs and symptoms of the deficit may not be present in every child, making it even more important to determine effective treatment measures early. See a list of signs and symptoms of CAS, organized by age level.

An intervention for a child who is evaluated and diagnosed with CAS requires a treatment program that is individually tailored to the challenges he or she has with the execution of speech. At Cawn/Krantz, only a certified and trained speech and language therapist—a therapist who has specific knowledge of motor learning theory, essential and invaluable for treatment—is involved in the diagnostic and therapy process.

The focus of such an intervention is on improving the planning, sequencing, and coordination of muscle movements for speech. Isolated exercises designed to "strengthen" the oral muscles will not help without a combined focus on speech production; CAS is a disorder of speech coordination, not strength. Therapy may include a combination of techniques and programs involving multisensory (tactile, visual, and proprioceptive) input: the Kaufman Apraxia Treatment Program, NeuroNet, Integral Stimulation therapy, and others. Cawn/Krantz emphasizes the therapeutic relationship so that presentation of sounds, vocabulary and language are meaningful to the child.

American Speech-Language Hearing Association. (2007). Childhood apraxia of speech. Available at www.asha.org/policy

What are some signs or symptoms of childhood apraxia of speech (CAS)?

In A Very Young Child

  • Does not coo or babble as an infant
  • Produces first words late; first words may be missing sounds
  • Utilizes only a few consonant and vowel sounds
  • Demonstrates problems when combining sounds; may take long pauses between sounds
  • Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)
  • May have problems eating


In An Older Child

  • Makes inconsistent sound errors
  • Has difficulty imitating speech, but imitated speech is a more accurate production than his/her spontaneous speech production
  • May appear to be groping when attempting to produce sounds or coordinating the lips, tongue, and jaw for purposeful movement
  • Evinces greater difficulty speaking longer words or phrases clearly than shorter ones
  • Production is more difficult when he or she is anxious
  • Is hard to understand, especially for an unfamiliar listener
  • Sounds choppy or monotonous; stresses the wrong syllable or word


Other Potential Problems

  • Weakness of the lips, jaw, and/or tongue
  • Delayed language development
  • Other expressive language problems (e.g., word order confusions and word recall)
  • Difficulties with fine motor movement/coordination
  • Over-sensitive (hypersensitive) or under-sensitive (hyposensitive) in the mouth (e.g., may not like tooth-brushing or crunchy foods; may not be able to identify an object in his/her mouth through touch)
  • May have problems when learning to read, spell, and write

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