What Is Childhood Apraxia Of Speech & How It Affects Children

By Nicola Kirkpatrick

Updated February 01, 2020

Reviewer Lisa Cooper

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Many speech difficulties can arise during childhood. Some of them are minor and can be fixed with time, while others are more difficult to change and can last into adulthood. Today, we'll be looking at one speech disorder that affects children: childhood apraxia of speech, or CAS.

What Is CAS?

CAS is a speech disorder involving inaccurate movements of a child's speech muscles. The muscles themselves aren't affected so much as the brain is. The brain formulates a plan to speak, and it tells the speech muscles. With CAS, there is a miscommunication between the brain and muscles, and this makes it difficult for children to speak.

While many children develop some speech difficulty, CAS is uncommon. It affects approximately 1 in 1,000 children.

About Childhood Apraxia Of Speech (CAS)

To speak, messages need to go from your brain to your mouth. These messages tell the muscles how and when to move to make sounds. If your child has apraxia of speech, the messages do not get through correctly. Your child might not be able to move his lips or tongue to the right place to say sounds, even though his muscles are not weak. Sometimes, he might not be able to say much at all.

A child with CAS knows what she wants to say. CAS is a problem with her brain getting her mouth muscles to move, not with how well she thinks. You may hear CAS called verbal dyspraxia or developmental apraxia.

Even though you may hear the term "developmental," CAS is not a problem that children simply outgrow. A child with a developmental speech disorder learns sounds in a typical order, just at a slower pace. If your child has CAS, he will not follow typical patterns and will not make progress without treatment. It will take a lot of work, but your child's speech can improve.


CAS has varying degrees of symptoms, and different children will struggle with different parts of speech. CAS can affect children before they fully learn to speak, and it can affect children past the toddler stage.

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Symptoms For Children Under 3

  • Difficulty eating
  • Pauses between words or sounds for a long time
  • Pronounces a word differently each time
  • When they're an infant, they don't make noises
  • Speech development seems delayed. Only knows a few sounds.

Some of these symptoms may be a sign of something else or common, but if your infant has multiple symptoms, it could be a sign of CAS.

Symptoms For Children Over 3

  • Your child can understand words but can barely talk.
  • Imitating words sounds clearer than words said on their own.
  • Struggles to move their mouth region when they speak.
  • Longer words are more difficult to say.
  • Words are sometimes said each time differently.
  • Strangers have trouble understanding them.
  • Cannot stress their syllables well.
  • The difficulty with fine motor skills.

The child may also be moody and frustrated because they are unable to get their words out, or they are made fun of for not speaking properly. If your child has any of these symptoms, it's recommended they see a professional. They can help see if your child has CAS and rule out any other possible causes such as hearing loss.

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The Cause

As mentioned, CAS is when the brain has difficulty sending commands to the speech muscles. The exact cause is still unknown. Some say it's a genetic reason. If your child had a brain injury, that might be the culprit.


If you suspect your child has CAS, where can you go to diagnose it? You should take them to a speech-language pathologist, or SLP. They can look at your child's speech and diagnose any speech difficulties they have. They will test how well your child can comprehend speech and look at their motor skills. There are several factors they will test to determine if your child has CAS.

They will first test their oral motor skills. They will do this by

  • Seeing if the child has dysarthria, which is a weakness in the mouth area. While most cases of CAS are absent from dysarthria, it is still worth checking.
  • Look at the mouth movements and see how well they are. The child will have to perform common mouth movements such as sticking out the tongue, puckering lips, and more.
  • Check the speed of the mouth movements. Can the child perform fast mouth movements? If not, they may have CAS.
  • Compare pretend mouth movements to real life. For example, the child can pretend to suck on some candy, and then be given real candy and see how they compare.

Afterward, the child's intonation, or speech melody, may be tested. To test this, the therapist may:

  • See how the child stresses certain syllables. Syllables are stressed certain ways, and how they are stressed can change the meaning of the word. For example, the word subject. It has two meanings that change depending on the syllable. If you say SUBject, you're talking about a topic. If you say subJECT, you're talking about something someone has imposed on you. Children with CAS will have trouble getting the right syllables.
  • Testing for pitch changes. If your child's pitch goes up at the end of the word when it should go up in the beginning, or vice versa, it may be a sign of CAS.
  • Listen to how your children pause when they are speaking. Pauses are the commas of your spoken sentences, and if they are pausing at the wrong times, it can change the meaning of the sentence, or make it harder to keep up with what they are saying.
  • They will also listen to how your child says the sounds of letters, be it combined or individually.

All these factors will play together when it comes to figuring out if the child has CAS or some other form of speech impediment. Regardless of what thediagnosis, they will then help you and your child seek therapy. While CAS has no straight cure, therapy can help the child learn how to speak properly.

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Treatment of CAS

If your child has CAS, you may wonder how it can be treated, and if it will last into adulthood. This will ultimately depend on the severity of the CAS. Some children who have mild CAS can take therapy, learn how to manage their speech, and grow up to be your average member of society. Those who have a more severe case can still benefit from therapy, but it may take longer.

Treatment involves getting the child to see words in a clearer manner. CAS treatment involves learning how to move the speech muscles in time with the brain's command to speak. Your SLP can help your child figure out the best treatment for their CAS severity.

Speech therapy involves practice, and it may use different senses to help them pronounce certain syllables. For example, there may be physical cues, such as touching their arm when they say a certain sound they have trouble pronouncing. It may require listening to their recordings as well.

Depending on the severity, alternative ways of communicating may be used until the CAS improves. Children may use computers, phones, or any other way to communicate instead. This does not teach the child to be dependent on technology, but instead gives them an outlet to speak until the CAS manages to get better. The ultimate goal is to learn how to speak.

Treatment may take some time, and it's best to monitor your child's behavior. Some children may feel frustrated because they are unable to speak properly, and they may be bullied due to their inability to speak. By keeping your child's spirits up, it makes treatment a lot easier, and you can be able to have a higher chance of success.

Treatment may also happen often. If your child has a moderate case, they may start by going to therapy five times a week. The more they improve, the less they need to go. Even as speech improves, it should be monitored in case there are any slipups.

Seek Help!

In addition to a speech therapist, a counselor can help your child deal with the stress they experience when they have CAS. A counselor can remind your child that they can get through their experience and help them with any other problems they have. If you are having difficulties with your child, or any other family problem, a counselor can also be there to help you too.

CAS can be tough to overcome, but with therapy and persistence, your child can speak normally.

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