What Is Childhood Apraxia Of Speech, And How Does It Affect Children?

Medically reviewed by Majesty Purvis, LCMHC
Updated April 19, 2024by BetterHelp Editorial Team

In some cases, speech difficulties arise during childhood. Speech impediments can be challenging to overcome and may significantly impact a child's emotional and mental development. Some speech challenges are minor and can be fixed with time, while others are more difficult to change and can last into adulthood. 

One condition that can occur in very young children is childhood apraxia of speech (CAS), also called verbal apraxia. Understanding how apraxia occurs and how to treat it can help parents and caregivers provide quality support to children experiencing this condition.

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What is childhood apraxia? 

Childhood apraxia of speech (CAS) is a speech disorder involving inaccurate movements of a child's speech muscles. However, it is not the muscles that are impacted by this condition – CAS affects the brain. 

A neurotypical brain formulates a plan to speak, commanding the speech muscles to move so words can be spoken. With CAS, there is miscommunication between the brain and the muscles, causing difficulty in formulating words. While many children develop some speech difficulty or have speech problems that interfere with functional communication, CAS is uncommon. It affects approximately one in 1,000 children

How does childhood apraxia of speech work? 

To speak, messages must go from your brain to your mouth. These messages tell the muscles what movements are needed to make sounds. If your child has apraxia of speech, messages do not pass correctly. Your child might not be able to move their lips or tongue to say sounds, even though they are not experiencing muscle weakness. In some cases, CAS causes a loss of speech. 

A child with CAS has normal thoughts and may know what they want to say along with the correct grammar to express their thoughts. As CAS is a problem with their brain getting their mouth muscles to move, it does not impact a child’s progress with intelligence or social skills. Other names for CAS are verbal dyspraxia or developmental apraxia.

Although you may hear the term "developmental" regarding this condition, CAS is not a problem children can outgrow without support. A child with a developmental speech disorder learns sounds in a typical order but at a slower pace. If your child has CAS, they may not follow typical patterns or progress without treatment. With speech treatment, apraxia can sometimes be managed early in life. 

What are the symptoms of CAS? 

Childhood apraxia of speech symptoms can vary, and different children may struggle with different parts of speech. CAS can affect children before they learn to speak and can affect children past the toddler stage.

Symptoms for children under three

Below are some of the symptoms children under three with apraxia may experience: 

  • Difficulty eating

  • Long pauses between words or sounds 

  • Pronouncing words differently each time 

  • Not making many noises as an infant 

  • Delayed speech development, only seeming to know a few sounds 

If your child has multiple symptoms, it could be a sign of CAS. However, some symptoms can also represent other conditions related to communication difficulties, such as childhood disintegrative disorder, autism spectrum disorder, or cerebral palsy. For this reason, seek a professional evaluation if you notice symptoms in your child. 

Symptoms for children over three

Below are some of the symptoms children over three may experience: 

  • Understanding words but struggling to speak clearly 

  • Ease in imitating words but difficulty saying them independently 

  • Struggling to move the mouth when speaking 

  • Struggling to say longer words 

  • Saying words differently each time 

  • Not being understood by strangers 

  • Struggling to stress syllables 

  • Difficulty with fine motor skills

Children with CAS may also be moody and frustrated due to the inability to communicate their thoughts. Some children may also face bullying from others. If your child has these symptoms, having them checked by a professional early on may be beneficial. 

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How are speech disorders like apraxia diagnosed? 

If you suspect your child has CAS, take them to a speech-language pathologist (SLP). These professionals might examine your child’s specific progression along developmental milestones, such as when they spoke their first words (or if they have). 

This type of doctor can listen to your child's speech and diagnose any speech difficulties. They will test how well your child can comprehend speech and check their fine motor skills. There are several factors they will test to determine if your child has CAS, including the following. 

Oral motor skills testing 

When you take your child to a speech-language pathologist, the doctor may first test their oral motor skills and motor coordination. They will do this by seeing if the child has dysarthria, which is a weakness in the mouth area. While many cases of CAS don't present with dysarthria, it can be a sign of this condition. 

They may also look at the child's mouth movements to see their development. Your child may be asked to perform everyday mouth movements such as sticking out their tongue, puckering their lips, or smiling. 

The doctor may check the speed of your child's mouth movements as they test motor skills for fine motor issues to treat CAS or other language problems the child may be experiencing. It could be a sign of apraxia if they struggle to perform quick mouth movements. The doctor may also compare pretend mouth movements to real life. For example, the child could pretend to suck on candy and then do so in real life to showcase any differences between the two. 

Intonation testing for speech sounds

After testing their motor skills, your child's intonation (speech melody) may be tested. To test this, the therapist may see how the child stresses certain syllables. Syllables are stressed in specific ways, and how they are stressed can change the word's meaning. The word "subject" is an example. Subject has two meanings differentiated by which syllable is stressed. 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 may struggle with stressing the syllables correctly.

After testing syllables, the doctor may test 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 more difficult to understand meanings. 

Your child's doctor may also listen to how your child says the sounds of letters, whether combined or individually. These factors can combine to show the doctor whether the child has CAS or another form of speech impediment. Regardless of the diagnosis, your child's SLP may help you find treatment options. While CAS has no quick cure, therapy can help your child learn how to speak correctly.

CAS treatments: Speech therapy and speech-language pathologists (SLP)

If your child has CAS, you may wonder how it can be treated and if it will last into your child’s school years or into adulthood. The length of your child's condition may depend on the severity. Those with more severe cases can still benefit from speech-language therapy, but it may take longer to show growth.

Treatment often involves learning to move the speech muscles in time with the brain's command to speak. A treatment plan can be developed based on the severity of your child's CAS. Speech therapy is offered by a speech therapist or speech pathologist and employs all the senses to work on pronouncing certain syllables. For example, there may be physical cues, such as touching their arm when they say a particular sound they have trouble pronouncing. It may require listening to recordings of themselves as well.

Depending on the severity of the CAS, alternative communication methods may be used until the CAS improves. Children may use computers, phones, or other ways to communicate instead. Speech-generating devices and augmentative and alternative communication (AAC) options are commonly suggested. This method does not teach the child to be dependent on technology but gives them an outlet to speak until their condition improves. The goal is to learn how to speak.

Treatment may take time, so monitoring your child's behavior may be beneficial. Some children may become frustrated or experience bullying by beers. By keeping your child's spirits up, treatment may feel more doable, and there may be a higher chance of success.

If your child has a moderate case of apraxia, they may start treatment by attending therapy five times a week. The more they improve, the less they may be asked to go to therapy. As speech improves, the speech therapist may monitor progress to ensure slip-ups don't occur. 

Does childhood apraxia of speech last forever? 

Childhood apraxia of speech is considered lifelong when untreated. However, it can be treated with early intervention and support. Frequent speech therapy is often the most successful treatment option for this condition. 

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Support options for parents and caregivers

It can be challenging to support your child with speech. Watching them experience frustration or bullying because of their condition may cause caregivers and parents to have thoughts of hopelessness. You may benefit from talk therapy if you're experiencing this as a parent. 

If you have a busy schedule, online therapy through platforms like BetterHelp may provide a flexible option for finding support. Research has shown that family members or caregivers participating in online therapy find successful methods for coping with challenges together. Individually, parents may learn that they are not alone and gain strategies for getting through the day-to-day.

With online therapy, parents can choose an appointment slot that works for them. Many online therapists offer sessions outside of standard business hours, which may be valuable for those with a busy schedule due to their child's speech therapy. You can also choose between phone, video, or live chat sessions with your provider, offering control over how you receive support. 

Takeaway

Childhood apraxia of speech is a rare speech impediment disability that can be lifelong if not treated. However, this condition is often considered treatable or manageable with speech therapy and long-term support. If you're struggling with a child's speech apraxia diagnosis, consider contacting a licensed therapist online or in your area for support. You're not alone, and support options are available.
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