What is Childhood Apraxia of Speech?

By AASLMay 6, 2021

Childhood Apraxia of Speech (CAS) is a motor speech disorder that initially becomes apparent when a child is learning how to talk.  Children with CAS have difficulty planning, coordinating, and producing the movements necessary to produce speech that is considered intelligible, that is, easily understood by those around them including both familiar (i.e. family) and unfamiliar (i.e. someone new)  listeners.  In order for speech to occur, the brain sends messages to your mouth, which tells the muscles of the tongue, lips, jaw, and palate how and when to move in the right ways.  This difficulty occurs despite not having weak muscles of the mouth.   Furthermore, children with CAS know what they want to say, however, the problem occurs in how the brain sends the signals for the muscles of the mouth to move.  Children with CAS do not learn speech sounds in the typical developmental sequence that other children learn and often require skilled therapy in order to make progress for their speech to improve.  

Signs and Symptoms
Children with CAS may show some or all of the signs listed below.  As with all children, not all children with CAS are the same and they develop differently!  If you have concerns you should talk to your doctor and seek getting an evaluation from a speech-language pathologist.  The most common signs and symptoms of CAS include: 

  • Unable to say words the same way every time resulting in inconsistent and unpredictable errors (i.e. dog> do, dod, gog)
  • Distorts or changes sounds in words across vowels and consonants  
  • Can say shorter words more clearly than longer words
  • Individual words are easier to understand than connected speech 
  • Groping aka “silent posturing” of the mouth when trying to get words out 
  • Disturbances in the prosody of speech (i.e. speaking rate, melody, intonation, voicing, pausing) across sounds and syllables in words
  • Puts stress on the wrong syllable or word

Children with CAS may have other difficulties, including:

  • Fine motor skills, having poor coordination, and low tone
  • Delayed language or a gap between what they understand (receptive language) and what they are able to communicate (expressive language ) 
  • Problems with reading, spelling, and writing

What Key Factors Should Speech Therapy Include? 

  1. Practice and Repetition:  Short, frequent therapy sessions throughout the week are recommended in order to get as much practice and repetition with speech as possible.  Intensity (practicing a lot) and frequency (practicing often) will be more effective for the speech targets (i.e. sounds and words) that are being addressed than less frequent, longer sessions.   A functional and practical home-program implemented by the clinician with the family will be key to ensuring these targets are practiced and carried over with in the child’s natural environment. 
  2. Use of Cues and Feedback: The use of visual, verbal, and tactile (i.e. touch) cues will guide your child so they learn what to do with their mouth when they are attempting and practicing how to produce sounds, syllables, and words.  Feedback will come from your therapist in an effort to to guide your child with their speech attempts.  The therapist is monitoring how much feedback, what kind of feedback, and when feedback should be given in order to help your child relative to the sounds and targets you are working on in therapy.
  3. Address Sequences and Movement Patterns Across Words: Speech is a series of rapidly, highly defined movements, and children with CAS have difficulty coordinating and programming these specific movements that underlie speech.  Therefore, building from sounds to syllable shapes to words across movement sequences will ensure your child is learning how to coordinate their mouth to produce speech more accurately.  As a result, functional targets should be selected in therapy!  This means that words should be useful, relevant, and something the child may actually need or want to say! Your therapist will think about all the sounds your child can produce and build in appropriate and functional speech targets from there.  This will also include sequences or syllable shapes your child can produce or may need to work on in order to get to this functional target.   

    For example, “up” may be a functional word for your child to learn.  If your child can say the vowel /u/, your therapist will build from the V (vowel) to the VC (vowel consonant) through the use of cues and feedback and addressing the sound sequences necessary in order to produce this target more accurately.  This will then be included in the home-program with feedback for how to implement this target and when to address it (i.e. when your child wants to be picked up or when cleaning your toys and picking them up) to maximize on short, frequent practice in building this word into the child’s word inventory.   

    Note, in some instances, your therapist may suggest the use of PECS or AAC to support your child during this time.  As research supports, these programs or devices will only positively impact your child’s development, it will not hinder their ability to learn to talk.  Often these aids are beneficial in helping your child feel successful in the moment by decreasing frustration when otherwise they are not understood.  Think of these programs and devices as tools to help your child get to the end result, which is speaking more independently and clearly!
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