Childhood Apraxia of Speech (CAS)

Childhood Apraxia of Speech (CAS)

In order for speech to occur, messages need to go from your brain to your mouth. These messages tell the muscles how and when to move to make sounds. When a child has apraxia of speech, the messages do not get through correctly. The child might not be able to move their lips or tongue in the right ways, even though their muscles are not weak. Sometimes, the child might not be able to say much at all.

A child with CAS knows what they want to say. The problem is not how the child thinks but how the brain tells the mouth muscles to coordinate and move.

CAS is sometimes called verbal dyspraxia or developmental apraxia. Even though the word “developmental" is used, CAS is not a problem that children outgrow. A child with CAS will not learn speech sounds in typical order and will not make significant progress without treatment. While therapy can take a lot of time and hard work, child’s speech can improve with intensive intervention.

Signs and Symptoms

Not all children with CAS are the same. Your child may show some or all of the signs below. You should talk to your doctor and see an SLP if your child is older than 3 years and:

  • does not always say words the same way every time
  • tends to put the stress on the wrong syllable or word
  • distorts or changes sounds
  • can say shorter words more clearly than longer words

Children with CAS may have other problems, including

  • difficulty with fine motor skills
  • delayed language
  • problems with reading, spelling, and/or writing.

Treatment Goals

The goal of treatment is to help your child say sounds, words, and sentences more clearly. Your child will learn how to

  • plan the movements needed to say sounds and
  • make those movements the right way at the right time.

Doing exercises to make the mouth muscles stronger will not help. Mouth muscles are not weak in children with CAS. Working on how to move those muscles to say sounds will help your child learn and develop more accurate neural pathways for motor planning of speech.

Your child must practice speaking to get better at it. It helps to use all the senses when learning how to say sounds. Your child may use

  • “touch” cues, like putting their finger on their lips when saying the “p” sound as a reminder to close the lips
  • “visual” cues, like looking into a mirror when making sounds
  • “listening” cues, like practicing sounds with a recorder and then listening to hear if the sounds were made correctly

Treatment plans may also include the use of Alternative or Augmentative Communication (AAC) devices.

  • Manual signs, picture exchange communication boards and/or speech generating devices may be recommended to help your child communicate effectively while they develop the motor planning needed to coordinate verbal speech
  • AAC can assist with increased functional communication and development of language
  • AAC can help "bridge the gap" in communication
  • AAC and verbal speech sound treatment for CAS do not need to be mutually exclusive - a comprehensive therapy plan including both of these elements may provide a greater level of success than choosing only one methodology.


ASHA American Speech-Language-Hearing Association