The Intricacies of Childhood Apraxia of Speech

Providing Insight into the Complexities of CAS Diagnosis

Childhood Apraxia of Speech (CAS), also sometimes referred to as verbal dyspraxia, is a rare speech disorder that is both underdiagnosed and overdiagnosed. For those that are underdiagnosed, children are typically treated for speech disorders that can mimic CAS; for those overdiagnosed, assumptions are likely being made during an initial visit without evaluating clinical symptoms over time. In this month’s newsletter, CAS is highlighted in order to provide important information regarding this intricate, often confusing, disorder and the ways in which those with a true CAS diagnosis can be helped.

As we enter a new year fresh with possibilities, CTC wishes to extend blessings for a healthy, happy and inspiring 2024!


Feliz New Year, Ava Gabriela!

Ava welcomes in the new year with her family in Columbia, but her boisterous family suddenly makes her feel quiet and shy. How can she regain her voice before the new year?

Product: Indoor swing and trapeze

This indoor swing and trapeze will help energetic youngsters stay active and entertained, even on the coldest of days that keep you indoors. It’s also helpful for improving gross motor strength, body awareness and hand-eye coordination!

Quote of the Month

Celebrate endings- for they precede new beginnings.

– Jonathan Lockwood Huie

Understanding Childhood Apraxia of Speech

Signs, Symptoms and Treatment

Childhood Apraxia of Speech (CAS), as it is currently understood, is a neurologically-based motor speech disorder that negatively impairs the precision and consistency of speech in children. It is differentiated from speech disorders that result from neuromuscular deficits, and is not a cognitive disorder or developmental delay. However, it can occur in conjunction with other speech and language conditions or developmental disabilities such as dysarthria (weakness in the muscles used for speech), phonological errors, low tone, autism and/or Down syndrome.

While the description of CAS sounds dizzying, further breaking down this disorder by highlighting its signs and symptoms may help clear up confusion.

Signs and Symptoms of CAS

Children with suspected CAS often exhibit the following symptoms:

  • Limited or minimal cooing or babbling as an infant
  • May have feeding difficulties, including requiring prompts to bite, chew, swallow and drink
  • First word attempts often occur after 18 months of age, without developing into intelligible simple words by 2 years of age
  • Continuous pointing and grunting beyond age 2
  • Understands most of what is said, but cannot verbalize well
  • Difficulty imitating words, phrases, and oral motor movements on command (e.g., movement of mouth, lips, tongue, cheeks and jaw)
  • Gross motor skills (e.g., running, jumping, climbing) may be slow to develop
  • Prosody of speech may be unusual, such as in sounding monotone
  • May produce words in certain contexts or randomly, with difficulty repeating a word when prompted
  • May speak mostly in vowels, with an overall limited repertoire of sounds
  • Difficulty sequencing consonant-vowel combinations, resulting in effortful and unintelligible speech
  • Oral groping may occur when attempting to imitate oral motor movements or consonant/vowel productions
  • May exhibit poor body awareness and/or fine motor difficulties
  • Inconsistencies in speech sound production; the same word may be pronounced differently each time it is attempted

Therapy for CAS

It is essential for parents to schedule a speech-language evaluation should concerns regarding CAS exist. Oftentimes, parents schedule an evaluation even when unaware of CAS, as many of its signs and symptoms are similar to those seen in speech-language delays and phonological disorders. Here’s where CAS gets even trickier: in order for a speech-language pathologist (SLP) to accurately provide a CAS diagnosis, the child must be verbal. SLPs need to carefully observe speech


Indoor Winter Fun

Ideas for home activities when the winter doldrums hit

Bake a special treat

Along with engaging in a meaningful and hands-on activity, baking something with your child on a cold winter’s day will have the added benefit of warming up your household! It also helps your child improve their ability to sequence steps of a task and allows you to incorporate other skills that your child may need to work on (e.g., counting, naming vocabulary, reducing impulsivity, etc.).

Have an indoor snowball fight

Have your child ball up sheets of paper (great for fine motor strengthening), make sure you have lots of space to move around, and have an indoor snowball battle! Whether you keep score or not, it can be an entertaining activity full of laughter and much-needed movement.

Bring the outdoors in

When the weather is just TOO cold outside and/or your child has a case of the sniffles that you don’t want to worsen, grab a pile of snow and place it in a bowl or on a cookie tin for your child to explore. It’s a natural (and free!) source of sensory exploration.

Read and snuggle

Need we say more? While movement is vital for all of our bodies, do not forget the importance of taking time to read with your children. Snuggles are a wonderful bonus.

Build a fort

Get creative with your young ones and do what you likely did as a child yourself: build a fort indoors! Gather up a multitude of chairs, blankets and pillows and create a dim and cozy place where your child will likely love to crawl into and explore. Keep the old-school charm of this activity and make it device-free. Instead, allow flashlights, books and stuffed animals and get their imaginations moving!

patterns along with a multitude of other observations in order to make a differential diagnosis of CAS. For children who are primarily non-verbal or who have extremely limited verbalizations when they begin therapy, a CAS diagnosis can take months or even years to be given with certainty. For children in this population, it is more likely that they will be subjectively given a diagnosis of “suspected CAS,” with treatment tailored to their specific challenges. While treatment strategies used for improving verbal expression and phonological errors can be appropriate to use in the treatment of CAS as well, there are certain therapy approaches that have been shown to be particularly helpful in treating CAS. These include:

Consistent and intensive therapy sessions

Children with CAS or suspected CAS tend to benefit more from frequent and intense therapy that is relatively short in duration than from less frequent sessions that are longer in length.

Strong parental support

As with nearly any form of therapy that exists, home practice is essential for better outcomes. For children, this means that strong parental support and commitment is crucial to their progress.

Incorporation of oral motor movement

Since CAS is a motor-based disorder, it is important that the SLP incorporate treatment strategies that improve the child’s ability to sequence the oral motor movements necessary to move from one sound to the next.

Multi-Sensory Input

Another approach that works for a wide array of speech disorders is the clinician’s use of multi-sensory prompts and cues. These include the use of visual, tactile, auditory, gestural and proprioceptive cues to help the child achieve particular goals. As the child gains consistency in their progress, these cues can be faded.

Focus on Prosody

Children with CAS often struggle with producing prosody in their speech, resulting in speech that can sound monotone or awkward, due to the child’s potential difficulties with rate, stress/emphasis and fluency of speech, among other factors.

For parents concerned about Childhood Apraxia of Speech or who have questions regarding their child’s existing speech-language goals and progress, be sure to book a speech-language evaluation or have a discussion regarding your concerns with your child’s current SLP. Of utmost importance is to work collaboratively with your child’s clinician(s), as everyone at hand more than likely has your child’s best interest at heart.

Content of this newsletter was written by:
Megan A. Miller, M.S., CCC-SLP

Please contact Megan with any questions or comments at: