Childhood Apraxia Of Speech (CAS)

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What is Childhood Apraxia of Speech (CAS)

Whenever we want to say something, our brain tells our mouth, jaw, and tongue what to say and how to say it by sending a message down a pathway. When the message is sent but is not received correctly, it makes it hard for us to move our mouth, jaw, and tongue, even if our muscles are strong. 

Childhood Apraxia of Speech is when your child knows what they want to say but they have trouble putting the sounds and words together to be understood due to a breakdown in this pathway from the brain. 

CAS is a rare disorder, with an estimated prevalence of 1-2 per 1,000 children. It is often diagnosed in children between the ages of 2 and 3, but it can be diagnosed in children as young as 18 months or as old as 8 years. CAS is not a disorder of intelligence and children with CAS typically have age-appropriate cognitive and language skills.

Sometimes, Childhood apraxia of speech is called: apraxia, developmental apraxia, or apraxia of speech. Although the word developmental is sometimes used, Childhood Apraxia of Speech is not something that your child can outgrow. 

What Causes Childhood Apraxia of Speech (CAS)

Although there has been research into causes for Childhood Apraxia of Speech, the exact cause of CAS is not fully understood, but it is thought to be related to problems with the brain’s ability to plan and coordinate the movement of the lips, tongue, and jaw needed to produce speech sounds.

There are several potential causes of CAS, including:

  • Developmental: CAS may be present from birth or develop during the first few years of life. It is not fully understood why some children develop CAS, but it is thought to be related to problems with the development of the brain’s speech and language centers.
  • Acquired: CAS can also be acquired as a result of brain damage or injury, such as a stroke or traumatic brain injury.
  • Genetic: CAS may also have a genetic component, as it has been observed to run in families. Researchers are currently studying the genetic basis of CAS and how it may be inherited.
  • Other medical conditions: CAS may also be associated with other medical conditions, such as cerebral palsy, Down syndrome, or Fragile X syndrome.

It is important to note that the cause of CAS is not always clear and may be a combination of factors. A thorough evaluation by a qualified speech-language pathologist (SLP) is typically needed to determine the cause and appropriate treatment for a child with CAS.

What are the symptoms of Childhood Apraxia of Speech (CAS)

At home, our children are the most relaxed and the most talkative. If you are concerned about your child’s speech, you can look for these typical signs of Childhood apraxia of speech. 

Children with childhood apraxia of speech may present with some, all or just a few of the following:

  1. Says the same word differently when asked to say it again (bee can become bay, bee, by, boo)
  2. Says the word correctly put stresses the wrong syllable (umBRElla is the correct stress, they may produce as umbreLLA) 
  3. Can change the sound in a word or say it distorted (its close but not quite right) (boo is produced boh-oo) 
  4. Shorter words are more clear than long words (her is clearer than hurting)
  5. Difficulty producing speech sounds, particularly consonants
  6. Difficulty producing words or phrases in the correct order
  7. Difficulty imitating speech sounds or words
  8. Excessive errors in word production, including omissions, substitutions, and distortions

Diagnosis for Childhood Apraxia of Speech (CAS)

CAS is often misdiagnosed or undiagnosed due to its rarity and the fact that it can be mistaken for other speech and language disorders. It is important for children with CAS to receive an accurate diagnosis and appropriate treatment as early as possible, as early intervention can improve outcomes and reduce the risk of long-term language and communication difficulties.

If you think your child has any symptoms listed above, talk with your pediatrician about getting a referral for Speech Therapy (pediatric clinics tend to have more openings from 9am to 3pm). During the intake call with the Speech Clinic, please mention your concerns for Childhood Apraxia of Speech. 

Your Speech therapist will provide a comprehensive evaluation to determine your child’s current level of articulation and language skills. 

During the evaluation, your therapists will discuss the outcomes of the assessment and a tentative plan for therapy. Apraxia and other speech sound disorders are closely related and therapy is used to help determine if your child has apraxia of speech or a speech sound disorder. 

Treatment for Apraxia of Speech (CAS)

Treatment for CAS typically involves speech therapy with a qualified speech-language pathologist (SLP). The goals of therapy may include improving speech sound production, increasing the child’s intelligibility, and expanding their vocabulary and language skills.

Treatment approaches for CAS may include:

  • Oral-motor exercises to improve the strength and coordination of the lips, tongue, and jaw
  • Multisensory approaches, including visual and auditory feedback, to help the child learn to produce speech sounds accurately
  • Use of augmentative and alternative communication (AAC) devices, such as picture or symbol boards, to help the child communicate their needs and wants
  • Parent and caregiver involvement to support the child’s language and communication development at home

With Apraxia of speech, short-intense sessions of practice have been found to be the most beneficial. Work with your Speech therapist to establish a home exercise program. Your therapist will give you exercises, worksheets, flashcards, or a list of words to practice at home with your child. 5 minutes of practice a day is all it takes to see improvements in your child’s speech. 

It is important for parents and caregivers of children with CAS to work closely with their child’s SLP and follow their recommended treatment plan. Children with CAS may make slower progress than those with other speech and language disorders, but with consistent and dedicated therapy and support, they can make significant progress and achieve their full potential.

In addition to speech therapy, there are other strategies that can support a child with CAS, including:

  • Providing a supportive and language-rich environment at home, including reading books, singing songs, and engaging in conversation
  • Encouraging the child to communicate through gestures, facial expressions, and other forms of nonverbal communication
  • Using visual supports, such as picture cards, to help the child understand and express their needs and wants
  • Seeking support from other parents and caregivers of children with CAS through online groups or in-person support groups

If you are the parent or caregiver of a child with CAS or suspect that your child may have CAS, it is important to seek a referral to a qualified SLP for assessment and treatment. With early identification and intervention, children with CAS can make significant progress and achieve their full potential.

Other resources 

For more information about Apraxia of Speech and some resources for support:

For more information from the Speech Pathologist governing board:

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