Childhood apraxia of speech (CAS) occurs when the brain’s “command center” for talking has trouble sending precise, timed messages to the lips, tongue and jaw. Children who have it usually understand language well, but the faulty signals make it hard to string sounds together, so words may come out inconsistently, pause-filled or hard to decipher.

Although CAS is uncommon, early evaluation by a speech-language pathologist and intensive, individualized therapy can greatly improve a child’s ability to communicate. The sections ahead explain how CAS differs from other speech issues, its possible causes, early warning signs, the diagnostic process, treatment options and answers to frequently asked questions.

What Is Childhood Apraxia of Speech (CAS)?

Childhood Apraxia of Speech (CAS) is a motor speech disorder that makes it difficult for children to speak. It is not a common disorder and tends to happen more frequently in boys than girls. Children with CAS do not have a problem with thinking or understanding language, their issue is with learning and using movements that are necessary for speech. A disruption in the nerve pathways between the brain and the mouth muscles make it difficult to form words. Because of this, children with CAS may not speak clearly or accurately. Common issues children with CAS may also have include:

• Speech or language delays.
• Difficulty with fine motor skills.
• Problems with reading, writing, and spelling.
• Trouble swallowing or chewing.

There is not a cure for apraxia, but early detection and specific childhood interventions, such as working with a speech pathologist, can greatly improve your child’s ability to speak clearly and accurately.

Speech Disorders Confused with CAS

There are other speech disorders that sometimes get confused with CAS. Those disorders include:

• Aphasia – problems with the use of words.
• Developmental delay of speech – normal speech development, but at a slower rate.
• Phonological speech disorder – difficulty making and using specific sounds.
• Dysarthria – issues related to the function of speech muscles.

Childhood Apraxia of Speech Causes

The exact cause of CAS remains unknown. There are many potential causes, but usually an exact cause is not observable and cannot be determined. CAS occurs when nerve pathways from the brain to the muscles of the mouth get disrupted. This inhibits the mouth from moving appropriately when trying to form words. Possible underlying causes for the nerve pathway disruptions include:

• Stroke
• Infection
• Traumatic brain injury (TBI)
• Genetic disorder
• Metabolic condition

Research has also shown that CAS may be a part of a larger disorder your child has, including:

• Autism
• Cerebral palsy
• Epilepsy
• Galactosemia
• Neuromuscular disorders
• Certain mitochondrial disorders
• Other intellectual disabilities

Early Signs of Childhood Apraxia of Speech

Early detection is important for better treatment outcomes. Early (3 years of age or younger) signs your child may have CAS include:

• Not making cooing or babbling sounds, or a lack of variety in babbling sounds.
• Trouble putting sounds together.
• Words are said differently each time.
• Delay in saying their first words.
• Long pauses between sounds.
• Use only a few sounds.
• Problems with eating.

Symptoms of CAS

There are several symptoms of CAS. Children with CAS do not generally have an issue with understanding language but do have trouble with speaking. Symptoms may include:

• Several attempts to say a word before saying it.
• Coordination difficulties when transitioning from one syllable to the next.
• Deleting or distorting sounds.
• Errors in tone, stress, or rhythm of speech.
• Inconsistent errors in speech.

Children older than 3 may:

• Be difficult to understand.
• Have flat or choppy speech.
• Grope or search for words by moving their mouth before speaking.
• Have difficulty enunciating or pronouncing longer words.
• Speak with a lack of clarity.
• Have more difficulty speaking when nervous.
• Trouble imitating what others say.

CAS Risk Factors

Researchers have discovered a specific gene that may put children at a greater risk of developing CAS, as well as additional genes that may impact motor speech development. The gene that may increase the risk of CAS and other speech and language disorders is called the FOXP2 gene. This gene may be related to how certain nerves and nerve pathways develop in the brain. The gene may impact motor coordination and speech and language processing in the brain.

Childhood Apraxia of Speech Diagnosis Process

CAS is a complex disorder, making it difficult to diagnose. Due to the complex nature of CAS, a speech-language pathologist (SLP) is usually needed to make a diagnosis. Your child’s SLP will listen to your child’s symptoms and take a thorough medical history. Often, a part of diagnosis is ruling out other conditions first. Additionally, an SLP will assess your child’s language skills, including vocabulary, sentence structure, and your child’s ability to understand speech.

A diagnosis of CAS is not made based on any singular test or observation. It typically takes ongoing observation and assessments to recognize patterns and specific behaviors to rule out other conditions and determine whether your child meets criteria for CAS.

Diagnosing your child with CAS may also prove difficult if your child’s speech is limited or if they speak very little. Determining a diagnosis may also be challenging if your child struggles to interact or cooperate with the speech-language pathologist.

Specific tests that may be administered include:

• Hearing tests
• Oral-motor assessment
• Speech evaluation
• Genetic testing

Treating Childhood Apraxia of Speech

Treatment for CAS requires consistent therapy over a long period of time. If your child missed important language development milestones, treatment may require several years. Treatment may require therapy three-to-five times a week to develop their speaking ability. More specifically, treatment includes:

• Individualized speech therapy to address your child’s unique issues with syllables, words, and phrases.
• Learning alternative forms of communication through sign language or electronic devices.
• Practicing skills and repetitive language exercises outside of therapy.

Complications of Childhood Apraxia of Speech

Some children with CAS have other issues that impact their ability to communicate. The issues or complications are not caused by CAS but may appear alongside CAS. Issues include:

• Delayed language, which may include difficulty understanding speech, smaller vocabulary, and poor use of grammar.
• Delay in intellectual and motor development, causing problems with reading, writing, and spelling.
• Problems with gross and fine motor movement skills or coordination.
• Trouble speaking or communicating in social settings.

Can You Prevent CAS?

There is no way to prevent CAS, but early childhood detection can certainly improve treatment outcomes. Specifically, it can reduce long-term persistence of the condition. If you are noticing symptoms of language or speech issues in your child, reach out to a speech pathologist for an assessment.

Childhood Apraxia of Speech FAQs

Is CAS the Same as a Speech Delay?

No. A speech delay occurs when a child has normal speech development, but at a slower rate. CAS indicates an issue with the nerve pathways between the brain and muscles in the mouth that are responsible for forming words.

Does Childhood Apraxia Go Away?

There is no cure for CAS, but early childhood intervention may increase your child’s chances of being able to eventually speak relatively normally.

How Rare is Childhood Apraxia of Speech?

Childhood apraxia of speech is a rare disorder, affecting 1–2 out of every 1000 children in the United States.

What’s the Difference Between CAS and Dysarthria?

CAS is a disruption of nerve pathways between the brain and mouth that impacts the planning of movements needed for speech. Dysarthria is a motor speech disorder that involves difficulty with coordinating or controlling the movements needed for speech. It can be caused by weak or poorly coordinated muscles.