What Are the Signs of Childhood Apraxia of Speech?

When your child or client has very few sounds, it can be difficult to figure out how to best support their development or where to begin with treatment. 

Childhood Apraxia of Speech (CAS) is a complex motor speech disorder that affects a child's ability to plan and coordinate the movements needed to make clear, accurate sounds and fluently transition between syllables within a word or phrase. 

This post will help you understand how a CAS diagnosis is made, common red flags and characteristics of CAS, and when to use motor based therapy. 

How do we diagnose CAS? 

CAS should always be diagnosed by a trained apraxia specialist. 

The child must be able to participate in a dynamic motor speech assessment. This means they must be able to imitate (or attempt imitation) of words and attend to cues via the principles of motor learning. 

The information gathered from a dynamic motor speech assessment allows the clinician assessing apraxia of speech to see how the child responds to cueing. This helps us make a proper diagnosis and determine prognosis.

When the child attempts production of new words and movement patterns, we can usually see the discriminative characteristics or symptoms of childhood apraxia of speech. 

What are discriminative characteristics or symptoms of CAS?

If you suspect your child or client has CAS, here are some of the characteristics that are typically discriminative of childhood apraxia of speech: 

• Awkward movement from one articulatory configuration to another
• Groping and/or trial-and-error behavior
• Vowel distortions
• Prosodic errors 
• Inconsistent voicing errors
• Intrusive schwa
• Inconsistency of word or phrase production over repeated trials 

Some red flags to be aware of (but don't necessarily indicate CAS) include:

• Limited vocalizations
• Decreased babbling before 12 months
• 5 or fewer consonants between 17-24 months
• Simple syllable shapes 
• Ghost words: words that appear then disappear 

Myths about diagnosing CAS 

There are several myths parents and SLPs may have heard about CAS. Let's clear up what's true and what's false. 

Myth #1
The child is too smart / not smart enough to be diagnosed with CAS. 

The truth? Children at all cognitive levels can have CAS.

Myth #2
The child is under 3 years old, so we cannot diagnose with CAS.

The truth? If a child can participate in a dynamic assessment, and we see discriminative characteristics, then we can make a diagnosis.

Myth #3
A child cannot have CAS and another speech sound disorder. 

The truth? A child can have a combination of speech sound disorders. (There are significant connections between autism and apraxia.) 

Can a child receive apraxia therapy without a diagnosis? 

Before receiving a CAS diagnosis, many children can still benefit from motor based therapy. 

If they cannot participate in a dynamic assessment and CAS is suspected, there is no downside to treating the child using principles of motor learning.

A child who has CAS and is treated with a language based approach, will not progress.   

If a child has been receiving traditional language based therapy for a long period of time and is not progressing, a diagnosis of suspected childhood apraxia of speech should be considered. 

What's next? 

If you're a parent looking to support you child with CAS or suspected CAS, you can check out all my parent resources here! 

SLPs can find comprehensive courses and mini courses specifically designed to help you learn more about CAS and effectively use motor based therapy to help your clients make more meaningful progress. 

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