Childhood Apraxia of Speech


What is childhood apraxia of speech?

Childhood apraxia of speech (CAS), also known as verbal dyspraxia or developmental apraxia, is a motor speech, or neurological, disorder that affects some young children as they learn to speak. Children with CAS know what they want to say, but are unable to form the words.

Who is affected by childhood apraxia of speech?

Childhood apraxia of speech can affect any child. Children may be more likely to develop this condition if they have:

  • A language delay (the child is not speaking at an appropriate level for his or her age). The child generally understands language but is unable to express him- or herself verbally. The child follows directions, but has limited speech output.
  • Difficulties with reading, writing and spelling when they become school-aged. (CAS is usually identified before a child is reading and writing.)
  • Trouble with fine motor skills. For example, the child may have difficulty drawing or picking up small things.
  • Difficulties with chewing foods, using a straw or drinking from a cup, and processing what they feel in the mouth.

Symptoms and Causes

What causes childhood apraxia of speech?

The exact causes of CAS are not known. CAS occurs because of problems with the way nerves in the brain communicate with mouth muscles.

Children who have CAS may have interruptions in certain nerve pathways in the brain. These nerve pathways are responsible for planning the movements that are necessary for speech. In children who have CAS, therefore, the messages from the brain to the parts of the mouth used for speech are not being sent correctly.

CAS is not related to weakness or paralysis of the muscles involved in speech, including those of the lips, jaw and tongue.

What are the symptoms of childhood apraxia of speech?

The symptoms of CAS vary from child to child. In general, children affected by CAS usually understand language, but have difficulty with speaking and communicating. For instance, children with CAS:

  • Make inconsistent errors in speech. They also have difficulty coordinating the movement from one syllable of a word to the next syllable.
  • Distort sounds.
  • Grope for sounds.
  • Make errors in the tone, stress or rhythm of speech.

Signs and symptoms of CAS may appear at different stages of a child’s life. Children younger than 3 years may:

  • Not make babbling or cooing sounds.
  • Use only a few different sounds.
  • Have trouble putting sounds together.
  • Take long pauses between sounds.
  • Say words differently each time.
  • Say their first words later than expected.
  • Have problems eating.

Children older than 3 may:

  • Have difficulty saying longer words clearly.
  • Have trouble imitating what other people say.
  • Be hard to understand, especially for people who don’t know the child.
  • Have a flat or choppy speech pattern.
  • Grope, or search, for words by moving the mouth a few times before speaking.
  • Have more trouble speaking when nervous.

Diagnosis and Tests

How is childhood apraxia of speech diagnosed?

Childhood apraxia of speech is usually definitively diagnosed by a speech-language pathologist (SLP). SLPs have extensive training and skill in treating speech disorders.

To diagnose CAS, an SLP will learn about the child’s history, including any known medical problems. The SLP will also test the child’s oral-motor skills and intonation (pitch) and the way he or she says sounds.

The SLP will also test the child’s ability to speak by:

  • Checking for signs of mouth muscle weakness.
  • Looking at non-speech oral motor skills such as blowing, smiling, rounding lips, and how quickly the child can move his or her mouth.
  • Observing how the child pauses or changes the pitch of his or her voice.
  • Checking how well the child makes consonant and vowel sounds.
  • Observing how well others can understand what the child is saying.

Management and Treatment

How is childhood apraxia of speech treated?

Children who have CAS do not outgrow the problem. A speech-language pathologist can work with children to develop their speaking ability. In many cases, SLPs work with children three to five times a week.

Children with severe CAS symptoms may need treatment for years. Some children use other methods to express their thoughts, including sign language, electronic communication or pictures.


Can childhood apraxia of speech be prevented?

There is no way to prevent childhood apraxia of speech. It is a neurological condition, tied to the brain’s development.

Outlook / Prognosis

What is the prognosis (outlook) for people with childhood apraxia of speech?

Many children show improvements in speech with the help of a speech-language pathologist. Children’s treatment plans will depend on their unique needs.

Living With

When should I call my doctor about childhood apraxia of speech?

If you notice symptoms or signs of CAS in your child, contact your doctor for a referral to a speech-language pathologist.

Last reviewed by a Cleveland Clinic medical professional on 01/04/2019.


  • National Institute on Deafness and Other Communication Disorders (NIDCD). Apraxia of Speech. ( Accessed 1/8/2019.
  • American Speech-Language-Hearing Association. Childhood Apraxia of Speech. ( Accessed 1/8/2019.
  • Apraxia Kids. What is Childhood Apraxia of Speech? ( Accessed 1/8/2019.
  • Apraxia Kids. How is CAS diagnosed? ( Accessed 1/8/2019.
  • American Academy of Pediatrics. Language Delays in Toddlers: Information for Parents. ( Accessed 1/8/2019.

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