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Childhood Apraxia of Speech Signs and Symptoms by: Carly Bisesar M.S., CCC-SLP, RBT

Written by in Apraxia, Speech language pathology
Childhood Apraxia of Speech Signs and Symptoms by: Carly Bisesar M.S., CCC-SLP, RBT

Are you familiar with the diagnosis Childhood Apraxia of speech (CAS)? The American Speech and Hearing Association (ASHA) defines Childhood apraxia of speech as a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words. A population estimate based on clinical referral data suggests that CAS occurs in 1-2 children per 1,000 (Shriberg et al., 1997) and is found in 3.4%-4.3% of the children referred for speech disorders (Delaney & Kent, 2004). On average, idiopathic CAS affects more boys than girls by a ratio of 2 or 3:1 (Hall, Jordan, & Robin, 1993; Lewis, Freebairn, Hansen, Taylor et al., 2004). Higher prevalence rates have also been reported with certain medical conditions, such as galactosemia and fragile X syndrome (Shriberg, Potter, & Strand, 2011; Spinelli, Rocha, Giacheti, & Richieri-Costa, 1995).

Childhood Apraxia of speech requires a specialized approach different from other commonly used treatments for speech and language delays. ASHA denotes that the qualified professional to diagnose CAS is a Masters level Speech and Language Pathologist (SLP) with specialized knowledge in motor learning theory and skills with differential diagnosis in childhood motor speech disorder, not a neurologist or other medical practitioner. It’s important to know the signs, but also to refer your child to a qualified SLP for differential diagnosis if you suspect childhood apraxia of speech.

ASHA identifies 10 early signs and symptoms of childhood apraxia of speech:

  • Limited babbling, or variation within babbling
  • Limited phonetic diversity
  • Inconsistent errors
  • Increased errors or difficulty with longer or more complex syllable and word patterns
  • Omissions, particularly in word initial syllable patterns
  • Vowel errors/distortions
  • Excessive, equal stress
  • Loss of previously produced words
  • More difficulty with volitional versus automatic speech responses
  • Predominant use of simple syllable patterns

Other non-speech signs that may be present include:

  • Impaired volitional oral movements (oral apraxia)
    • Difficulty with volitional “smiling” “kissing” “puckering”
  • Delays with fine/gross motor skills
  • Feeding difficulties that include choking and/or poor manipulation of food
  • General awkwardness or clumsiness

These are early signs, but many overlap with other phonologic and language delays, so it’s important to keep in mind that differential diagnosis is critical, as over-diagnosis of CAS remains problematic. It’s still a relatively rare disorder; however, there are resources that can help if you suspect it.

Below are resources to learn more about childhood apraxia of speech.

  • (CASANA):
    • Offers a growing library of on-demand webinars for professionals and parents.
    • Recently developed a practice portal for childhood apraxia of speech.

Apraxia awareness is crucial for professionals and families, so every child who has CAS gets the services he or she needs and deserves, regardless of how “rare” the disorder. If you are concerned that your child is exhibiting signs and symptoms of CAS please ask your SLP or seek an evaluation by an ASHA certified SLP.


American Speech-Language-Hearing Association. (2007a). Childhood apraxia of speech [Technical report]. Available from

Hall. P. K., Jordan, L., & Robin, D. (1993). Developmental apraxia of speech: Theory and clinical practice. Austin, TX: PRO-ED.

Lewis, B. A., Freebairn, L. A., Hansen, A. J., Iyengar, S. K., & Taylor, H. G. (2004). School-age follow-up of children with childhood apraxia of speech. Language, Speech, and Hearing Services in Schools, 35, 122-140.

Shriberg, L. D., Aram, D., & Kwiatkowski, J. (1997). Developmental apraxia of speech: I. Descriptive and theoretical perspectives. Journal of Speech, Language, and Hearing Research, 40, 273-285.

Shriberg, L. D., Potter, N., & Strand, E. A. (2011). Prevalence and phenotype of childhood apraxia of speech in youth with galactosemia. Journal of Speech, Language, and Hearing Research, 54, 487-519.

Smith, L. (2015, April 09). 10 Early Signs and Symptoms of Childhood Apraxia of Speech. Retrieved January 25, 2016, from for-childhood-apraxia-of-speech/

Spinelli, M., Rocha, A., Giacheti, C., & Richieri-Costa, A. (1995). Word-finding difficulties, verbal paraphasis, and verbal dyspraxia in ten individuals with fragile x syndrome. American Journal of Medical Genetics, 60, 39-43.



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