Childhood apraxia of speech

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 19, 2016
StartDiseasesChildhood apraxia of speech

Childhood apraxia of speech (CAS) is a rare neurological disorder that impacts children. It is a speech sound disorder in which a child produces unintelligible speech. Children with speech apraxia generally do not experience receptive language issues (that is they do not have difficulty understanding the meaning of other people's speech), but they can experience profound difficulty in trying to express themselves to those around them. Another term for childhood apraxia of speech is developmental verbal dyspraxia and developmental apraxia of speech.


Definition & Facts

Childhood apraxia of speech is a motor speech disorder associated with childhood. Children impacted by childhood apraxia of speech often experience difficulty in the pronunciation of syllables, words, and other sounds. In general, children with childhood apraxia of speech know what they want to say but they experience difficulty with the formation of the words. Muscle weakness and paralysis of muscles are not related to childhood apraxia of speech.

Childhood apraxia of speech is not a disorder that a child will simply outgrow; by contrast, some who have acquired apraxia can experience spontaneous recovery. Children with this disorder require specialized treatment in order to make progress. There is no cure for childhood apraxia of speech but with early intervention and intensive speech therapy, many children are able to make substantial progress with the motor coordination of their speech.

While childhood apraxia of speech is a speech disorder, many with this disorder also have a expressive language disorder, a type of language disorder. This category of disorders involve the impaired ability to coordinate vocabulary and syntax and recall words.

Symptoms & Complaints

All cases of childhood apraxia of speech are unique, but each child is likely to experience a common set of apraxia symptoms. In general, associated symptoms of childhood apraxia of speech are:

  • Lack of babbling as infants
  • First words are delayed and missing sounds
  • Lack of difference in enunciation of vowels and consonants
  • Difficulty with combinations of sounds
  • Long unnatural pauses between sounds
  • Simplifying words with easier sounds
  • Difficulty eating
  • Inconsistent sound errors unrelated to age
  • Understands language but experiences difficulty expressing language
  • Difficulty saying longer words
  • Confusion with word order
  • New listeners have difficulty understanding the child
  • Difficulty with word recall
  • Issues with coordination and fine motor skills.
  • Overly sensitive about sensations in the mouth
  • Lack of sensation in the mouth
  • Speech delay (Delayed development in speech)
  • Other expressive language issues
  • Difficulty speaking while anxious
  • Difficulty with speech imitation


Childhood apraxia of speech is caused by a child's brain experiencing substantial difficulty in getting the appropriate message to that child's vocal and oral muscles in order to help the child pronounce words correctly. Sometimes, apraxia is caused by neurological injury, traumatic brain injury, infection or other illness.

At times, childhood apraxia of speech is a secondary issue, caused by genetic disorders, metabolic disorders, degenerative diseases, seizure disorders, and other congenital disorders or birth defects. Often the specific cause of childhood apraxia of speech is entirely unknown or said to be idiopathic.

Medical researchers are researching the role that genetic mutations in the FOXP2 gene may play in childhood apraxia of speech. It is the first gene to be identified as causing speech and language disorders. The FOXP2 gene is essential for brain and lung development.

Diagnosis & Tests 

Some experts recommend studying a child for between six to twelve months before administering a diagnosis of childhood apraxia of speech. It is recommended for parents to take their child in for an evaluation as soon as any speech or language problems are noticed at home.

In order to accurately diagnose childhood apraxia of speech, a thorough hearing evaluation conducted by a hearing specialist called an audiologist is required. Audiologists can conduct various tests to help rule out hearing loss as a cause of a speech disturbance in a child.

A speech-language pathologist can help diagnose a child's unique oral and motor capabilities as well as speech sound development and a child's melody of speech. The speech-language pathologist will assess the oral muscles to rule out dysarthria, which involves the impairment of messages from the central nervous system to the muscles involved in producing language. The speech-language pathologist will also examine the child's receptive language skills, expressive language skills, and literacy skills.

Treatment & Therapy 

Children often do quite well with consistent, constant treatment for childhood apraxia of speech. The early diagnosis and treatment of childhood apraxia can help lessen the risk of long-term consequences of apraxia.

Melodic intonation therapy (MIT) is one therapy that is used to treat apraxia. This incorporates musical techniques such as singing, rhythmic tapping, and repetition. It may generate new connections between neurons. Learning and utilizing sign language may be necessary for extreme cases of apraxia.

Prevention & Prophylaxis

It is difficult to prevent childhood apraxia of speech because the cause of the disorder is still mostly unknown. However, there are certain tips that may help decrease the risk of childhood apraxia. During pregnancy, a mother should abstain from the use of drugs and alcohol as well as maintain proper nutrition.

Parents can promote healthy language and speech development among their children by talking, reading and also playing with their children on a daily basis. It is important to give children the opportunity to speak on a regular basis, so parents must cultivate an environment in which their child feels most comfortable trying to speak. Parents should also avoid treating their child as if something is "wrong" when the child is attempting to communicate.

Parents should be mindful of the care of the health of their child's teeth and mouth and parents should address any oral issues as soon as possible. A child's hearing should be checked regularly and often to help diagnose any hearing issues early on. Parents can have their child's hearing screened at school, at the doctor's office, or at a local community clinic. Minimally, a child's hearing should be screened annually.