5 Essential Targets: Childhood Apraxia of Speech (CAS)

Apraxia Series: Apraxia 101

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This is part one of a series on Childhood Apraxia of Speech (CAS). This blog post will give basic information on the definition of CAS and signs of CAS. Future blog posts will dive deeper into what speech therapy can look like for a child with severe articulation needs.

What is Childhood Apraxia of Speech (CAS?)

“Childhood apraxia of speech (CAS) is 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”

~American Speech and Hearing Association

My first client with CAS

I remember my first client with diagnosed Childhood Apraxia of Speech (CAS). He was a verbal boy with difficulty coordinating his mouth movements for sounds. This little boy knew exactly what he wanted to say, but others could understand less than half of the words he said. He often left out syllables in words (television sounded more like “uh-viz”) and many sounds were left out or substituted. As he spoke, his tongue and jaw seemed unstable. His mouth would move and overcompensate to try and make the sounds he wanted. His brain knew what he wanted to say, but there was a lack of coordination between his brain and his mouth for the movements needed to produce the speech sounds he wanted to say.

Since my first client with Childhood Apraxia of Speech many years ago, I have worked with many other children with CAS and done my own research on how to best help clients with severe articulation needs speak clearly. This is one of my interest areas, and is one of my clinical passions. I am encouraged and energized when I can see children with CAS make progress with effective techniques.

What are the signs of CAS?

CAS is an impairment in planning or programming the movements necessary to produce speech sounds.

Some signs in Childhood Apraxia of Speech are:

– making inconsistent sound errors (using sounds one way in a word and then producing those same words differently later on)

– inconsistent consonant and/or vowel errors when repeating words

– difficulty sequencing longer words and longer utterances (tends to break down)

– even though imitation may be difficult, it is still clearer than conversational speech

– speech may have excess or equal stress, sound monotone

– may be difficulties regulating voicing, rate, pitch, loudness, nasality

– you may see groping in the lips, tongue and jaw as the child tries to produce speech sounds (but not always)

A child with CAS may be very difficult to understand to those who don’t hear his or her speech frequently.

Considerations for CAS diagnosis

I personally do not diagnose very young children with CAS. When very young children have few words, it is difficult to distinguish CAS from another speech and language disorder (like articulation delay or expressive language delay).

Remember every child with CAS will present with different motor challenges. It is important to remember that CAS in several different children can look pretty different.

If you are wondering if your child might struggle with CAS, your first step would be to schedule an evaluation with a Speech Language Pathologist. If you are looking for more information about CAS, the Apraxia Kids website has more information and resources.