Childhood Apraxia of Speech

Diagnosis

To evaluate childhood apraxia of speech (CAS), a speech-language pathologist reviews your child’s medical history, symptoms, and speech development. The evaluation involves assessing how your child produces sounds, words, and phrases, as well as examining the muscles used for speech.

The speech-language pathologist may also evaluate your child’s language skills, including vocabulary, sentence structure, and understanding of spoken language.

Diagnosis of CAS is based on identifying a consistent pattern of speech difficulties rather than a single test result. The specific assessments depend on your child’s age, ability to cooperate, and the severity of the speech issue. Diagnosing CAS can be challenging, especially when a child speaks very little, but early identification helps ensure the right treatment.

Tests may include:

• Hearing tests: To check if hearing problems are contributing to speech difficulties.

• Oral-motor assessment: To examine the lips, tongue, jaw, and palate for structural issues such as tongue-tie or cleft palate, and to observe muscle tone and movement.

• Speech evaluation: To observe how your child makes sounds, words, and sentences during activities or play. This includes checking coordination and smoothness of speech movements and assessing the rhythm and melody of speech.

The speech-language pathologist may also provide cues, such as slowing down speech or using touch prompts, to observe how your child responds. A short trial of speech therapy can help confirm the diagnosis of CAS.

Treatment

Children with CAS do not outgrow the condition, but speech therapy can help them make significant progress. Treatment is tailored to each child’s needs and often involves frequent and consistent speech practice.

Speech therapy
Speech-language pathologists usually provide therapy that focuses on practicing syllables, words, and phrases. Depending on severity, children may need therapy three to five times a week initially, with the frequency reduced as progress is made.

Individual sessions are generally most effective, allowing the child more time to practice. Therapy often emphasizes:

• Paying attention to how speech sounds feel and sound

• Repeating words and phrases to build coordination

• Using visual and touch cues to guide mouth movements

Key principles of CAS speech therapy include:

• Speech drills: Repetition of words or phrases during each session to reinforce correct movements.

• Sound and movement exercises: Watching and listening to the speech-language pathologist to learn how movements correspond to sounds.

• Speaking practice: Focusing on syllables, words, and phrases rather than isolated sounds.

• Vowel practice: Correcting distorted vowel sounds by practicing words like “hi,” “mine,” “bite,” or “house.”

• Paced learning: Starting with a small set of words and gradually increasing as speech improves.

Speech practice at home
Home practice is essential. The speech-language pathologist may give a list of words or phrases to practice for short sessions, around five minutes, twice a day. Practice can also happen naturally, such as asking your child to say “Hi, Mom” when greeting a parent.

Alternative communication methods
If your child struggles to communicate through speech, alternative methods like sign language, gestures, or communication devices (such as tablets) can be used. These help reduce frustration and support language development.

Therapies for coexisting problems
Children with CAS may also have other developmental challenges, such as delayed language or motor skills. In such cases, additional therapies like physical or occupational therapy may be recommended. Treating any underlying medical conditions is also important.

Treatments that aren’t effective for CAS
Exercises designed to strengthen speech muscles do not improve speech in children with CAS, as the problem lies in planning and coordinating movements, not muscle strength.