Childhood Apraxia of Speech (CAS)

“As a baby, he was very quiet. He didn’t babble and make those funny noises babies make before they start to talk.”

“Ella was a late talker. When she started talking, she only seemed to be able to say a few sounds.”

“Joel finds it really frustrating. He never knows which sounds will come out of his mouth even though he knows what he wants to say.”

Children with CAS have difficulty planning, co-ordinating and producing the sounds required for clear speech. They have difficulty pronouncing individual sounds and sounds in words, sentences and conversation. As a result, their speech is often difficult for others to understand.

CAS can occur in children with or without any other developmental and/or learning difficulties. However, some children may also have:

 Oro-motor apraxia
This is characterised by difficulties coordinating the lips, tongue, palate and larynx (often presenting as difficulties with chewing and swallowing)

Generalised apraxia
This is characterised by difficulties with fine and gross motor movements such as hopping, writing, catching a ball.

What are the characteristics of CAS?

  • A limited range of speech sounds
  • Overuse of one specific sound
  • Vowel distortions
  • Inconsistency
  • Increased difficulties as words or sentences get longer
  • Leaving out sounds or substituting sounds with other sounds
  • Irregular voice volume, pitch, length, quality
  • Irregular nasality
  • Irregular rate, rhythm, stress and intonation
  • Speech that is generally difficult for others to understand

Children with CAS may also present with:

  • Family history of speech, language or learning difficulties
  • Language delay
  • Feeding difficulties
  • Literacy difficulties

What does this mean for my child?
Many children attend speech therapy to increase their speech sound pronunciation. They may have an articulation delay characterised by difficulties placing the lips, tongue and teeth in the right place to produce a sound (eg a lisp). They may have a phonological delay characterised by difficulties “using” sounds they are able to say on their own, in conversation.

Children with apraxic features often present with more severe speech sound difficulties, are inconsistent in their productions and have a higher rate of vowel distortions and sequencing of sounds than children with articulation/phonological delay.

Intervention is often more long-term for children with CAS than for those with articulation and phonological delays.

Many children with CAS present with typical comprehension of language. They therefore become very frustrated at not being understood by others.

What is the treatment for CAS?
Children with CAS require regular speech pathology intervention with a comprehensive intervention plan that is reviewed regularly as the child’s speech patterns change, evolve and improve. Parents play an important role in developing therapy goals and implementing home practice strategies. Every child is different and therapy goals require the consideration of many factors affecting the child such as school environment, siblings, other developmental needs and time restraints.

Tips for helping your child’s speech clarity

  • Provide a good model particularly if you have understood what your child has said even though his/her sounds were not accurate. For example:
    Child: “Oo, Mu, pei!” (as s/he points to the sky as a plane flies by.)
    Mum: “Yes, look a plane.”
  • Praise effort as well as success.  Give specific praise e.g. “You tried really hard to say the quiet sound for me (shhh) didn’t you? Well done.”
  • Encourage your child to SHOW you if they can’t TELL you.
  • Take the problem away from the child e.g. “Mummy, can’t understand. Can you show me what you want?” Then take the opportunity to model the word once you know what it is!