Childhood Apraxia of Speech - Diagnosis and Treatment

Diagnosis

A speech-language pathologist guides the diagnosis of childhood apraxia of speech (CAS) through several steps.

No single test confirms CAS. Instead, the diagnosis relies on identifying a pattern of speech and movement problems that match known features of this motor speech disorder.

A clinician gathers information about the child’s symptoms and medical history to understand early clues related to speech and language development. Observing how a child forms sounds, words, and sentences is very important.

Testing often looks at the following areas:

Assessment Tool	Purpose	Examples of What Is Checked
Hearing Tests	Rule out hearing loss	Response to sounds, ability to hear speech
Oral-Motor Evaluation	Examine speech muscles and their movements	Strength and shape of lips, tongue, jaw, palate
Speech Sound Assessment	Observe how sounds and words are spoken	Naming pictures, repeating words or syllables
Language Skill Evaluation	Check vocabulary and understanding	Size of vocabulary, use of sentences, comprehension

During the oral-motor assessment, the pathologist examines the lips, tongue, jaw, and palate for physical differences such as tongue-tie or cleft palate.

The clinician also checks for any weakness or low muscle tone, though this is not usually present in apraxia of speech. The professional observes how the child moves their mouth during activities like blowing, smiling, or kissing.

In the speech evaluation, the clinician asks the child to repeat certain sounds, words, or sentences, and watches for coordination, rhythm, and melody in the child’s speech.

For example, the pathologist might ask the child to repeat syllables like “pa-ta-ka” or say multi-syllable words to assess accuracy and smoothness.

The clinician also reviews language skills, including how well the child uses words and sentences, and how much of what is heard makes sense. Some children with CAS may show delays in vocabulary or difficulty understanding speech.

If the child can speak in sentences, the pathologist listens carefully to the stress and rhythm of speech to help distinguish CAS from other speech sound disorders.

Sometimes, the clinician includes a trial of speech therapy. By observing how the child responds to specific treatment for CAS, the pathologist gathers more clues, which can help confirm the diagnosis even if signs are not clear at first.

The clinician also considers differential diagnosis because other speech disorders can have similar symptoms, like other motor speech disorders or general speech sound disorders. Accurate diagnosis matters because treatments can be very different.

Treatment

Professional Speech Support

Children with childhood apraxia of speech (CAS) often attend frequent sessions with a speech-language specialist. These professionals create customized plans for each child, focusing on practicing syllables, words, and phrases instead of single sounds.

Therapy usually occurs several times a week at first, with the frequency decreasing as speech skills improve. Individual sessions give children more chances to practice and receive direct feedback.

A typical session might include:

Speech Drills: Repeating words or short phrases many times.
Sound and Movement Modeling: Watching and listening to how the mouth and face move to produce certain words.
Practice with Transitions: Moving smoothly from one sound to the next within words.
Vowel Correction: Practicing words with challenging vowel sounds.
Gradual Increase of Difficulty: Starting small and adding complexity as the child improves.

Speech-language experts use a variety of cues, such as visual cues (watching the mouth), auditory cues (listening carefully), and tactile cues (gently guiding mouth or facial movements).

This helps children become more aware of how speech feels and sounds, which is important for planning and producing clear speech. The plan is based on the child’s needs.

Example Table: Common Speech Therapy Focuses

Focus Area	Activity Example
Speech Drills	Repeating “puppy” many times
Vowel Practice	Practicing “down” and “out”
Sound-to-Sound Transitions	Saying “bite” and “bike”
Watching Movements	Observing mouth for “oo” sounds

At-Home Speech Practice

Regular practice outside of therapy sessions supports progress. Caregivers can help by practicing words or phrases with the child, following suggestions from the speech-language provider.

Practice at home should be short but consistent, typically about five minutes, twice each day. Incorporating real-life situations into practice helps children use speech naturally.

For instance, saying “good morning” when greeting someone or repeating simple phrases during daily routines reinforces learning. Practicing in different settings and with different people helps a child generalize their new skills.

Non-Speech Ways to Communicate

Some children with CAS use non-verbal methods to express themselves, especially while their speech is still developing. Early use of alternative communication methods can reduce frustration and support language development.

Options include:

Sign Language: Using gestures or signs for words.
Natural Gestures: Pointing or miming actions like eating or drinking.
Communication Devices: Tablets with speech apps or picture boards.

These tools help children share needs and ideas while their speech skills improve. As speech production gets better, the use of these methods may decrease.

Alternative Method	Example Use
Sign Language	Signing “cookie” to request one.
Picture Board	Pointing to objects or actions.
Communication App	Selecting pictures to speak.

Support for Other Related Challenges

Children with CAS sometimes experience additional challenges, such as trouble with receptive language (understanding), expressive language (using words), or movements in their arms and legs. Extra support may be needed.

Language Therapy: Helps with understanding and using language, not just speech sounds.
Physical Therapy: Supports movement and strength if there are issues walking or with fine motor tasks.
Occupational Therapy: Assists with everyday activities and coordination.

If another health problem affects the child, medical treatment for that issue can also support speech progress. A team approach involving multiple professionals can address all of a child’s needs.

Methods Not Effective for Treating CAS

Some interventions do not improve speech in children with CAS. For example, exercises aimed at making the speech muscles stronger do not help because CAS involves the brain’s ability to plan and sequence speech movements, not muscle strength.

Unproven or non-specific therapies do not target the core difficulties of CAS. Treatments should focus on improving the planning and coordination needed for speech, not just on general language or muscle exercises.

Not Helpful Methods

Muscle-strengthening routines for the mouth.
General speech exercises not focused on movement planning.
Alternative therapies without evidence for CAS.

Families should seek treatments backed by research and tailored to their child’s needs, focusing on speech coordination and effective communication.

Daily Routines and At-Home Tips

Families can help their child develop speech and language skills by practicing daily at home, not just during therapy sessions. Consistent, gentle encouragement helps a child feel motivated and proud of their progress.

Use short, fun practice sessions to keep your child engaged.
Offer regular breaks, especially if the child is also doing physical or occupational therapy.
Stay patient and positive, celebrating every improvement.

Practice Tip	Why It Helps
Short practice time	Keeps sessions focused
Regular encouragement	Boosts confidence
Adequate rest	Prevents fatigue

Finding Encouragement and Help

Many parents find it difficult when their child struggles to speak clearly. Joining a support group can be helpful. These groups offer a place to share stories, ask questions, and learn from others who understand childhood apraxia of speech.

Ways support groups can help:

Connect with others facing similar experiences.
Share practical tips and resources.
Give and receive emotional support.

Getting Ready for Your Visit

Steps Parents Can Take Before the Appointment

Parents can prepare for the visit by gathering important information and questions. First, note any speech or other symptoms your child is experiencing, even if they seem minor or unrelated to the main concern.

This can include changes in how your child speaks, struggles with certain sounds, or activities that seem harder for them than for other children.

Bring a list of all medicines, supplements, or vitamins your child takes. You can write this on paper or use your smartphone to keep track. This information helps the health care team understand the full picture of your child’s health.

Prepare a list of questions for the health care team and the speech-language pathologist (SLP). Questions could cover diagnosis, differences between types of speech disorders, expected progress, and what families can do at home to help.

If your child has already seen a speech-language pathologist or is receiving services, bring a copy of recent progress reports or your child’s Individual Education Plan (IEP).

These documents help the team see what has already been done and how your child is responding.

Sample questions for the SLP:

Questions To Ask	Purpose of the Question
What kind of speech or language problem does my child have?	Helps to understand the diagnosis.
How is childhood apraxia of speech different from other disorders?	Clarifies unique aspects of the condition.
What are the next steps in treatment?	Outlines what will happen going forward.
How can I help my child at home?	Offers practical tips for daily support.
Are there any helpful resources or websites?	Provides additional information and support materials.

Tip: Time with the team is usually short, so keep questions nearby and take notes during the visit. If anything is confusing, ask for clarification right away.

What Families Will Talk About With the Speech Specialist

During the appointment, the speech-language pathologist will likely ask a series of questions about your child’s speech, language history, and family background.

This helps the SLP identify when symptoms first appeared and what might be affecting your child’s development.

The speech-language pathologist may ask:

When concerns about your child’s speech or language first started.
If your child babbled as an infant, such as saying simple repeated sounds like “ba-ba” or “da-da”.
The age at which your child first spoke a word.
When your child reached a vocabulary of five common words.
How many words does your child currently use that people outside your family can understand.
How your child communicates aside from speech, such as using gestures, pointing, or acting things out.

Childhood Apraxia of Speech – Diagnosis and Treatment