Childhood Apraxia of Speech

Not all children with CAS are the same. Your child may show some or all of the signs below. You should talk to your doctor or see an SLP if:

Your child is younger than 3 years old and

• Does not coo or babble as an infant.
• Says her first words later than you think she should.
• Says only a few different sounds.
• Has problems putting sounds together.
• Puts long pauses between sounds she says.
• Does not always say a word the same way.
• Has some problems eating.

Your child is older than 3 years old and

• Does not always say words the same way each time he says them.
• Can understand what others say to him better than he can talk.
• Has problems imitating what others say. If he can imitate, those words will sound better than words he says on his own.
• Seems like he has to move his lips, tongue, or jaw a few times to make sounds. This is called groping.
• Has more trouble saying longer words clearly than shorter ones.
• Seems to have more trouble talking when he is nervous.
• Is hard to understand, especially for someone who doesn’t know him well.
• Sounds choppy or flat. He may put the stress on the wrong syllable or word.

There are some other problems that your child may have that could put her at risk for CAS. These include:

• Language delay.
• Problems with fine motor skills, like drawing, writing, or picking up small things.
• Problems with how she feels things in her mouth. She may be very sensitive and not like to have her teeth brushed or eat crunchy foods. Or, she may not be very sensitive and may not feel hot or cold very well.
• Learning problems. Children with CAS or other speech problems may have problems learning to read, spell, and write.

If you have any concerns, talk to your doctor or see an SLP for help.

There is help available if you are worried about how your child talks. You should talk to your doctor, who can check for any medical problems. It is important to have your child’s hearing checked to make sure she does not have a hearing loss. A child with a hearing loss may have more trouble talking.

An SLP can test your child’s speech and language. The SLP will test how well your child understands what he hears, called receptive language. The SLP will also test

how well your child uses words to tell others what he is thinking, called expressive language. To test for CAS, the SLP will look at your child’s oral-motor skills, speech melody, and how he says different sounds.

To test oral-motor skills, the SLP will:

• Check for signs of lip, jaw, or tongue weakness, called dysarthria. Most children with CAS do not have weakness, but it is important to check.
• See how well your child can move her mouth. The SLP may ask her to copy movements like smiling, sticking out her tongue, and puckering her lips.
• Test how well your child can make fast mouth movements. This tells the SLP how well she can coordinate her movements since our mouths move fast when we talk.
• See how well your child can do “real-life” mouth movements like licking a lollipop. The SLP will compare that to how well she can do the same thing when pretending. A child with CAS may be able to do a movement when she doesn’t think about it but not when asked to do it.

To test your child’s speech melody, called intonation, the SLP will:

• Listen to how your child puts stress on syllables and words in sentences. When you get a gift, you call it a “PREsent.” The stress is on the first syllable. When you give a speech, you “preSENT.” The stress is on the second syllable. Children with CAS may have trouble putting stress on the right syllables.
• See if your child can change her pitch to ask questions or make statements. Think about how you say “Hello?” when you answer the phone. Your pitch goes up at the end of the word because you are asking a question. Now think about how you say “Hello” to someone who walks into a room. You say the same sounds, but your pitch changes. Children with CAS may have trouble changing pitch correctly.
• See how your child uses pauses to mark different parts of a sentence. When you say, “We went to the store, then back home,” you pause after the word “store” to mark a change in the sentence. Children with CAS may put pauses in the wrong place or not use them at all.

To test how your child says sounds, the SLP will:

• Test both vowel and consonant sounds. Vowels are sounds like A, E, I, O, U, and consonants are sounds like B, G, M, R, S.
• Check how well your child says sounds alone and combined in syllables or words.
• Check how well others can understand what your child says.

The goal of treatment is to help your child say sounds, words, and sentences more clearly. Your child needs to learn how to plan the movements he needs to say sounds. Then he needs to learn how to make those movements the right way at the right time. Doing exercises to make his mouth muscles stronger will not help. His muscles are not weak if he has CAS. Working on how to move those muscles to say sounds will help.

Your child must practice speaking to get better at it. It helps to use all of her senses as she learns how to say sounds. She may use “touch” cues, like putting her finger on her lips when saying the “p” sound to remind her to close her lips. Or, she may use visual cues, like watching herself in a mirror. Hearing how she sounds on a recording can help, too. This sensory feedback can help your child repeat sounds and words and start using them in longer sentences.