Childhood Apraxia of Speech

  • Childhood Apraxia of Speech (CAS) affects the ability of a child to produce speech. CAS can also be referred to as dyspraxia, developmental verbal dyspraxia (DVD), or speech apraxia.

    CAS is a speech disorder that can start to show when a child is learning to speak. There are a number of different reasons that a child may have difficulty learning to speak. CAS is a relatively rare disorder. A child with CAS has difficulty planning and coordinating their movement of muscles used (e.g. tongue, lips, jaw, palate) to produce the right speech sounds or words. However, there is no actual damage to the child's nerves or muscles used in speech.

    Children with CAS may have difficulty with the speed, accuracy and timing of movement sequences that are required to produce speech. This will often result in delays in speech development and others will likely have difficulty understanding the child's speech. 

    There is no obvious cause for CAS, although a genetic explanation accounts for about 30 per cent of cases. A speech pathologist can diagnose and help treat the condition. Many children's speech will improve with specific treatment.

    There is another type of dyspraxia that is caused by brain injury, which is not addressed in this fact sheet. For information, see our fact sheet Brain injury – dyspraxia.  

    Signs and symptoms of CAS

    The signs and symptoms depend on the severity of the problem. If your child has CAS, they may: 

    • have difficulty making sounds or repeating sequences of sounds or words 
    • make different mistakes when they say the same word 
    • have difficulty with normal intonation patterns (e.g. speaking in a monotone, placing equal stress on each syllable in words)
    • have a very limited vocabulary 
    • speak more slowly than other children their age, and use more pauses and fewer words 
    • make searching movements with their lips and tongue when trying to say a sound  

    When to see a doctor

    If you are concerned about your child’s speech, talk to your Maternal and Child Health Care Nurse or GP, who may refer you to a speech pathologist. You can visit a speech pathologist privately or via your local community health service. A speech pathologist can assess whether your child has CAS or if there is another cause for their difficulties with speech and language development. 

    Treatment for CAS

    There are several ways to help treat CAS, with specific treatments available from speech pathologists who are experienced in the condition. Therapy is often intensive and involves exercises specially designed for your child. For example, therapy may focus on producing specific sounds, or words and phrases of various lengths and complexities. As CAS is a motor speech disorder affecting planning and programming of speech movements, it is important that treatment also focuses upon improving motor control and motor patterns. 

    For children with more severe CAS, the speech pathologist may also consider alternative ways of communicating, such as sign language or specialised communication tools like computers or books to point to.

    Key points to remember 

    • A child with CAS has difficulty coordinating their muscles to produce speech, but there is no damage to the nerves or muscles used in speech 
    • They may have difficulty making normal speech sounds, a limited vocabulary or a delay in spoken language development
    • If you have any concerns about your child's speech and language, see your Maternal and Child Health Nurse, GP or paediatrician, or consult a speech pathologist 
    • A speech pathologist can diagnose and treat CAS 

    For more information 

    Common questions our doctors are asked

    Will my child grow out of CAS?

    Children with CAS won’t simply outgrow the condition, but over time and with regular (and often intensive) speech therapy, their speech is likely to improve. The speech pathologist will approach the treatment to address the specific motor planning difficulties that your child is experiencing.

    My Maternal and Child Health Nurse suspected that my child might be on the autism spectrum, but he has been diagnosed with developmental CAS. Are these conditions linked? 

    Many children with language difficulties may become frustrated because it's difficult for them to communicate. This then results in challenging behaviours from their frustration. The combination of challenging behaviours and language delay occurs often in children on the autism spectrum, which is why it can be difficult to tell them apart at first. You should discuss these concerns with your child's paediatrician.

    What’s the difference between CAS and verbal dyspraxia? I’ve come across both terms when trying to find out more about my child’s condition.

    There is no difference. Both CAS and developmental verbal dyspraxia (DVD) describe difficulties with motor sequencing for clear speech production.

    Developed by The Royal Children's Hospital Paediatric Speech Pathology Service. We acknowledge the input of RCH consumers and carers. 

    Reviewed July 2020. 

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