When Words Won’t Come Easily: Understanding Childhood Apraxia of Speech

Key Points:

• Childhood apraxia of speech (CAS) is a neurological speech disorder that affects how the brain plans and coordinates speech movements.
• Children with CAS often say the same word differently each time they attempt it.
• Communication challenges can impact social interactions and a child's ability to express wants and needs.
• Early evaluation and intervention can play an important role in communication development.

Insights by Dr. Jennifer Ferry, Associate Professor of SLP at LVC

A toddler points to a favorite toy but struggles to say its name. A preschooler can pronounce a word clearly one day but not the next. For some children, these communication challenges may be signs of childhood apraxia of speech (CAS), a neurological speech disorder that affects the brain's ability to plan and coordinate the movements needed for speech.

While many parents are familiar with speech delays, CAS is less widely understood and is often mistaken for other speech disorders. Dr. Jennifer Ferry, associate professor of Speech-Language Pathology at Lebanon Valley College, says recognizing the signs early can make a significant difference in a child's communication development.

"Childhood apraxia of speech is a pediatric speech sound disorder that impacts the consistency, timing, accuracy, and sequencing of muscle movements to produce speech during development," Ferry explained. "Unlike articulation or phonological disorders, CAS is rooted in challenges within the motor and neurological systems that plan speech production."

Children develop speech at different rates, but CAS presents unique characteristics that distinguish it from other communication disorders. While a child with an articulation disorder may consistently substitute one sound for another, children with CAS often produce words differently each time they attempt them.

"Children with typical speech development and many other speech sound disorders will say words consistently, even if they are not correct," Ferry said. "Children with CAS, however, often have inconsistent errors."

The disorder originates in the motor-neurological system, but its causes can vary. In some cases, CAS may be associated with a genetic syndrome or neurological injury. In many instances, however, there is no identifiable cause.

"CAS can occur when brain damage has occurred from events such as stroke or traumatic brain injury, and it can be linked to specific syndromes or conditions," Ferry noted. "Often, however, the cause is not known."

For parents, the earliest signs may appear long before a child begins speaking in full sentences. Children with CAS often babble less frequently as infants and may have delayed first words. When those words do emerge, they may be difficult to understand or produced inconsistently.

"Children with CAS often will babble less and have fewer vocalizations between seven and 12 months," Ferry said. "When first words emerge, they are often later than expected and may be produced inconsistently."

Children with CAS also tend to have greater difficulty with longer, multi-syllable words and may struggle with both consonant and vowel sounds. Their speech can sometimes sound robotic because of challenges with rhythm, stress, and intonation.

Because speech and language skills are still developing during the toddler years, diagnosing CAS can be challenging. Ferry encourages families to seek professional guidance whenever they have concerns about a child's communication development.

"The key is to seek an evaluation when there are concerns that a child is not communicating as expected for their age," Ferry said.

For many families, those concerns become more apparent around a child's second birthday.

"Children who are two years old are typically understood about 50 percent of the time," Ferry explained. "Typically around 2 years old is when caregivers become concerned."

Communication difficulties can affect more than just speech. Children with CAS may struggle to express their wants and needs and can become hesitant to engage socially, particularly with people who are unfamiliar with their communication style.

"CAS impacts a child's ability to communicate their wants and needs and to engage with others," Ferry said. "Many children rely heavily on gestures to communicate, which can make interactions more difficult with people who are less familiar with them."

Fortunately, research-based interventions can help children make substantial progress. Therapy for CAS differs from traditional speech therapy because it focuses on learning and practicing the motor movements required for speech rather than simply correcting individual sounds.

"Therapy for CAS is based on motor principles of learning," Ferry said. "We begin with a small inventory of meaningful, functional words and provide high levels of support to help children successfully practice speech movements."

Repetition plays a critical role in that process. Through frequent practice and carefully selected target words, children gradually build more accurate and consistent speech patterns.

"The key to intervention is high levels of practice for a few target words," Ferry said. "The more repetition and practice, the greater the consistency of speech production and the child's success in producing speech."

Families are essential partners in helping children succeed. Ferry recommends incorporating brief, frequent practice opportunities into everyday routines and continuing the work that begins in therapy sessions.

"Caregivers can best support intervention through continued practice that is short, frequent, and focused on the target words selected during therapy," Ferry said. "Those everyday opportunities to communicate make a real difference."

As awareness of childhood apraxia of speech grows, Ferry hopes more families will recognize the signs and seek help early. With timely intervention, consistent support, and evidence-based treatment, children with CAS can strengthen their communication skills and gain confidence in sharing their thoughts, ideas, and personalities with the world around them.