Speech-Language Pathologist Barbara Davis joins us today to discuss the signs and symptoms of Childhood Apraxia of Speech (CAS) as well as how it is diagnosed.  Click the play button below to listen to the entire episode or scroll down to view the show notes.

Show Notes:

What is Childhood Apraxia of Speech?

  • Disorder of speech, not a delay.  Delay would be learning to speak later than typically-developing children but in the same order and way.  A disorder is when the child learns in an atypical manner.
  • Common symptoms of CAS:
    • Variability in production (says it differently each time he tries)
    • Vowel errors (kids typically master vowels between 18-24 mos)
    • Trouble sequencing sounds (can say “oh” but has trouble putting it with a consonant to say “toe” or “go”).
    • Unusual prosody (the pitch, tone, and pausing of speech)
    • Severe sound errors
    • Symptoms persist to older ages than other speech problems

Differential Diagnosis of Childhood Apraxia of Speech:

Many other disorders can look like CAS.  Differential diagnosis involves looking at all of these possibilities to make sure the child doesn’t need a different diagnosis instead.  Here are some other disorders that should be ruled out for an appropriate diagnosis of CAS:

  • Dysarthria (trouble with the muscles and structures that produce speech)
  • Hearing Loss
  • Auditory Processing (being able to hear but not being able to process the sounds)
  • Cognitive Problems

**It’s important to note that children with CAS could have these things as well, but a purely CAS diagnosis would come without these things.

What Causes Childhood Apraxia of Speech?

CAS is caused by motor planning difficulties.  This means that the child knows what he wants to say, but the signal gets mixed up in his brain during the motor planning phase.  This is what causes the inconsistencies in his errors.  Sometimes, these types of problems are caused by injuries to the brain or nervous systems, but often they do not seem to have any cause at all.

Who Can Diagnose Childhood Apraxia of Speech?

Any speech-language pathologist (SLP) has the basic knowledge and certification to diagnose CAS but based on how tricky the diagnosis can be, it is advised that an SLP have additional training, workshops, and experience with CAS in order to make a confident diagnosis.

How is a Childhood Apraxia of Speech Diagnosis Made?

In short, cautiously!  Many severe speech problems can look like CAS at first.  It is important to only make the diagnosis of CAS after a course of therapy has been observed.  Children with true CAS often make very slow progress with typical therapies.  You also should not be diagnosing children with CAS before they are consistently using spoken language to communicate.  That means, if the child isn’t talking, even if you observe them trying to make sounds, a diagnosis of CAS should NOT be made.  At this point, CAS looks exactly the same to severe phonological disorders, severe articulation disorders, severe dysarthria, and many more.

Are there Tests for Childhood Apraxia of Speech?

Currently, there are very few instruments for differential diagnosis of CAS.  Barbara Dodd and Nancy Kaufmann are two who have created CAS-specific diagnostic tools but you must not solely rely on a standard speech test, such as the Goldmann Fristoe Test of Articulation.  These tests do not measure the variability, prosody, or vowel productions.  If you are an SLP looking into CAS diagnosis, you should do plenty of research about the current diagnostic tools and how they are used.  You should also make sure to do a thorough spontaneous speech sample to collect data on all features of CAS.

What’s a Parent to Do?

If you are the parent of a child with suspected or diagnosed CAS, you should talk openly with your speech-language pathologist (SLP) about CAS.  Talk about the various other diagnoses that need to be ruled out and ask how it has been determined that your child does not have those conditions instead.  Also, ask your SLP about their background, training, and experience with CAS.  CAS is treated quite differently from typical speech errors so you want to make sure to find an SLP with experience.

How to Find More Information:

  • Apraxia Kids Website: a fabulous resource for families and professionals working with children with CAS
  • Use continuing education courses: find workshops, conferences, webinars, or other trainings about the subject
  • Join email lists about CAS
  • ASHA Certified CEUs
  • Set up Google Alerts to let you know whenever new information on CAS is available

More Information on Barbara Davis:

Click the link below to visit Barbara’s page:


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