Apraxia of Speech

Childhood Apraxia of Speech (CAS)

Praxis is the neurological process by which cognition directs motor action (Jean Ayres, 1985). People with apraxia have difficulty planning motor actions. Apraxia is a motor planning disorder. Children with motor planning disorders, childhood apraxia of speech (CAS), generally understand what people are saying to them but they are unable to get out what they want to say. It is like they are stuck. Speech is intricate and complex and all the articulators have to work together to produce speech. Children with CAS know what they want to say but can’t get the words out correctly.

Typically, children with childhood apraxia of speech (CAS) do not respond to traditional speech therapy techniques such as modeling, expansion, repetition, withholding etc used for late talkers. Instead, children with CAS benefit from a motor learning approach to therapy and dynamic temporal and tactile cueing (DTTC.) This type of therapy should be performed by a speech and language pathologist who has experience treating children with childhood apraxia of speech (CAS) and who is knowledgeable in the area of motor learning.

Additionally, children with childhood apraxia of speech may benefit from seeing a speech and language pathologist who is PROMPT trained. PROMPT stands for Prompts for Restructuring Oral Muscular Phonetic Targets. The PROMPT approach goes beyond speech and language by using a multidimensional approach to speech production disorders. To achieve the best outcome with PROMPT, it should be used as a program to develop motor skills for expressive language. At Crossroads we value continuing education and more than 7 of our therapists are PROMPT trained and our owner, Katie Dimond M.A. CCC-SLP, is advanced PROMPT trained and listed as a provider on the Apraxia Kids website. Additionally, one of Katie’s own children has childhood apraxia of speech and, through therapy, has overcome it.


Katie and the PROMPT trained therapists are knowledgeable and highly competent in this area and have treated countless children who have childhood apraxia of speech as well as suspected childhood apraxia of speech. The Crossroads team has a true passion to help children overcome childhood apraxia of speech.


Research done in 2019, reported that there are early signs in children who have childhood apraxia of speech (CAS) and these can be observed in children under age two.

Early signs of childhood apraxia of speech are:

      1. Limited vocalizations during the first two years of life.

      2. Lack of a consonant sound by 12 months of age. Use of fewer than three consonants by 16 months of age. By this age, we would expect the child to have a history of babbling a variety of words.

      3. Use of fewer than five consonants by 24 months of age.

      4. Lack of posterior sounds by 24 months of age. Lack of /k/ and /g/ in words such as “car, cat, kiss, dog, go, bug.”

      5. Preference of stop sounds and nasal sounds in the first 24 months. Children produce /p, b, d, t/ and nasal sounds /m, n, ng/ while missing other consonant sounds.

      6. Limited syllable shapes. Children with CAS will use mostly VC, vowel-consonant, and CV consonant-vowel, syllable shapes to communicate. (e.g., saying “a” for “open” or “ba” for “bubble”).

Reference: Overby, Caspari, & Schreiber (2019). Volubility, Consonant Emergence, and Syllabic Structure in Infants Later Diagnosed with CAS, Speech Sound Disorder, and Typical Development. Journal of Speech, Language and Hearing Research , 62(6), 1657-1675.

There are also characteristics of older and more verbal children who have childhood apraxia of speech (CAS.)

Key Characteristics of Childhood Apraxia of Speech are:

      1. Inconsistent speech errors.
      2. Pauses between sounds and syllables.
      3. Challenges with the melody, prosody, of speech.
      4. Difficulty with coarticulation.
      5. Vowel errors
      6. Voicing errors.
      7. More difficulty saying longer and more complex words.
      8. Reversing sounds and syllables in words.
      9. Observable difficulty producing words.

For apraxia of speech therapy and services, please contact us, we serve Chicago, the North Shore, and Northern and Western Suburbs.

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