Childhood Apraxia of Speech

1 · What is childhood apraxia of speech (CAS)?

The clearest way to explain it: the message is intact, the instructions to the mouth are not.

A child with apraxia knows the word, and the muscles work. What is disrupted is the brain's planning of the sequence of movements — the lips, tongue, jaw, and voice all have to move in a precise order and timing, and that plan is not coming together reliably.⁠¹

ASHA describes it as a neurological speech sound disorder of childhood. Reflexes are intact and muscle tone is typical; the difficulty lies in planning and programming the timing, direction, force and sequence of the movements that produce speech sounds and the rhythm of speech.⁠²

Which is why the same word can come out differently on consecutive attempts. That inconsistency is one of the core features researchers agree on.⁠¹

On terminology: you may also see developmental apraxia of speech or developmental verbal dyspraxia, which refer to the same thing.⁠² Apraxia of speech that begins in an adult, after a stroke or a brain injury, is a separate disorder; section 17 explains the difference.⁠⁸

2 · Apraxia vs speech delay: how is CAS different?

What clinicians look for in apraxia specifically:

• Inconsistent errors on the same word across repeated attempts⁠¹
• Difficulty with the transitions between sounds and syllables, not just the sounds themselves⁠¹
• Unusual rhythm, stress, or intonation⁠¹
• Groping — visible searching movements of the mouth before a sound comes out⁠²
• More difficulty with longer or more complex words than shorter ones⁠²

Inconsistency alone does not settle it. A child with inconsistent phonological disorder can also say the same word differently on different occasions, so the speech-language pathologist looks for other signs of difficulty planning movements as well.⁠²

Any of these can appear in other conditions, and no validated list of features yet separates apraxia from other speech sound disorders — which is part of why diagnosis is difficult.⁠²

These can also co-occur. A child may have apraxia alongside a language disorder or a phonological difficulty, and that changes the plan.⁠²

3 · Early signs of childhood apraxia of speech

The signs change with age and with how hard the speaking task is, and no single sign means a child has CAS.⁠^1,2

Signs in babies and toddlers

• Fewer sounds as a baby — fewer vocalizations and fewer consonants than expected⁠²
• A small range of sounds, with an early preference for sounds like b, d, m and n, and consonants arriving later than usual⁠²
• A limited set of syllable and word shapes⁠²

Research now supports many of these early signs, though how the disorder unfolds from infancy is still uncertain.⁠¹⁶

Signs in preschool and school-age children

• The same word said differently from one attempt to the next — sometimes said correctly once, then not again⁠^1,7
• Visible effort — the mouth moving, searching, before anything comes out⁠²
• Choppy speech, with pauses between sounds or syllables, and stress on the wrong syllable⁠²
• Distorted vowels and consonants, and voicing mix-ups such as “b” for “p”⁠²
• Longer words falling apart more than short ones⁠²
• Slower speech than expected for the child's age⁠²
• Understanding that runs well ahead of talking: children with apraxia of speech generally understand language much better than they can use it⁠⁷

4 · How common is childhood apraxia of speech?

It is uncommon. The current estimate is about 1 in 1,000 children aged 4 to 8.⁠² Among children of that age who have a speech delay with no known cause, about 2.4 percent are estimated to have CAS.⁠² It appears to affect more boys than girls.⁠⁷

It has been reported more often with some conditions, including Down syndrome, galactosemia, 22q11.2 deletion syndrome, velocardiofacial syndrome, CDK13-related disorder and changes that disrupt the FOXP2 gene.⁠² → Speech therapy for Down syndrome

Autism: the findings are mixed, and there are no large population studies.⁠² In a review of the medical records of 375 children with CAS, about a third (33.6 percent) also had autism, and those children were no more likely than the others to have severe CAS.⁠¹²

5 · What causes childhood apraxia of speech?

The causes are not fully understood.⁠⁷ ASHA describes three settings in which CAS occurs:⁠²

• No identifiable cause (idiopathic): no observable neurological problem or other condition⁠²
• As part of a broader neurodevelopmental condition, such as autism, epilepsy, fragile X syndrome, Rett syndrome or Prader–Willi syndrome⁠²
• After a neurological event, such as a stroke before birth or in early childhood, an infection, an injury, or surgery to remove a brain tumor⁠²

It is not caused by weak speech muscles; weakness or paralysis of those muscles causes a separate disorder, dysarthria.⁠⁷

The role of genes

Children with CAS often have relatives with a history of a communication disorder or a learning disability.⁠⁷ The first gene linked to CAS, FOXP2, was found in a large London family, many of whose members had apraxia of speech.⁠^2,11

More than 30 genes have now been linked to CAS.⁠^2,11 A 2024 review of three research cohorts, 122 children with CAS in all, found that about one child in three had a genetic variant that explains the condition, and its authors argue that clinical genetic testing should now be offered to children with CAS.⁠¹¹ ASHA's guidance has the speech-language pathologist refer a child to a geneticist when the medical or family history suggests a genetic condition.⁠² If you are wondering about it, ask your child's doctor.

6 · What other conditions often come with CAS?

Most children with CAS have other difficulties too. In the review of 375 children's medical records, only one child had no co-occurring condition, and over 95 percent had difficulty with expressive language (putting thoughts into words). Children who also had intellectual disability, difficulty understanding language, or apraxia affecting other movements were more likely to have severe CAS. That study drew on a convenience sample, so its figures may not hold for every group of children.⁠¹²

Language, reading and social communication. As in other speech disorders, children with CAS commonly have delayed language development, trouble with word order and grammar, difficulty learning to read, spell and write, and difficulty with social language.⁠²

Movement and coordination. Gross and fine motor delays, clumsiness, developmental coordination disorder, apraxia of nonspeech mouth movements (oral apraxia) or of the limbs, feeding difficulties, and over- or under-sensitivity around the mouth commonly co-occur.⁠² In a small preliminary study, six of seven children with CAS met the criteria for developmental coordination disorder, yet only four had had a physical or occupational therapy evaluation and treatment; the authors call formal movement assessment essential for children with CAS.⁠¹³

RelatedDevelopmental language disorderOccupational therapy for dyspraxia (DCD)

7 · Why is apraxia of speech hard to diagnose?

Very young children may not produce enough speech to assess. ASHA counts limited speech output, and the way speech can change during the first three years, among the challenges of diagnosing CAS in infants and toddlers.⁠²

The features overlap with other conditions, and misdiagnosis can happen.⁠² Distorted sounds and slow speech, for example, also occur in dysarthria, and CAS can occur together with dysarthria or a phonological disorder.⁠²

It can be overdiagnosed. A diagnosis based only on how severe a child's speech difficulty is, rather than on its features, can lead to overdiagnosis.⁠²

Which is why a provisional term, such as “suspected CAS” or “CAS cannot be ruled out,” may be used before a firm diagnosis, and why a child's progress in therapy can help settle the question.⁠^1,2 Parents and professionals may need to watch a child's speech over a period of time.⁠⁷

8 · How is childhood apraxia of speech diagnosed?

A speech-language pathologist carries out the assessment. ASHA advises that a child suspected of having CAS be given a comprehensive motor speech assessment by an SLP with experience in childhood motor speech disorders, and there is no standardized screening test specific to CAS.⁠²

What is involved:

• A case history: your child's development, health and family background⁠²
• A hearing screening, with a referral to an audiologist if your child does not pass⁠²
• A look at the mouth (an oral mechanism examination), including nonspeech movements such as smiling and puckering for a kiss⁠²
• Speech in several settings: naming pictures, retelling a story and everyday talk, because results can vary from one context to another⁠²
• Repeated productions of the same words, to look for consistency, and words of increasing length, such as “love, loving, lovingly”⁠^2,7
• Quick syllable sequences such as “pa-pa-pa” and “pa-ta-ka”⁠²
• Cues to see what helps (dynamic assessment): the SLP offers cues and strategies and watches which ones improve your child's speech, which also suggests where treatment can start⁠²
• Language: a screening or evaluation of how your child understands and uses language, where possible⁠²

What can come out of it: a diagnosis or provisional diagnosis of CAS, or of another speech sound disorder; a description of its severity; any language or literacy difficulty; recommendations for therapy and, where needed, AAC; and referrals as needed to an audiologist, an ear, nose and throat doctor, an occupational therapist (for fine motor, sensory motor or other nonspeech concerns), a physical therapist (for gross motor skills or muscle tone), a pediatric neurologist or a geneticist.⁠²

RelatedFind a speech-language pathologistHow to get a free evaluation for your child

9 · Who treats childhood apraxia of speech: SLP, OT or PT?

A speech-language pathologist (SLP). ASHA's policy is that diagnosing and treating CAS belongs to certified speech-language pathologists with specialized knowledge of motor learning, skill in telling childhood motor speech disorders apart, and experience with a range of treatments, including AAC. The SLP makes the primary diagnosis, designs the individualized, intensive treatment and monitors progress.⁠¹

It is fair to ask about experience. ASHA's code of ethics expects SLPs who serve children with CAS to be specifically educated and trained to do so, and to refer a family on, or seek supervision, when they are not.⁠²

Occupational and physical therapists may also be part of the team. Motor difficulties commonly come with CAS, and an SLP refers to an occupational therapist for fine motor, sensory motor or other nonspeech concerns and to a physical therapist for gross motor skills or muscle tone.⁠² The SLP treats the speech itself, and ASHA encourages the professionals to work together and, when it fits, to treat together.⁠²

10 · Childhood apraxia of speech treatment

Speech therapy is the treatment. Its goals are to make your child's speech more accurate and easier to understand and, where needed, to give your child other ways to communicate through AAC.⁠² Effective approaches for CAS work on movement rather than on sound patterns.⁠²

Principles of motor learning. Frequent, intensive practice; a focus on accurate movement; cues through hearing, sight and touch; a deliberate choice between mixed and blocked practice; and planned feedback.⁠²

Cues through the senses. Many treatments add cues a child can see, hear or feel: simple hand signs, spoken instructions such as “make a circle shape with your lips,” saying a word together with the therapist, and touch on the face or neck to guide a movement.⁠²

Speech movements and sound patterns together. Many children with CAS also have a phonological or language disorder, and the SLP weighs how much of the difficulty is motor and how much is linguistic when planning treatment. Approaches aimed at sound patterns can help a co-occurring phonological problem but are often not enough on their own for the motor planning difficulty of CAS.⁠²

Home practice matters, because apraxia needs a great deal of repeated practice.⁠² ASHA recommends involving caregivers in treatment, which helps them understand the goals and carry practice into home and community life, and NIDCD calls family support and extra practice at home important.⁠^2,7 Your speech-language pathologist should show you exactly what to practice and how.

Preschool is not a substitute. Children with apraxia of speech do not pick up the basics of speech just from being around other children, as in a classroom, and NIDCD calls speech therapy necessary.⁠⁷

11 · Do DTTC, ReST, Nuffield and PROMPT work?

You may hear these names. They differ in method, and a speech-language pathologist chooses among them, often combining approaches, based on your child's profile and the severity of the CAS.⁠² ASHA's list of approaches is not an endorsement of any one of them.⁠²

How strong is the evidence? Limited. A 2018 Cochrane review found one randomized trial, the ReST and Nuffield comparison above. It concluded that there is limited evidence that both, delivered intensively, may improve word accuracy in children aged 4 to 12 with CAS. The trial did not measure everyday communication, and the review could not say whether either treatment is better than no treatment or usual therapy, or that one is better than the other.⁠⁹ No randomized trial evidence yet supports other treatments for children aged 4 to 12 with CAS of unknown cause.⁠⁹ NIDCD likewise notes that no single approach has been proven the most effective.⁠⁷

Approaches built on melody and rhythm, such as melodic intonation therapy, can be combined with these motor approaches.⁠²

12 · How much therapy does a child with CAS need?

Frequent, intensive, individual sessions. Apraxia is a motor speech disorder, and it requires repeated, individualized practice.⁠² NIDCD describes frequent, intensive, one-on-one sessions as needed, because the repetition and personal attention are hard to deliver in a group.⁠⁷ ASHA prefers individual sessions while the goal is the movements of speech; group sessions may be added later for carryover, language and social skills.⁠²

Twice a week did better than once a week in one study. In a study of 37 children aged between 32 and 54 months, those treated twice a week for ten weeks showed significantly better articulation and functional communication than those treated once a week; once-weekly treatment did not produce the same gains. Neither schedule changed how well listeners understood the children's words and sentences over those ten weeks.⁠⁴

Fewer sessions can get there, more slowly. ASHA notes that children seen twice a week over 12 weeks can eventually make the same communication gains as children seen four times a week, and that the clinician weighs the cost of slower progress. Within a session, more practice attempts helped too: 100 productions in 15 minutes led to quicker learning and more carryover than 30 to 40.⁠² Ask your speech-language pathologist how often your child should be seen, and why.

Start early. ASHA calls early motor-based treatment critical to progress, and early treatment is indicated for children with a suspected or provisional diagnosis too.⁠²

For how long. It differs from child to child; some children make more progress than others, and children with severe apraxia of speech may need intensive therapy for years, alongside regular school.⁠⁷ Long-term outcomes vary widely.⁠¹⁴

Watching progress. The SLP documents progress and plans the next steps with your family.⁠² Researchers who followed children with CAS into adulthood advise exploring other approaches for children who make limited progress with more traditional speech therapy.⁠¹⁴

Online sessions. Speech therapy can be delivered by telepractice. There is emerging evidence that children with CAS treated this way make gains, but the research is limited.⁠² → Online speech therapy for kids

13 · Communicating with AAC while speech develops

A child who cannot yet speak still needs to communicate. When speech alone is not enough, augmentative and alternative communication (AAC) can give a child a working way to communicate while supporting their speech.⁠²

What counts as AAC. Unaided forms use only the body: gestures, manual signs and finger spelling. Aided forms use something more: pictures, line drawings, communication boards and speech-generating devices.⁠² AAC can also help a child build language skills that speech cannot yet carry.⁠² Some children with CAS also have limb apraxia, which can make manual signs hard to use, so that matters when choosing a system.⁠²

Does AAC hold back speech?

Two things worth knowing about that finding. The gains were, for the most part, modest. And the participants were people with developmental disabilities generally — mostly autism and intellectual disability, across a wide age range — rather than children with apraxia specifically. In that review, AAC did not hold speech back.⁠³

AAC can support and enhance speech rather than replace it.⁠² AAC and speech therapy run alongside each other. One does not replace the other.

RelatedNonspeaking autism and AACGestalt language processingAAC device funding

14 · Should a bilingual child with CAS use one language?

There is no need to drop a language. CAS affects speech in every language a child uses, though its features can differ from one language to another.⁠² A child may seem to prefer one language, but that can reflect the easier movements rather than a true preference, and ASHA says it does not justify limiting the child and family to a single language.⁠²

Assessment in every language. Checklists of English features cannot simply be applied to other languages, so a culturally responsive assessment covers all the languages the child uses, working with the family.⁠²

Treatment across languages. Starting with sounds shared by all of the child's languages improves intelligibility across them, bilingual treatment may help the child's whole speech sound system, and home practice is given in the languages the family uses.⁠² → Finding therapy with Medicaid, access or language needs

15 · What to expect over time with apraxia of speech

Children do not grow out of apraxia, but they can improve their communication with speech therapy. How much and how quickly varies from child to child.⁠^2,7

Some children continue to have difficulty, such as with rhythm and stress, distorted sounds, or unfamiliar long words, and continue to benefit from support.⁠²

If progress seems to stall, raise it with your speech-language pathologist.

Reading and spelling are worth watching. Children with apraxia are at increased risk of weakness in the sound-based skills that reading builds on, and ASHA lists literacy below grade-level expectations among persisting difficulties, so it is worth monitoring early.⁠² A 2024 scoping review of 23 studies found children with CAS at high risk of literacy difficulty, often doing worse than children with other speech disorders, and suggested they may need early literacy support.⁠¹⁷ → Dyslexia

16 · Does childhood apraxia continue into adulthood?

For some children, yes. ASHA notes that speech difficulties can persist through the school years and sometimes into adulthood.⁠²

One long-term study drew on 25 years of follow-up to look at 32 people with a history of CAS, aged 12½ to 25. Their outcomes varied widely. Some still made speech sound errors as teenagers and young adults, mostly on sounds that develop later, and those who did were more likely to have had early motor difficulties. Trouble with long words, with the sound skills behind reading, and with reading itself was common whether or not the speech errors had cleared.⁠¹⁴

Planning the move to college or work. Young people whose difficulties persist may continue to have problems with spoken communication, literacy and social life as they move into further education and jobs, and ASHA points to transition planning and continued support.⁠² → Speech therapy for teenagers

17 · Apraxia of speech in adults: a different condition

If you are reading for an adult whose speech changed after a stroke, a head injury or another illness affecting the brain, this page is not the right guide. That condition is acquired apraxia of speech, and ASHA treats childhood apraxia of speech as a separate and distinct disorder.⁠⁸

Acquired apraxia of speech can occur at any age but most often affects adults. It results from damage to the parts of the brain involved in speaking, such as from a stroke, head injury or tumor, and it involves losing speech abilities a person already had.⁠⁷ It often comes with aphasia, a language disorder, or with dysarthria; an estimated 44 percent of people with long-term aphasia have some degree of it.⁠⁸ Primary progressive apraxia of speech is a degenerative condition in which apraxia of speech is the first or main neurological symptom.⁠⁸

Sudden trouble speaking or understanding speech is an emergency: call 911.⁠²⁰

For adultsSpeech therapy for apraxia of speech in adultsAphasia vs dysarthria vs apraxia of speechStart here for adults

18 · How to get help for childhood apraxia of speech

Under three in the US, a parent can refer their own child to early intervention directly — no doctor's referral, no diagnosis required — and the evaluation is free; some states charge sliding fees for services.⁠^2,6 Search for your state's early intervention program.

Three and over: request a school evaluation in writing. A parent can ask for an initial evaluation, and it must be completed within 60 days of the school receiving your consent, or within your state's own timeframe.⁠¹⁸ A speech or language impairment that affects a child's educational performance can qualify a child for services; the SLP also weighs the effect on social interactions and the state's own criteria.⁠^2,18

For schoolSample letter: requesting a school evaluationIEPs and 504 plansEarly intervention vs private therapy

Privately, at any age, at a clinic with a speech-language pathologist experienced in childhood apraxia of speech.

By ageSpeech therapy for babies and toddlersSpeech therapy for preschoolersSpeech therapy for school-age childrenFind a speech-language pathologist

Questions worth asking:

• Do you have experience with childhood motor speech disorders such as CAS?
• How often would you see my child, and why that frequency?
• What approach do you use, and what is it based on?
• What should we practice at home?
• How do we know it is working, and by when?
• Do you use AAC alongside speech work?

19 · How do families pay for apraxia therapy?

• Early intervention (under 3): the evaluation, service coordination and the family's plan are free; a state may charge sliding fees for some services, and a family the state finds unable to pay receives all services at no cost.⁠⁶
• School (3 and over): the services in an IEP, which can include speech-language pathology as a related service, are provided at public expense and without charge.⁠¹⁸
• Medicaid: for beneficiaries under 21, Medicaid's EPSDT benefit provides treatment to correct or ameliorate conditions found. Medicaid's speech services are given by or under the direction of a speech pathologist on referral from a physician or other licensed practitioner, so ask your child's doctor.⁠¹⁹
• Private insurance: plans differ, so ask yours how many visits it covers and whether it needs a referral or prior authorization.
• AAC devices have their own funding routes, covered in the guide below.

RelatedDoes insurance cover therapy for kids?Speech therapy costsAAC device fundingFinding therapy with Medicaid

20 · Frequently asked questions

RelatedSpeech therapySpeech delay

Find a speech therapist who treats apraxia

Clinics in the DrSensory directory that name apraxia among the conditions they treat, grouped by state. Childhood apraxia of speech is treated by a speech-language pathologist, so look for clinics marked SLP.⁠¹

Each clinic appears here because its own listing names this among what it treats. A listing is not an endorsement or a referral, and inclusion does not mean we have verified a clinic’s credentials, licensure or insurance — check those directly.

Browse all speech therapy clinics

Sources

1. American Speech-Language-Hearing Association. Childhood apraxia of speech: position statement. 2007. www.asha.org/policy/ps2007-00277/ Checked November 3, 2026.
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   The definition: CAS is a disorder “in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits”; the features with “some consensus” are “(a) inconsistent errors on consonants and vowels in repeated productions of syllables or words, (b) lengthened and disrupted coarticulatory transitions between sounds and syllables, and (c) inappropriate prosody, especially in the realization of lexical or phrasal stress.” “It is the policy of ASHA that the diagnosis and treatment of CAS are the proper purview of certified speech-language pathologists with specialized knowledge in motor learning theory, skills in differential diagnosis of childhood motor speech disorders, and experience with a variety of intervention techniques that may include augmentative and alternative communication and assistive technology. It is the certified speech-language pathologist who is responsible for making the primary diagnosis of CAS, for designing and implementing the individualized and intensive speech-language treatment programs needed to make optimum improvement, and for closely monitoring progress.” Provisional classifications: “CAS cannot be ruled out, signs are consistent with CAS, or suspected to have CAS.”
2. American Speech-Language-Hearing Association. Practice portal: childhood apraxia of speech. www.asha.org/practice-portal/clinical-topics/childhood-apraxia-of-speech/ The passages relied on: “the precision and consistency of movements during speech production are impaired, but reflexes are intact and muscle tone is typical”; “People with CAS do not ‘grow out’ of it but can improve their communication with speech and language services”; “The population point-prevalence estimate for CAS in children 4–8 years of age is currently estimated to be 1 in 1,000”; “Among children 4–8 years of age with idiopathic speech delay, it has been estimated that the prevalence of CAS falls around 2.4%”; “Currently, there are no validated diagnostic features that differentiate childhood apraxia of speech (CAS) from other childhood speech sound disorders”; early indicators “fewer vocalizations; fewer consonants; a less diverse phonetic inventory (e.g., early preference for stops and nasals); later consonant acquisition; and limited syllable/word shapes”; “More than 30 genes, including CDK13, EBF3, FOXP2, and SETBP1, account for approximately one third of CAS cases”; “The diagnosis of CAS cannot be based solely on the severity of a child’s SSD, as this may result in overdiagnosis”; “Children with CAS receiving a lower frequency (i.e., twice per week over 12 weeks) can eventually make the same communication gains over time as children receiving a higher frequency (i.e., four times per week)”; “SLPs treat the speech motor and linguistic aspects of the child’s SSD. Checked November 3, 2026.
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   Other professionals (e.g., physical therapist or occupational therapist) may also be involved in the treatment of children with apraxia”; “There is emerging evidence that children receiving CAS interventions via telepractice make positive gains, but research is limited”; “This pattern does not justify limiting communication to a single language for the child and family.”
3. Millar DC, Light JC, Schlosser RW. The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: a research review. Journal of Speech, Language, and Hearing Research. 2006;49(2):248–264. doi:10.1044/1092-4388(2006/021) (PMID 16671842)
4. Namasivayam AK, Pukonen M, Goshulak D, Hard J, Rudzicz F, Rietveld T, et al. Treatment intensity and childhood apraxia of speech. International Journal of Language & Communication Disorders. 2015;50(4):529–546. doi:10.1111/1460-6984.12154 (PMID 25581372).
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   37 children aged 32 to 54 months, treated once or twice a week for 10 weeks: “only higher intensity treatment (2×/week) led to significantly better outcomes for articulation and functional communication”; “neither lower nor higher intensity treatment yielded a significant change for speech intelligibility at the word or sentence level.”
5. Lee ASY, Gibbon FE. Non-speech oral motor treatment for children with developmental speech sound disorders. Cochrane Database of Systematic Reviews. 2015;(3):CD009383. doi:10.1002/14651858.CD009383.pub2 (PMID 25805060).
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   Three studies with 22 children; the overall quality of the evidence was judged low; “Currently no strong evidence suggests that NSOMTs are an effective treatment or an effective adjunctive treatment for children with developmental speech sound disorders.”
6. Individuals with Disabilities Education Act, Part C regulations, 34 CFR Part 303 (eCFR). Parents are primary referral sources: §303.303(c). Checked November 3, 2026.
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   Evaluation and assessment, service coordination and the IFSP “must be carried out at public expense, and for which no fees may be charged to parents”; a State may set a “schedule of sliding or cost participation fees that may be charged to the parent for early intervention services,” and a family the State finds unable to pay receives all Part C services at no cost: §303.521.
7. National Institute on Deafness and Other Communication Disorders. Apraxia of speech. NIH Pub. No. 13-7466, last updated October 31, 2017. www.nidcd.nih.gov/health/apraxia-speech “AOS is not caused by weakness or paralysis of the speech muscles”; acquired AOS “can affect someone at any age, although it most typically occurs in adults,” is “caused by damage to the parts of the brain that are involved in speaking and involves the loss or impairment of existing speech abilities,” and “may result from a stroke, head injury, tumor, or other illness affecting the brain”; developmental delays in speech are those “in which a child follows the typical path of speech development but does so more slowly than is typical”; “The causes of childhood AOS are not well understood”; “Children with AOS often have family members who have a history of a communication disorder or a learning disability”; “Childhood AOS appears to affect more boys than girls”; “Children with AOS generally understand language much better than they are able to use it”; a speech-language pathologist may ask a person to repeat “a list of words of increasing length (for example, love, loving, lovingly)”; “To diagnose childhood AOS, parents and professionals may need to observe a child’s speech over a period of time”; “Children with AOS will not outgrow the problem on their own. Checked November 3, 2026.
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   They also do not acquire the basics of speech just by being around other children, such as in a classroom”; “no single approach has been proven to be the most effective”; “Frequent, intensive, one-on-one speech-language therapy sessions are needed for both children and adults with AOS. (The repetitive exercises and personal attention needed to improve AOS are difficult to deliver in group therapy.)”; “Children with severe AOS may need intensive speech-language therapy for years, in parallel with normal schooling”; “Some adults and children will make more progress during treatment than others. Support and encouragement from family members and friends and extra practice in the home environment are important.”
8. American Speech-Language-Hearing Association. Practice portal: acquired apraxia of speech. www.asha.org/practice-portal/clinical-topics/acquired-apraxia-of-speech/ “Childhood apraxia of speech is a separate and distinct disorder”; “AOS commonly co-occurs with dysarthria and aphasia”; “It is estimated that 44% of patients with chronic aphasia have some degree of AOS”; “Primary progressive apraxia of speech (PPAOS) is a degenerative disease in which AOS is the first, only, or most prominent neurological symptom.” Checked November 3, 2026.
9. Morgan AT, Murray E, Liégeois FJ. Interventions for childhood apraxia of speech. Cochrane Database of Systematic Reviews. 2018;(5):CD006278. doi:10.1002/14651858.CD006278.pub3 (PMID 29845607).
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   Systematic review of randomized and quasi-randomized trials in children aged 3 to 16 with CAS; one trial met the criteria (26 children aged 4 to 12, NDP-3 versus ReST). “There is limited evidence that, when delivered intensively, both the NDP-3 and ReST may effect improvement in word accuracy in 4- to 12-year-old children with CAS”; “The study did not measure functional communication”; “one treatment cannot be reliably advocated over the other. We are also unable to say whether either treatment is better than no treatment or treatment as usual. No evidence currently exists to support the effectiveness of other treatments for children aged 4 to 12 years with idiopathic CAS without other comorbid neurodevelopmental disorders.”
10. Murray E, McCabe P, Ballard KJ. A randomized controlled trial for children with childhood apraxia of speech comparing Rapid Syllable Transition Treatment and the Nuffield Dyspraxia Programme–Third Edition. Journal of Speech, Language, and Hearing Research. 2015;58(3):669–686. doi:10.1044/2015_JSLHR-S-13-0179 (PMID 25807891).
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    26 children with mild to severe CAS aged 4 to 12, 1-hour sessions 4 days a week for 3 weeks: “The ReST and NDP3 treatments demonstrated large treatment effects. ReST maintained treatment gains from 1-week to 4-months posttreatment more effectively than the NDP3. Significant generalization to untreated stimuli was observed for both ReST and NDP3.”
11. Morgan AT, Amor DJ, St John MD, Scheffer IE, Hildebrand MS. Genetic architecture of childhood speech disorder: a review. Molecular Psychiatry. 2024;29(5):1281–1292. doi:10.1038/s41380-024-02409-8 (PMID 38366112).
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    Narrative review: in 2001 a family with CAS “revealed the first causative gene; FOXP2”; “A total of 36 pathogenic variants have been identified from 122 cases across 3 cohorts”; “current findings suggest a remarkable one in three children have a genetic variant that explains their CAS”; “Clinical genetic testing for should now be implemented for individuals with CAS.”
12. Chenausky KV, Baas B, Stoeckel R, Brown T, Green JR, Runke C, et al. Comorbidity and severity in childhood apraxia of speech: a retrospective chart review. Journal of Speech, Language, and Hearing Research. 2023;66(3):791–803. doi:10.1044/2022_JSLHR-22-00436 (PMID 36795544).
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    Medical records of 375 children with CAS: “Only one child had no comorbidities”; “Over 95% of children had comorbid expressive language impairment”; children with intellectual disability, receptive language impairment and nonspeech apraxia “were significantly more likely to have severe CAS”; “children with comorbid autism spectrum disorder (33.6%) were no more likely to have severe CAS than children without autism”; “Findings are limited by being from a convenience sample of participants.”
13. Iuzzini-Seigel J, Moorer L, Tamplain P. An investigation of developmental coordination disorder characteristics in children with childhood apraxia of speech. Language, Speech, and Hearing Services in Schools. 2022;53(4):1006–1021. doi:10.1044/2022_LSHSS-21-00163 (PMID 36041512).
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    Preliminary clinical focus article: “Six out of seven participants met DCD criteria”; “only 57% had previously undergone a physical/occupational therapy evaluation and intervention”; “formal movement assessments are essential for children with a CAS diagnosis.”
14. Lewis BA, Miller GJ, Iyengar SK, Stein C, Benchek P. Long-term outcomes for individuals with childhood apraxia of speech. Journal of Speech, Language, and Hearing Research. 2024;67(9S):3463–3479. doi:10.1044/2023_JSLHR-22-00647 (PMID 37734154).
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    32 people with a history of CAS, aged 12;6 to 25 years, from “a large longitudinal 25-year study”: “Outcomes for individuals with CAS are highly variable, with some demonstrating speech sound errors into adolescence and young adulthood. Speech sound errors were primarily on later developing sounds. Persistence was significantly associated with early motor difficulties. Difficulties with multisyllabic words, phonological processing, and literacy were often present regardless of persistence or nonpersistence of speech errors”; “For children showing limited progress with more traditional speech therapy, alternative interventions should be explored.”
15. Grigos MI, Case J, Lu Y, Lyu Z. Dynamic Temporal and Tactile Cueing in young children with childhood apraxia of speech: a multiple single-case design. Journal of Speech, Language, and Hearing Research. 2024;67(4):1042–1071. doi:10.1044/2024_JSLHR-23-00415 (PMID 38512002).
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    “seven children with CAS (aged 2.5-5 years) over the course of 6 weeks of intervention”; “six of seven children displayed medium-to-large effect sizes”; “DTTC can yield positive change in some young children with CAS.”
16. Highman C, Overby M, Leitão S, Abbiati C, Velleman S. Update on identification and treatment of infants and toddlers with suspected childhood apraxia of speech. Journal of Speech, Language, and Hearing Research. 2024;67(9S):3288–3308. doi:10.1044/2023_JSLHR-22-00639 (PMID 37441847).
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    Tutorial: “Many of the originally proposed correlates of CAS in infants and toddlers now have research supporting their presence. However, questions remain about the developmental trajectory of the disorder”; infants and toddlers with suspected CAS “need not wait for a definitive diagnosis to initiate intervention.”
17. Chou STY, Sutherland R, McCabe P. A systematic scoping review of the literacy skills of children with childhood apraxia of speech: recommendations for best practice and further research. International Journal of Speech-Language Pathology. 2024;26(3):346–366. doi:10.1080/17549507.2024.2363935 (PMID 38973309).
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    Twenty-three articles: children with CAS “frequently had poorer outcomes compared with both typical readers and children with other speech disorders”; “Children with CAS are at high risk of literacy difficulty and may require early literacy intervention.”
18. Individuals with Disabilities Education Act, Part B regulations, 34 CFR Part 300 (eCFR). A speech or language impairment is “a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance”: §300.8(c)(11). Checked November 3, 2026.
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    A free appropriate public education is special education and related services “provided at public expense, under public supervision and direction, and without charge”: §300.17. Related services include “speech-language pathology and audiology services”: §300.34(a). “either a parent of a child or a public agency may initiate a request for an initial evaluation,” which “Must be conducted within 60 days of receiving parental consent for the evaluation; or ... If the State establishes a timeframe within which the evaluation must be conducted, within that timeframe”: §300.301.
19. Medicaid regulations, 42 CFR (eCFR). The EPSDT subpart covers “eligible Medicaid beneficiaries under age 21” and “providing treatment to correct or ameliorate defects and chronic conditions found”: §441.50. Checked November 3, 2026.
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    Services for speech, hearing and language disorders are “diagnostic, screening, preventive, or corrective services provided by or under the direction of a speech pathologist or audiologist, for which a patient is referred by a physician or other licensed practitioner of the healing arts”: §440.110(c).
20. National Institute of Neurological Disorders and Stroke. Stroke: signs and symptoms. www.ninds.nih.gov/health-information/stroke/signs-and-symptoms “Call 9-1-1 immediately if one or more of the following symptoms appear suddenly”, including “Trouble speaking, or trouble understanding speech.” Checked November 3, 2026.
21. National Health Service (England). Developmental co-ordination disorder (dyspraxia) in children. Page last reviewed March 8, 2023. www.nhs.uk/conditions/developmental-coordination-disorder-dyspraxia/ “Developmental co-ordination disorder (DCD), also known as dyspraxia, is a condition affecting physical co-ordination.” Checked November 3, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child. It has not been reviewed by a speech-language pathologist. If you have concerns about your child's speech, speak to a speech-language pathologist or your pediatrician.