Giving a voice to individuals with apraxia of speech
Recognising Possible Childhood Apraxia of Speech
When CAS Should Be Considered
Childhood Apraxia of Speech should be considered when a child has persistent speech difficulties that appear greater than would be expected from a typical speech delay or a straightforward articulation difficulty.
Concerns may arise when speech is very limited, difficult to understand, inconsistent or unusually effortful, particularly when the child appears to know what they want to say but has difficulty producing the required sequence of speech movements.
CAS should be considered as part of a wider assessment rather than assumed from one characteristic alone.
Delayed or Limited Speech
Some children with CAS may begin speaking later than expected or may have a much smaller spoken vocabulary than other children of a similar age.
They may produce:
- few recognisable words
- a limited range of consonants
- a restricted range of vowels
- only simple syllable shapes
- fewer spontaneous attempts at speech
Delayed speech is not specific to CAS and can occur for many reasons, but it may form part of the overall clinical picture.
Reduced Speech Intelligibility
Restricted Speech Sound and Syllable Repertoire
Children with CAS may be difficult to understand, particularly for people who do not know them well.
Intelligibility can be affected by:
- inaccurate consonants
- vowel errors
- disrupted sound transitions
- omitted sounds or syllables
- unusual stress
- slow or segmented speech
- inconsistent word production
It is useful to compare how well the child is understood by parents, teachers, peers and unfamiliar listeners.
Restricted Speech Sound and Syllable Repertoire
Restricted Speech Sound and Syllable Repertoire
A child with suspected CAS may use a smaller range of speech sounds and syllable structures than expected.
Assessment should consider:
- number of consonants used
- number and accuracy of vowels
- range of syllable shapes
- ability to combine different consonants and vowels
- ability to produce consonant clusters
- variety of word shapes
The child’s speech repertoire should be considered in relation to age, language level and the language or languages they speak.
Difficulty With Longer or Unfamiliar Words
Speech may become more difficult as words become longer or motorically more complex.
A child may produce short, familiar words relatively successfully but have increasing difficulty with:
- multisyllabic words
- unfamiliar vocabulary
- words containing several different speech movements
- consonant clusters
- longer phrases
This increase in errors as complexity rises can be useful during assessment.
Communication Intent and Attempts at Speech
For a meaningful motor speech assessment, the clinician needs opportunities to observe the child attempting to communicate through speech.
A child does not need to have extensive spoken language, but there should be enough intentional vocal or spoken attempts to examine how speech movements are being planned and produced.
For children with very limited speech, assessment may also use:
- play
- imitation
- parent interaction
- familiar routines
- home video
- vocalisations
- AAC and gesture alongside speech
Where there is not yet enough speech to make a confident diagnosis, the clinician may use a provisional description and review over time.
Differences Across Speaking Tasks
Differences Across Speaking Tasks
Speech performance may vary depending on what the child is being asked to do.
The clinician may compare:
- spontaneous speech
- imitation
- single words
- repeated words
- phrases
- connected speech
- familiar versus unfamiliar words
- supported versus unsupported production
A child should not be assessed from one task alone. Important characteristics may only become apparent when speech demands change.
Screening Is Not Diagnosis
Differences Across Speaking Tasks
Screening can help identify children who may need further assessment, but it cannot confirm CAS.
A screening tool may highlight:
- reduced intelligibility
- inconsistency
- restricted sound repertoire
- difficulty with complex words
- unusual prosody
- possible motor speech concerns
However, these features can occur in other speech sound disorders.
A diagnosis of CAS requires a more comprehensive assessment that examines speech across different tasks and considers alternative explanations.
Slow Progress in Therapy Is Not Diagnostic
A child should not be diagnosed with CAS simply because progress in previous speech therapy has been slow.
Limited progress can occur for many reasons, including:
- insufficient therapy intensity
- unsuitable treatment approach
- inconsistent attendance
- complex co-occurring needs
- hearing difficulties
- language difficulties
- severity of the speech disorder
Previous response to intervention can provide useful clinical information, but it should be considered alongside the wider assessment rather than used as evidence of CAS on its own.
When to Refer for Specialist Assessment
When to Refer for Specialist Assessment
Referral for specialist motor speech assessment should be considered when:
- speech is significantly difficult to understand
- speech development is markedly delayed
- the same words are produced differently across attempts
- longer words are disproportionately difficult
- speech appears effortful or segmented
- stress or rhythm sounds unusual
- the child has a very limited sound repertoire
- there is concern about speech motor planning
- the child has had limited progress despite appropriate intervention
- another professional has raised concern about possible CAS
Assessment should ideally be carried out by a Speech and Language Therapist or Speech Pathologist with experience in paediatric motor speech disorders.
Core Diagnostic Features of Childhood Apraxia of Speech
ASHA Consensus Features
Three speech characteristics are most consistently associated with Childhood Apraxia of Speech:
- inconsistent errors on consonants and vowels across repeated productions
- lengthened or disrupted transitions between sounds and syllables
- inappropriate prosody, particularly unusual stress patterns
These features are important, but they should not be treated as a simple checklist. Diagnosis depends on the overall speech pattern across more than one task.
Inconsistent Consonant and Vowel Errors
A child with CAS may produce the same word differently across repeated attempts.
Changes may involve:
- different consonant substitutions
- different vowel errors
- omission of different sounds
- changes in syllable structure
- variable accuracy from one attempt to the next
During assessment, repeated productions of the same words can help determine whether the child’s errors are stable or variable.
Inconsistency alone does not confirm CAS because it can also occur in other speech sound disorders.
Lengthened Coarticulatory Transitions
Disrupted Transitions Between Sounds and Syllables
Speech normally involves smooth and rapid movement from one sound to another.
In CAS, these transitions may be unusually prolonged. The child may appear to take extra time moving between articulatory positions.
This may be heard as:
- stretched transitions
- delayed movement between sounds
- unusually slow movement through a word
- reduced smoothness between syllables
These difficulties can become more obvious in longer or more complex words.
Disrupted Transitions Between Sounds and Syllables
Disrupted Transitions Between Sounds and Syllables
Some children show clear breaks in the flow of speech.
This may include:
- pauses within words
- separation of individual syllables
- disrupted consonant-vowel transitions
- repeated attempts to move into the next sound
- speech that sounds segmented or effortful
Assessment should consider whether these disruptions occur consistently across different tasks and levels of complexity.
Inappropriate Prosody and Stress
Vowel Distortions and Vowel Errors
Prosody includes stress, rhythm, timing, pitch and intonation.
Children with CAS may:
- stress the wrong syllable
- give syllables unusually equal stress
- pause in unexpected places
- use an unusual rhythm
- produce speech with reduced naturalness
- have difficulty adjusting stress across phrases and sentences
Prosodic differences are particularly important because inappropriate prosody is one of the three widely recognised consensus features of CAS.
Vowel Distortions and Vowel Errors
Vowel Distortions and Vowel Errors
Vowels should be assessed carefully rather than focusing only on consonants.
A child may:
- substitute one vowel for another
- produce a vowel that sounds distorted
- vary the vowel across repeated attempts
- have difficulty maintaining the correct vowel in longer words
Vowel distortions are clinically important because they may contribute to reduced intelligibility and can support a motor speech diagnosis when present alongside other CAS characteristics
Additional Motor Speech Features
Other characteristics may strengthen concern about CAS when they occur as part of the wider speech profile.
These can include:
Groping
Visible trial-and-error movements of the lips, tongue or jaw when attempting speech.
Schwa insertion
Adding a neutral vowel between consonants or syllables.
Segmented speech
Producing words as separate sounds or syllables rather than as a smooth sequence.
Slow speech rate
Speech may become unusually slow, particularly during difficult words or phrases.
Difficulty initiating speech
The child may hesitate before starting a word or appear to search for the correct articulatory position.
Voicing errors
Difficulty consistently producing voiced and voiceless consonants accurately.
Increasing errors with complexity
Speech may become less accurate as words become longer, less familiar or more complex.
These features are not unique to CAS and should not be interpreted in isolation.
Mayo 10+1 Features
Another diagnostic framework described in the CAS literature is the Mayo 10+1 feature set.
This approach considers a wider group of perceptual speech characteristics associated with CAS. Recent evidence summaries indicate that a pattern including vowel distortions together with several additional Mayo features across multiple speech tasks can contribute to diagnostic decision-making.
The value of this framework is that it encourages clinicians to look at a broad speech-motor profile rather than relying only on one or two characteristics.
Features Should Be Seen Across More Than One Task
Why No Single Feature Diagnoses Childhood Apraxia of Speech
A characteristic observed during one word or one assessment activity is not enough to establish CAS.
Assessment should look for patterns across several types of speech, such as:
- single words
- repeated words
- imitation
- multisyllabic words
- phrases
- spontaneous speech
- connected speech
Current evidence recommends using multiple speech tasks so that the clinician can determine whether motor speech features are consistent across different speaking demands.
Why No Single Feature Diagnoses Childhood Apraxia of Speech
Why No Single Feature Diagnoses Childhood Apraxia of Speech
Why No Single Feature Diagnoses Childhood Apraxia of Speech
There is no single symptom, test score or speech characteristic that proves a child has CAS.
Some individuals without CAS may show inconsistency, unusual prosody or difficulty with complex words. Likewise, a child with CAS may not display every commonly described characteristic in every situation.
Diagnosis therefore depends on the overall pattern across:
- consonants
- vowels
- transitions
- prosody
- word complexity
- repeated productions
- connected speech
- dynamic assessment
- functional intelligibility
- differential diagnosis
The strongest diagnosis comes from converging evidence across several assessment tasks rather than from one isolated finding.
Planning a Comprehensive CAS Assessment
Assessment by an Experienced Clinician
Childhood Apraxia of Speech should be assessed by a Speech and Language Therapist or Speech Pathologist with knowledge and experience of paediatric motor speech disorders.
CAS can be difficult to distinguish from other speech sound disorders, so the clinician needs to interpret the child’s speech pattern across a range of tasks rather than rely on a single score or checklist.
Tailoring the Assessment to the Child
Assessment should be adapted to the individual child rather than using exactly the same procedure for everyone.
The clinician should consider:
- age
- severity of speech difficulty
- amount of spoken language
- attention and tolerance for assessment
- developmental level
- language or languages spoken
- co-occurring conditions
- previous assessment and therapy
A younger or minimally verbal child will often need a very different assessment approach from an older child with mild residual CAS.
Use More Than One Speech Task
Assess More Than Speech Motor Planning
A comprehensive CAS assessment should include several different speaking tasks.
Current evidence supports using at least three speech tasks so that the clinician can compare performance under different levels of motor and linguistic demand.
Tasks may include:
- single words
- repeated word productions
- multisyllabic words
- imitation
- phrases
- connected speech
- rapid sequencing tasks
- dynamic motor speech tasks
This helps show whether suspected CAS features occur consistently across different contexts.
Assess More Than Speech Motor Planning
Assess More Than Speech Motor Planning
CAS assessment should not focus only on motor speech.
A broader assessment may also need to consider:
- receptive language
- expressive language
- phonological awareness
- literacy
- social communication
- hearing
- oral motor function
- functional communication
This is important because CAS can occur alongside other communication and developmental difficulties.
Hearing assessment
Hearing should be considered as part of the assessment process.
Even mild hearing difficulties can affect speech development, speech sound learning and intelligibility.
Where hearing has not been checked recently, referral for audiological assessment may be appropriate.
Hearing difficulties do not rule out CAS, and CAS and hearing loss can occur together.
Oral Structure and Movement
The clinician should examine the structures and movements involved in speech.
This may include:
- lips
- tongue
- jaw
- palate
- facial movement
- range of movement
- symmetry
- coordination
The purpose is partly to identify whether another motor speech disorder, such as dysarthria, may be contributing to the speech difficulty.
Non-speech oral motor difficulties should not be treated as proof of CAS.
Consider Age, Language, Accent and Culture
Assessment materials should be appropriate for the person’s linguistic and cultural background.
The clinician should consider:
- the child’s first language
- additional languages
- accent or dialect
- typical speech patterns in those languages
- language exposure
- cultural familiarity with assessment materials
A speech pattern that is typical in one language or dialect should not be misidentified as a disorder
Younger and Adults Need Different Assessment Tasks
Assessment should change as children become older and more verbally able.
For younger or more severely affected children, assessment may rely more on:
- play-based interaction
- simple words
- imitation
- dynamic assessment
- parent-child interaction
- vocalisations
- simple syllable structures
For adults,older or more mildly affected children, assessment should place greater demands on the speech motor system through:
- polysyllabic words
- unfamiliar words
- rapid speech sequencing
- connected speech
- reading aloud
- longer utterances
Residual CAS can be missed if assessment tasks are too easy.
The CAS Assessment Process
Observing Natural Communication
Observe the child interacting naturally with a parent, carer or clinician to see how speech functions outside structured testing.
Connected Speech Sampling
Collect conversation, story retell, picture description or play-based speech to examine accuracy when the child has to plan continuous speech. The 2026 evidence brief specifically recommends connected-speech samples as part of CAS assessment.
Comparing Structured and Spontaneous Speech
Compare performance when the child repeats a clinician's model with speech they generate independently.
Increasing Linguistic Demand
Move from straightforward utterances to sentences, narratives or more complex language to examine whether speech changes as formulation and motor-planning demands increase.
Recording a Representative Sample
Audio or video recording allows detailed analysis after the session and provides a baseline for future comparison.
Phonetic Transcription
Use narrow or broad phonetic transcription where appropriate to document distortions, substitutions, omissions and unusual vowel productions accurately.
Assessment Tools and Measures
Childhood Apraxia of Speech Assessment Tools and Measures
No single assessment tool can diagnose Childhood Apraxia of Speech on its own. Tools and structured tasks should be used as part of a wider motor speech assessment and interpreted alongside connected speech, prosody, inconsistency, dynamic assessment and differential diagnosis.
Dynamic Evaluation of Motor Speech Skill (DEMSS)
DEMSS is a dynamic motor speech assessment designed particularly for children with severe speech disorders or limited speech output. It examines articulatory accuracy, vowel accuracy, prosody, consistency and how the child responds to different levels of cueing.
It is particularly useful where standard articulation testing does not provide enough information about speech motor planning.
Reference:
Strand, E. A. and McCauley, R. J. (2019). Dynamic Evaluation of Motor Speech Skill (DEMSS) Manual. Windsor Mill, MD: Brookes Publishing.
Validation study:
Strand, E. A., McCauley, R. J., Weigand, S. D., Stoeckel, R. E. and Baas, B. S. (2013). ‘A motor speech assessment for children with severe speech disorders: Reliability and validity evidence’, Journal of Speech, Language, and Hearing Research, 56, pp. 505–520.
Nuffield Dyspraxia Programme Assessment
The Nuffield Dyspraxia Programme (NDP3) includes structured assessment of speech sound production, syllable structures and increasingly complex speech sequences.
It can contribute useful information about the child’s speech repertoire and the level of complexity at which difficulties become more apparent.
It should be used as part of a wider assessment rather than as a stand-alone diagnostic test for CAS.
Reference:
Williams, P. and Stephens, H. (2009). The Nuffield Dyspraxia Programme.
Website:
http://www.ndp3.org/
Verbal Motor Production Assessment for Children – Revised (VMPAC-R)
The Nuffield Dyspraxia Programme (NDP3) includes structured assessment of speech sound production, syllable structures and increasingly complex speech sequences.
It can contribute useful information about the child’s speech repertoire and the level of complexity at which difficulties become more apparent.
It should be used as part of a wider assessment rather than as a stand-alone diagnostic test for CAS.
Reference:
Williams, P. and Stephens, H. (2009). The Nuffield Dyspraxia Programme.
Website:
http://www.ndp3.org/
Diagnostic Evaluation of Articulation and Phonology (DEAP)
The DEAP is a standardised assessment of articulation and phonology.
Its inconsistency component can be particularly useful when distinguishing CAS from inconsistent phonological disorder, because inconsistency by itself does not establish a diagnosis of CAS.
DEAP does not diagnose CAS, but it can provide valuable information for differential diagnosis.
Reference:
Dodd, B., Hua, Z., Crosbie, S., Holm, A. and Ozanne, A. (2002). Diagnostic Evaluation of Articulation and Phonology (DEAP). London: The Psychological Corporation.
Website:
https://www.pearsonclinical.co.uk
In the video Lorraine Bamblet (Friend of Speech Apraxia) demonstrates the practical application of the DEAP assessment to diagnose specific speech sound disorder subtypes in children. This guide details how to navigate the picture stimulus book, record phonetic transcriptions, and utilize subtests to differentiate between phonological, articulation, and inconsistency difficulties
Syllable Repetition Task (SRT)
The Syllable Repetition Task uses simple nonword syllables to examine speech processing, memory and sequencing while reducing the influence of a child’s previously learned speech errors.
It can provide useful additional information when evaluating children with complex speech sound disorders, particularly older or more verbal children.
It is a complementary assessment task rather than a CAS diagnostic test.
Reference:
Shriberg, L. D., Lohmeier, H. L., Campbell, T. F., Dollaghan, C. A., Green, J. R. and Moore, C. A. (2009). ‘A nonword repetition task for speakers with misarticulations: The Syllable Repetition Task (SRT)’, Journal of Speech, Language, and Hearing Research, 52(5), pp. 1189–1212.
Full text:
https://pmc.ncbi.nlm.nih.gov/articles/PMC3875157/
THE SYLLABLE REPETITION TASK (SRT) Technical Report No. 14 Lawrence D. Shriberg Heather L. Lohmeier
http//:phonology.waisman.wisc.edu/wp-content/uploads/sites/532/2018/05/TREP14.pdf
Maximum Repetition Rate and Diadochokinetic Tasks
Maximum repetition rate and diadochokinetic tasks involve rapid repetition of syllables or syllable sequences.
These tasks can provide information about speech motor sequencing, coordination and rate, particularly in older children.
Results need to be interpreted carefully because performance is influenced by age, speech accuracy and the child’s ability to understand and complete the task. Poor performance is not specific to CAS.
Reference:
Diepeveen, S., van Haaften, L., Terband, H., de Swart, B. and Maassen, B. (2019). ‘A standardized protocol for maximum repetition rate assessment in children’, Folia Phoniatrica et Logopaedica, 71(5–6), pp. 238–250.
Full text:
https://pmc.ncbi.nlm.nih.gov/articles/PMC7050664/
Intelligibility in Context Scale (ICS)
The Intelligibility in Context Scale is a short parent-report measure that examines how well a child is understood by different people in everyday life.
It considers communication with:
- parents
- immediate family
- extended family
- friends
- teachers
- acquaintances
- strangers
The ICS does not diagnose CAS, but it provides valuable information about the functional impact of the child’s speech difficulties and can complement impairment-based motor speech assessment.
Reference:
McLeod, S., Harrison, L. J. and McCormack, J. (2012). ‘The Intelligibility in Context Scale: Validity and reliability of a subjective rating measure’, Journal of Speech, Language, and Hearing Research, 55(2), pp. 648–656.
Website:
https://www.csu.edu.au/research/multilingual-speech/ics
Using Assessment Tools Appropriately
The tools above have different purposes.
Named assessment instruments:
DEMSS, VMPAC-R, NDP3 and DEAP.
Complementary assessment measures and tasks:
Syllable Repetition Task, maximum repetition rate, polysyllabic speech tasks and the Intelligibility in Context Scale.
None should be presented as a stand-alone “CAS test”. The strongest assessment combines several sources of evidence and examines the child across different speech tasks and communication situations.
Key Research Supporting Comprehensive CAS
Differential diagnosis of children with suspected childhood apraxia of speech.
Murray, E., McCabe, P., Heard, R. and Ballard, K. J. (2015).
.Journal of Speech, Language, and Hearing Research, 58(1), 43–60.
This study examined which assessment measures best distinguished CAS from other speech disorders. It found that a combination of measures, including syllable segregation, lexical stress, polysyllabic speech accuracy and rapid syllable sequencing, provided strong diagnostic value. It supports using multiple complementary speech tasks rather than relying on one test or feature.
https://pubmed.ncbi.nlm.nih.gov/25480674
Dynamic Evaluation of Motor Speech Skill (DEMSS) Manual
Strand, E. A. and McCauley, R. J. (2019).
Baltimore, MD: Brookes Publishing.
DEMSS is a dynamic motor speech assessment particularly useful for children with severe or limited speech. It examines how speech changes with cueing and support, helping clinicians assess motor planning, severity and differential diagnosis. It is especially useful when standardised articulation testing does not provide enough information.
https://brookespublishing.com/product/demss
Speech inconsistency in children with Childhood Apraxia of Speech, language impairment, and speech delay: Depends on the stimuli.
Iuzzini-Seigel, J., Hogan, T. P. and Green, J. R. (2017Journal of Speech, Language, and Hearing Research, 60(5), 1194–1210.
This study showed that inconsistency can help distinguish CAS from other speech disorders, but its usefulness depends on the words and tasks used. It supports assessing inconsistency across carefully selected and varied speech stimuli, rather than treating inconsistency alone as diagnostic of CAS.
https://pubmed.ncbi.nlm.nih.gov/28395359/
A tool for differential diagnosis of Childhood Apraxia of Speech and dysarthria in children: A tutorial. Language, Speech, and Hearing Services in Schools
Iuzzini-Seigel, J., Allison, K. M. and Stoeckel, R. (2022).
53(4), 926–946.
This paper introduces the Profile of Childhood Apraxia of Speech and Dysarthria (ProCAD), a structured approach to distinguishing CAS from childhood dysarthria. It considers articulatory, prosodic, phonatory, respiratory and resonatory features across multiple speech tasks and is particularly useful when a mixed motor speech disorder is suspected.
https://epublications.marquette.edu/spaud_fac/66/
Childhood Apraxia of Speech
Childhood apraxia of speech multilingual children
CAS Diagnosis Isn’t Always Clear-Cut: Why Some Children Go Undiagnosed
CAS Diagnosis Isn’t Always Clear-Cut: Why Some Children Go Undiagnosed
CAS Diagnosis Isn’t Always Clear-Cut: Why Some Children Go Undiagnosed
Some people may go undiagnosed with Childhood Apraxia of Speech (CAS) due to the circumstances of their evaluation or because their difficulties resemble CAS but do not meet the diagnostic threshold. This group may include children who are too young to participate fully in assessment, those with additional challenges such as cognitive impairment or hearing loss, or those who present with some but not all of the features required by a clinician to confirm CAS.
Adults symptoms of CAS
Adults with CAS may continue to present with symptoms and might find support helpful.
Adults typically present with fewer features especially if they have benefited from early therapy.
. Examples of residual symptoms include:
- restricted and stable phonetic repertoires over time
- atypical prosody, such as uniform pitch, loudness, and duration across syllables in multisyllabic words
- vowel errors
- difficulty generalising accurate productions from simple syllable shapes (e.g., CV) to more complex ones (e.g., CCVC, CVCVC).
What happens when children with childhood apraxia of speech become adults with Tricia McCabe -World Expert on CAS
Another excellent linked video by Friend of Speech Apraxia Mac MacKay above. Thanks Mac for all you are doing to raise awareness!
Looking Beyond Phonology: Motor Planning Strategies for Children with Speech Difficulties
Treatment strategies informed by motor learning principles—commonly applied in CAS intervention—can be adapted to support these children. Key strategies include:
- increasing practice opportunities, both through more frequent sessions and a higher number of productions per session
- using facilitators such as slowed rate, tactile cues, or visual prompts to support accuracy
- regularly employing assessment probes to ensure that gains are stable and generalisable rather than short-lived.
By applying these strategies, clinicians can address speech motor planning difficulties in young children—even when a formal CAS diagnosis is not given.
Childhood Apraxia of Speech compared with Acquired Apraxia of Speech
Childhood Apraxia of Speech compared with Acquired Apraxia of Speech
Although both CAS and AOS are motor speech disorders involving difficulties with planning and programming speech movements, there are important differences.
Childhood Apraxia of Speech (CAS)
- Present from early childhood during speech and language development.
- Occurs before the speech and language system has fully developed.
- Affects the development of speech, phonology and language skills.
- Children have not yet developed automatic or overlearned speech patterns.
- Speech and language skills develop atypically from the outset.
Acquired Apraxia of Speech (AOS)
- Occurs after speech and language have developed normally.
- Results from damage to the brain (e.g. stroke, traumatic brain injury or neurological disease).
- Disrupts a previously intact speech and language system.
- Automatic or overlearned speech (e.g. counting, greetings or familiar phrases) may be relatively preserved.
- Previously learned speech skills are lost or impaired following brain injury
Questions and answers
Can CAS still affect me as an adult?
While many improve with therapy, some adults continue to experience residual speech challenges, like difficulty with articulation, rhythm, or confidence when speaking. Does CAS get better on its own?
What are the signs?
You might notice inconsistent speech errors, effortful or slowed speech, challenges with multi-syllabic words, or anxiety about speaking in social settings. These issues can fluctuate depending on fatigue, stress, or environment.
Can My Speech Still Improve?
Absolutely. While progress may be slower than in childhood, speech therapy with a specialist who understands motor speech disorders can help refine and improve fluency, and build confidence. Approaches may include motor-based therapy, prosody training, and assistive tools. Either go via the NHS or use ASLTIP for a private speech and language therapist in your area Find a speech therapist - ASLTIP and look here for adult therapy approaches
I get nervous about how people perceive my speech;what can I say?
You can keep it simple and honest: “I have a speech motor disorder that makes some words come out differently, but I’m working on it.” People often appreciate the clarity, and it can reduce pressure during conversations. You may get questions like "where are you from?" as others try to place your accent. Apraxia of speech can sometimes distort what we say, so they are just being curious. Saying the Words I’ve Avoided My Whole Life - Apraxia of Speech
Are there practical ways to manage speaking challenges in work or life?
Yes. You might try pacing strategies (like pausing between phrases), rehearsing key phrases ahead of time, using supportive tech (e.g. text-to-speech apps), or practicing public speaking in safe environments. Confidence often grows with preparation and support. See our 'Information sources for study and employment'
Who’s to say what ‘normal’ is? I personally really dislike the word ‘normal.’ Everyone is ‘different’ in some way or another.
Mikey Akers
Understanding CAS and Dysarthria
What are childhood motor speech disorders?
Motor speech disorders affect the movements needed to produce speech. Speaking requires the brain to organise and coordinate breathing, voice production and movements of the lips, tongue, jaw and palateChildhood apraxia of speech, or CAS, primarily affects speech motor planning and programming. Dysarthria affects the execution of speech movements. A child can experience either condition or both.
What is childhood apraxia of speech?
CAS is a neurological speech disorder involving difficulty planning and programming speech movements.
The child may struggle to organise the timing and sequence of movements needed to produce sounds, syllables and words. Difficulties can become more noticeable when speech requires longer or more complex movement sequences.
Research reference: Childhood Apraxia of Speech: Technical Report.
This report explains the definition of CAS and the evidence informing its assessment and diagnosis. Read the report
What does speech motor planning mean?
Speech motor planning involves organising the movements needed for speech. Speech motor programming concerns specifying aspects of those movements, including their timing and coordination.
In CAS, these processes are disrupted. A child may have difficulty establishing a starting position or moving smoothly between successive sounds.
What is childhood dysarthria?
Dysarthria is a neurological motor speech disorder affecting how speech movements are carried out.
It can involve changes in muscle strength, speed, range, steadiness, tone or movement accuracy. These changes can affect breathing, voice, resonance, articulation and speech rhythm.
The resulting pattern varies between children.
Reference: Motor Speech Disorders: Substrates, Differential Diagnosis, and Management.
Joseph Duffy’s clinical textbook explains dysarthria, its underlying mechanisms and assessment principles. Its main focus is acquired motor speech disorders, so childhood assessment also requires paediatric evidence. View the book
What does speech motor execution mean?
Speech motor execution is the physical performance of the movements used to speak.
A child with dysarthria may have difficulty controlling the force, speed or precision of movements. The effects may be heard in speech clarity, loudness, voice quality, breathing patterns or rhythm.
How are CAS and dysarthria different?
The main distinction concerns the level at which speech movement is affected.
CAS primarily involves planning and programming movements. Dysarthria involves executing them.
However, this distinction cannot always be made simply by listening for one particular symptom. Both conditions can affect sound accuracy, speaking rate and prosody.
Research reference: A Tool for Differential Diagnosis of Childhood Apraxia of Speech and Dysarthria in Children: A Tutorial.
The publication explains why different underlying difficulties can produce some similar speech characteristics. Read the publication
Can an individual have both conditions?
Yes. An individual can have difficulties with both speech motor planning and speech motor execution.
For example, problems with speech transitions and syllable stress may occur alongside difficulties with voice quality or articulatory precision. Identifying one condition does not automatically exclude the other.
Research reference: Estimates of the Prevalence of Speech and Motor Speech Disorders in Adolescents With Down Syndrome.
This study identified participants with CAS, dysarthria and a combination of both conditions. Read the publication
How common are childhood motor speech disorders?
Published estimates suggest that CAS and childhood dysarthria may each affect approximately one child in 1,000, although these are estimates rather than precise rates.
Frequency differs considerably between populations. Motor speech disorders are more common in some groups with complex neurodevelopmental conditions.
Research reference: Estimates of the Prevalence of Speech and Motor Speech Disorders in Persons With Complex Neurodevelopmental Disorders.
This research examines prevalence across selected neurodevelopmental groups and illustrates why population and diagnostic methods matter. Full publication details are listed in Section 36.
Dysarthria and cerebral palsy
Dysarthria can occur in children with cerebral palsy because the neurological condition can affect movements used for speech.
In one study of 84 children with cerebral palsy, approximately five to six years old, dysarthria was identified in 78% of the 64 verbal participants. This figure describes that subgroup, not every child with cerebral palsy.
Research reference: Speech in Children With Cerebral Palsy.
This study examined speech difficulties and mixed speech profiles in a community sample. Read the publication
Motor speech disorders and Down syndrome
Why each child needs an individual speech profile
Children and young people with Down syndrome may have different combinations of speech difficulties.
One adolescent study identified dysarthria alone in 37.8%, CAS alone in 11.1%, and both conditions in 22.2% of participants. These findings highlight the importance of individual assessment rather than assuming that everyone has the same speech profile.
Research reference: Estimates of the Prevalence of Speech and Motor Speech Disorders in Adolescents With Down Syndrome.
This publication provides the study findings and distinguishes between diagnostic groups. Read the publication
Conditions associated with dysarthria
Why each child needs an individual speech profile
Why each child needs an individual speech profile
Dysarthria can occur alongside congenital neurological or neuromuscular conditions, including cerebral palsy, genetic syndromes, metabolic disorders, spinal muscular atrophy and muscular dystrophy.
It may also develop following acquired neurological injury, including traumatic brain injury, brain tumours or injury involving reduced oxygen supply.
The associated condition alone does not establish the child’s speech diagnosis
Why each child needs an individual speech profile
Why each child needs an individual speech profile
Why each child needs an individual speech profile
Two children with the same diagnosis may have different strengths and difficulties.
One child may have prominent voice and breathing difficulties, while another has greater difficulty with articulation or prosody. Assessment needs to identify the particular systems involved and their effects on
Recognising Speech Features and Wider Needs-Comparing speech
Inconsistent speech errors
Difficulty moving between sounds
A individual may produce the same word differently across repeated attempts. Consonants, vowels or the overall word form may change. This is not typical in dsyarthria
Inconsistency is relevant when assessing CAS, but it is not sufficient to diagnose CAS on its own. The clinician needs to consider the type of inconsistency and the other features present.
Difficulty moving between sounds
Difficulty moving between sounds
Speech normally involves overlapping movements that allow sounds and syllables to flow together.
In CAS, these transitions may be lengthened or disrupted. A child may struggle to establish an initial speech position or move one articulatory gesture to the next which is not typical in dsyarthria.
Speech rhythm and stress
Prosody includes the rhythm, emphasis and intonation of speech.
A child may place emphasis on an unexpected syllable, use unusually equal stress or have difficulty producing clear differences between stressed and unstressed syllables.
Prosodic difficulties occur in both CAS and dysarthria, so the pattern needs careful interpretation.
Syllable segregation and additional vowel sounds
Syllable segregation makes a word sound as though its syllables are being spoken separately.
An intrusive schwa is an additional “uh”-like vowel within a speech production. Both observations may be relevant when exploring the organisation and smoothness of speech movements.
Neither should be interpreted independently of the rest of the speech profile.
Groping and difficulty with longer words
Groping describes searching movements as a individual tries to achieve a speech position. Typically just in CAS.
Longer words may also be harder because they require more movements to be sequenced and coordinated. The clinician considers whether difficulty increases with word length and complexity.
Sound distortions and voicing errors
Consonants or vowels may sound different from their intended form. An individual may also have difficulty coordinating whether the voice is switched on or off for a sound.
These features can occur in both CAS and dysarthria.
An overall lack of precise articulatory contacts is also important to assess, particularly when considering dysarthria.
Breathing and voice features
Resonance and nasal-sounding speech
Dysarthria may affect the breathing support and voice production needed for speech.
Features can include low volume, fading loudness, excessive loudness, large loudness variations, effortful inhalation, short breath groups and unusual pausing.
Voice quality may be breathy, hoarse or strained. Pitch and loudness regulation may also be difficult.
Resonance and nasal-sounding speech
Resonance and nasal-sounding speech
Resonance concerns how sound travels through the mouth and nose.
Hypernasality means excessive nasal resonance. Hyponasality means reduced nasal resonance. Changes may be consistent or fluctuate across speech.
Consistent hypernasality, with or without nasal air emission, may be relevant to dysarthria assessment. Structural and other possible causes also require consideration.
Speaking rate and rapid syllable tasks
Some individuals speak slowly or have difficulty rapidly repeating syllables.
Rapid repetition tasks are often called diadochokinetic, or DDK, tasks. They allow clinicians to observe aspects of speech movement performance.
Slow rate can occur in both CAS and dysarthria. Performance needs to be interpreted alongside other speech findings
Can SLPs distinguish between CAS and dysarthria
Differential diagnosis can be challenging when speech features overlap.
In an exploratory survey of 359 speech-language pathologists, 62% reported moderate or high confidence in diagnosing CAS. Sixty per cent reported low or no confidence in diagnosing childhood dysarthria, and 40% reported that uncertainty contributed to their tendency not to make that diagnosis.
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