What Is Apraxia of Speech?
Sub-types of oral/verbal /speech apraxia
Non-Verbal Oral Apraxia: Often referred to as oral apraxia, this condition specifically affects the ability to perform non-speech movements with the mouth, such as blowing, licking, or chewing. Individuals may have difficulty executing these movements on command, even though they can perform them automatically in other contexts
Non-Verbal Oral Apraxia: Often referred to as oral apraxia, this condition specifically affects the ability to perform non-speech movements with the mouth, such as blowing, licking, or chewing. Individuals may have difficulty executing these movements on command, even though they can perform them automatically in other contexts
What is the relationship between oral and verbal dyspraxia? | Dyspraxia Foundation
Childhood Apraxia of Speech- developmental during childhood or from birth.
Aquired Apraxia of Speech- Disorder that happens after a stroke/neurological incidence. Often found later in life. Normally found alongside aphasia.
Primary Progressive Apraxia of Speech (PPAOS )is a progressive motor speech disorder in which the brain gradually loses the ability to plan and program the movements required for speech. Unlike stroke-related apraxia, which occurs suddenly, PPAOS develops slowly, initially causing subtle speech difficulties that worsen over time. Individuals often know the words they want to say but struggle to articulate them correctly, resulting in distorted or halting speech
You can have more then one type
Recording and analysing speech +Phoemic inventories
https://www.seeingspeech.ac.uk/ipa-charts/?chart=3
These resources include video and audio recordings of individual sound segments produced by a male and a female speaker.
https://teaching.ncl.ac.uk/ipa/consonants-pulmonic.html
A very useful website that allows you to type in phonetic symbols.
https://www.seeingspeech.ac.uk/ipa-charts/?chart=3
These resources include video and audio recordings of individual sound segments produced by a male and a female speaker.
https://teaching.ncl.ac.uk/ipa/consonants-pulmonic.html
A very useful website that allows you to type in phonetic symbols.
IPA Online from Newcastle University, UK
Phonemic Inventories and Cultural and Linguistic Information (ASHA, 2026)
Phonemic Inventories Across Languages
Amharic
- Amharic Phonemic Inventory
- Predicted Influences of Amharic on Spoken English: Clinical Implications [PDF]
- Amharic (Ethiopia) (MABS Lab at University of St. Augustine)
Arabic
- Arabic Phonemic Inventory [PDF]
- Arabic (MABS Lab at University of St. Augustine)
- Refugees from Iraq [PDF]
Bosnian
- Bosnian (MustGo Travel)
Burmese
- Burmese Phonemic Inventory
- Refugees from Burma [PDF]
- Burmese (Myanmar) (MABS Lab at University of St. Augustine)
Chinese
- Cantonese Phonemic Inventory [PDF]
- Cantonese (Hong Kong) (MABS Lab at University of St. Augustine)
- Mandarin Phonemic Inventory [PDF]
- Mandarin Linguistic Features
- Mandarin vs. English Consonants
- Mandarin (China and Taiwan) (MABS Lab at University of St. Augustine)
English
- African American English: Nature, Origin and Implications for Clinicians [PDF]
- African American Vernacular English (AAVE) (MABS Lab at University of St. Augustine)
- Chicano English (MABS Lab at University of St. Augustine)
- General American English Phonemic Inventory [PDF]
Haitian Creole
- Haitian Creole (MABS Lab at University of St. Augustine)
- Haitian Creole (MustGo)
Hebrew
- Hebrew (MustGo)
- Hebrew Phonetic Inventory
Hindi/Urdu
- Hindi (MABS Lab at University of St. Augustine)
- Urdu Linguistic Features
- Hindi-Urdu vs. English Consonants
Hmong
- Phonetic Inventory of the Mong Leng [PDF]
- Hmong (MABS Lab at University of St. Augustine)
- Information about the Hmong Language (Asian Pacific Islander Speech-Language-Hearing Caucus)
- Hmong Speech and Language Development (Bilinguistics)
Japanese
- Japanese (MABS Lab at University of St. Augustine)
Korean
- Korean Phonemic Inventory [PDF]
- Korean (MABS Lab at University of St. Augustine)
Navajo
- Navajo Sound Profile (University of New Mexico)
- Navajo (MustGo)
Pashto and Persian
- Afghan Backgrounder
- Pashto (Afghanistan) (MABS Lab at University of St. Augustine)
- Farsi/Persian (MABS Lab at University of St. Augustine)
- Dari (Afghanistan) (MABS Lab at University of St. Augustine)
Polish
- Polish Linguistic Features
- Polish vs. English Consonants
- Polish (MABS Lab at University of St. Augustine)
Portuguese
- Portuguese (MustGo)
- Portuguese (Speech Accent Archive)
- Portuguese Speech and Language Development (Bilinguistics)
Russian
- Russian and English Speech Sounds [PDF]
- Russian (MABS Lab at University of St. Augustine)
Spanish
- Spanish Phonemic Inventory [PDF]
- The Cubans [PDF, 7.1MB]
- Cuban Spanish (MABS Lab at University of St. Augustine)
- Latin America Spanish ("Standard") (MABS Lab at University of St. Augustine)
- Puerto Rican Spanish (MABS Lab at University of St. Augustine)
- Spanish Linguistic Features
- Spanish vs. English Consonants
- Spanish (Mexican) (MABS Lab at University of St. Augustine)
Somali
- Somali (MABS Lab at University of St. Augustine)
Tagalog
- Filipino – Tagalog Speech and Language Development (Bilinguistics)
- Tagalog (Filipino) (MABS Lab at University of St. Augustine)
- Tagalog (MustGo)
Ukrainian
- Ukrainian (MustGo)
- Ukrainian Speech and Language Development (Bilinguistics)
Vietnamese
- Vietnamese Phonemic Inventory [PDF]
- Vietnamese (MABS Lab at University of St. Augustine)
Yiddish
- Yiddish (MustGo)
- Yiddish Phonetic Inventory
Refugee Profiles/Information USA
STAR Speech Therapy Animation and Imaging Resource
Supporting and Understanding Speech Sound Disorder (SuSSD)
Acoustic voice markers like vocal jitter and shimmer could help identify Childhood Apraxia of Speech. Aerodynamic data? Not so much.
Measuring Speech Intelligibility in Children With Motor Speech Disorders
https://doi.org/10.1044/2020_PERSP-19-00110
Age of Acquisition of English Consonants (Crowe & McLeod 2020) [PDF]
Different from Other Speech and language Disorders
Different from Other Speech and language Disorders
Unlike aphasia (language difficulty) or dysarthria (muscle weakness affecting speech), apraxia specifically impacts the brain's ability to coordinate the complex movements required for accurate speech production. Picture is from ASHA website
Articulation disorders
Articulation disorders are due to difficulty making the correct movements fo
Unlike aphasia (language difficulty) or dysarthria (muscle weakness affecting speech), apraxia specifically impacts the brain's ability to coordinate the complex movements required for accurate speech production. Picture is from ASHA website
Articulation disorders
Articulation disorders are due to difficulty making the correct movements for speech. It usually affects only a small number of sounds. Common examples in English are where the ‘s’ sound is said like a ‘th’ sound e.g. sing sounds like thing (a lisp) and ‘r’ sounds like ‘w’ e.g. ‘rabbit’ sounds like ‘wabbit’. The child finds it difficult to say the sound on its own and in words. Some children find this impacts on their wellbeing and mental health. Referral to speech and language therapy can help. Some articulation disorders make speech very hard to understand. These children should be referred to speech and language therapy.
Phonological disorders
Phonological disorders are when the child has difficulty using sounds in the correct place in a word or is using the wrong sounds in words. The child can say the sound on its own but has difficulty saying it in words or misses out sounds e.g. the child can say ‘k’ and ‘g’ on their own, but says ‘teep’ instead of ‘keep’ or ‘pid’ instead of ‘pig’. These can make the child very difficult to understand to people outside their family and sometimes to close family members. These children should be referred to speech and language therapy.
Speech Sound Disorders: Articulation and Phonology
Dysarthria
Dysarthria is a condition characterized by impaired articulation of speech due to neurological or muscular dysfunction affecting the muscles used for speaking. Anarthria refers to a more severe form where speech is completely absent. These disorders are typically caused by conditions affecting the central or peripheral nervous system, such as stroke, traumatic brain injury, cerebral palsy, or neurodegenerative diseases (ICD-10-CM R47.1)
Differences in voice quality (e.g., strained, breathy) -
Reduced breath support and short phrases -
Altered resonance (e.g., hypernasality) - Consistent, imprecise articulation - Prosody changes related to rate and volume
newcastle-ebp-dysarthria-assessment-tool-n-dat-dec-2015.pdf
Practical-resource-pack-for-someone-with-dysarthria.pdf
Headway: communication problems after brain injury
Stroke Association: communication tools
Aphasia
Aphasia (also called dysphasia) is a condition that makes it difficult to communicate. It can make it hard to speak, read, write and understand others. It's often caused by a stroke or brain injury. There's no cure, but people usually improve with treatment
Expert opinion
Prosody importance/definition
Different from Other Speech and language Disorders
Professor Emeritus Anita Van de Merwe who specialises in speech apraxia at Pretoria University, writes for Speech Apraxia International-Apraxia of speech is a disturbance of the voluntary control of speech movements. It may occur in children as childhood apraxia of speech (CAS) or as acquired apraxia of speech (AOS) due to acquired damage
Professor Emeritus Anita Van de Merwe who specialises in speech apraxia at Pretoria University, writes for Speech Apraxia International-Apraxia of speech is a disturbance of the voluntary control of speech movements. It may occur in children as childhood apraxia of speech (CAS) or as acquired apraxia of speech (AOS) due to acquired damage of the areas in the brain responsible for motor planning. Both these conditions should be differentiated from a language disorder such as aphasia, and from dysarthria, which is a disorder of lower levels of motor control. Speech apraxia is a disorder in planning the place and manner of articulation of speech sounds.
Assessment of prosody
Prosody importance/definition
Prosody importance/definition
Prosody can be assessed using acoustic measures, perceptual assessment, or a combination of both (Littlejohn & Maas, 2025).
Acoustic Assessment
- Measures lexical stress, syllable duration, loudness and pitch.
- More objective but time-consuming.
Perceptual Assessment
- Formal or informal assessment by listening to speech.
- Easier to use clinically bu
Prosody can be assessed using acoustic measures, perceptual assessment, or a combination of both (Littlejohn & Maas, 2025).
Acoustic Assessment
- Measures lexical stress, syllable duration, loudness and pitch.
- More objective but time-consuming.
Perceptual Assessment
- Formal or informal assessment by listening to speech.
- Easier to use clinically but more subjective.
- Judgements can be influenced by the listener's language and dialect.
- By around 8 years of age, typically developing children usually have adult-like prosody.
Standardised Assessments
DEMSS – evaluates lexical stress in children with suspected CAS.
Developers: Edythe A. Strand & Rebecca J. McCauley
- Designed specifically for the differential diagnosis of childhood apraxia of speech (CAS).
- Age: 3 years and older.
- Assesses speech accuracy, consistency, vowels, prosody and response to cueing.
Official information:
VMPAC-R – assesses prosody, pitch, loudness, resonance, voice quality and speech rate.
Developers: Deborah Hayden & Aravind Namasivayam
- Age: 3–12 years.
- Assesses neuromotor speech skills including speech movement, sequencing, prosody, resonance, loudness and speech rate.
- Not specific to CAS but commonly used in motor speech assessment.
Official website:
PEPS-C – assesses prosodic skills
Developers: Sue Peppé & Julie McCann
- Age: 4 years and older.
- Assesses receptive and expressive prosody.
- Evaluates stress, intonation, phrasing and prosodic function.
- Useful for assessing prosody across a range of communication disorders, although not designed specifically for CAS.
Official website:
Prosody-Voice Screening Profile – evaluates prosody and voice across a wide age range.
Developer: Lawrence D. Shriberg & Jane L. McSweeney
- Age: 3–81 years.
- Screens prosody and voice, including stress, rate, pitch, loudness and resonance.
- Limited normative data and requires training for administration.
There is no current standalone official website for the PVSP. It is primarily available through published manuals and research literature rather than a commercial publisher.
Informal Assessment
- Listen to spontaneous conversation.
- Use reading passages (e.g. The Caterpillar Passage) for older children.
- Use multisyllabic word lists for younger children.
- Assess:
- Lexical stress
- Contrastive stress
- Intonation
- Rhythm
- Pitch
- Loudness
- Emotional tone
Assessing Vocal Tone
- Model different vocal tones.
- Teach emotion through changes in voice.
- Use book reading and role-play to practise expressive intonation.
- Encourage variation in pitch, loudness and emotional expression.
Prosody importance/definition
Prosody importance/definition
Prosody importance/definition
Speech often sounds robotic with abnormal rhythm, stress patterns, and intonation. The person may speak very slowly with unusual pauses between syllables or words as they mentally plan each sound sequence.
Why important?
Brings prominence to some words
Affects meaning
Affects Intelligibility
Signals word and phrases
Importance in Speech •
Give
Speech often sounds robotic with abnormal rhythm, stress patterns, and intonation. The person may speak very slowly with unusual pauses between syllables or words as they mentally plan each sound sequence.
Why important?
Brings prominence to some words
Affects meaning
Affects Intelligibility
Signals word and phrases
Importance in Speech •
Gives meaning and context to speech • Social cues and expectations
• How vs what is said •
Keeps listener engaged •
Prosodic errors and decreased intelligibility (Klopfenstein, 2009) •
Assists infants and toddlers to learn new words (Gervain et al., 2020) •
Enhances early listening skills •
Prosodic aspects emerge before other language areas (see Souda et al., 2022) Teaches infants and toddlers structure/melody of sentence
Components of Prosody
Intonation Variation in pitch or tone to convey particular meaning
Phrasing/Rhythm Pattern of stressed and unstressed words
Loudness Volume can highlight information Stress Emphasis on certain syllables or words.
Pitch How high or low the voice is Voice Quality Vocal tone conveys emotion (joy, sadness, worry, etc.)
Pace/Rate How quickly or slowly words spoken
Pausing/Juncture Pauses: interruptions in flow of speech to convey punctuation Juncture: Pausing with changes in tone and rate
Prosody Screens
Prosody-Voice Screening Profile (PVSP; Shriberg, Kwiatkowski, & Rasmussen, 1990)
https://phonology.waisman.wisc.edu/about-the-pvsp/
Speech Prosody matrix -Teachers pay teachers https://www.pinterest.com/pin/speech-prosody-matrix--81768549490206968/
PEPS-C: a test of prosodic ability PEPS-C: a test of prosodic ability
Apps
The prosody toolkit by Biospeech (Apple App) Search for prosody assessment (not prosody toolkit) https://www.biospeech.com/prosody-toolkit/
Voice analyst https://www.amazon.com/dp/B00PMP30E6?lv=shuf&channelId=500&plpRedirect=mhFallback (Apple app--$17.99; Google Play--$14.99) • Looks at pitch and volume in real-time • Provides visual feedback
Waveform, Spectrogram, and Pitch (WASP) • Free, web-based program • Provides waveform, spectrogram, and pitch track and marks WASP2 - Waveform, Spectrogram and Pitch Display
Praat with Plug-ins Prosody Pro/ProsoBox
Free software • Provides acoustic analysis with waveforms and spectrograms
Plug-ins can provide more sophisticated analyses Praat: doing Phonetics by Computer PRAAT Tutorial
Altering a component of prosody alters the articulatory movements needed to produce the target
Example: increased loudness
More subglottal air pressure, more vocal fold tension, increased jaw and lip aperture which means the tongue position is lowered • Increased Loudness Example: increased stress on syllable Pitch increases, higher volume, longer duration, stressed vowels require increased muscle effort. Articulatory targets for stressed syllable are therefore different. than when unstressed
Do children omit stressed or unstressed syllables? Think "banana" or "television"
Do not stress missing syllable because it teaches incorrect lexical stress •
Try backward chaining for multisyllabic productions • " Vi-sion" "le-vi-sion" "te-le-vi-sion"
Very young children
Interactive/Modeling of Vocalizations • Babble Boot Camp (Peter et al., 2019) • Model/imitate at level of development • Coo • Babbling • Reading stories • Singing (alerting baby to rhythms) • Use IDS (emphasize prosodic cues)
Babble Boot Camp (BBC) Training | Online ASHA CEUs
Storybooks (electronic and hard copy) that can help
Lexical stress and inflection (changing pitch, tone, loudness)
Yo! Yes? By: Chris Raschka • (2007) (2014) Yo! Yes? By: Chris Raschka - YouTube
Moo by David LaRochelle with illustrations by Mike Wohnoutka Moo by David LaRochelle with illustrations by Mike Wohnoutka Childrens Read Aloud Bedtime Stories - YouTube
Childrens Read Aloud Bedtime Stories Up, Up, Down by R. Munsch (2020) Up, Up, Down - YouTube
Techniques to Work on Prosody - YouTube Edythe Strand
Intonation (Fish & Skinder-Meridith, 2023)
Targeting rising and falling intonation
Providing visuals and multi-sensory cues to support understanding and modulation of intonation • Activities to differentiate between rising and falling intonation to improve understanding and perceptual skills
Falling intonation
Counting
Making declarative statements including answer questions
Rising intonation • Asking questions
SQR Method (see Fish & Skinder-Meredith, 2023) •
Statement (clinician or printed): The dog is loud. •
Question (clinician): How does the dog sound? •
Response (child): The dog is LOUD. Question: What is loud?
Response: The DOG is loud.
May use visuals to highlight stressed words
Phonological awareness
Why working on speech alone may not be sufficient -language should also be assessed
Why working on speech alone may not be sufficient -language should also be assessed
Speech apraxia especially developmental, can affect the ability to detect parts of speech or 'phonemes.' It can affect reading, writing, and spelling.
About the NIPA | Newcastle Phonological Awareness | Newcastle University includes assessment and intervention suitable for all children but specifically for children with SLCN. This interv
Speech apraxia especially developmental, can affect the ability to detect parts of speech or 'phonemes.' It can affect reading, writing, and spelling.
About the NIPA | Newcastle Phonological Awareness | Newcastle University includes assessment and intervention suitable for all children but specifically for children with SLCN. This intervention provides adaptable session plans for SLTs.
by Gillon, A Better start to Reading and for preschool children with SSD.
About the NIPA | Newcastle Phonological Awareness | Newcastle University
APAR - Assessment of Phonological Awareness and Reading - Home page
Why working on speech alone may not be sufficient -language should also be assessed
Why working on speech alone may not be sufficient -language should also be assessed
Why working on speech alone may not be sufficient -language should also be assessed
It may be that other areas also need a focus. Resources such as Elklan products will provide a good basis for holistic intervention www.elklan.co.uk
- Attention and listening
- Helping school age children understand spoken language and develop verbal reasoning skills
- Helping school age children develop their expressive language
- Phonological proc
It may be that other areas also need a focus. Resources such as Elklan products will provide a good basis for holistic intervention www.elklan.co.uk
- Attention and listening
- Helping school age children understand spoken language and develop verbal reasoning skills
- Helping school age children develop their expressive language
- Phonological processing activities
- Developing vocabulary and story writing and use of mind maps
- Helping school age children develop their social skills
- Helping school age children with unclear speech
Structured Assessment for Childhood Apraxia of Speech (CAS)
Why working on speech alone may not be sufficient -language should also be assessed
Structured Assessment for Childhood Apraxia of Speech (CAS)
A Structured Assessment for Childhood Apraxia of Speech (CAS)
No single assessment can diagnose Childhood Apraxia of Speech (CAS). Instead, assessment involves combining information from several tasks to identify the characteristic features of CAS while ruling out other speech sound disorders.
Key Terms
- Oral motor skills – Movements of the l
A Structured Assessment for Childhood Apraxia of Speech (CAS)
No single assessment can diagnose Childhood Apraxia of Speech (CAS). Instead, assessment involves combining information from several tasks to identify the characteristic features of CAS while ruling out other speech sound disorders.
Key Terms
- Oral motor skills – Movements of the lips, tongue, jaw and soft palate used for eating, drinking and non-speech tasks.
- Oral apraxia – Difficulty planning and carrying out voluntary mouth movements that are not related to speaking (e.g. sticking out the tongue on request). Oral apraxia often occurs alongside CAS but is not required for a diagnosis.
- Phonemic inventory – The speech sounds (consonants and vowels) a child can produce correctly.
- Speech sample – A recording of the child's spontaneous speech during conversation or play.
- Dynamic assessment – An assessment in which the clinician provides different cues and repeated attempts to see how the child's speech changes with support.
- Stimulability – How easily a child can produce a sound or word after being given a model or cues.
- Syllable structure – The pattern of consonants and vowels within a word (e.g. CV = "me", CVC = "cat", CVCV = "baby").
- Cueing – Strategies used by the therapist to help speech production, such as visual, verbal, tactile or gesture cues.
- Core characteristics of CAS – The speech features most strongly associated with Childhood Apraxia of Speech, such as inconsistent errors, disrupted transitions between sounds, and inappropriate stress.
Step 1: Non-Speech Oral Motor Examination (NSOME)
Purpose
To assess how well the child can move their lips, tongue and jaw during non-speech tasks.
Why is this important?
This assessment helps determine whether the child has oral apraxia, which is difficulty planning voluntary mouth movements that are unrelated to speech. Although oral apraxia is more common in children with CAS, it does not diagnose CAS on its own.
Step 2: Phonemic Inventory
Purpose
To identify which speech sounds the child can already produce.
Why is this important?
Knowing the child's sound repertoire helps the therapist choose appropriate therapy targets. Therapy is usually most successful when initial target words contain sounds that the child can already produce independently or with prompting.
This assessment usually considers all 22 English consonants and 12 English vowels.
Step 3: Speech Sample
Purpose
To observe the child's everyday speech during natural communication.
Why is this important?
A spontaneous speech sample allows the therapist to:
- identify speech sounds used naturally
- observe consistency of errors
- listen for the core characteristics of CAS
- understand how speech differs in conversation compared with structured testing.
Step 4: Dynamic Articulation Assessment
Purpose
To assess how consistently the child produces speech sounds across repeated attempts.
Why is this important?
Unlike a standard articulation test, a dynamic assessment asks the child to attempt the same sounds or words several times while different levels of support are provided.
Children with CAS are often consistently inconsistent—they may produce the same word differently each time they say it. Repeated trials are therefore essential to identify this important feature.
Step 5: Dynamic Motor Speech Assessment
Purpose
To identify the level of speech complexity at which the child's speech begins to break down.
Why is this important?
The assessment examines increasingly complex syllable shapes and words to determine the child's current motor speech abilities. This helps ensure therapy targets are challenging enough to encourage progress while still allowing success.
During this assessment the therapist aims to:
- identify the core characteristics of CAS
- determine which syllable structures are most difficult
- assess stimulability
- identify which cueing strategies are most effective for that child.
Step 6: Core Word List
Purpose
To develop a small set of highly functional words that the child can practise consistently.
Why is this important?
Children with severe CAS or a limited vocabulary often struggle to combine individual words into longer phrases because each new word sequence requires additional motor planning.
For example, a child may be able to say:
- "go away"
- "dinosaur"
but struggle to produce:
- "Go away, dinosaur."
Practising a consistent set of everyday words helps build confidence and supports the development of longer, more accurate utterances.
Interpreting the Results
The clinician should review the findings from the speech sample, dynamic articulation assessment, and dynamic motor speech assessment together.
If the child demonstrates four or more core characteristics of CAS across three or more assessment contexts, this provides evidence that CAS is likely.
It is important to remember that CAS can occur alongside other speech sound disorders, such as a phonological disorder. A child with both conditions may require treatment that addresses both:
- Motor planning and sequencing (for CAS), and
- Speech sound patterns (for phonological disorder).
Accurate differential diagnosis is essential because a phonological therapy approach alone does not address the underlying motor planning difficulties seen in Childhood Apraxia of Speech.
Childhood Apraxia Speech-Developmental dyspraxia of speech
Terminology and resources -childhood apraxia of speech
Terminology and resources -childhood apraxia of speech
Terminology
Speech apraxia has been described using a variety of terms over the years. Today, Childhood Apraxia of Speech (CAS) is the internationally recommended term. However for adults with CAS, they may feel happier dropping the 'childhood' in preference for another variation.
Current Preferred Terms
- Childhood Apraxia of Speech (CAS) – Preferred term internationally (used in the USA, UK, Australia, Canada, and increasingly worldwide).
- Developmental Verbal Dyspraxia (DVD) – Historical term used in the UK. The Royal College of Speech and Language Therapists (RCSLT) now recommends using Childhood Apraxia of Speech (CAS).
Previous and Alternative Terms
The following terms have appeared in the literature but are no longer commonly recommended:
- Apraxia of Speech (AOS) (when referring to children)
- Dyspraxia of Speech
- Isolated Developmental Verbal Dyspraxia (DVD)
- Pure Childhood Apraxia of Speech
- Pure CAS
- Isolated CAS
- Speech-Language Disorder Type 1
- Speech and Language Disorder with Orofacial Dyspraxia
Why do we use the term Childhood Apraxia of Speech (CAS)?
Professional organisations now recommend the use of CAS because it:
- Provides consistent terminology internationally.
- Reduces confusion between childhood and acquired forms of apraxia.
- Makes research studies easier to compare.
- Helps support consistent coding, funding and insurance reimbursement in many healthcare systems.
The RCSLT Position Paper (2024) recommends that UK clinicians adopt the term Childhood Apraxia of Speech (CAS) in line with international practice.
Overview, Causes and Prevalence
Terminology and resources -childhood apraxia of speech
What is Childhood Apraxia of Speech (CAS)?
Childhood Apraxia of Speech (CAS) is a neurological motor speech disorder that affects a child's ability to plan and programme the movements needed for speech. The speech muscles are not weak or paralysed; instead, the brain has difficulty planning and sequencing the movements of the lips, tongue, jaw and palate for accurate speech.
Speech and language therapy is currently the most effective treatment for CAS.
Prevalence
- Approximately 16% of children have a speech sound disorder (SSD) at 3 years of age.
- This falls to around 3.8% by 6 years of age.
- Childhood Apraxia of Speech affects approximately 2–3 children per 1,000.
- CAS represents approximately 3–4% of all children with speech sound disorders.
- Boys are diagnosed approximately 2–3 times more often than girls.
Causes of CAS
The exact cause is not always known, but research suggests CAS is frequently neurological and often has a genetic basis.
Congenital CAS (Most Common)
Speech motor planning difficulties are present from early development.
Acquired CAS
Less commonly, CAS develops following childhood neurological injury, including:
- Stroke
- Brain infection
- Traumatic brain injury
- Brain tumour
- Neurosurgery
In this case it would be childhood apraxia of speech as it is developmental but also acquired apraxia of speech.
Genetic Factors
Co-occurring Conditions with Apraxia of Speech – CAS & AOS
Neurological Basis
Brain imaging (MRI) has not consistently identified structural brain abnormalities in children with idiopathic CAS.
The difficulty lies in the brain's ability to:
- Plan speech movements
- Programme speech movements
- Sequence movements accurately
Importantly:
- Speech muscles are not weak.
- There is no paralysis.
- Intelligence and language comprehension may be completely typical.
Associated Conditions (see additional page)
CAS may occur alongside:
- Autism spectrum disorder (ASD)
- Developmental Coordination Disorder (DCD/dyspraxia)
- Dysarthria
- Developmental language disorder
- Epilepsy
- Genetic syndromes (e.g. Fragile X, Rett syndrome, Down syndrome, Prader–Willi syndrome)
Factors That Affect Symptoms
Speech may vary depending on:
- Age
- Severity
- Word complexity
- Fatigue
- Familiarity of words
- Anxiety
- Speaking environment
Recognising Children Who May Have Signs and Symptoms of Childhood Apraxia of Speech (CAS)
Recognising Children Who May Have Signs and Symptoms of Childhood Apraxia of Speech (CAS)
Before undertaking a comprehensive assessment, clinicians identify children who demonstrate characteristics commonly associated with CAS. These screening questions and observations help determine whether a specialist assessment is required.
Areas to consider include:
- Delayed speech development
- Difficult-to-understand speech
- Better understanding than spoken expression
- Frequent use of gesture
- Inconsistent pronunciation of the same word
- Reduced speech output
- Increasing difficulty with longer words
These features raise clinical suspicion but do not diagnose CAS.
Resources
FREE OKAT CAS Screener (Olga Komadina)
https://olgakomadina.com/cas-screener
A free screening tool that helps identify children who may require a comprehensive assessment for Childhood Apraxia of Speech.
Speech Sounds Screening Tool (Charles Sturt University)
https://assets.csu.edu.au/__data/assets/pdf_file/0008/3799970/speech-sounds-screening-tool.pdf
A free evidence-based screening tool to identify children who require further assessment of speech sound disorders.
Core Triage Questions
These questions help identify children who may require a comprehensive assessment.
- Is your child difficult to understand?
- Do family members sometimes struggle to understand what they say?
- Do they appear to understand much more than they can express?
- Do they use gestures to communicate words they cannot say?
- Do they pronounce the same word differently each time?
These questions support clinical suspicion but do not diagnose CAS.
Core Diagnostic Features (ASHA Consensus)
Current research identifies three features with the strongest evidence:
Inconsistent Speech Errors
- Inconsistent consonant and vowel errors.
- Same word produced differently across attempts.
Difficulty Transitioning Between Sounds
- Lengthened or disrupted transitions.
- Difficulty sequencing sounds and syllables.
- Segmented speech.
Prosody Difficulties
- Incorrect word stress.
- Equal stress.
- Abnormal rhythm and intonation.
See our Prosody section for more information.
Mayo Clinic "10 + 1" Characteristics
Common clinical features include:
- Vowel distortions
- Sound distortions
- Groping movements
- Equal or incorrect stress
- Syllable segregation
- Intrusive schwa
- Voicing errors
- Slow speech rate
- Slow DDK rates
- Increased difficulty with longer words
- Inconsistent productions across repeated attempts
Associated Difficulties
Some children also experience:
Language
- Delayed expressive language
- Grammar difficulties
- Reduced sentence complexity
Literacy
- Phonological awareness difficulties
- Reading difficulties
- Spelling difficulties
- Writing difficulties
Motor Skills
- DCD
- Gross and fine motor delays
- Oral apraxia
- Limb apraxia
Feeding and Oral Sensory
- Feeding difficulties
- Chewing difficulties
- Oral hypersensitivity
- Oral hyposensitivity
Important Clinical Notes
- No single symptom confirms CAS.
- The is currently no single diagnostic test.
- It is possible to have very mild symptoms.
- Suspected CAS is a diagnosis and typical in early stages or early on.
- Differential diagnosis is essential because many features overlap with dysarthria, phonological disorder and language disorder.
- Diagnosis should always be completed by an experienced Speech and Language Therapist/Speech-Language Pathologist.
Diagnosis and Assessment of Childhood Apraxia of Speech
Recognising Children Who May Have Signs and Symptoms of Childhood Apraxia of Speech (CAS)
A diagnosis should be based on information gathered from multiple assessment tasks rather than one individual test. Assessment should identify both the presence of CAS and rule out other speech sound disorders.
A comprehensive assessment typically includes:
- Detailed developmental and medical case history
- Parent interview
- Hearing screening
- Non-speech oral motor examination
- Phonemic inventory
- Speech sample
- Dynamic articulation assessment
- Dynamic motor speech assessment
- Stimulability testing
- Assessment of prosody
- Functional communication
- Intelligibility
- Language assessment where appropriate
- Differential diagnosis
Dynamic assessment is particularly important because it allows the clinician to observe how speech changes when different cueing strategies are provided and whether repeated practice improves accuracy.
Resources
ASHA Childhood Apraxia of Speech Practice Portal
https://www.asha.org/practice-portal/clinical-topics/childhood-apraxia-of-speech/
Evidence-based guidance covering assessment procedures, diagnosis and differential diagnosis.
American Speech-Language-Hearing Association (ASHA) – Childhood Apraxia of Speech Position Statement (2007)
https://www.asha.org/policy/PS2007-00277/
ASHA's official position statement recognising Childhood Apraxia of Speech as a distinct motor speech disorder. It outlines recommended terminology, the role of Speech-Language Pathologists in diagnosis and management, and the principles underpinning evidence-based assessment and intervention.
American Speech-Language-Hearing Association (ASHA) – Childhood Apraxia of Speech Technical Report (2007)
https://www.asha.org/policy/TR2007-00278/
A comprehensive review of the scientific evidence supporting the diagnosis and management of Childhood Apraxia of Speech. The report examines the evidence for diagnostic characteristics, differential diagnosis, assessment methods, underlying causes and current intervention approaches.
Royal College of Speech and Language Therapists (RCSLT) – Childhood Apraxia of Speech Position Paper (2024)
The current UK professional guidance on Childhood Apraxia of Speech. It provides recommendations on terminology, diagnosis, assessment, differential diagnosis, service delivery and education, aligning UK practice with international evidence.
Speech Pathology Australia – Childhood Apraxia of Speech
Dynamic Assessment
Dynamic assessment is considered one of the most valuable components of a CAS evaluation because it examines how speech changes with support, rather than simply recording correct and incorrect responses.
During assessment, the clinician may:
- Ask the child to repeat words several times
- Increase word and syllable complexity
- Trial different cueing strategies
- Assess consistency across repeated productions
- Identify stimulability
- Determine the child's optimal level for therapy targets
The aim is to establish:
- Whether errors are inconsistent
- Which syllable structures cause breakdown
- Which cueing strategies are most effective
- How speech changes with increasing complexity
This information helps distinguish CAS from phonological disorder and dysarthria while guiding therapy planning.
Resources
DEMSS Manual
https://products.brookespublishing.com/Dynamic-Evaluation-of-Motor-Speech-Skill-DEMSS-P639.aspx
Provides one of the most widely used standardised dynamic assessments for Childhood Apraxia of Speech.
Additional Speech Characteristics in CAS
Many children demonstrate additional features that support the diagnosis, although none are diagnostic on their own.
These may include:
- Vowel distortions
- Consonant distortions
- Groping movements
- Schwa insertions
- Segmented speech
- Slow speech rate
- Difficulty initiating speech
- Reduced intelligibility
- Increased errors with longer words
- Variable voicing errors
Clinicians should consider the complete speech profile rather than relying on individual symptoms
Assessment of CAS in Minimally Verbal Children
Diagnosing CAS in minimally verbal children presents additional challenges because many standard speech assessments require verbal responses. Assessment therefore needs to be flexible and often takes place over several sessions.
Clinicians may:
- Build rapport before formal assessment
- Observe communication during play
- Use motivating activities and preferred toys
- Adapt picture-based tasks using real objects
- Collect speech samples across home, school and therapy settings
- Use dynamic assessment whenever speech is produced
- Assess phonetic inventory from all vocalisations
- Examine syllable shapes and vocal imitation
- Observe prosody where sufficient speech is available
- Combine parent interviews with functional communication measures such as the Intelligibility in Context Scale (ICS) or FOCUS
- Consider hearing, cognition, language, behaviour and autism as part of the wider assessment
For some children, there may not initially be enough speech to make a definitive diagnosis. In these cases, clinicians may use the term suspected Childhood Apraxia of Speech until further evidence is available. Multiple assessment sessions are often required.
Resources
Lottie Berry- A journey to a diagnosis and support for her son -Talking Speech Apraxia Podcast
Lottie is the founder of Tap Type Talk and a passionate parent/carer advocate for everything AAC! This podcast explores her journey through advocacy for her son to finally get him the diagnosis and support for his childhood apraxia of speech. Her 11-year-old son Joshua is autistic, uses a speech device, and until very recently, was completely non-speaking.
How to Differentially Diagnose CAS in Children with ASD and Low Verbal Ability
https://pubs.asha.org/
Discusses practical approaches for assessing motor speech difficulties in autistic and minimally verbal children.
Intelligibility in Context Scale (ICS)
https://www.csu.edu.au/research/multilingual-speech/ics
A parent questionnaire measuring how well a child's speech is understood by different communication partners.
https://onlinelibrary.wiley.com/doi/epdf/10.1111/1460-6984.13121
Buckeridge, K., Abrahamson, V., Pellatt-Higgins, T., Sellers, D. and Forbes, L. J. (2024) ‘Child, family and professional views on valued communication outcomes for non-verbal children with neurodisability: A qualitative meta-synthesis’
Literature Review: What Do SLTs Perceive as Their Knowledge in Childhood Apraxia of Speech Treatment?
https://us06web.zoom.us/j/88475461574?pwd=rZhbfjHqWnL3EfdaSuCWdlxBXZ4G0c
A recorded presentation reviewing the published literature on Speech and Language Therapists' knowledge, confidence and perceived competence in the assessment and treatment of Childhood Apraxia of Speech.
IALP Panel 2: SSD and CAS – How Should Motor Planning Disorders Be Classified in Children?
An expert international panel discussing current thinking around the classification of Childhood Apraxia of Speech, developmental speech disorders and motor planning disorders in children. The webinar explores terminology, diagnostic boundaries and implications for clinical practice.
Differential Diagnosis of Apraxia of Speech in Children and Adults: A Scoping Review
PMC (Free full text): https://pmc.ncbi.nlm.nih.gov/articles/PMC7890226/
Journal version: https://doi.org/10.1044/2020_JSLHR-20-00061
One of the most comprehensive reviews of the evidence surrounding the diagnosis of Childhood and Acquired Apraxia of Speech. The review compares current approaches to differential diagnosis, examines speech characteristics, quantitative speech measures, motor planning tasks and neuroimaging, and identifies important gaps in the evidence base. It concludes that although several promising diagnostic markers exist, there is still no single validated diagnostic test for CAS, highlighting the importance of comprehensive clinical assessment
Differential Diagnosis
Many speech disorders share characteristics with CAS. Differential diagnosis is therefore essential.
CAS should be distinguished from:
- Phonological Disorder
- Dysarthria
- Developmental Language Disorder
- Selective Mutism
- Childhood stuttering where appropriate
Children may also present with more than one diagnosis, such as CAS alongside phonological disorder or developmental language disorder. Treatment should address each condition separately.
Resources
Decision making tree for children with speech sound disorder (SSD) -RCSLT
HSDecision making tree SSDv5.1.pdf
SSD Decision Making Tree (Charles Sturt University)
https://www.csu.edu.au/research/multilingual-speech/speech-sound-disorders/ssd-decision-making-tree
An evidence-based clinical decision tree that assists clinicians in differentiating between speech sound disorders.
Adults with CAS-SLT/SLP referrals
Adults with CAS-SLT/SLP referrals
Therapy can be very useful as an adult and tends to be led by your needs. For example, you may seek functional help speaking at meetings or pacing speech to avoid misarticulation.
You have the same right to speech and language services as children and in the NHS can self-refer to provision.
Professionals involved
Adults with CAS-SLT/SLP referrals
CAS can only be diagnosed by a qualified speech and language professional.
Other professionals
Family doctor-makes referrals to speech and language services
Pediatricians screen for and diagnoses other conditions
Geneticist may be involved if there is a genetic component.
Occupational therapist may be involved in therapy
Audiologist- children with speech sound disorders are typically screened for hearing
Talking with a child who has apraxia of speech
How you and other people respond to your child's communication is important. It will shape your child’s confidence and how they see themselves as a communicator.
It's natural to feel worried at first, but if you seem anxious, your child may also pick up on this. Try to stay calm and positive, even if you're feeling unsure inside.
Here are some things you can do. They may not seem like big changes, but they can make a huge difference by reducing pressure and supporting your child’s communication:
Slow down your own rate of speech and use longer pauses. This helps keep the conversation relaxed and gives your child time to process and answer.
Have regular one-to-one time with your child, even for just five minutes. Choose a time when they don’t have to compete with other people or tasks for your attention.
Ask one question at a time and allow extra time for responses. Show them that you follow their speech but are not putting pressure on them.
Allow the child to point/gesture as a valid form of communication, Try not to insist that everything must be spoken.
Don’t keep correcting their speech. While it may feel supportive, it can be frustrating if you guess wrong.
Keep natural eye contact. Show interest in what they’re saying, not how clearly the words come out.
Focus on the message, not the mistakes. Listen to what your child is telling you, rather than how they pronounce it.
If it feels right, gently acknowledge when talking is tricky. Encourage and reassure them, for example: “Talking can be hard to practise, but you’re doing really well and I love hearing what you have to say.”
Make sure everyone gets a turn to speak. Give your child equal opportunities to share their ideas.
Avoid telling them to “say it properly,” “slow down,” or “try harder.” Instead, praise the ideas and what they are saying.
Interventions for Speech Sound Disorders in Children, Lynn Williams (2020)
An essential building block of every speech-language pathologist’s professional preparation, the second edition of this bestselling textbook is a comprehensive critical analysis of 21 interventions for highly prevalent speech sound disorders in children.
American Speech Hearing Association Resources
- Childhood Apraxia of Speech—Position Statement
- Childhood Apraxia of Speech—Technical Report
- Consumer Information: Childhood Apraxia of Speech
- Focusing Care on Individuals and Their Care Partners
- Interprofessional Education/Interprofessional Practice (IPE/IPP)
Other Resources
- Age of Acquisition of English Consonants (Crowe & McLeod 2020) [PDF]
- Apraxia Kids
- Child Apraxia Treatment: Once Upon a Time Foundation
- National Institute on Deafness and Other Communication Disorders | Apraxia of Speech
Childhood Apraxia of Speech
Childhood apraxia of speech multilingual children
CAS Diagnosis Isn’t Always Clear-Cut: Why Some Children Go Undiagnosed
Children with CAS can successfully learn more than one language, although symptoms may present differently because languages vary in their sounds, word shapes and stress patterns.
Assessment
Consider both languages, including:
- Speech sounds (phonemes)
- Phonology
- Word shapes
- Stress patterns
Treatment
- Motor learning principles remain the same across languages.
- Target speech features shared by both languages where possible to encourage generalisation.
- Therapy should support all of the child's languages whenever possible.
Home Language (L1)
- Using the home language supports learning.
- Strong L1 skills help development of a second language.
- Treating the home language does not hinder learning another language.
- Bilingual intervention is recommended whenever possible.
Apraxia Kids | Bilinguals With CAS: You’ve Got This
Portuguese Resources on Speech Apraxia
APRAXIA DE FALA NA INFÂNCIA - O ATO DE FALAR É SURPREENDENTE - YouTube
Procurando por alguns recursos em português sobre Apraxia da Fala na Infância, experimente o cana
Punjabi Resources
https://www.new-pathways.co.uk/panjabi-aphasia-screening-test
AAC Language Library
A library of AAC resources catalogued by language
AAC Language Library | Ace Centre
India
edusoft.ro https://share.google/wq8w5IqPapixsYKqT
Israel
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
Acquired Apraxia of Speech (AOS)
How do I get it
Acquired Apraxia of Speech (AOS) is a motor speech disorder that affects a person’s ability to plan and coordinate the movements needed for clear, accurate speech. It is not caused by muscle weakness or paralysis; instead, the brain has difficulty organising and sending the correct messages to the muscles used in speech.
AOS most commonly appears after a brain injury, such as a stroke, traumatic brain injury or a neurological condition. Individuals with AOS usually know what they want to say but the words may come out incorrectly, distorted or with unusual pauses and effort. Speech can be inconsistent, the same word might be spoken clearly one moment and be difficult the next, which can be frustrating and confusing.
Speech and Language Therapists diagnose AOS through detailed assessment and provide tailored therapy. Support often focuses on motor-based speech practice, repetition and techniques to strengthen the brain’s planning and speech movement connection. Additional communication tools, such as gestures, writing, communication books or communication apps (low and high tech Augmentative and Alternative Communication) may also help individuals communicate confidently.
Because AOS varies from person to person, assessment by a Speech and Language Therapist is important. With early, consistent support and understanding from family and the community, many people with AOS make meaningful progress in their communication skills. Thank you for taking the time to learn more about this important condition. Raising awareness helps ensure that people feel supported, heard and empowered during their recovery.
Why does it occur
Organisations that support the health event can have great information, such as the Stroke Association, which has loads of helpful resources. Types of communication problems | Stroke Association
CogNeuroApp—explains where breakdown can occur in processing
Top 10 things to know about AOS
https://www.instagram.com/p/DQpRtCjjFPK/?igsh=Nzh5NDZrMTNmcW9q
Meet a therapist, Kimberley Williams Founder, Nova Speech Therapy
My name is Kimberley Williams, founder of Nova Speech Therapy in West Yorkshire and I have a keen professional interest in supporting individuals with communication difficulties, particularly Acquired Apraxia of Speech (AOS). She has contributed to the contect of this section. Kimberley has done a fantastic podcast for our 'Talking Speech Apraxia' series.
Diagnosis
There isn’t one test that confirms or rules out AOS. The patient must meet specific diagnostic criteria in the speech assessment (Molloy & Jagoe, 2019). According to Wambaugh et al. (2006), the primary features of AOS include:
- slow, effortful speech
- dysprosody (i.e. equal stress pattern)
- sound distortions
- distorted substitutions
Duffy (2019) also notes that individuals with AOS have greater difficulty with sequential motion rates (SMRs) compared to alternating motion rates (AMRs).
Non-diagnostic characteristics of AOS can be found in aphasia without apraxia, so their presence alone does not indicate apraxia (despite what you may have learned in school years ago). These characteristics include:
- trouble initiating speech
- groping to find the right articulatory posture
- perseverative errors
- more difficulty with longer words
- self-correcting frequently, indicating error awareness
- easier automatic speech (e.g. counting, curse words)
- islands of error-free speech
Example: Following conversation easily but struggling to respond verbally.
Visible groping movements refer to noticeable searching or trial and error movements of the lips, tongue or jaw when trying to produce a sound or word. These movements reflect the person’s effort to find the correct speech position. However, groping is not always present in every individual with AOS.
There are also exclusionary characteristics, like normal or fast speech rate or typical prosody. If a person speaks normally or quickly, such as a person with fluent aphasia, they cannot have AOS.
Published tests that can be useful
ABA-2: Apraxia Battery for Adults-Second Edition
Aphasia, dysarthia or apraxia of speech?
Aphasia can affect both receptive and expressive language, not just comprehension.There can be overlap in symptoms among acquired conditions, which complicates diagnosis and treatment planning.
Dysarthia effects muscle coordination or movement and may lead to symptoms like slurred speech.
AOS can occur alone but it frequently co-occurs with aphasia and/or dysarthria and may also be seen alongside dysphagia when wider motor systems are involved.
Ask the Expert Webinars - National Aphasia Association
Severity ranges and symptoms
Some people experience subtle prosodic disturbances (e.g. rhythm or speed of speech) that might go unnoticed by unfamiliar listeners.
Others have severe forms, struggling to produce any intelligible speech and may use AAC instead.
Acquired Apraxia of Speech: A Treatment Overview | The ASHA Leader Archive
Therapy apps
Therapy focuses on improving speech clarity, coordination, and confidence.
Exercises may include sound repetition, syllable practice, and structured word-building.
Visual cues, gesture support, and written prompts can help speech planning.
Sessions are personalised to suit your goals, abilities, and communication style
Therapy apps such as Cuespeak can be really effective.
Speech Apraxia UK undertook an impartial review of this excellent product.
Common signs
Sounds may come out in the wrong order, even after several attempts.
The person often knows it’s wrong but can’t fix it (e.g., saying hos-ti-pal).
Some words may be spoken clearly, while others are much harder.
Speech errors can vary from one attempt to the next, with hesitations or struggles to shape the word.
Automatic speech (like days of the week) may be easier than creating new sentences.
ASHA Resources
- Aphasia
- Apraxia of Speech in Adults
- Assessment Tools, Techniques, and Data Sources
- Childhood Apraxia of Speech
- Dynamic Assessment
- Focusing Care on Individuals and Their Care Partners
- Person-Centered Focus on Function: Acquired Apraxia of Speech [PDF]
- Speech Sound Disorders: Articulation and Phonology
- Apraxia of Speech (Childhood)
Other Resources
- American Stroke Association: Aphasia vs. Apraxia
- National Institute on Deafness and Other Communication Disorders (NIDCD): Apraxia of Speech
- United States Society for Augmentative and Alternative Communication
Frequently co-occurring condition—Aphasia
Acquired apraxia of speech resources
ASHA evidence map for apraxia of speech
Conversations with aphasia learning resource
Communication partner training for carers
Microsoft Word - Communication Partner Training Handout.docx
Acquired apraxia of speech article in RCLST bulletin
Relearning communication
Aphasia & Apraxia Recovery and Healing
It is important to see a registered speech and language therapist /pathologist to get an adequate assessment. Some people also find doing excersises helpful. Books like these are not a substitute for speech and language therapy but can start to rebuild confidence.
Aphasia & Apraxia Recovery and Healing
Aphasia & Apraxia Recovery and Healing
The Aphasia & Apraxia Recovery and Healing Workbook is a practical, supportive tool designed to help individuals improve communication skills and rebuild confidence after a stroke or brain injury.
Acquired apraxia of speech after a stroke
Stroke and Brain Damage
Common Communication Problems
Language and Motor Planning
A stroke occurs when the blood supply to part of the brain is cut off, causing damage to brain cells. Speech apraxia happens when the areas of the brain responsible for planning and coordinating the movements needed for speech are affected. This means that even though the muscles may work properly, the brain struggles to send the correct instructions.
Language and Motor Planning
Common Communication Problems
Language and Motor Planning
Speaking involves several brain regions working together. The brain must not only understand language but also plan and sequence the movements of the lips, tongue, and jaw. When a stroke disrupts these motor planning areas, a person may know what they want to say but cannot get the words out clearly or consistently.
Common Communication Problems
Common Communication Problems
Around two-thirds of people experience communication difficulties after a stroke. For some, this includes apraxia of speech, where words come out jumbled, effortful, or inconsistent.This can be particularly frustrating, as people often remain aware of what they want to say but cannot produce it smoothly.
Individual Variation
The impact of a stroke on communication depends on its size and location in the brain. Not everyone who has a stroke will develop apraxia of speech, but if the left hemisphere motor speech areas are affected, the likelihood is higher. Each person’s recovery journey will be unique.
Fluctuating Abilities
Apraxia of speech after stroke can vary from day to day. Tiredness, low mood, or noisy environments may make it harder for someone to speak clearly. A person may have moments of fluent speech but struggle the next moment, which can be confusing for both the speaker and their conversation partners.
The Role of Support and Therapy
With the right therapy and support, communication can improve after a stroke. Speech and language therapy focuses on rebuilding speech motor planning skills, while encouragement from family and friends helps maintain confidence. Supportive environments make a significant difference in daily communication success.
Advice for friends and family
Had A Stroke? Now What? Hospital to Rehabilitation and Beyond (2020) Tom Balchin
Advice for friends and family
It can be hard to support a loved one.
Here is some advice.
Get involved.
Work together
Be patient.
Encourage independence – Make time.
Look after yourself.
There are loads of resources which may help such as this book.
Helpful products
Had A Stroke? Now What? Hospital to Rehabilitation and Beyond (2020) Tom Balchin
Advice for friends and family
Diagnosis may be difficult (at least initially) if speech is minimal. However during the early stages communication aids can be very useful.
Talking devices such as those by Talking Products can be helpful after a stroke.
Tools such as paper-based communication and apps can help with diagnosis.
Had A Stroke? Now What? Hospital to Rehabilitation and Beyond (2020) Tom Balchin
Had A Stroke? Now What? Hospital to Rehabilitation and Beyond (2020) Tom Balchin
Had A Stroke? Now What? Hospital to Rehabilitation and Beyond (2020) Tom Balchin
Here you will find out how to cope with stroke, and recover from it optimally. Taking you through the full process; from arriving at hospital onward. this book reveals a battle-plan of how to rehabilitate effectively and self-manage at home over the long term in a relatively cost-free way
Primary Progessive Apraxia of speech
What is it?
Primary progressive apraxia of speech is a neurodegenerative motor speech disorder characterized by a gradual loss of the ability to plan and sequence speech movements.
Overview
PPAOS is a progressive motor speech disorder in which the brain gradually loses the ability to plan and program the movements required for speech. Unlike stroke-related apraxia, which occurs suddenly, PPAOS develops slowly, initially causing subtle speech difficulties that worsen over time. Individuals often know the words they want to say but struggle to articulate them correctly, resulting in distorted or halting speech aphasia.org+2.
Causes and Pathology
PPAOS is most commonly associated with frontotemporal degeneration (FTD), particularly 4-repeat tauopathies such as corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP). These conditions lead to atrophy in brain regions responsible for planning speech movements, primarily in the left hemisphere. Unlike Alzheimer’s disease, memory and spatial skills are typically preserved in the early stages
Primary Progressive Apraxia of Speech (PPAOS) - National Aphasia Association
Delayed Progressive Apraxia of Speech:A Distinct Clinical Subtype
What you might be asked in a healthcare visit for later developing speech apraxia
When did the symptoms of the speech issues begin?
Is speech harder to understand at certain times, such as when you are tired or stressed or speaking quickly?
Do you understand what others say to you?
Do others understand what you're saying?
Have you noticed changes in your speech, such as the way you move your jaw, tongue and lips to make speech sounds, or changes in the sound of your voice?
Is it hard to plan or coordinate mouth movements for speech?
Have there been changes in writing, typing or non-speech movements?
(taken from the Mayo Clinic website)
How common is it?
More commonly diagnosed in people aged 50–70. No study has yet looked into its prevalence. However, it can be estimated at 4.4 per 100,000 (Botha, H., & Josephs, K. A., 2019).
Studies suggest that PPAOS may account for about 20–30% of cases initially diagnosed as primary progressive aphasia (PPA) when speech motor impairments are the dominant symptom.
Due to overlap with other neurodegenerative diseases, the condition is often underdiagnosed or misdiagnosed in early stages.
Apraxia of Speech with Primary Progressive Aphasia
Primary Progressive Aphasia and Apraxia of Speech - PMC
Corticobasal syndrome and speech apraxia
Primary progressive apraxia of speech: from recognition to diagnosis and care
Research
Chance to get involved in key research into PPAOS
https://www.mayo.edu/research/clinical-trials/cls-20342653
What are the symtoms
Primary Progressive Apraxia of Speech (PPAOS) can present in different ways, each affecting how your speech sounds.
Prosodic AOS
- Speech is slow and uneven.
- Words or syllables may be stretched or broken apart
- The rhythm can sound unnatural or robotic.
Phonetic AOS
- Speech sounds may be unclear or slightly distorted.
- You might visibly work to find the right mouth position for certain sounds.
Most people with PPAOS experience Prosodic AOS as their main difficulty, but Phonetic AOS can also be present. Many have a combination of both patterns.
Chris Kamara's Experience
Chris Kamara says he "suffered in silence" with speech problems for almost two years before he was diagnosed with a thyroid problem. ttps://www.itv.com/news/calendar/2022-12-13/kamara-suffering-with-balance-issues-and-weakness-due-to-thyroid-issue
Speaking to ITV News ahead of a documentary about his condition, Kamara – known to millions by his nickname "Kammy" said he wanted his experience to be a warning to other people.
He said: "Initially I was in denial. I'm a dinosaur. I suffered in silence for about 20 months and in that time my thyroid gland became virtually non-existent , so that could be the reason for all my problems along the line, by just not going to see a doctor.
"Now not only have I got an underactive thyroid, the apraxia of speech has come on, my balance is no good, I'm really weak."
Chris is a former Leeds United, Sheffield United, and Bradford City player, from Middlesbrough,. (ITVX, 2025) Chris Kamara: Lost for Words - ITVX
Resources
Educational resources for support with diagnosis from Rare Dementia Support (UK Based)
Together we learn – Rare Dementia Support .
Association for Frontotemporal Degeneration
USA based-Call 866-507-7222 or send an email to info@theaftd.org for answers to your Frontemporal dementia questions
Diagnostic checklist- FTD-ALS
FTD-ALS - English - Diagnostic Checklist
Diagnostic checklist Primary Progressive Aphasia (PPA)
Diagnostic checklist Behavioral Variant Frontotemporal Degeneration (bvFTD)
Diagnostic Checklist- Progressive Supranuclear Palsy (PSP)
PSP - English - Diagnostic Checklist
Primary Progressive Apraxia of Speech MC194832 Mayo Clinic Information Booklet
Primary Progressive Apraxia of Speech?- A useful resource to print from the https://www.brain.northwestern.edu/docs/Mesulam-Center---PPA-Card.pdf
Do you want to help research PSP? If so you can join this register. Our work in congenital conditions and rare diseases - NDRS
Groups/support organisations
National Aphasia Association
https://aphasia.org/series/ppa-chat-2/
This US organisatgion runs a support group where individuals are invited to learn, share strategies, and connect with each other.
When: The second and fourth Friday of each month, 2:30-3:30 pm Eastern Time | 1:30 pm Central Time | 12:30 pm Mountain Time | 11:30 am Pacific Time
More Information: This program is for people with PPA / PPAOS and their communication partners. We start as a full group, sometimes with a short presentation. Then, we split into breakout rooms based on PPA / PPAOS type or symptoms, so you can learn and connect with others in a similar situation. There’s also a breakout room for communication partners. Communication partners are welcome to assist during the chat, like using supports
UW Department of Speech and Hearing Science
Do you or a loved one live with PPA/PPAOS? Come explore a group just for you! We meet monthly, on Wednesday afternoons. A free event.
Offered in partnership by UW Department of Speech and Hearing Sciences, UW Memory and Brain Wellness Center, UW Alzheimer's Disease Research Center.
https://thememoryhub.org/page/ppa-together
Diagnosis
Primary Progressive Apraxia of Speech (PPAOS) is characterized by a gradual decline in motor speech planning and programming, leading to a range of speech impairments.
FDG-PET is particularly sensitive in detecting early hypometabolism in premotor regions. MRI may show atrophy later. Advanced imaging helps refine diagnosis.
Possible genetic link
A positive family history for neurodegenerative disease is found in 25% of patients diagnosed with PPAOS (Duffy, J. R., Utianski, R. L., & Josephs, K. A., 2020)
https://www.sciencedaily.com/rel.../2025/11/251101000713.htm
Symptoms of Primary Progressive Apraxia
Speech Rate and Segmentation
Sound Errors and Utterance Complexity
Sound Errors and Utterance Complexity
Individuals with PPAOS often exhibit a slow speech rate and lengthened intersegment durations, with syllable segmentation occurring both within multisyllabic words and across phrases.
People with PPAOS tend to speak slowly, with noticeable pauses between syllables and words. This segmentation affects both long words and phrases, making their speech sound choppy or disjointed.
Sound Errors and Utterance Complexity
Sound Errors and Utterance Complexity
Sound Errors and Utterance Complexity
Sound distortions, distorted substitutions, and additions become more prominent with increasing utterance complexity or length.
As sentences become longer or more complex, speech errors increase. These may include slurred or imprecise sounds, incorrect substitutions, or adding extra sounds. This reflects the growing difficulty the brain has with organizing motor plans for complex speech.
Struggle Behaviours
Speech Motor Tasks (SMRs vs AMRs)
Speech Motor Tasks (SMRs vs AMRs)
Articulatory groping, false starts, and audible or visible effort are common, reflecting the struggle to initiate or sequence movements.
Visible signs of struggle, like repeated attempts to form words (groping), hesitations, and exaggerated effort indicate the person's difficulty in starting or sequencing the precise motor movements needed for speech.
Speech Motor Tasks (SMRs vs AMRs)
Speech Motor Tasks (SMRs vs AMRs)
Speech Motor Tasks (SMRs vs AMRs)
Speech motor tasks such as Sequential Motion Rates (SMRs) are typically deliberate, slow, and segmented, with distorted productions compared to Alternating Motion Rates (AMRs), which also often show inaccuracy in place or manner.
When asked to repeat sequences like “pa-ta-ka” (SMR), individuals perform slowly and with errors, showing how hard it is to shift between movements. Even simpler tasks like repeating “pa-pa-pa” (AMR) show mistakes, though typically less complex than SMRs. Both reveal underlying motor planning deficits