What is childhood apraxia of speech (CAS)?

It’s natural to feel worried or unsure when your child has difficulty speaking. This page explains childhood apraxia of speech (CAS) and offers practical ways to support children at home and in school.

What is Childhood Apraxia of Speech (CAS)?

Childhood apraxia of speech (CAS) is a rare type of speech sound disorder. About 1 in 1000 children have it.

Children with CAS know what they want to say, but their brain has difficulty sending the right messages to the muscles of the lips, tongue and jaw, so that they can move in the right way, at the right time and in the right order. This makes it hard for them to say sounds and words clearly.

CAS will affect speech in all the languages a child speaks.

With the right support, most children with CAS can make great progress and learn to speak more clearly.

What are the signs of CAS?

Every child with CAS is different. Some common signs include:

• Saying the same word differently at different times, for example, ‘see saw’ might be ‘heegaw’, ‘geegaw’, or ‘eehaw’
• Difficulty joining sounds, syllables, and words smoothly. Speech might sound disjointed, with gaps between sounds or syllables, for example saying “wa…ter”
• Difficulty using speech with natural timing, rhythms, and intonation. This means that speech can sound flat, robotic, or without natural expression
• Trouble using the right vowel sounds, for example, saying ‘bah’ for bye or ‘toh’ for toy
• Concentrating hard or struggling to move their mouth when trying to speak
• Using very few different sounds, so words are hard to understand, for example, saying ‘da’ for cat, dog, hat and sun
• More errors with longer or more complicated words

How is CAS diagnosed?

CAS is diagnosed by a specialist speech and language therapist. Because it shares features with other speech conditions, assessment needs to be careful and detailed. It may take time to reach a clear diagnosis. It can be difficult to diagnose CAS in very young children or in children who do not use many spoken words.

What causes CAS?

In most cases, the cause is not known.

Sometimes CAS occurs alongside other developmental, genetic, or neurological conditions.

It is not caused by parenting, shyness, laziness, or lack of effort from the child.

What helps children with CAS?

Children with CAS need help from a speech and language therapist to develop their speech and communication skills.

Children with CAS can sometimes feel frustrated or upset when it is hard to talk. It is important that adults help them to share their ideas while their speech is unclear. A speech and language therapist can support the child, their family and school staff to use other ways to communicate, such as signing, pictures, symbols, or an electronic device. These usually do not replace talking, but can help children to feel heard and less frustrated.

Children with CAS need speech therapy to help them learn the sounds and movements for talking. Therapy works best when children practise their sounds or words many times every day, so that the movements become easier and more automatic. Therapy should be fun and part of daily routines. Parents and school staff play an important role by supporting regular practice as advised by the therapist.

Some children may need support with confidence, attention, or other communication skills before they are ready to work directly on their speech.

Progress in therapy is different for each child. It can take time and depends on things like how severe their speech difficulties are, whether they have other needs, their age, and how much practice they do.

With the right therapy and support, most children with CAS will learn to speak in a way that others can understand. The best progress happens when the child, family, school staff, and therapist all work together.

How can CAS affect a child in school?

CAS can affect learning, friendships, and emotional wellbeing.

Children with CAS often have many ideas and experiences they want to share. However, it can be difficult for them to get their message across in school.

Communication struggles may affect their feelings. Some children may avoid talking to others, or feel upset, frustrated, or angry when they cannot make themselves understood.

Speech difficulties can sometimes make children feel more isolated. They may find it hard to start conversations or join in with play. This can make it harder to make and keep friends. Some children may lose confidence or feel embarrassed about talking in front of others.

Because speech and language are closely linked to literacy, children with CAS may also find reading, writing, and spelling more difficult. They may struggle to sound out or blend words, or to put their ideas clearly into written form.

Planning and producing speech takes a lot of effort. Children with CAS may become tired from this, which can affect their focus on other learning tasks.

How can teachers support a child with CAS?

Teachers can make a big difference. Helpful strategies include:

Create a supportive classroom environment. Encourage respect for differences so the child feels safe and included.

• Use visual supports to help the child share ideas and join in lessons. These might include symbols, pictures, communication mats or books, and visual sentence-builders. A speech and language therapist can suggest the best supports for each child
• Adapt phonics teaching. Children with CAS may need changes to phonics programmes so they can work on sounds that are most achievable for them. Use visual cues such as Cued Articulation to help with recognising and producing sounds
• Allow extra time. Give the child longer to process questions, respond, and complete tasks without feeling rushed. Reduce pressure to speak in front of others if this causes anxiety
• Celebrate strengths. Build confidence and self-esteem by encouraging and praising the child’s skills, interests, and talents
• Support friendships. Pair or group the child carefully with peers. Provide opportunities to work together on practical activities. Support them to take part in lunchtime or after-school activities. Younger children may need help to join in play
• Work closely with parents and the speech and language therapist. Regular communication helps everyone provide consistent support

How can parents help?

• Use other ways to communicate – encourage gestures, signs, pictures, or apps so your child can share ideas while their speech is still developing. This reduces frustration
• Be patient and give time – let your child finish what they want to say without rushing or speaking for them
• Show you understand – repeat back or expand on what your child says, to show you’ve understood and to give them a clear model of words
• Celebrate effort and success – praise your child for trying, not just for getting the word “right.” Confidence is just as important as accuracy
• Read together – books and stories give natural opportunities to practise sounds, build vocabulary, and enjoy communication
• Keep communication relaxed – avoid correcting too much. Instead, model the word back clearly in a natural way
• Work as a team – follow the advice from your child’s Speech and Language Therapist and share progress or difficulties with school staff