What is childhood apraxia of speech (CAS)?

When children have childhood apraxia of speech (CAS), they cannot speak well. They understand language. They know what they want to say. And the muscles of the mouth and throat have the strength and tone needed to speak. But their brains aren't able to plan the order and timing needed for the muscles to move together to create speech that others can understand.

CAS makes it hard for infants and toddlers to practice the sounds they hear when people talk to them. In older children, CAS can make it hard for family members or other people to understand them. If your child has CAS, both you and your child can get frustrated and anxious.

Experts don't know what causes CAS. But with treatment, most children can learn to communicate better.

What happens when your child has CAS?

• Infants may not babble very much and may babble only a few sounds.
• Toddlers may:
  • Be able to say only a few words clearly.
  • Leave out parts of words or put parts of words in the wrong place.
  • Use gestures more than words.
• Older children may:
  • Be able to make single sounds, but not be able to put them together into longer words or phrases. For example, they might be able to say "ah" or "m" sounds, but not "mom" or "mama."
  • Sometimes say the wrong sound in a word, leave out some sounds, or make sounds in the wrong order. For example, they might say "uhkey ar" instead of "monkey bars" or "bubby dau" for "puppy dog."
  • Often pause or struggle to say something.

How is it diagnosed?

The doctor will do a physical exam and ask questions about your child's medical history. The doctor will also ask you questions about whether your child has reached speech and language milestones for their age.

If it looks like your child has a speech problem, the doctor will refer your child to a speech-language pathologist (SLP). SLPs diagnose and treat speech and language problems. They are also called speech therapists.

Your doctor or SLP may suggest other tests to:

• Look for other conditions. For example, your child may get a hearing test to rule out hearing loss.
• Find out what speech sounds your child can say.
• See if your child has problems putting speech sounds together to form words and sentences.
• Review how your child is gaining speech, language, and motor skills.
• Make sure your child understands the speech of others and can follow directions.
• Find out if your child is having other problems. These could include behaviour problems or being clumsy. It could also include trouble doing some of the common skills for your child's age, such as sucking, chewing, or swallowing.

To test your child's speech, the SLP will listen to your child talk. He or she will ask your child to say certain sounds, words, and sentences.

How is CAS treated?

If your child has CAS, they will need regular speech therapy to learn how to speak more clearly. The speech-language pathologist may:

• Help your child learn to make different speech sounds and combinations of sounds. This can make speech easier for your child. It can also make his or her speech more clear.
• Help your child learn sign language or use devices to communicate if needed.

Treatment works best when problems are caught early. Your child's speech therapy team will help you decide on the best schedule for treatment.

A common schedule is for a child to get therapy once or twice a week and to practice every day at home. Often the SLP will suggest that it's best for the child to have several short practice sessions over the course of a day.

How can you care for your child at home?

• Talk, play, sing, or read together. These activities help your child's brain develop. Make reading a part of your child's daily routine.
• Don't imitate your child's unclear speech or constantly correct your child.
• Follow the speech-language pathologist's directions for activities that support the skills your child learns in therapy.