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How is CAS Diagnosed?

Because Childhood Apraxia of Speech is a communication disorder, the most qualified professional to provide assessment, evaluation, and diagnosis is a licensed speech-language pathologist (SLP).  Other professionals can be helpful and necessary at some point in time for children with CAS; however, they have not typically undergone the extensive and concentrated study and certification to fully evaluate speech and/or language disorders.  Professionals such as pediatric neurologists or developmental pediatricians sometimes make diagnoses’ but more often, and more appropriately, they refer to the speech-language pathologist on their team who has the skill and extensive training to distinguish between CAS and other types of speech sound disorders.

The Evaluation

An SLP will take a very careful history of the child’s development history and note any known medical issues or other problems.  The evaluation most likely will include the following:

  • A complete inventory of the sounds, syllable shapes (consonant and vowel combinations that make up syllables), and words a child can make or attempts to make will be noted, as well as any “mistakes” the child makes when doing so.  Errors and/or distortions of sounds will be compared with what is known about normal speech development to determine if the child’s speech performance is normal or not.
  • The SLP will try to interact with your child and try to get them to use their speech in order to see what happens when they are asked to repeat syllables, words, or phrases a number of times.  Observations will be made about how your child combines sounds together and whether the length or difficulty level of words or phrases makes a differences to the accuracy with which the child says words.
  • A child’s ability to both use and understand words, phrases, word endings, grammar, etc. will be evaluated and compared to what is typical for their age range.
  • The child’s oral structures and the oral cavity (inside the mouth) will be examined to determine that they appear normal and are in good working order for speech.  Some young children do not like strangers peering in their mouths, thus this part might be a challenge!  Some children also might be sensitive to touch around the mouth and this will be noted.
  • Observations will be made about the child’s respiratory system and if they seem to have enough airflow to sustain speech; how they hold their bodies; if they appear to have enough muscle strength and muscle tone for speech; if the quality of their voice seems appropriate; if their face appears symmetrical and if they seem able to move the lips, tongue, jaw and soft palate normally.
  • The SLP will make note of the child’s intentions to communicate and interact; engage in social interaction; listen; and respond.  They will observe what other forms of communication the child makes such as pointing and gesturing.
  • Especially if an SLP suspects apraxia of speech, she/he will observe what effect certain types of “help” have for the child’s speech accuracy.  For example, the SLP may slow down their own speech and ask the child to try a word or phrase with them (simultaneously).  Or the SLP may use words of other types of “cues” to help the child figure out how to form the mouth or how to place the tongue in order to produce the desired target word.
  • If CAS is suspected, the SLP will attempt to do a “motor speech exam.”  This means that the SLP will try to get the child to repeat increasingly difficult and challenging syllables, words, and phrases and will observe how length and complexity impacts the child’s speech intelligibility.  Typically, at the same time, the SLP will use the “cueing” mentioned above to observe the impact.

Once the SLP has collected enough information, they will attempt to determine if the child’s speech and language is developing normally or not.  If they determine that the child’s speech is developing normally, however it is at a slower rate than most other children are, the child may be said to have a speech and/or language delay.

If the SLP has observed characteristics that do not fit with normal speech/language development, they will try to determine a “differential diagnosis.”  A differential diagnosis is when there is enough information to state that the child’s skills “fit” with a specific speech/language disorder.  When a child is diagnosed with Childhood Apraxia of Speech, the SLP has made a differential diagnosis.  She/he has determined that after thorough evaluation, the child demonstrates characteristics of CAS that helps the SLP distinguish it from other possible speech problems.

Top Three Characteristics of Childhood Apraxia of Speech

The top three characteristics of Childhood Apraxia of Speech, as reported by the American Speech-Language-Hearing Association (ASHA) Technical Report on Childhood Apraxia of Speech, that can help the SLP make a differential diagnosis are:

  • Inconsistent errors with consonants and vowels on repeated productions of syllables and words (your child says the same word in different ways when asked to repeat it several times.  This might be more apparent in new words or longer more complex words.)
  • Difficulty moving from sound to sound or syllable to syllable, resulting in lengthened pauses between sounds and/or syllables
  • Inappropriate stress on syllables or words (such as all syllables are said with equal stress on each one causing the “melody” of speech to sound odd)

Other Possible Symptoms of Childhood Apraxia of Speech

Other possible signs of apraxia of speech are:

  • Increased mistakes in longer or more difficult and complex syllables and words.
  • Reduced vowel inventory (the number and assortment of vowel sounds that your child can produce), or errors when producing vowels, and
  • Possible “groping” behaviors in which your child appears to struggle to achieve the correct oral posture to start or produce the syllable or word.  (Not all children exhibit this at all times or situations.  If your child does not demonstrate groping of their speech musculature, that alone is not enough to rule out apraxia of speech.)

Listen to more about how Childhood Apraxia is Diagnosed:


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