If you've ever left a pediatrician's office with more questions than answers about your child's speech, you're not alone. Parents often notice that their child sounds different from other children their age but have a hard time explaining exactly what they are hearing.
Childhood apraxia of speech, or CAS, is a motor speech disorder that affects a child's ability to plan and program the precise movements needed for speech. The child may know exactly what they want to say, but coordinating the movements to say it clearly can be difficult.
Looking at real childhood apraxia of speech examples can make those differences easier to understand. But there is one thing I want every parent to know before we get started:
There is no single speech characteristic that confirms childhood apraxia of speech.
Instead, diagnosis depends on the overall pattern of speech motor characteristics a child shows across different words, phrases, and speaking tasks. Current research supports using a combination of features and measures rather than relying on one sign alone (Murray et al., 2021; Iuzzini-Seigel, Allison, & Stoeckel, 2022).
What this article covers:
- Examples of Signs of Childhood Apraxia of Speech
- How Do Speech Therapists Diagnose Childhood Apraxia of Speech?
- How Is Childhood Apraxia of Speech Treated?
- What Should Parents Look for in a Speech Therapist?
- When Should You Seek an Evaluation?
Examples of Signs of Childhood Apraxia of Speech
1. Difficulty Moving Smoothly Between Sounds and Syllables
Speech is movement. When we talk, our jaw, lips, and tongue are constantly moving from one articulatory position to the next.
For children with CAS, those transitions may be especially difficult. You may hear a child pause or segment a word that should flow together, stretch a sound while trying to move into the next one, or have difficulty getting smoothly from one syllable to another.
These challenges may become more noticeable as words get longer or movement patterns become more complex. Disrupted or lengthened transitions between sounds and syllables are among the characteristics clinicians consider when evaluating CAS (Iuzzini-Seigel, Allison, & Stoeckel, 2022).
2. Unusual Stress and Rhythm
Speech has rhythm. We naturally make some syllables stronger and others weaker.
Take the word banana. In American English, the middle syllable receives the strongest stress: buh-NA-nuh.
A child with CAS may give each syllable similar stress, stress an unexpected syllable, or separate syllables in a way that changes the natural rhythm of the word. Speech may sound choppy or unusually segmented.
Prosodic differences, including lexical stress errors and syllable segregation, are important features clinicians consider during a CAS evaluation (Shriberg et al., 2003; Iuzzini-Seigel, Allison, & Stoeckel, 2022).
3. Difficulty Getting Into and Out of Speech Positions
Sometimes the challenge begins before the word even gets going.
A child may have difficulty finding the initial position needed to start a word or moving efficiently from one articulatory configuration into the next.
You might notice the child's lips, jaw, or tongue changing position several times while trying to begin a word. In some children, this may look like groping, or visible searching for an articulatory position.
Groping can be seen in CAS, but it should not be treated as a requirement for diagnosis. Clinicians look at it alongside other speech motor characteristics rather than using it by itself to identify CAS (Iuzzini-Seigel, Allison, & Stoeckel, 2022).
4. Vowels That Sound Distorted or “Not Quite Right”
Vowels are an important part of the CAS picture.
A child may be aiming for the correct vowel but not reach the intended articulatory position precisely. The word may sound close but still slightly “off” to the listener.
For example, the consonants in a word may be recognizable while the vowel sounds distorted or unstable.
Vowel distortions are among the speech characteristics clinicians may consider when evaluating suspected CAS, particularly when they occur along with difficulty with transitions, prosody, or other motor speech features (Iuzzini-Seigel, Allison, & Stoeckel, 2022).
5. Speech Gets Harder as Words Get Longer or More Complex
A child may be able to say a short or simple word but struggle when additional syllables or more complicated movement sequences are added.
That matters in CAS because every additional sound and syllable creates another movement transition that has to be planned and coordinated.
For example, a child may produce a shortened version of a word more successfully but lose accuracy when attempting the full multisyllabic word.
Increased difficulty with multisyllabic words is one characteristic that can contribute to the overall CAS profile, which is why assessment should include words and utterances of different lengths and levels of complexity (Iuzzini-Seigel, Allison, & Stoeckel, 2022).
6. Inconsistent Speech Errors With an Important Caution
Children with CAS may produce the same word differently across repeated attempts. However, inconsistency alone does not mean a child has CAS.
This distinction matters because inconsistent whole-word productions can also occur in other speech sound disorders.
Research has shown that the usefulness of inconsistency for differentiating CAS depends partly on the speaking task and the words being tested (Iuzzini-Seigel, Hogan, & Green, 2017).
So if your child says the same word differently several times, that is useful information to share with a speech-language pathologist, but it should never be treated as a diagnosis on its own.
A knowledgeable clinician considers inconsistency together with movement transitions, prosody, vowel accuracy, word complexity, articulatory configurations, and the child's performance across multiple speech tasks.
7. Early Speech Development May Look Different
For some children later diagnosed with CAS, differences may be noticeable before they are speaking in sentences.
Research examining early videos of children later diagnosed with CAS has found differences in areas such as vocal output, consonant development, and syllable structure during infancy and toddlerhood (Overby, Caspari, & Schreiber, 2019).
However, identifying CAS in very young children can be challenging, especially when there is not yet enough speech to evaluate a full range of motor speech characteristics. Clinicians may use the term suspected childhood apraxia of speech, or sCAS, while gathering more information over time.
Recent work continues to examine how clinicians identify and treat CAS in children under age 3 and supports the importance of early identification rather than delaying appropriate evaluation and intervention (Highman et al., 2024; Valentine et al., 2026).
An early speech difference does not automatically mean CAS, but concerns about limited or unusual speech development are a reason to seek an evaluation rather than simply waiting to see if it resolves on its own.
How Do Speech Therapists Diagnose Childhood Apraxia of Speech?
There is not one CAS test, one sound error, or one behavior that gives us the diagnosis.
Instead, speech therapists experienced in pediatric motor speech disorders gather information across multiple tasks and look for a pattern of features.
An evaluation may examine:
- consonants and vowels
- movement transitions between sounds and syllables
- lexical stress and prosody
- accuracy across words of increasing length and complexity
- repeated productions
- initial articulatory configurations
- connected speech
- how the child's speech changes when the clinician provides different levels of cueing
This matters because differential diagnosis can be difficult. Research reviews have found that no single measure has enough sensitivity and specificity to diagnose CAS by itself, so clinicians use combinations of measures and markers (Murray et al., 2021).
Dynamic motor speech assessment can also be helpful. Rather than simply asking whether a child can or cannot say a word, the clinician examines what kind of support helps the child's speech become more accurate.
The Dynamic Evaluation of Motor Speech Skill, or DEMSS, is one assessment developed to support differential diagnosis in children with severe speech disorders (Strand et al., 2013).
The best children's speech therapist for a child with suspected CAS is one with specific experience in pediatric motor speech disorders and differential diagnosis.
How Is Childhood Apraxia of Speech Treated?
Treatment for CAS should address speech motor planning and programming, not simply work through individual speech sounds.
Effective motor-based treatment typically includes many opportunities to practice accurate speech movements, carefully selected targets, individualized cueing, and attention to movement transitions and prosody.
Treatment may include auditory models, visual information, gestures, and tactile cues. The type and amount of support should change based on the child's success rather than remaining fixed.
If you're looking for Childhood Apraxia of Speech treatment ideas, remember that the activity itself is only the vehicle. What matters most is what the child is practicing, how accurately the motor movement is being produced, how much practice the child gets, and how the clinician is applying principles of motor learning.
Children who cannot reliably communicate everything they want to say should also have access to communication supports such as robust AAC, gestures, and manual sign. AAC can be used alongside speech and should give children access to a broad range of communicative functions, not only requesting (American Speech-Language-Hearing Association, n.d.).
What Should Parents Look for in a Speech Therapist?
CAS is a specialized area of speech-language pathology.
When looking for a speech therapist, ask about experience with pediatric motor speech disorders and CAS specifically.
A clinician should be able to explain:
- why particular speech targets were selected
- which movement patterns are being addressed
- how and why cues are being used
- when those cues will be changed or faded
- how much accurate practice the child is getting
- how progress is being measured
- how caregivers can safely support practice outside therapy
Parents should be partners in treatment. You should understand what your child's speech therapist is working on and why.
When Should You Seek an Evaluation?
If you're concerned about your child's speech, you do not need to diagnose CAS yourself before asking for help.
You may hear several of the characteristics described above, only one of them, or something entirely different.
CAS can overlap with or resemble other speech sound disorders, and differential diagnosis can be difficult even for experienced professionals. That is why current research supports looking at multiple measures and converging evidence rather than relying on one “tell-tale” sign (Murray et al., 2021).
If something about your child's speech development concerns you, seek an evaluation from a speech-language pathologist with experience in pediatric speech sound and motor speech disorders.
Conclusion
There is no single speech characteristic that confirms childhood apraxia of speech. Instead, diagnosis depends on the overall pattern of speech motor characteristics a child shows across different words, phrases, and speaking tasks.
A child may struggle with movement transitions, stress patterns, vowel accuracy, longer words, or other features of speech motor planning. Inconsistency may be part of the picture, but it should never be used alone to identify CAS.
If these childhood apraxia of speech examples sound familiar, connect with speech therapists who have experience with pediatric motor speech disorders. The best children's speech therapist for a child with suspected CAS is one who understands differential diagnosis and can look at the full pattern of speech characteristics.
If you are concerned, don't wait. Evaluate.
Bjorem Speech speech therapists create research-informed tools to help speech-language pathologists and families understand and support children with CAS.
Sources:
- American Speech-Language-Hearing Association. (n.d.). Augmentative and alternative communication (AAC). ASHA Practice Portal.
- Highman, C., Overby, M., Leitão, S., Abbiati, C., & Velleman, S. (2024). Update on identification and treatment of infants and toddlers with suspected childhood apraxia of speech. Journal of Speech, Language, and Hearing Research, 67(9S), 3288–3308. https://doi.org/10.1044/2023_JSLHR-22-00639
- Iuzzini-Seigel, J., Allison, K. M., & Stoeckel, R. (2022). A tool for differential diagnosis of childhood apraxia of speech and dysarthria in children: A tutorial. Language, Speech, and Hearing Services in Schools, 53(4). https://doi.org/10.1044/2022_LSHSS-21-00164
- Iuzzini-Seigel, J., Hogan, T. P., & Green, J. R. (2017). Speech inconsistency in children with childhood apraxia of speech, language impairment, and speech delay: Depends on the stimuli. Journal of Speech, Language, and Hearing Research, 60(5), 1194–1210. https://doi.org/10.1044/2016_JSLHR-S-15-0184
- Murray, E., Iuzzini-Seigel, J., Maas, E., Terband, H., & Ballard, K. J. (2021). Differential diagnosis of childhood apraxia of speech compared to other speech sound disorders: A systematic review. American Journal of Speech-Language Pathology, 30(1), 279–300. https://doi.org/10.1044/2020_AJSLP-20-00063
- Overby, M. S., Caspari, S. S., & Schreiber, J. (2019). Volubility, consonant emergence, and syllabic structure in infants and toddlers later diagnosed with childhood apraxia of speech, speech sound disorder, and typical development: A retrospective video analysis. Journal of Speech, Language, and Hearing Research.
- Shriberg, L. D., Campbell, T. F., Karlsson, H. B., Brown, R. L., McSweeny, J. L., & Nadler, C. J. (2003). A diagnostic marker for childhood apraxia of speech: The lexical stress ratio. Clinical Linguistics & Phonetics, 17(7), 549–574. https://doi.org/10.1080/0269920031000138123
- Strand, E. A., McCauley, R. J., Weigand, S. D., Stoeckel, R. E., & 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(2), 505–520. https://doi.org/10.1044/1092-4388(2012/12-0094)
- Valentine, H. C., Keller, S., Harel, D., & Grigos, M. I. (2026). Clinicians' perspectives on diagnosing and treating childhood apraxia of speech in children under 3 years old. American Journal of Speech-Language Pathology, 35(1), 266–283. https://doi.org/10.1044/2025_AJSLP-25-00215
