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Childhood apraxia of speech (CAS)
CAS is a developmental disorder of planning and programming speech movements; the three consensus signs are inconsistency across repeated productions of the same word, slow, broken movement from one sound or syllable to the next, and abnormal prosody, especially stress.
Why it matters in the exam
The exam mainly asks about differential diagnosis: CAS versus a phonological disorder (CAS shows inconsistency, vowel and stress errors) and versus childhood dysarthria (dysarthria shows weakness, low tone, drooling and consistent distortions). You may also be asked what is not a feature of CAS — for example difficulty controlling loudness — and that no single sign appears in every child.
Another part deals with assessment and treatment: the most informative task is repeating the same multisyllabic words several times, and comparing repetition of a sequence of different syllables (pa-ta-ka) with repetition of a single syllable. Treatment rests on motor learning principles — frequent, intensive practice, sensory cues such as DTTC that are faded, and a move to random practice so gains carry over to other settings — and not on non-speech oral exercises.
Key points
- CAS = planning and programming of speech movements, without weakness.
- Three consensus signs: inconsistency, disrupted transitions, abnormal prosody.
- Vowel and stress errors set CAS apart from a phonological disorder.
- Assessment: repeat the same multisyllabic words and sequences of different syllables.
- Treatment: motor learning, frequent practice, fading cues and random practice.
Summary table
| Feature | CAS | Phonological disorder | Childhood dysarthria |
|---|---|---|---|
| Consistency | Different productions of the same word on each attempt | Stable patterns (processes) | Consistent distortions across all tasks |
| Vowels | Errors are common | Rare | Possible |
| Prosody | Wrong stress, equal or segmented syllables | Usually normal | Depends on the lesion |
| Weakness and tone | None | None | Present; sometimes drooling and swallowing difficulty |
| Repeating a syllable sequence (pataka) | Slow, syllable order disrupted, while repeating one syllable is normal | Usually normal | Slow and imprecise in every task |
| Treatment | Motor learning: frequent practice, fading sensory cues, random practice | Phonological contrasts (minimal pairs) | Subsystem strengthening, breathing and rate |
A free exam question
A 4-year-old with limited intelligibility is referred to rule out CAS. Which assessment task is most informative for this question?
- A. A single naming of each item on a standard articulation test
- B. Measuring the rate of /pʌ pʌ pʌ/ only
- C. Repeating the same multisyllabic words several times
- D. A receptive vocabulary test with picture pointing
In the full version for subscribers
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Sources
- ASHA Technical Report, 2007 — Childhood Apraxia of Speech
- ASHA Practice Portal, 2024 — Childhood Apraxia of Speech
- Maas et al., American Journal of Speech-Language Pathology, 2008 — Principles of motor learning in treatment of motor speech disorders
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.