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Seventy Five Percent Of Apraxia Cases Wrongly Diagnosed

Recently, I have been getting an influx of children with the diagnosis of Childhood Apraxia of Speech (CAS). Sometimes the child actually has Childhood Apraxia of Speech. However, most often they are wrongly diagnosed.

There have been several studies over the past few years that have shown that when evaluated by an expert in Childhood Apraxia of Speech roughly 75% of children with the diagnosis are found not to have the disorder. One study even reported that out of 53 children previously diagnosed or suspected of having Childhood Apraxia of Speech, only 7 did. So a full 87%, did not actually have the severe speech disorder.

Neurologists Should Not Diagnose Apraxia
It feels as if every time I turn around there is another non-verbal 2 year old getting this diagnosis from a well meaning Neurologist. There seems to be many Neurologists who will diagnose any child who has a normal neurological exam at age 2 and is not talking with Childhood Apraxia of Speech.

I am not blaming the Neurologists for this. Most of the time, they are put in this position by Speech Language Pathologists who don’t feel comfortable giving the diagnosis themselves.

Unfortunately diagnosing this severe speech disorder is not easy. In fact there is no one agreed upon assessment tool within the field to make the diagnosis. Because of this many Speech Language Pathologists do not feel as if it is their role to make this call when in fact it is.

Expertise Matters
Of course the Speech Language Pathologist should have extensive knowledge of childhood motor speech disorders to properly diagnose and to treat Childhood Apraxia of Speech. If they don’t, a referral to Speech Language Pathologist who does is the more appropriate next step.

While the person who makes the diagnosis may seem unimportant, it really is extremely important.

A neurologist can rule out any other neurological causes for a severe speech disorder; however they should not be asked to make the diagnosis of Childhood Apraxia of Speech. They are not experts in speech and language disorders, only Speech Language Pathologists are. Neurologists have plenty of other areas in which they are the experts; this is not one of them.

This scenario is contributing to the over-diagnosis of this disorder.

Age Of Diagnosis Also A Factor
Another factor contributing to this problem is the age of diagnosis. A child should be at least 3 before they can be accurately diagnosed. Prior to age 3 the disorder may be suspected, but it should not be diagnosed. A lot can change between the ages of two and three.

Childhood Apraxia of Speech is a speech disorder which involves motor planning deficits of volitional speech. Until a child makes an attempt to speak we have no idea what is going on. We can suspect motor planning is an issue due to some red flags we look for, however a diagnosis should not be made too early.

Important Red Flags
Some red flags in infants and toddlers include; little or no babbling, drooling and feeding difficulties, limited intonation, and words used and then lost.
While these characteristics are not enough to make a diagnosis they are reason to be concerned and take action. A child suspected to have Childhood Apraxia of Speech should be treated as though they have the disorder even without a diagnosis.

Just because there is over-diagnosis does not mean that therapy should be avoided. With any speech disorder the sooner therapy starts the better the outcome.

When a child has Childhood Apraxia of Speech he or she may need 3000 productions of a sound combination or word to learn a muscle memory for that combination. So I am a strong believer that the more therapy a child is able to get, and the sooner they get it, the better. I would add to that, that therapy must be fun and doable for everyone. If someone in the equation is miserable something must change.

Stop Searching and Take Action
So if you are a parent of a young child who is diagnosed with Childhood Apraxia of Speech and you are searching and searching for answers and opinions, stop now. Find yourself an excellent Speech Language Pathologist with the proper experience and start therapy immediately.

While finding answers is important, getting the right therapy for your child is a better use of your time.

Sources noting over-diagnosis of Childhood Apraxia of Speech:
Stoeckel R., (2008). Childhood Apraxia of Speech (CAS) Differential Diagnosis and Practical Treatment Strategies, 8-9. Rye, NY

Jakielski, K J., (2006) Childhood Apraxia of Speech (CAS) Assessment and Intervention, 12-13. White Plains, NY.

Shriberg L.D, Campbell T.F., (2002). Proceedings of the 2002 Childhood Apraxia of Speech Research Symposium, 38. Tucson, Arizona: The Hendrix Foundation

Davis, B.L., Jakielski, K J., & Marquqrdt, T.M. (1998). Deveopmental Apraxia of Speech: Determiners of Differential Diagnosis. Clinical Linguistics and Phonetics, 12, 25-45.


About the author: Isa Marrs is a board-certified speech-language pathologist who specializes in articulation, pragmatic language and feeding disorders in children. She is an expert in the field who is frequently sought after by institutions and therapists to provide training for working with these and other disorders. Isa also served as a guest expert on Nickelodeon’s ParentsConnect.com, and has been quoted by numerous top media such as Disney’s BabyZone.com, LoveToKnow.com, and Univision. She can be reached at 914.488.5282

  • Leslie N. April 25, 2009, 4:58 pm

    You say, “A child suspected to have Childhood Apraxia of Speech should be treated as though they have the disorder even without a diagnosis.” However, as a mom who has logged hundreds of hours fighting with her insurance company, I can tell you that without a diagnosis, the insurers will not approve speech therapy at all. In addition, some State EI programs are ill equipped to handle the needs of these children. My son was diagnosed by an SLP in my State’s EI program as having suspected apraxia at age 21 months. He then languished for months without progress under the care of a traditionally trained SLP who claimed to have experience treating children with apraxia. Luckily, we found a developmental pediatrician who was willing to diagnose him with apraxia because the insurance company would not accept the diagnosis from an SLP, it had to be from a medical professional. So I realize that you believe that an MD cannot diagnose apraxia, but most insurance companies will not accept any diagnoses from non-MDs. We also located the *ONLY* SLP under EI in our area who was trained in Kaufman (none were trained or certified in PROMPT) and, amazingly, my son began to show progress under her care! With the diagnosis of apraxia from our MD, the insurance company approved PROMPT therapy which he has in addition to Kaufman from the EI SLP. What little “speech” he has is still largely unintelligible at 2.5 yrs old, but how wonderful it is to hear him try at last! I can sympathize that you think the condition is being over diagnosed, but you also say that childern with suspected apraxia should be given the same treatment tools as those with confirmed apraxia. You should know that without someone (typically an MD) who is willing to diagnose “apraxia” children with suspected apraxia will NOT receive the proper treatment. Yes, some will be just fine over time, but some won’t and frankly I don’t want to bet that my child will be just fine. I’d rather get treatment early as you recommended in your article. I just thought you might benefit from hearing why a diagnosis of apraxia is SOOO important from a parent who has fought the good fight with insurance and the EI system.


  • Isa Marrs April 27, 2009, 6:25 am

    Hi Les,
    Thank you very much for your comments. I agree with what you said and deal with reimbursement issues just about every day in my practice. Regardless of the diagnosis insurance companies always want documentation from an MD. I will most often make the specific diagnosis or recommendation and then refer the child to their doctor or neurologist to get a letter of medical necessity with a diagnosis code.

    While the code and letter are needed for reimbursement a Speech Language Pathologist is the one with expertise in sound speech disorders and should make the original diagnosis. When I speak of proper diagnosis I am looking at the diagnosis of the disorder separate from the funding issue. It’s disappointing that your original EI Speech Language Pathologist did not have the expertise to treat speech sound disorders.

    Happy to hear you found the right therapist now and your son is making progress!

  • kgreen July 29, 2010, 11:46 am

    What questions do I ask of the speech pathologist to gleen whether or not he/she is qualified to treat apraxia?

  • Isa Marrs August 24, 2010, 9:30 am

    First I would learn as much as I can as a parent which I am sure you have already. I would ask her how much experience she has treating children with Childhood Apraxia of Speech (CAS). I would hope she would be honest! If she is up to date on the speech disorder she will refer to it as Childhood Apraxia of Speech. I would also ask her to explain how CAS is different from other speech disorders and how the treatment differs as well.

  • Heather Hoffman September 28, 2010, 11:59 am

    Hi Isa, my 2-year-old son appears to be on the path to a diagnosis of Apraxia. You indicate that 75% of children are misdiagnosed. What are some differential diagnosis for Apraxia? Although under 3, my son strongly exhibits many of the symptoms of Apraxia. He says only a few words correctly (mommy, mimi) and the rest (which isn’t much) incorrectly. He does attempt some words but they come out wrong. I notice he watches my mouth when speaking but he just can’t mimic what is being said. If it isn’t Apraxia, I would like some information on other diagnoses. Thanks

  • Isa Marrs October 4, 2010, 7:06 am

    Hi Heather,
    It’s great that you are trying to learn as much as you can. Being an informed advocate for your child is one of the best things you can do. You should also find a Speech Language Pathologist who specializes in Childhood Apraxia of Speech. If you cannot find that then you should find one who specializes in early childhood speech disorders. Finding the right therapist for your child is critical in helping him.

    Since I have never met your son I can’t give you specifics; however, some of the other diagnosis that get misdiagnosed as Childhood Apraxia of Speech are Dysarthria, Phonological Processing Disorder, Expressive Language Disorder, and even Autism Spectrum Disorders. You will need to have you son evaluated by a Speech Language Pathologist, with the right expertise, to determine this.

  • Kelly Brehm March 10, 2011, 8:45 pm

    Hello. My question is how to get a diagnosis for my son so that I can make sure he is getting the correct therapy for his needs. He has had several evaluations by OT and ST with both EI and also at a Feeding Disorder Clinic/Neurodevelopment Clinic. All that anyone is willing to tell me is that he has severe delays in both eating and speech/language (both expressive and receptive). No one will answer any of my questions regarding what the underlying cause of these symptoms/delays is or even what they suspect. Thank You!

  • Isa Marrs March 22, 2011, 1:12 pm

    Hi Kelly,
    Unfortunately, sometimes the cause is never known. If an underlying medical cause has been ruled out, the most important thing to look at is if he is making progress with the therapy he is getting.
    Good luck, Isa

  • Becky Belleville March 22, 2011, 9:33 pm

    Hello, My OT recently told me she is sure my son has Oral apraxia. He has feeding issues. He is 3 years old and not able to feed himself without help. He’s not able to dress himself either. He was diagnosed with low muscle tone when he was 14 months old. Why isn’t there more information on oral apraxia? It is always linked with verbal apraxia. My son is just becoming verbal but his words are clear (sometimes he will say it in the wrong context), so I don’t think he has verbal apraxia. I do believe he has limb apraxia also. He has trouble problem solving. He will tell me he needs help to get simple things. If he drops something I have to place his hand on it to show him to pick it up. This is also true with feeding I have to put his food on his utensil and put it in his hand so he can eat. Im going to see the neuro dev specialist in july and I was hoping to get an offical diagnosis. Early on doesn’t like to do that. So where should i go to get this diagnosis? Who do you call childrens hospital?

  • Isa Marrs March 30, 2011, 11:07 am

    When a child has Oral Apraxia they do not always have Childhood Apraxia of Speech. It is a great sign that his words are coming out clear. You need to rule out any underlying medical causes. After that a Speech Language Pathologist would be the professional to diagnose Oral Apraxia or Childhood Apraxia of Speech.

  • Susan S. June 13, 2011, 10:10 pm

    Hello Isa,
    I am new to the field of special education and have recently taken on a case under CPSE. The child is 3.7 years old and comes from a bilingual home. She only speaks 10 words (half in her native language and the other half in English).
    She is highly receptive and can easily follow 2 and 3 step commands. I have her look at my mouth when I speak and I notice that she intensely looks at the shape and movement of my mouth, as she appears to want to imitate the motions.
    Needless to say, I am not equipped to diagnose her, but from what I have read about CAS and the symptoms that she displays, I am more apt to say that she suffers from CAS than from ASD. Today, too often a child who is non-verbal is labeled with ASD. She will start getting SLP services within the coming weeks, would I be stepping on the therapists toes if I shared my thoughts and insight?
    Lastly, I could not agree with you more. I am less concerned about a diagnosis than a am about an effective treatment. If she has CAS and not ASD, then I would steer away from ABA and employ PROMPT-like therapies.
    Can you direct me to a good website that offers on-lne training or workshops locally within the NY metropolitan area?
    Thanks in advance!

  • Isa Marrs June 15, 2011, 12:02 pm

    Hi Susan,
    It is always helpful to have someone who is working with a child to offer their opinions and insight. I would hope a new therapist joining the team would feel the same way.

    If you are looking for PROMPT training they do have a website and offer a variety of trainings in the NY Metropolitan area. It would also be beneficial to allow the Speech Language Pathologist a couple of weeks to work with her and then touch base about her opinions.

  • Samantha June 17, 2011, 3:02 pm


    As an SLP, I was wondering what icd code you use for a child you suspect has CAS but is under 3 years of age.


  • Isa Marrs June 21, 2011, 9:56 am

    I do not bill insurance so I am not the person to ask.

  • Amy July 18, 2011, 3:02 pm

    Hello Isa,
    My son had his first ear infection at 13 months, at that time he could say cup, cookie, mama, and dada. Those words I remember clearly. He had a total of 5 infections and an advocate before recieving his PE tubes. This whole process took 11 months from him. He was finally fluid free and hearing test passed at 20 months old. He is now turning three and just broken(1 month) from his pacifier. He doesnt speak clearly but tries on his own and can repeat many words and sounds. He can say clearly help please and up please. car and simple words. He just finished his IEP and they have put him in speech, but have said they suspect apraxia. I keep trying to wrap my head around it but except for the speech delay which I figured was normal for missing a year of hearing the world, He doesnt display any other symptoms. He eats well and he cooed and babbled very early in his milestones. He wasnt speaking much until the last three world where we moved to another state and have had another child. Everyday he tries to say and learn more words. They dont come out clear sometimes but its like he cant get enough of learning words. I know you havent seen my child but I feel like people are labeling him and he just needs to be given a chance to get caught up for the year lost.

  • Amy July 18, 2011, 3:09 pm

    Towards the end it is suppose to read the last three months not world.

    Also my own mother said I didnt say much until after I turned almost three. I just want to do whats right for my son. I have had him in playgroups but of course all the other kids didnt talk either, so it still left him not talking much. When we moved, just in April, He didnt say much in vocabulary and in three months he has more than tripled the vocal words. Most he will drop either the end or begining of the word.

  • Isa Marrs July 19, 2011, 8:36 am

    At this point I would not get too caught up in the actual diagnosis as long as he is getting high quality therapy and is making progress. As I mentioned in the article Childhood Apraxia of Speech (CAS) is over diagnosed quite often. From your description he does not sound like a child with CAS however as you mentioned in your letter I can’t give you an accurate opinion without evaluating him.

  • Gloria August 2, 2011, 11:01 pm

    Hi! I stumbled upon this site while researching apraxia, a word that was dropped during my 27 month olds speech therapy. Her speech therapist didnt diagnose her with it, but did mention it enough to scare me. My daughter is seeing a SLP through early intervention twice a month (working on getting that bumped up to every week) and has already made big improvements. She says between 20-30 words now (still not putting many together yet) but i would say she has gained at least half of those in the past 2 months. She has no other delays and has no problems with eating. She can move her tongue in and out, side to side, etc on command. She does struggle with dropping constanants at the end of words but in the past few days is now saying out,hot,up, etc…where before they never had an end sound. She does struggle with wanting to put the “D” sound in front of a lot of words until i slow her down and seperate the word, then sometimes i can get her to say it properly. She does do a lot of pointing and gesturing, but also tries to say words to communicate. She does definately seem delayed in her speech, and seems very similar to her little 22 month old friend in his speech. She makes lots of babbly noises when shes playing, although she does seem much more vocal in that area since turning 2. I guess im wondering if she sounds like we should seek someone that specializes in apraxia for a diagnoses? I understand it is hard to tell without meeting her, but i get so many mixed answers on the web and with her SLP.

  • Isa Marrs August 16, 2011, 2:28 pm

    Getting a proper diagnosis for your daughter could be beneficial because it would help guide her therapy when it comes to treatment techniques and frequency. However after reading your email it seems as if your daughter is making good gains with her speech and language without any real intervention which makes it unlikely that she has Childhood Apraxia of Speech.

    Given her speech and language delay she would benefit from 2 short speech sessions per week. If she is still significantly delayed when she turns 3 you might want to consider increasing her therapy and finding a Speech Language Pathologist who has experience working with children with suspected CAS.

  • Irene August 18, 2011, 4:17 pm

    My daughter’s SLP has diagnosed her with apraxia of speech – however like most people I required a diagnosis from an MD so that I can get her the help that she needs to continue with both Speech & OT. She is about to transition from EI into CPSE and like most school districts cut backs are meaning it’s more difficult to get the kids the services they need. Could you recommend a Neurologist who specialises in this area? I live in the Hudson Valley, NY.

  • concerned parent October 9, 2011, 1:17 am

    My son is 3 1/2 now and recently he was diagnosed with verbal apraxia by a neurologist and a speech therapist. Him and I are going to speech therapist twice a week since mid Augost now. He started the therapy by playing and now we are doing the oral therapy as well as playing time. But the section is only for half an hour. The stuff speech pathologist does teach me how to get the words out clearly so that my son can understand and pick-up ( like I didn’t know that) !!! The oral therapy is with a lolly-pop and tongue excersise (which we do that daily) and she wants to see him eat crackers each and everytime to see if he closes his mouth or not when he chews. I could of told her that. My point is, what he is getting from these sections, is what we are normally doing at home on daily bases. Should the speech therapy sections suppose to be like this ? What should I expect from these sections cause frankly, they are teaching me and not him !

  • Jennifer October 16, 2011, 10:06 pm

    This is very interesting that I stumbled upon this article today. My sons SLP has diagnosed him with CAS. Although he is only 2 and a half she has come to this conclusion after 8 months of therapy, and being able to rule out many other disorders, but it seems he is a classic case. Ie losing words, not babbling, cant talk when asked, having a favorite word, and the words that don come outnare jumbled and sound different every single time.
    Progress has been made, enough to help his own confidence levels to communicate (using sign and so forth) but nowhere near enough. So his SLP has suggested to also use an OT for a term to boost his neurological pathways and encourage speech.
    What is your opinion on the use of an OT with a child with no other obvious concerns?
    Thanks for your time

  • Isa Marrs November 1, 2011, 4:21 pm

    Occupational therapy when needed can be very helpful when combined with quality speech language therapy. My opinion is that it does not hurt to have an evaluation. If the OT recommends therapy and can give you a good rationale I would go for it!

  • Ruby November 8, 2011, 8:12 am

    Hi Isa, I am interested in reading the articles you have listed but despite searching for these I am struggling to find the four you have referenced. Is it possible to know where I can find these please. Thankyou for you time.

  • Isa Marrs November 8, 2011, 2:36 pm

    Hi Ruby,
    The first two references are from professional conferences; so they won’t be on-line. However, you can find some of the original research by searching journal clearing houses such as pubmed, informa, etc. Some of the names that will be helpful are Ruth Stoeckel, PHD, CCC-SLP; Barbara Davis, Ph.D; Edythe Strand, PH.D., BC-NCD and Thomas Campbell, P.H.D., BC-NCD.

    The third reference was also a conference, but you may be able to get it through Apraxia-Kids.org.

    The fourth reference is an article that appeared in the journal of Clinical Linguistics and Phonetics. It should still be available for purchase through one of the journal clearing houses such as pubmed, informa, etc.

    Good luck, Isa

  • Isa Marrs November 8, 2011, 2:39 pm

    Hi Irene,
    Sorry for the delay in responding. Please feel free to call me and we can discuss this issue further. I would feel more comfortable having more information before I make any referrals. I can be reached at (914) 488-5282.


  • Isa Marrs November 8, 2011, 2:44 pm

    Hi Concerned Parent,
    It is actually great that the sessions are teaching you. He is only with her for a short period of time and with you for the rest. Most often parents have the opposite complaint that they are not getting any feedback from the therapist about how to help their child. Some of the activities you mention I do question however. I would suggest getting a second opinion if possible.

    Good Luck, Isa

  • Worried Mom November 15, 2011, 1:03 pm

    Hi Isa,
    My daughter was diagnosed with CAS at 24 months by a SLP. At that time she had about 40-50 words (no phrases) but she did not repeat after us as much, and was progressing very slow. Her receptive scores were much higher than expressive, and at the time she wasn’t using all the words she knew. Needless to say my world turned upside down. However between 24 and 25.5 months my daughter made amazing progress – she has only had may be 4 therapy sessions (which started after she turned 25 mo) but I consciously started naming objects more and teaching her phrase construction with a noun+verb, reading a lot more etc. Today she has 150+words (she just turned 26 months, so all this progress in <2 months), repeats 7 out of 10 times (of course she has to be in the mood), learns 4-5 new spoken words every week and says 40-50 new words/phrases every week. She uses a lot of negation based phrases like no eat, no food, or simple phrases like my puppy, my book, clean up, bye car, go home, go school etc. It is indeed a significant difference and has taught herself all the letters of the alphabet (she reads them out loud from TV screens, books) , learnt couple of colors (at school circle time) and working on numbers now. She has also significantly transitioned from signing to verbal communication, but of course lots of times she speaks gibberish as well (but reducing). Her words are mostly clear, the approximations are over and above the 150 spoken words.

    She had no early signs of CAS, babbled and cooed, first words were early, no feeding issues, no drooling, advanced motor skills (walking at 9 months) and is really strong for her age. The only issue was that it was very hard to get her to repeat after us and language development from 12-24 months was slow. She has been always the most social and outgoing kid, making people laugh etc. However in the last 2-3 weeks as her speech has taken off at home, she has become very quiet outside and will not verbally interact with anyone at school or outside. She talks just fine in front of her SLP though but she is not as boisterous as she is at home with us or with her nanny. Developmentally I see no other issues, her ped thought the CAS was misdiagnosed and that the no talking outside has to do with being cautious and the fact that she is aware her expressive speech may be lagging her classmates. But as a mom I can't stop worrying because I have always known her as the noisy, happy and outgoing kid. She does play very well with her friends at school and in fact prefers to play with kids more than parallel play which is typical for her age. She also continues to interact with adults though non-verbally but is verbal and loud if we are outside at the mall or restaurant only if there is no one else with us.

    Do you think she could be misdiagnosed with CAS and is there anything I should worry about her silence outside of home?

    Thanks for reading.

  • Worried Mom November 15, 2011, 1:09 pm

    Hi Isa,
    I forgot to mention that she always stayed home with nanny and started school only around 23.5 months, so she is quite new to school. However the first month she was doing fine, she would say bye-bye so loud on her way out that everyone would laugh. Now though (past month or so), I cannot get her to say bye to anyone (she will instead give a hug to her teachers and friends), but the moment we step out the door into the parking lot she starts saying bye-bye or go home or car-car really loud. I am baffled! Her doc thinks it’s just a phase and she should be fine by the end of the school year.


  • Worried Mom November 15, 2011, 2:27 pm

    Seems like I am hijacking this thread, but wanted to add that we are a bilingual household. Her receptive in our native language is better than English (both are pretty good) but she prefers to only speak English though she says some words in our language. Thanks.

  • Isa Marrs November 17, 2011, 5:36 pm

    From what you are reporting I do agree that the CAS was a misdiagnosis. Seems as if your daughter is really catching up. You should breathe a sigh of relief.

    In regards to her shyness outside of the home I agree with the pediatrician that it could just be a phase. Don’t make a big deal out of it and try hard not to put her on the spot to talk in front of others. Her lack of speaking outside of the house should be monitored. If it seems to continue or get worse you can speak with your SLP.

  • Liz November 30, 2011, 5:30 pm

    What a helpful blogsite! My now 2 1/2 year old son was cautiously diagnosed with CAS by two different SLP’s . They are still on the fence about it. Both my husband and I are almost positive our son has CAS by doing some research and reading of our own. The SLP’s both agree it’s a motor planning “thing”. But, I am just not sure why they don’t want to give us a definite diagnosis.

    He has been seeing a SLP once a week for about 4 months and has gone from saying about 2 words correctly every once in a while to saying “mommy” and “daddy” and some short words that start with vowel sounds. He is definitely saying a whole lot more, but I can barely understand what he is saying because most of the words he says are the ends of words. Like, “uck” is for “stuck, truck, snack, walk, ect,” I have incorporated asl signs that he uses for better communication. He also has a hard time when we work with him on putting the beginning sounds to words. Like, “mmm-milk”. He will reply with, “mmmm-gilk” or “ilk”. And refuses to use the sign for “milk”. (I will give him credit for being 2). He is also putting 2 word phrases together, but also with out the beginning sounds to either of the words. Only the vowel sounds. Like, “i-uck” for “big truck”. He usually gets “big-uck” out by the third try. I try and work with him to get both pronunciation and sounds out. Its mostly just sounds of words . So, I have a hard time understanding what he tells me most of the time. Also, when we are out around other children if the child talks to him he shuts down completely. He will only play and talk at the same time when he is at home or all by himself and around just a few children.

    My concern is if he has CAS at all. He has a lot of words, but it takes time to get just one out, and pronounced correctly. When he turns 3 he will get ST through our school system, and I will be homeschooling for preschool. Should I push for some sort of different therapy? Should I ask to be evaluated specifically for CAS?

  • Isa Marrs December 2, 2011, 4:43 pm

    Hi Liz,
    I am glad to hear that you found my information helpful. It would be great to see a therapist for an evaluation who has knowledge and experience with CAS. In regards to therapy the frequency and quality of the therapy is extremely important. Given your description of your son it would be beneficial for him to receive therapy at least 2x a week.If the school is unable to provide it I recommend investigating other options.

  • Naomi Melby December 7, 2011, 5:33 pm

    My daughter is 30 months old and has a vocabulary of 60 words with some two word sentences. She is very bright, and has no other delays. She hasn’t lost any words, only she used to say puppy and now says baby, and used to say Dada and now says GAGA. Does this sound like Apraxia?

  • Isa Marrs December 8, 2011, 1:38 pm

    Hi Naomi,
    From your description this does not sound like CAS; however I would recommend a speech and language evaluation. At 30 months her vocabulary should be much larger than 60 words. She may have an expressive language delay and could benefit from speech therapy.

  • Rachel Johnson December 12, 2011, 6:04 pm

    Hi Isa,
    My son is seeing a SLP three times a week BUT only in groups at our overseas elementary (military family) which also means he isn’t able to see his SLP during summer or any other breaks the schools has. He has not been diagnosis with CAS, they just have said he has severe language delays and they don’t like to diagnose kids until seven years of age ( I have never brought the idea of CAS up to them if that makes a difference). My son is four years old and can’t really put more than two words together and even then the pronunciation is hard to understand ( i.e. the other day he was trying to say “back” but what came out was “butt” even after I tried helping him or cat sounds more like “ah” or “at”) he does understand what we are telling him it’s just hard for him to vocalize himself. So my question to you is do you think he may have CAS and is there anything I could do(even at home just me and him? At this point I am desperate!

  • gabriela December 16, 2011, 12:53 am

    Hi. My son will be four in two months and has a significant speech delay. He started speech therapy a year and a half ago and started head start in aug. He currently only gets speech therapy once per week while he is at school. I recently took him to appoint to try and get more help/ information on what needs to be done to give my child the right help as i feel we need to be doing more. This is the first time apraxia of speech was brought up. Do children with this disorder usually have eating problems? My child has always been a good eater and has not had any problems with eating. He did start to say a few words before the age of one (mama,papa, bye bye)and later stopped. Between the ages of 2- 3 1/2 he would not atempt to imatate any words and only had 15- 25 word he would say. He now says alot more words and will attempt to say any word i ask him to say but they are noe very clear. He only says a few phrases other than that he sticks to one or two words to communicate. Do these seem like signs that point to this disorder

  • Crystal Agard December 18, 2011, 3:35 pm


    My daughter is 20 months. We’ve had diagnoses that run the gammet: PFO, Central Apnea, Hypotonia, Gross Motor Delay, Developmental Delay, Thin Corpus Callosum to name a few. I tell you this because she is presently receiving state assistance for her motor and speech delay, and every therapist that walks into my house says that she “presents like a child with CAS”. They tell me that her motor issues can be directly related to her speech delays, and the fact that she is suddenly regressing in her motor skills can be a cause of the apraxia.

    I have only ever wanted to be sure that she was getting the therapy that she so clearly needs – she signs, and she can problem solve like no 3 year old I know, but she gets frustrated because she can’t communicate clearly. She babbles like crazy, but can’t seem to retain the words she learns. Bye-bye has recently turned into mao-mao, but occasionally she says it correctly. She is also adding a hard k sound on the end of the word more – it usually comes out mooooor…..k. She signs the word as well, so I know that’s what she’s saying, but I can’t seem to get her to drop the k sound.

    She went from being able to walk up stairs with assistance using alternating feet – one foot per step (I know, it’s so young for that skill) – to not even being able to crawl up the stairs. I’ve been concerned about a Neuro issue since day one which is how we came to have therapists for her to begin with, but does a diagnosis of CAS fit a child who is having motor issues in conjunction with her expressive communication problems?

    I worry that they are jumping to a diagnosis early to get me to stop worrying about every decline she has, but it seems to me that a child shouldn’t get better and then regress like she is. With every concern I’ve related to physicians I’m met with the response of, “Well, she looks good, and she seems to be improving”. Every time I hear that I want to ask them, “If it took your car 5 miles to get up to 15 mph, but after that it ran like normal, would you accept from the mechanic that it does fine once it’s at 15 mph?”

    We have a speech therapist who works through the county program that provides service to children with special needs, but can it be detrimental for them to jump to a diagnosis that they shouldn’t be able to come to for another 16 months? The therapy seemed to be doing wonderfully until the past few weeks when she started to regress. They keep telling me not to worry, but it seems like something I should be worried about…if I’m being an overbearing, psychotic, munchausen-by-proxy kind of Mom, let me know. I just want to do what’s best for my little one, and it’s scary putting your trust in medical professionals anymore because (as sad as it is), C=MD, and you just don’t know where a doctor graduated in their class….

  • ggKate December 19, 2011, 1:11 pm

    To be honest I read about CAS a few times before I have heard about it from our SLP as a possible diagnosis. However, I almost immediately dismissed it because nearly all descriptions say that CAS babies do not coo and babble until later, and are generally very quite. This was not the case with my son. He started to babble at the same time as his peers did. If anything I kept hearing from his caregivers about how “talkative” he was. But then he turned 1, and there was no first word. He still bubbled a lot though. And then, 15 m, and 18 m and still no first word. Of course well-meaning friends, and just about anyone else I met were telling me how, he is a boy, and boys tend to be late talkers. Also my baby is bilingual. So that came into play as well, as I read and heard about how multilingual babies often start to speak later. Even at our 18 m Dr.’s appointment our pediatrician told us that we could wait till 2, because between 18 m and 2 years is when “speech explosions” usually happen. We have decided to involve EI when he was about 20 m. o. At 20 month he was still only pointing and granting. Not a single word. They evaluated him and concluded that he is eligible for 1 h per week of speech therapy. He has no other developmental delays. So far we have had 7 weeks of speech therapy and one week the appointment was missed, so 6 appointments total. There is no improvement. He still does not say a word. Couple of therapies ago, our SLP said that she suspected that he had CAS. Some of the Early Signs and Symptoms of Apraxia apply to our case and some don’t. Like I said he used to bubble a lot as an infant. Now he actually bubbles much less. SLP said that it’s because kids of his age don’t usually bubble. They say “words” that have meaning (at least to them). And since she believes that he cannot really say words that have meaning , it causes him to remain quite most of the time. He is still bubbling once in a while, and we can definitely solicit bubbling. For example if I say “ba-ba” when he is in a good mood, he repeats. But most of the times he just points and grunts. Sometimes it sounds like he is talking inside of his head. For example, sometimes I spot him “reading a book” – he is seating with a book, pointing at pictures and “talking” with his mouth shut. “M-m-m” is all I hear, but with different intonations. Same when we are going for a walk. He continuously points at thing throughout the walk and says “m-m-m”. He also always looks into my eyes, as if to make sure that I’m listening. He understands a lot. He can count to 5, I’m pretty sure, if not to 10. And he knows quite a few alphabet letters. He can point almost all the animals in a book. He definitely knows a lot of words but does not say out loud any. The only thing that he consistently “pronounces” is “growling”, when I ask “What does a lion (or a tiger) say?”. I have also noticed that he started to do the “growling sound” lately when I’m asking him to vocalize other animals. I will ask “What does the dog sat?”, and he growls. He also growls when naming letter ‘R’ (which I guess is a fair game because it kind of is a same sound☺ The only exception is a cow. It seems like lately he really has been trying to say “moo”, however only ‘”m-m-m” comes out. No “oo”. It seems like he is really trying to say “moo” but cannot. It’s a first time that I have noticed an attempt “to talk” on his part. However, I really cannot say that I see to much “struggle behavior” there. He just tries; I am praising him on whatever comes out. That’s about it. He also uses vowels a lot. And his consonant repertoire is pretty limited. He says “ba”, “da”, and “va” without any problem while bubbling (not using any of the above consistently as a “word”). As soon as anyone tries to solicit “mama” – he usually stops bubbling all together. Even though lately I did hear him trying to imitate. Something like “ma-pa” came out. I also read this: “The child is able to open and close mouth, lick lips, protrude, retract and lateralize tongue while eating, but may not be able to when directed to do so.” That does not seem to be a problem. He pretty easily opens his mouth, retracts his tongue and “gives kisses” if solicited. I have also noticed that he watches my mouth very closely when I pronounce certain words or sounds. For example, he will seat on my lap facing the book while I’m reading a story to him, but when I get to the part where a certain animal makes a certain sound (a rooster for instance) he turns his head all the way around and looks at my mouth while I’m making a sound. But he never tries to imitate it.

    My son will turn 2 in less than a months. I realize that he is still too small to be given a definite diagnosis. I understand that a lot may change between the ages of 2 and 3. He also did not really make that much of an attempt to speak as of now – so it can only be suspected that motor planning is an issue for him at this time. But you are also mentioning that even if it’s just suspected that he has CAS, he should be treated as though he has the disorder. So at this point I am concerned that with the therapy we are having today we are just loosing time so to speak. Our SLP has mentioned that there will be some period during which she will only work on her relationship with our son, and that before he warms up to her, there is really not much she can do. It takes my son some time to warm up to strangers. And quite frankly she only sees him once a week for 1 h, and some times even less than that (if there are holidays in the middle) and by the time she comes back he pretty much treats her as a new person again. During the therapy sessions she is pretty much just playing with him with different toys and showing him different signs while saying words out loud. I am teaching him signs too. He is now signing consistently, but needless to say he has never attempted to repeat a word during a therapy or otherwise. Are we not wasting time at this point? So if he does indeed (and I hope not) has CAS, is not every day that passes by gets us further and further away from getting him ever to speak normally (obviously I read a lot about brain plasticity, etc☺ How long should I wait for my son to “warm up” to her, and her actually doing anything with regards to his speech, before I say something. And quite frankly, I don’t even know what is it that she is planning to do, and I don’t exactly know how to ask. If I ask her what’s the plan and she names some techniques she is planning to use, will I know the difference? I know that she has been treating kids with CAS before because she has mentioned it, however, I don’t know if she specializes in CAS per se or just had a few patients, and I don’t know how to ask it without it sounding like an interrogation. What makes an SLP an expert on CAS? So far from all my online research I consistently read only about two supposedly effective techniques in treating CAS: PROMPT and Kaufman’s program (and I think someone has already mentioned them above). But does it mean that SLP that is not certified in the above techniques will not be effective in treating CAS and we are just wasting time at this point? Should I be reaching out to EI coordinator and demanding PROMPT therapist? And if they don’t have any available, should I search them out in my area and look into paying for them out of pocket or through the insurance? And most importantly in the later case should we still keep seeing our current SLP, or having 2 different SLPs can actually do more harm due to a potential inconsistency in their treatment. I guess what I’m trying to say is, that it’s very difficult to navigate our way through this disorder and find the best possible approach for helping our son. Like any other parent with a kid who was just diagnosed with suspected CAS, I am extremely anxious about loosing the valuable time and the potential effect of this on my son’s progress. On the other hand it’s extremely hard to navigate between literally hundreds of sites and personal blogs of SLPs and parents of the formerly CAS diagnosed and now miraculously cured kids, and figuring out which are the real proven techniques, and which is just another experimental approach that may or may not work for different kids but costs hundreds if not thousands of dollars.

    From reading your blog I can tell, that your feedback is sincere. What would you do if you were in my shoes?

  • Micki December 20, 2011, 3:17 pm

    This article and links have been extremely helpful. My baby is 3.5 has been in traditional speech since she was 18 mo 1x week. We are now suspecting CAS due to drooling, low oral muscle tone, loss of words… She only has about 2O words 10 signs and those words arent that clear… It is evident she needs more therapy, can you help me find out how to get insurance to cover more than 20 visits a year??? My speech path is telling me appeal is futile!! HelP:((

  • Isa Marrs January 2, 2012, 2:18 pm

    Hi Micki,
    You are right that she definitely needs more therapy. Unfortunately I do not have any helpful hints in dealing with insurance. We choose not to take insurance here because it is difficult to get them to cover speech therapy.

    I would suggest having your therapist write a letter of necessity to your insurance company. It may work and it may not work. Sorry I could not be of more assistance to you.

  • Isa Marrs January 2, 2012, 2:22 pm

    While it is impossible to diagnose CAS without seeing your child it definitely sounds as if he has a significant speech and language delay. I would recommend a high quality evaluation by a licensed speech language pathologist who has knowledge and experience with CAS. From your description I would recommend at least 2 weekly therapy sessions as well.

    While many children with CAS also have oral apraxia feeding problems are not always associated with CAS.

  • Isa Marrs January 2, 2012, 2:23 pm

    Hi Crystal,
    Has your daughter ever been seen by a pediatric neurologist? If not I would make this a priority. I agree with you that any regression in children is worrisome. A pediatric Neurologist could rule out any other neurological conditions. It is possible that your daughter has CAS however it is not possible to make a diagnosis without seeing her. Do you have a child development team in any of the hospitals or universities near you? If so I would recommend getting a thorough evaluation from a full team of therapists.

  • Isa Marrs January 2, 2012, 2:26 pm

    Hi ggKate,
    If I was in your shoes I would do my own research and find out who is the best pediatric speech language pathologist in my area and if she treats children with CAS. If so I would find a way to see her. If not I would ask her for a referral and go from there. The state programs could be great but they could also be terrible and I would not want to take that chance with my child.

  • Isa Marrs January 2, 2012, 6:40 pm

    Hi Rachel,
    It definitely sounds like a possibility that your son could have CAS. Without knowing him I would not be able to give you any tips on how to work with him. However his SLP should be able to help you. Most likely he will need daily practice on his target words and phrases which she should be able to generate and you can do at home. You might even want to practice a couple times a day for maybe 15 minutes each time. Your SLP should be able to help you know what is appropriate and when to move on. Choosing the right goals and lots of repetition is the key when working with children who have CAS.

  • Sam January 2, 2012, 11:30 pm

    I would love any feedback you may have after I tell you a bit about my son. He will be 19 months on the 8th of January. We have never been concerned about any developmental delays until recently. I am a psychologist and work with infants and toddlers, which has made it somewhat difficult to not overly scrutinize every developmental stage. He seems to always fall on the later side of milestones (walked at 15 months), but it is almost like he sits back and takes it all in and then takes off. Although he didn’t walk until 15 months, he was nearly running when he did start. He has been gesturing and communicating nonverbally for months and his receptive language skills are very strong. He follows two step directions and has learned the few signs that I have taught him. I have never observed any oral motor difficulties. I can remember thinking that he didn’t imitate sounds or make any attempts at animal sounds or saying uh-oh etc, but until the last month I just felt like he was progressing and would be a late talker. When he started gesturing to get his needs met he was also vocalizing. At around a year we felt like he had a few words and at that time he started responding yes when asked a question. His yea, was very accurate and if it wasn’t something he agreed with or wanted he wouldn’t say anything. Now at 18 months when we really think about it, other than the yea, he doesn’t seem to have any words. There are times when the inflection of his voice sounds like two and three words phrases appropriate to the situation, but he doesn’t verbalize any words for objects etc. He can identify most anything in a book or in his environment, but other than one or two utterances of ball in the last 6 months he hasn’t used any other words. We have noticed his babbling has increased over recent months, but up until a month ago everything was really dadadadada. We have heard other sounds, but not regularly. In the last month we have really worked on trying to get him to imitate p, b, and m and we now hear him using b, d, and m sounds spontaneously. With lots of work and prompting we can now get him to make a p sound, but it seems to take a ton of prompting. He responds very well to our praise and encouragement and again, in the last few weeks I feel like we are seeing more progress, but I’m concerned that he really doesn’t have any words and that his babbling was limited to mainly one sound for so long. I have some knowledge of CAS and have been doing some online research, but from what I’ve told you would love to hear your opinion. I want to get the proper support if necessary, but am also afraid that having worked with so many non-typically developing children it is sometimes hard to know what the true range for typical development is.

  • ggKate January 3, 2012, 9:18 am

    Dear Isa,

    Thank you very much for your response!

    I don’t want to sound cynical at all but your suggestion to “find out who is the best pediatric speech language pathologist in my area ” is not as easily accomplish-able as it may sound…SLPs are not exactly rated on Yelp (and if they were I would not want to trust that probably, would I?:). How do I find out who is the best? I have much lesser goals, I am trying to find either PROMPT certified SLP or K-SLP knowledgeable SLP and I am having enough issues with that. It seems like there is no way to find out how knowledgeable one is with K-SLP as there is no real certification path there. As far as PROMPT, I searched through there web-site, and I found only 1 (!) SLP who completed PROMPT bridging and ZERO PROMPT certified SLPs anywhere even remotely close to my area (within 2 h of driving). And I live in a large metropolitan area. In addition to that, does it make someone “the best” just because they are certified in a certain technique? My guess is no…In short if you can suggest an online resource or a professional who could help me finding out the best SLP I’d greatly appreciate it.

    One more question. As I am in process of searching for SLP for my son, which proved to be extremely tedious process, I am getting more and more anxious with regards to the fact that he is bi-lingual. I understand that the general guidance here is to keep the kid using 2 languages as constricting him/her to only one language may degrade the quality of life. I would love my son to speak two language he currently understands (equally well). And needless to say I’d love him to be able to communicate with my parents who live in another country. This being said, considering the fact that we are living in US, I do not believe speaking only English will seriously degrade his quality of life. On the other hand not being able to speak any language properly, because the speech therapy was not very effective and because we were desperately trying to get him to speak 2 languages may pose quite a challenge.

    What is you opinion on the bi-bilingualism and children with CAS? (Provided he has CAS of course, who knows?)

  • Isa Marrs January 3, 2012, 2:59 pm

    I am sorry for making the process sound easier than it really is. And you are right there is no website that will tell you who the “best” SLP is in your area. In fact even if there was a SLP who was the best rated, she might not be the best fit for your child.

    My suggestion is to ask as many people as possible if they have a SLP to recommend. I would ask my doctors, friends, acquaintances and parents of other children with special needs. I would talk to each therapist and get a feel for their personality, knowledge and experience. I would also suggest meeting with several therapists until you find the one that really clicks. You will know when it does by watching her with your son. You will also likely see some immediate progress.

    In regards to PROMPT, a therapist who has completed bridging would be great. However, a PROMPT trained therapist could work as well depending on her skill level and rapport with your child. Again, I would suggest meeting with them before making a final decision. The level of certification does not necessarily correlate to quality of therapy.

    When it comes to the issue of bilingualism and CAS it does get a bit complicated. There is no reason why your son can’t be bilingual if other than his speech he is developing normally. I would recommend making sure the languages are really separated, meaning that he will hear English at certain times and a second language at a different time. I would never recommend mixing the 2 languages. However with that being said, if it is not that important to you, stick with English, as long as you are a competent English speaker, which it appears you are.

    Where do you live?

  • Isa Marrs January 3, 2012, 3:02 pm

    Hi Sam,
    From the description of your son it is clear that he is a Late Talker. At this point there is no way of knowing whether or not there is anything else going on. Some may label a non-verbal 19 month old with suspected CAS. However, the truth is that it is not possible to diagnose him this early.

    With that being said, I would recommend Speech and Language therapy at least 2 times weekly. The sessions should be short in duration, possibly 30 minutes and you should be very involved. While I have never met your son I am always concerned when a child is over 18 months and non verbal. You may see an explosion of language in a short period of time and then you can stop the therapy. However if you don’t you have not wasted precious time!

  • ggKate January 3, 2012, 3:56 pm

    Hi Isa,

    Thanks again for your response.

    With regards to the bi-bilingualism, my son does not have any other developmental delays at this time. We do try to separate the 2 languages as much as possible. The pressure is on me of course, because my husband speaks only English 🙂 I try my best to speak only the 2-nd language, but of course when all three of us are together it is REALLY hard not to mix. I appreciate your advice regarding this. I am currently considering switching to English only.

    We live in Philadelphia. If you know an SLP who is a CAS specialist in our area I’d greatly appreciate the referral.

  • Crystal Agard January 10, 2012, 12:26 pm


    We have been taking our daughter to a Pediatric Neurologist since she was 2 months old because of the many developmental delays she has had. We have also gotten involved with a county program that brings teams of therapists (of all sorts: OT, PT, SLP, and Special Education Teachers) into the childs home for a more comfortable and continuous evaluation. I feel like we are doing everything in our power to help her, but we are unfortunatly at the mercy of the physicians at this point. Her regression has been attributed to a growth spurt. She has also been having difficulty staying upright when sitting unless someone or something is behind her. Again, this has been attributed to a growth spurt and her being tired. Does that make sense????

  • Isa Marrs January 17, 2012, 2:54 pm

    Hi ggKate,
    Unfortunately, I do not know any therapists in the Philadelphia area. You can look on the American Speech and Hearing Association (ASHA) website which is our professional organization.

    Good luck!

  • Isa Marrs January 17, 2012, 2:55 pm

    Hi Crystal,
    I would recommend getting a second opinion. When it comes to speech and language a growth spurt would not cause regression.

  • Isa Marrs January 17, 2012, 3:08 pm

    Hi Micki,
    If she is in a quality school program I would say the 4 speech sessions and the 5 half day preschool would be great. It would be helpful if her Speech Language Pathologist connects with her classroom teachers and talks to them about what they can do to help carry over her speech goals. Please let me know how she does.

  • Jackie January 19, 2012, 11:00 pm

    Two issues to consider. Insurance Companies will not accept an apraxia diagnosis from a speech pathologist as it is a medical diagnosis.

    Second many insurance companies will not pay for a developmental speech delay, but will pay for an apraxia speech issue( referring ti speech therapy services)

  • Isa Marrs January 26, 2012, 12:20 pm

    Speech Language Pathologists are qualified and able to make the diagnosis of Childhood Apraxia of Speech (CAS). It is a motor speech disorder not a “medical diagnosis” and that is our area of expertise. Quite often insurance companies do not cover services for children with CAS regardless of who makes the diagnosis. They most often only cover services that are due to accident, injury or congenital anomaly and they do not feel that CAS is any of these three.

  • Claudia February 5, 2012, 4:23 pm

    Our kid is 4 and a half and has been recently diagnosed with Childhood Apraxia of Speech (CAS). We speak Spanish at home and the therapy is in English…One of the therapis is from the school and encourage us to keep speaking in Spanish…the other is private practice and asked to speak in English the whole time…What is your oppinion?

    Thank you!

  • Jen February 7, 2012, 4:02 pm

    Can you recommend any speech therapists in Los Angeles who are experts in apraxia?

  • Isa Marrs February 8, 2012, 5:21 pm

    If your primary language is Spanish and it is the language you speak fluently then you should definitely speak Spanish. If you are just as fluent in English you can use both languages as long as you don’t mix the two.

  • Isa Marrs February 8, 2012, 5:22 pm

    I am sorry to say that I don’t have any personal recommendations for Speech Language Pathologists in the Los Angeles area. You can try ASHA. That is our national organization and they have a database of therapists and their areas of expertise.

  • Dylan February 29, 2012, 9:24 pm

    Our daughter is 4 years old and was diagnosed with apraxia of speech 1 year ago. She is now receiving private speech therapy and ST at school, but her school ST feels she has a phonological disorder and not apraxia of speech. What exactly is the difference? Are they treated the same?

  • REYNA March 13, 2012, 11:08 pm

    Hi, my daughter…2 year 4 months was just tested for speech….they think it may be verbal Apraxia. From everything I have been reading, it seems like it may be accurate. They say she is fine cognitively…..I am really wondering what her outcome may be….will she talk? after how long? what is typical? She has not started speech therapy yet but they suggested 1-2 times a week. They (child connections) said they will contact the speech therapist that typically works with children who have verbal apraxia. Please, any comments or experiences are welcomed.

  • Isa Marrs March 21, 2012, 3:26 pm

    There is so much confusion around Childhood Apraxia of Speech. It is rare for a child to have only CAS as they often have other phonological sound errors as well. So it is likely they are both right!

  • Isa Marrs March 21, 2012, 3:29 pm

    Without meeting your daughter it would be impossible to give any sort of prognosis. In fact I usually like to work with a child for a while before giving my opinion of what the future may hold. I do recommend that the speech be provided at least 2 times a week. One session per week is just not enough. Also, if she is only 2 and not talking yet, I would not be comfortable with a diagnosis of Childhood Apraxia of Speech.

  • Mir April 12, 2012, 6:20 pm

    My daughter is now 4 1/2, she was diagosed @ age 2. Right away she was visited 2 home up to 3 times a wk. She now talks, sing, jokes around, tells stories, he even reads her favorite book to us GOSSIE & FRIENDS. She goes to speech school 3 to 5 days a wk. I have to say the sooner the speech therapy is started the better, im gratefull for everyone that help her talk. It was such a beautiful song when I heard her talk for the 1st time……. we have learned some sing language as well, & I still practice this with her………….. As a parent I kept pushing & pushing…….(but not to the point that she wouldnt enjoy) I cant thank enough,………..Take advantage of everything thats offered for ur kid. It might seem like a though road, but its just a breeze……..

  • Isa Marrs May 22, 2012, 11:57 am

    Hi Mir,
    Thanks for the comments and words of hope!

  • REYNA May 22, 2012, 12:48 pm

    Since my last post, my daughter has started speech at home and I took her to get an outside evaluation done as well. She has a few more words than before and I am so grateful as she just starting saying “lu you!” which is her “love you.”
    CLAUDIA, I just read your post and since we also speak English and Spanish at home (and my hopes are that my daughter will be in the dual-language program when she starts Kinder), this was one of my first questions. I have spoken to a few speech therapists and they said to KEEP speaking in both languages (of course try not to mix the two- as with any child) but not to be surprised if your child speaks in English quicker than Spanish because many Spanish words have more syllables than English words (Pelota, ball…arriba, up)….this was something I never thought of until it was brought to my attention. Hope this helps!

  • Isa Marrs May 23, 2012, 4:05 pm

    Great to hear she is talking more! This will just be the beginning!

  • Beth May 29, 2012, 11:06 am

    Hi and thank you in advance for any help/advice you can give me. My son, Michael, just turned 4 years old. He was diagnosed by his Speech therapist (Early Intervention) at 3 years old. He’s suffered from tone, motor planning and OT issues and has been receiving services starting at 8 months old. At 3 he transitioned to the Public School….which is good and bad. Currently, he is receiving speech services thru the public school system, twice a week. And in addition, he receives private speech once a week, for a total of 3 sessions each week. Yet, he is still not speaking. He will say a few words and tries to say others but there is a definite deficiency with any sound where breath/air is pushed out – shhh, snake, moooo, etc. Also, he will not always attempt speaking a word/sound and refuses to cooperate at all. Thank goodness Michael fully understands when you speak to him and he is always able to get his needs met (he is very stubborn!). My concerns are…so many…..
    Will he ever really speak using more than one or two words (the two words have started recently).
    I was also just told by his new Speech Therapist that he does NOT have CAS. She thinks it may be something else….but didn’t say what it could be. Early on, maybe at a year, we took him to see a Speech Pathologist in Providence, RI and she had mentioned Cerebral Palsy. But, she was the only one to say it.
    Also, when he was younger, he spoke words – duck, quack, and even said caterpillar. (My mother was sitting across the table from him so I have a witness. Most people do not believe that he actually said it but, I had him repeat it and he did. And it was clear when he spoke.)
    So, now, at four years old, I am totally lost at what to do for him – Did we miss something? He’s had tests, hearing, vision, MRI etc with nothing out of the ordinary showing up
    I feel like I am failing my son. Where do I go from here? What else could he be suffering from? And, how do I help him?
    Also, he was a twin but the twin passed at around 12 weeks but I carried it the entire pregnancy. Could this have caused blood/nutrient loss? He was a full term c-section. I do not know his birth scores but have always wondered if something happened during his birth to cause this?
    Thank you again – I’m sorry this is so long but I am growing more desperate and cannot miss an opportunity to help my little guy!

  • Erin June 8, 2012, 9:46 am

    Hi, my son is a non-verbal 2 year old. He had fluid in his ears- we have no idea for how long and he got tubes in Feb. Since Feb, we still have no speech. My neurologist says we can no longer use his hearing loss as an excuse for not talking. Because of this he is now being labeled as suspected autism spectrum and suspected apraxia. He has 6 hours ABA, 2 speech and 2 OT a week. I guess my question is, if it really is apraxia- do we need to get a speech therapist who is PROMPT certified? How important is this? AND if so, how do I find a PROMPT certified speech therapist in NJ?

  • Catarina Lore July 3, 2012, 1:50 pm

    My son is 32months (almost 3) and he has a very limited vocabulary. Only recently has he been saying more words. 2 things we have changed are: prompt speech services (1hour a week) and we started 3 weeks ago giving him omega-3 supplements. He is making more sounds and saying things in context. He is enrolled in the CT birth to three and we have requested more speech hours but according to them CT only allows 1hour a week per child. If this is what he needs and it seems to be working I cant imagine we would be denied. Any further info you have in the westchester/lower fairfield county area? Thanks!!

  • Isa Marrs July 3, 2012, 3:49 pm

    Unfortunately state early intervention programs have limited funds and are not always able to provide the frequency of services that are most beneficial. I would recommend 2 weekly sessions as a minimum. If you have the ability I would recommend supplementing his services outside of early intervention with some private speech therapy.

  • Brenda July 4, 2012, 12:18 pm

    My son has been getting speech therapy (Early Steps) since he was 2. He is now approaching 4 (in September) and we have had two different SLP’s working with him. One suggesting he has CAS (and was unsuccessful in even getting him to say more than 10 words) and one confident he didn’t ( and was successful in getting him to speak2 & 3 word utterances and expand his vocabulary to over 80 words. She was convinced that it was strictly articulatioin). The reason we had to dismiss the successful SLP is because after 8 months my son became completly not interested in his sessions any more and more time was spent in trying to get his attention than on therapy.We are at odds on who to trust and are looking for a third SLP in our area that can test him. The first two knew each other and never got along, so the difference of opinion, I believe, stems from them not liking each other. If you can, please recommend someone in the Lafayette LA area.

  • Isa Marrs July 12, 2012, 9:23 am

    It is not possible at this point to confirm a diagnosis of Apraxia; however finding a really strong therapist is key. While PROMPT can be beneficial it is not necessary as many therapist work wonders with non verbal children without PROMPT. Finding a good match is the most important. PROMPT does have a website that could help locate therapists in your area. What area of NJ are you in? I do know some therapists in that area.

  • Isa Marrs July 12, 2012, 9:31 am

    My assumption as to why he did well with this particular therapist is that they were a really good match. Not every therapist is right for every child.

    In regards to the diagnosis I would assume that the therapist who made all the progress had the right diagnosis. Being that they were such a good fit I would reconsider letting her go. Maybe a short break would help. Maybe a change in location if she comes to your home or maybe the therapist needs to change her approach slightly to regain his attention. Maybe lessen the pressure to reengage him. In therapy with such young children we often see ups and downs with interest and behavior. I would not give up on her so fast.

    As per a recommendation I do not have any contacts in your area.

  • Isa Marrs July 13, 2012, 11:26 am

    Hi Beth,
    I am so sorry I missed your message and I took so long to respond. I can imagine it must be so difficult to wit this long for your little guy to talk. Since he has been making progress you should continue to expect him to make more progress. The progress is slow and will continue to be slow however there is progress. If possible I would increase the private speech to 2 times a week. It is difficult to make significant progress with a child who is only seen once a week by a particular therapist. It seems as if you have ruled out any neurological conditions when you saw a neurologist you can always get a second opinion. It might also be helpful to see a developmental pediatrician. Lastly, I would talk more with his new SLP about what she thinks is going on. It is your child and she should feel comfortable to express her thoughts to you.
    Please keep in touch and let me know how he progresses.

  • Sue July 24, 2012, 3:34 pm

    Hi Isa,
    I am a practicing k-5 SLP with very little “hands on” experience when it comes to CAS. I am about to begin my 2nd year at my current school and have a 4th grade child with a diagnosis of CAS on my caseload. Last year was a “catch up” year as far as progress goes. He was not even close to his end of the year %’s that were on his last progress report when I first met him. He has mainly isolated phonemic errors at this point with /r/ being his most difficult. Consistency is lacking to say the least. Isolation is 0-10% at best but oddly enough he does improve when the /r/ is within a word. Co-articulators are helping him produce the sound…sometimes. Lots more I could go into but needless to say, I’m out of ideas. Parents are frustrated, child is seemingly oblivious to the errors and I am at a loss. I believe his “obliviousness” to his errors may be impacting his ability to further his success but at the same time, worry that he may become self-conscience/introverted if more emphasis is being placed on his speech. He is a very social, well-liked, popular young man. Works very hard in all areas. I would very-much appreciate your thoughts/tips on working with older students with CAS, in particular students who have difficulties with that pesky /r/.

  • Isa Marrs July 25, 2012, 11:36 am

    Hi Sue,
    Are there any other language learning or attention issues? Are the parents working with him at home on a daily basis?

  • Sue July 26, 2012, 11:26 pm

    Hi Isa,
    He does have difficulty with reading but not too far off grade level. He also goes to speech outside the school 1x/week (he receives 120min/week at school). Family is very involved but not confident they are working every day on correct sound production (especially over the summer). I have been hesitant to send /r/ homework due to the inconsistent production in the speech room… I don’t want the “not so good” /r/ to be reinforced at home.

    Thank you!

  • Sandi August 5, 2012, 2:27 pm

    For the family looking for an SLP in Philly area w experience in CAS …Sue Caspari…Maria Unger
    Also look into Valley Forge educational center/The Luma Center – PreK for kids w speech/language disorders including CAS

  • Sue August 10, 2012, 8:46 am

    He is a little behind in reading but still within grade-level. No attention issues. Parents are very involved but do not practice on a daily basis. He receives 120min/wk at school and 45min/wk of outside therapy. I have been hesitant to give “homework” because he isn’t consistent in producing the /r/. I would hate for him to be reinforcing the “not so good” production at home. I believe his therapist from the outside agency does send home /r/ worksheets/stories.

    Thank you for any advice you can give!

  • Isa Marrs September 12, 2012, 6:50 am

    Sorry for the delay in responding. I do agree that sending home artic. homework when a sound has not been mastered is counterproductive. I would recommend having the family come in for a few of your sessions and hear what the sound sounds like when he gets it right. And talk with them about how to reinforce it at home. I would also work closely with the home based therapist. She could be the connection for you with the family.

  • Isa Marrs September 12, 2012, 6:53 am

    Sandi, thanks for the information!

  • Catherine September 15, 2012, 2:03 am

    Hi Isa,

    My son just turned two in August and has about 40 -50 words. As I understand this is on the low side. He does not string words together and by no means uses all of these words regularly. These are words I have heard him say and most of the time feel comfortable to repeat them. He uses his “own” sign language to get what he needs ( for example i know he wants to ride bikes when he taps his head…meaning he wants to put on his helmet) and can say no and ya to answer questions. I do many picture books with him and give him an m&m if he says a word or repeats when we are working. ( I’m desperate). All of this sounds not so bad but what worries me is he doesn’t getting new words often. He gets very frustrated. He won’t repeat new words. Sometimes it looks likes he’s trying but nothing comes out. If he doesn’t want to try then he says no or sometimes says “aaa” as if he thinks he’s saying what I’m asking. He has an older who asks him lots of yes and no questions and I am guilty of the same. I talked to his pedi who said I need to wait until 2.5 and we will reassess and she will make a recommendation. Plus she said the state won’t assess until 2.5 My question is should I wait? He is vey smart, excellent motor skills, no eating issues and communicates what he needs but it bothers me he won’t repeat. Many times I will say to him say nose….I would think that would be easy as he say no to me all day, yet instead of trying to talk he just points to his nose. Same with many things I ask him to say, he just points. He also says rock rock when on the rocking horse but outside we see a rock and i tell him then ask him to say it and he just says aaaaa…yet i know he can form the word in another context. I feel there is a connection missing.? And everything with wheels is either a room room or a choo choo. I sometimes feel he physically can’t and other times he’s just stubborn. I am in the SF bay area.
    Thank you for any advice

  • Isa Marrs September 17, 2012, 1:08 pm

    I would not recommend waiting if you are concerned. If the state won’t do it you can do it privately. The worst thing (best thing) that could happen is that the therapist you see will tell you that there is nothing to be concerned about.

  • Charity September 18, 2012, 8:23 pm

    Hello, My daughter will be 2 next month and has been receiving speech therapy for almost 6 months. In that time she has only learned 1 word Ut-Oh, She was already saying Mama witch she calls everyone and Dada witch is just for daddy. She has had a therapist through EI once a week, has had an autism screening, goes to a playgroup through EI once a week for 2 hours, and just today they added another speech pathologist once a week for an hour. I know every child is different and you can not diagnose a child under 3 or who you have not met, but my question is should she be talking more by now? Or should I be looking into a different group? During her Autism Screening they said shes too receptive to be autistic, but she does lack Social Emotional skills as well. Shes been in the play group for over a month and still will not interact with any of the other children and is quickly becoming MORE frustrated with herself everyday. They told me I should make picture strips and put them around the house so she can point to things she may want. I came across this site while trying to find materials like this. Do you know where I could find picture strips of sorts to communicate better with her? She does sign simple words please, open, more, bye, no, yes, eat, drink. I want to learn more myself so I can teach her, but again I find myself lost in an ocean of information called the internet! Is there any easy to use simple learning sign books/movies that you would recommend? Thanks in advance!

  • Dana September 24, 2012, 7:28 pm

    My son has just turned 3. He has been in early intervention for just under a year. I am not being given any direction as to what is causing his speech delay. I just want to help him but it seems that the specialists will not commit to a diagnosis or even an area. Please let me know if you know of a speech pathologist in the rockland county NY area. I will be willing to travel for help. Please. He gets speech therapy 3 x’ s a week and full day program and I’m not realy seeing an improvement.

  • Isa Marrs September 26, 2012, 12:16 pm

    Hi Dana,
    We are across the bridge in Westchester County. I would be happy to see him and give you my opinion.

  • Isa Marrs September 26, 2012, 12:18 pm

    I am always so sorry to hear from parents in such distress with no one to guide them. It is impossible for me to say whether or not your daughter is in the right program or with the right therapist. Sometimes progress can be extremely slow when they are so young. I am sure she is changing in many ways and it would be your therapists role to point out all the good things she is doing. If you are questioning your services I would recommend getting a second opinion.

    As far as picture strips I would recommend photos because she is so young. Take pictures yourself of things you want her to communicate and put them around the house. You can also make a book for her to look that has all her favorite things in it.

  • Catarina Lore September 26, 2012, 12:46 pm

    My son will be 3 in October, and has been working w/Birth to 3 in CT since he was 18months…although they have worked on play schemes, eye contact, pointing and joint attention his speech is still lacking. He did learn to sign (more, give me, again, etc) but his words are still very limited. In the recent weeks I hear more vowels, a, e, i, and the word HI but randomly he does say mamma, and daddy. Or other things. He receives speech w/prompting 2hours a week…and once he turns 3 will be leaving birth to three to enter a preschool special ed program. Do you know of anyone that can help diagnois his speech impediment or a speech pathologist in the Westchester NY or fairfield County area? I feel he may need more one on one time than what he has been receiving.

  • Reyna Sankey September 26, 2012, 1:14 pm

    Charity- does your daughter interact with other kids when NOT at the play group? Also, what did they (people who screened her) say about her cognitive level? I’m just wondering because my daughter who will be 3 in a couple weeks started speech therapy through Early Intervention 6 months ago. She has gone from saying about 3 words to three and four word sentences. She sees her speech therapist once a week and attends a play group once a week. Her therapist says my daughter has Apraxia (which of course they won’t give her a label until after being 3 years old) but my daughter’s receptive language is great and cognitively she has scored at and above her age level- she too, is not on the spectrum. One thing I did notice at the play group is that she does not interact with other kids but she will interact with other kids at the mall, at the playground, and in her dance class. I asked my duagher why she doesn’t talk to other kids at her “school” and she says “me shy”…..even though I KNOW she is not shy. The only conclusion I came to was that other children in her play group do not talk much either and they are into their “own thing” so my daughter responds the same way- she models their behavior. Hopefully this made sense. Just sharing my story because sometimes hearing similar stories will help you figure things out. BTW, my daughter was super frustrated before and this has lessened with the more she is able to speak. The speech therapist put together a book of pictures of our family (actual pictures) and that helped her learn and practice what to call everyone. Pictures of “real” things seem to work better for my daughter opposed to the drawn pictures.

  • Isa Marrs September 27, 2012, 8:12 am

    Hi Catarina,
    My practice is actually in Westchester County. We would love to see your son. Feel free to call me 914.488.5282 to set something up.

  • Dee October 30, 2012, 9:55 pm

    I have a 31 month old son who has been speech delayed since birth. He rarely cooed, never babbled, and when he was 12 months finally the doctor agreed he needed to be evaluated. Well, long story short we didn’t start therapy until 18 months. Around 20 months he started to babble the same sound over and over. He never changed them. He started to say mom mom and daw (dad) and dis (this) and k and rolling r (water). Around 24 months he started eee for (Minnie) and uck (truck & chuck). Around 29 months he started to experiment very little with sounds and when he tries to tell me a sentence he repeats mama-dada over and over. He cannot say any words clear besides mom mom and da still at 31 months.

    I have a few questions, is it common for children with childhood apraxia to not cooperate in attempting sounds? It is extremely hard to get his cooperation. Sometimes I bribe with sugary treats to get him to try. Unfortunately, he will do anything to get junk.

    At 30 months his therapists finally started him with the Kauffman sound cards. When I do those with him, I notice he cannot, one make all the easy sounds (tongue on the floor of mouth, vowel constant), two he seems to struggle to get the little he can to come out, three he cannot combine sounds like ah-w-t (out). It takes a long pause between each sound and I have to prompt each one, no matter how many times we have done that word. Now, they have said his comprehension is above his age level. So, he should be able to make these sounds without prompting, but he will make the wrong sound attempt if he doesn’t hear me do it first, and sometimes he still will say it wrong multiple times without realizing it.
    He sees his speech teacher 3x month at home, a special Ed teacher 2x a month at home and 1x week at a school play group, OT 2x month at home.

    My next question, am I being foolish to want a diagnosis? I feel frustrated that they don’t seem to know what is going on with him and I feel if I new something I could work in a specific direction. They have thrown up autism, apraxia, sensory integration, they cannot figure him out. Part of this confusion is probably my fault. My Nephew has autism and I worked a lot with him, so when I had my baby and I noticed something was different about him, I immediately started therapy with him. After they evaluated him they asked what things I was doing, and for the most part I was already doing what they were going to recommend. So, they said now they have to figure out whether if traits seem to be better in him because he is being treated all the time, or because he would have grown at that rate anyways.

    In my opinion, I have watched videos of kids with apraxia and I have read just about everything I can find, and I really think this might be what is going on except with his stubborness, he always has to be in control and he doesn’t like people ecspecially women talking to him. By all means, it is not my parenting, he is the third and I am a stickler with behavioral expectations. His siblings are a little older and enforce our parenting style, they don’t talk for him, and it is not just because of his age (he has always been this way). Can you tell I hear excuses all the time from others?

    What do you think I should do for my baby? Does this sound like apraxia to you, based on what I shared? I fear he is not getting enough help. Thank you very much.

  • Isa Marrs November 12, 2012, 10:21 am

    From your description it is a possibility that your son have Childhood Apraxia of Speech. Regardless of his diagnosis he is definitely not getting enough speech language therapy. That should really be the priority right now. While the other services may be beneficial getting him talking should be the main focus.

    When it comes to stubbornness with his words and sounds my guess is that he knows it is not easy for him. No one wants to keep doing something that is extremely difficult. Working with children at this age on motor speech is always difficult because their behaviors ALWAYS interfere. When a child can’t talk they are more controlling with their behavior. Especially if he is a otherwise typically developing little boy.

  • Reyna November 12, 2012, 2:46 pm

    Dee, I have a daughter who just turned 3 early last month. This sounds a lot like my daughter- the stubborness. My daughter did not start speech until she was 2 1/2. In 7 months, she has gone from saying “mama, papa, hi” to saying 4-5 word sentences. Our early intervention speech therapist used her form of the Kaufmann cards….this seemed to really help…but my daughter HATES anything to do with the cards…so our speech therapist would play games using the cards and when she no longer wanted to use the cards, the speeh therapist would use them as a guide (the sounds) to play other games. Once my daughter didn’t see the cards out, she would be less stubborn and practice. Also, one thing that worked a lot with my daughter when she didn’t have many words, was to play and sing silly words like “heha, lala, lela, mela”…..I’d start with the same repetitive sound (lala), then once she got it, I would change the second syllable (lale)….and a great piece of advice that I got from another mom who has a son with Apraxia is to not frustrate them and MAKE them say something when they ask for stuff, instead talk to them ALL the time….basically model what you would like them to say. I had made the mistake of forcing her to ask me for milk and it would go nowhere except frustrate her to the point of a meltdown and also frustrate me. I know people say not to speak for them but they need something to give them motiviation….even if you start out with few picture cards to meet their basic needs. I’ve heard that children with Apraxia are very stubborn….not sure if this is fact, but my daughter is the most stubborn of all three of my children. One huge goal we accomplished was saying her name…she used to say “A” for Alexa, then it moved into “Aleka”….and finally 3 days ago, she said Alexa correctly….you would have thought she won a huge prize….she kept saying it and giggling and singing it and laughing….what really sucks about Apraxia is that many children’s cognitive ability is at the same level as their peers, so they are very aware of what is going on especially with the difficulity of their speech.

  • Brenda December 6, 2012, 4:06 pm

    Hi Isa,
    I’d like to pick your brain on a few subjects.
    Our son has been in speech therapy for 2 years 7 months. Of course every eval we have, we get different answers. At our last eval he was diagnosed as having moderate to severe oral dyspraxia and moderate verbal dyspraxia. They administered the Kaufman Speech Praxis Test for children.
    1. is Dyspraxia and Apraxia the same?
    2. He attends 2 (40 min)private lessons a week and 2 (30min) group lessons a week. Is that too much? I find he is resisting (fidgets, not attentive) the group lesson he has attended for 8 months and can only assume it is because he has been submerged in therapy for over 2 years now. He is a model student at his pre-K3 school, and the teacher has completed a sensory screening for us and it came back that he is very well behaved in school. ( I only had her complete the screening because his private therapist is constantly pushing OT. You’d swear she was going to make a commission if he enrolls).
    3. Do you find that sometimes a student and therapist can no longer be compatible? In the group (of 2) therapy he attends, the therapist is very discouraged because he does not pay attention. Should I consider removing him from that therapy lesson?
    4. Our local university offers private lessons and I am considering enrolling him there. Just for a change of scenery. What is your opinion?
    He is also enrolled in piano once a week for 45 minutes. His teacher has worked with special needs children and I thought it would be a different type of therapy without him really thinking he is attending “speech therapy”.
    5. Am I sending him to too many different places? Should I focus solely on one center?

    Just last week 3 people told me they are understanding him a little better. But I have no idea what to attribute that to.
    Any suggestions you have would be greatly appreciated.

  • Leslie December 14, 2012, 9:48 am


    I am a speech language pathologist working in a hospital setting. I did not receive much (none, really) training on CAS in graduate school. Everything I know has been from my experience working in the field the past three years. I have a 2 year, 7 month old patient who I suspect has CAS. She has no true words. All vocalizations are /di/, but she can sometimes produce /buh/ when given a tactile prompt. Her oral motor skills are fine; I feel like it’s strictly verbal apraxia. Her receptive skills are also delayed, she tests on the PLS at around 1:5 on both receptive and expressive, which I know is atypical of a child who CAS. Mom states that she used to have words that she doesn’t use anymore.

    She is beginning to get frustrated and demonstrate behaviors in therapy, especially when I ask her to vocalize. She is receptive to ASL, which we have also been practicing, but her mother really wants her to be verbal. I have been seeing her twice a week for about 7 months, but lately her participation in therapy is decreasing significantly with each session. She becomes very behavioral and shuts down. I feel like we’re stuck in a rut, and I’m not sure where to go from here. I have tried a variety of new activities, we do a LOT of play therapy, but we are getting nowhere. Do you have any suggestions? I’m not 100% sure it’s CAS, if you have other ideas I welcome them! I feel truly stumped.

  • Jody Firneno January 1, 2013, 9:11 am

    Hello, my son, who wasn’t babbling by two years old, was dx w/CAS by an experienced SLP. He couldn’t purse his lips to blow out the candle on his b-day cake, didn’t know how to blow on a whistle or even blow bubbles from a wand. I put him through speech therapy for the next year and a half, he spoke his first words by his third b-day), the Early on program for another year. Now he’s in kindergarten and continues to do well except for the social aspect. He seems aloof when around his peers, he may teasingly nudge another child who takes it the wrong way and he doesn’t have many friends. It saddens me because I know he wants to be friends but has a hard time initiating a conversation. He also has sensory sensitivity to certain stimuli (labels on shirts, crunchy texture, loud noises), he is obsessed with out of state license plates (he’ll always find at least one when we’re out running errands), he is fearful we will run out of gas (its never happened) and has panic attacks every morning about missing the bus (25 min early)… Also, very resistant to pain (will not tell me his tooth aches until his face swells from a full blown abscess – had to have 2 teeth pulled), discipline is the most challenging, time outs do not work but if I threaten to pop my bubblegum he runs in fear. He used to scream bloody hell when I washed his hair, did not like his head touched but the chiropractic adjustments have helped immensely (her theory was his occipital bone was slightly protruding thus pinching a cranial nerve which made even the lightest touch on his head like excruciating pain perceived by him). Anyways, my question is do you find often times when a child is dx with CAS, does it affect their thought pattern and consequently their behavior? Can he be “apraxic” in his head even though he’s talking? My husband doesn’t support me on this, which of course we argue about my son being a “brat” vs. being emotionally behind due to his apraxia. I tried to get an OT evaluation but it costs $350.

  • Isa Marrs January 10, 2013, 1:34 pm

    Hi Brenda,
    I would love to give you some guidance regarding your son’s speech therapy. The only thing I don’t think you mentioned was his age.?? Yes, dyspraxia and Apraxia are often used interchangeably however Childhood Apraxia of Speech is now the preferred term. Given his diagnosis I don’t think group therapy is the best fit. If he’s not doing well with it, it seems to be a waste of his energy. Individual therapy is really what he needs right now given your description of him. Is the group therapy provided at the school? If he is doing well with his private therapist I would focus his energy and your resources there. In regards to therapy at a University I would not recommend it given your description of what is going on at this point. If he feels like he is doing too much he will not give it his all when he really needs to. I am assuming your private therapist is experienced and specialized working with pediatric motor speech disorders and the student at the University will not be. Sometimes when a child is in therapy long term there are ups and downs. If you think someone is really the right fit I would stick with it. If you are feeling that the therapist is no longer connecting with your son and meeting his needs I would look for a new therapist. Some therapists work better with very young children and some work better with older children. The most important thing to remember is that each child is different and only you know your child best. Read his cues and follow your own instincts!

    Let me know how it goes, Isa

  • Isa Marrs January 23, 2013, 5:15 pm

    Hi Leslie,
    I apologize in my delay in responding as I missed your post coming in. PROMPT is always a great tool to have and I strongly recommend getting trained if you are working with children who have suspected Apraxia. PECS is also great to decrease the frustration. However frustration as you know can be good as it shows the desire to communicate. In my experience these “types” of children will go through periods of non-compliance and you feel like you are getting nowhere. I usually back off a bit when this happens and lower my expectations and the pressure to say new sounds. By doing this I get them to remember why they like me and that they trust me. When I get their compliance back I slowly start increasing the demands of therapy again. Hope this helps. It works for me.

  • Isa Marrs January 29, 2013, 4:30 pm

    Hi Jody,
    Children with Childhood Apraxia of Speech often have other developmental delays and learning disabilities. I do not think that what you are describing is directly related to the Childhood Apraxia of Speech diagnosis; however I do believe that your son is struggling with some real serious issues and is not “just a brat”. I would strongly recommend seeing a Developmental Pediatrician to guide you in the right direction.

  • Charlie Hart's mom February 3, 2013, 10:07 pm

    My son was misdiagnosed from birth with a chromosome condition he did not have. As it turned out, he was rediagnosed at almost age 4 as being mosaic for the condition (a lesser form of the condition), but continued to be treated for a mild speech delay associated with the original condition with which he had been misdiagnosed. He was well into his 5th year before he got diagnosed with apraxia and about 6 years-old before he started getting appropriate & intensive therapy for apraxia. It took just as long, almost 3 more years, to get his co-morbid diagnosis of aphasia. Relentlessly, I tried to get therapists and doctors, alike, to listen. One therapist and two doctors finally did listen. Although I do think that apraxia is grossly misdiagnosed, evidenced by miraculously recoveries of speech (apraxia is a lifelong diagnosis, which can be remediated to an extent), there is no harm in going for the gold and diagnosing apraxia in order to get the most intense speech therapy services; however, in noting this, if the trained SLP is going to diagnose apraxia of speech, then he/she should be well-trained with many CEU’s in apraxia remediation as well. If and when the SLP realizes that the child does not meet the criteria for AOS, then the diagnosis should be quickly retracted to reflect the true nature of the speech disorder. It should not take 8 and a half years to get a child with such profound speech disorders to get appropriately diagnosed and sometimes it takes a well-versed pediatric neurologist to diagnose neurological conditions such as apraxia and aphasia.

  • Isa Marrs February 5, 2013, 3:49 pm

    Charlie Hart’s Mom,
    I am sorry to hear it took you so long to get a proper diagnosis for your son. I hope he is in good hands now and making progress with his motor speech.

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  • Cathy February 18, 2013, 5:19 pm

    I have a 3 1/2 year old son who has not received any specific diagnosis, but has been receiving speech therapy in blocks of 8 weeks (once weekly) 2 times per year. We have supplmented with private speech therapy once per week. In the past year he has moved from saying only ‘ah do’, to speaking in long sentences. He has most consonant sounds and all vowel sounds, but struggles with jaw control esspecially when he is excited. He learns very quickly and iss eager to communicate (bonus for us!). At this point he has begun basic reading, as well as singing and story telling. Does this sound like a typical developmental path for apraxia? And is an oral motor disorder always deemed apraxia? Regardless of any diagnosis, we are very happy with his progress to date and hope he continues to be engaged in learning!

  • Natasha February 22, 2013, 9:55 am

    Hello I wondering if it is possible for kids to not have other delays and still have apraxia? My son will be three next month and both his speech therapist think he might have apraxia. We recently went to get a third persons thoughts on the matter and this SLP said he couldn’t have apraxia because he was not delayed in any other areas. And had no issues with any motor function. I know usually kids who are apraxic do have other delays but want to know if there are cases where a child’s only symptom is the speech aspect.

  • Danielle Maher February 24, 2013, 4:29 pm

    I have a 2 1/2 year old daughter who was weeks premature. At the age of 2 she qualified for 2 days a week of PT. We were also given a DI person and requested it be speech. Over the last 6 months her expressive language is getting more and more delayed for her age. At first we thought it was stuttering but the speech therapist said it is “groping.” She will try to say something but it appears that her mouth muscles freeze. I feel so bad for her. We are working with a neurologist and our speech therapist. Can CP be an underlying cause of Apraxia? What type of formal assessment can be done to diagnosis apraxia?

  • Isa Marrs February 26, 2013, 3:43 pm

    Thanks! I am glad you enjoyed it.

  • Isa Marrs February 26, 2013, 3:45 pm

    It is rare, however it is possible. Children who have CAS are at risk for later learning and language disabilities and should be monitored.

  • Isa Marrs February 26, 2013, 3:49 pm

    Children with CAS do not always follow a neat path. The progress that you speak about is quick for a child with CAS. They usually progress at t much slower pace. There are children who have an oral motor apraxia which is different from CAS. The jaw control could be due to a weakness as well. What is your therapists opinion? Are they using PROMPT?

  • Katie March 14, 2013, 9:12 am

    I am a western PA pediatric SLP new in private practice and in the process of purchasing materials for my clinic. I was wondering what your thoughts are about attending apraxia seminars and buying assessments and treatment materials.
    I currently do not own my own apraxia assessment and am considering buying the Apraxia Profile versus the Kaufman Apraxia of Speech Assessment. There might be others out there too but those are the ones I’ve seriously considered buying.
    I am also looking into continuing Ed courses for apraxia of speech. Over the years, I have attended apraxia conferences by Pam Marshalla and Dave Hammer (plus I worked with him and a lot of other great CAS therapists at Children’s Hospital of Pittsburgh for a year and a half). I have also completed a couple of online CE courses. My experience at CHP led me to be less biased to a certain assessment or treatment materials so I am wary of the Kaufman assessment and materials for that reason but there is a Kaufman speech to language seminar that is not far from me next month that I’m considering attending. Here’s my dilemma, I feel like by attending the Kaufman seminar, I will be buying into that particular paradigm, using that assessment and it’s expensive line of treatment materials. Plus, the Kaufman assessment is twice the price of the Apraxia Profile.
    The other continuing ed course I considered was PROMPT training but it is very expensive ($600 plus travel, time off, etc…) and with such a small practice, I don’t think I can justify the cost right now. Plus, I do use hand cues from other sources.
    I would appreciate any thoughts on CAS continuing ed, assessments, commercial treatment materials.

  • Kristie March 14, 2013, 11:48 am

    Hi there… I just stumbled on this website and have a question or two… My son (Dec 2008 – he is 4 now) is in pre-k at a NYC school called the Children’s School (half of the students have IEPs for various reasons / half do not). My son was diagnosed at 3 years 4 months with verbal dyspraxia. He has severe speech delays, and it seems to be dripping over into his receptive communication and causing a cognitive delay. I am concerned that the diagnosis is incorrect… Do you have any expertise with dyspraxia? I don’t think I even understand the difference between apraxia and dyspraxia (although Dr. Google and I will be spending some time together later today). Are there any resources for dyspraxia? Thanks so much for any information!!

  • shelly April 10, 2013, 6:38 am

    My 2&1/2 yr old has been receiving speech therapy for 6 months now, with very little
    progress. His SLP”s supeevisor came out to evaluate him & basically said he is apraxic. The supervisor discussed using prompting, although my childs slp has never taken the course. I
    am Very cocerned and dont feel as though his slp is devoted enough toy child. For instance..
    The supervisor worked with him for a mere 15 mins & had my sons total attention and had
    He was forming words. Shod I get a second opinion & look for another slp? I think my son
    needs More therapy then 45mins a week. He will be 3 in august and can not put 2 words together. Im just very concerned. Thank you.

  • Deanna April 12, 2013, 9:26 am

    I just ran across your article; very informative, thank you.

    I am wondering if you could answer or direct me towards resources regarding a question that’s been bothering me.

    My son is 9 years old and will be 10 in July. He has been diagnosed with Apraxia and PDD-NOS. he has behavioral issues too; always had them. He is not easily directed, and has low interest level in adult directed activities if the activities are not in his area of interests. He refuses to do school work, frequently. And has little attending time capabilities although that is increasing and is pretty good when the task/subject pertains to a high interest area of his. We are not able to do traditional private therapy as he just cannot maintain in that setting. We have just started horse therapy but because insurance will not cover the place he attends, we cannot have speech therapy there. He has made progress – his utterance have increased although his average is still about 4 words. His intelligibility has increased too but we still are unable to understand a lot that he says, daily, especially if we don’t have understanding of the context. He does approximate pretty good so we can grasp what he is saying then, especially when we know the context. We have started sign language classes in hopes to start teaching him some signs for words that we simply do not understand; he naturally gestures. He also is drawn towards adults vs kids, but will “play” with kids but cannot negotiate play very well. He is a sensory seeker, which adds to his behaviors. There is more to say about him, but I will get on with the question.

    He is unable to read, write, and count consistently to 10. His writing, he simply does not have the fine motor control – proprioceptive stuff is an issue too. Reading; he can identify letters but not much beyond that. The school is trying to teach him whole words instead of phonic base learning. My question is this… Can he possibly have a very severe case of Apraxia that is interfering greatly with his ability to intake and understand what is needed in order to learn to read and do math? I feel like his severe to profound speech/language issues is greatly impacting this but if it is, how can we go about helping him? I also feel that the school does not have a strong grasp on how great apraxia can impact reading and math and look at it more from an articulation stand point. For instances, I have been reading articles and it seems that apraxia can impeded learning due to the significant speech/language skills not used throughout his early years that children just naturally utilize. And that perhaps it also effects the wiring in the brain that navigates all of this. Anyway, if I am way off base, I would like to know. It is hard for me to agree with the school that he has low cognitive functioning. I think some of that low functioning is because he has not been exposed as typical children are naturally exposed through life practice,hearing sound difference, etc. and it is hard to test him due to his low attending ability, behaviors, speech/language issues.

    I am hoping you have some insight or direction to send me for resources. I also would like to figure out how to find a professional in my area (northern illinois) who has a good understanding of his needs: an evaluation I would like to have in order to hopefully gain some direction and understanding of how to teach him.

    Thank you for your time,

  • Isa Marrs July 11, 2013, 8:59 am

    Danielle M,
    Your Speech Language Pathologist should be able to give the formal diagnosis of Childhood Apraxia of Speech. However your daughter may be too young at this point to know for sure. Children who have CP very often have motor speech disorders and Apraxia is a motor speech disorder. Has your daughter been diagnosed with Cerebral Palsy?

  • Isa Marrs July 11, 2013, 9:08 am

    I like the Apraxia Profile and find it useful. I think more about treatment than assessments; so I invest more in therapy material and seminars. PROMPT is a great tool to have and you will use it very often. I like to learn about all the approaches so I can and make my own decision about which approach works best with which clients.

  • Isa Marrs July 11, 2013, 9:10 am

    Verbal Dyspraxia is just an old term for Childhood Apraxia of Speech. Whoever diagnosed him was most likely referring to CAS. Children with CAS will often have other language and learning issues that should not be ruled out once a CAS diagnosis is given. CAS does not cause these other delays they often will occur together.

  • Isa Marrs July 11, 2013, 9:16 am

    If you do not feel that it is a good fit I would definitely recommend getting a new Speech Language Pathologist. Not every therapist is right for every child. The therapist needs to engage your child in order to make progress. I agree that a child who is turning 3 and non-verbal should receive more than 1 weekly session. 2 to 3 thirty minute sessions a week would be more appropriate.

  • Isa Marrs July 11, 2013, 9:18 am

    Thank you for all this information. It is true that many children with the diagnosis of Apraxia will have learning disabilities as well. Learning disabilities are different than cognitive functioning, you are absolutely right. Your son has so much on his plate that I am sure he is an extremely complicated kid to test. I am not sure who to refer you to in your area however some of the Graduate Speech Pathology programs do excellent Language Learning Evaluations. I would also recommend finding a Pediatric Psychologist who does evaluations and get a full Neurodevelopmental Evaluation. In my area we have Child Study Teams at the big hospitals that do excellent evaluations. You may also want to look into this. A thorough accurate evaluation would help immensely when it comes to proper treatment. Also, has anyone ever tried augmentative communication with your son?

  • JMS September 23, 2013, 1:21 pm


    Hello. I have recently been searching for information on developmental issues associated with CAS without much success. I am trying to get information about what non-speech issues CAS children have as they get older and advance in school.

    My daughter is currently 12 years old and just started 7th grade. She was diagnosed with CAS at about 2 years old, approximately 10 years ago. It seems to me that was the dark ages of CAS. I recall that it was a controversial diagnosis with some professionals believing that there was no such thing as CAS — only traditional adult apraxia of speech! I do not doubt it was a correct diagnosis based on everything I have learned and continue to read about it — at 18 months she spoke about 6 words, she had excellent receptive cognition and communicated extensively via non-verbal skills, and she did little cooing or babbling as an infant/baby (at one point I was convinced she had hearing issues she was so quite). However, my speech therapist was wonderful. She had speech therapy twice a week, which I always attended to participate and get our home practice work. We worked hard for about a year and the progress was stellar even though at times it was very difficult. At her 3 year old evaluation she was deemed to no longer need therapy. In fact, her vocabulary and speech were deemed to be advanced.

    I’m happy to say she displays no issues with speech that I can see or hear. Moreover, she is a voracious reader. However, she has had an issue since kindergarten with her ability to stay on task, complete projects and understand/follow directions. Each year I have literally heard the exact same thing from each of her teachers: she is very smart (well above average), articulate, happy, pleasant, etc., but she is distracted easily, does not always follow direction, doesn’t do her work in a timely manner, etc., even though she clearly knows and understands the material. She just can’t seem to stay on task (including at home doing school work) and complete projects in a reasonable time. Or when she does complete an assignment she forgets to hand it in! She jumps from one thing to another no matter how much I try to get her to focus. This has been a constant source of fighting in our house. She spends more time being grounded than not. So, now in middle school the problem is exasperated since the teachers just don’t have time for a student who can’t or will not hand in work on time.

    I’m convinced that this may not be entirely her “fault” and may be connected to the CAS. I was hoping you may have some insights for me. Are there any studies that have followed CAS babies up through school and reported similar issues? Are there any articles, books, etc. that deal with on-going issues related to CAS? I’m looking for any and all information on it, so anything would be appreciated. Finally, I was wondering if you might know what we could do to help her — perhaps a type of therapist (occupational maybe) or other support?

    By the way, I am over 50 and so learning disabilities were unheard of when I was a child and in school. However, I believe that I also had CAS or another learning disability. I continue to have some speech issues. (I hide it well, by avoiding words I can’t pronounce and using alternative words with which I’m comfortable.) I’ve worked tirelessly to improve my syntax so that others don’t find it odd (this has taken 7 years of school – I have a BA and JD). Although I have always been a voracious reader, I am the worst speller in the world, and while I can understand many words I can’t pronounce them or write them! Clearly this is connected to the phonic issues associated to CAS. I wonder if my daughter has inherited the CAS from me….

  • Patty October 1, 2013, 12:19 pm

    My grandson is 3 years, 3 months old. He did not babble much as an infant and was not saying any words at 14 months, at which time we tried to get him speech therapy. They called it developmental delay and would not accept him into the program until he was 2 years old. He sees a speech therapist once a week and she basically just plays with him. She says studies have shown that they do not learn to speak any faster with trying to make them speak and so does very little to help him. We have mentioned apraxia since he was 18 months old, but they say it is just developmental delay. They think it can’t be apraxia because he now babbles a lot. The only other symptom he has is waving his arms back & forth rapidly & snapping his fingers when he is excited. However, we have two relatives in the family who work in this area and they say it is apraxia. We live in a very small town and this is the same therapist he will have when he starts school. We live 3 hours from the nearest city where he could get help. Do you have suggestions as to what we should do next? I am very worried about him. His 1 year old sisters can talk very clearly and it is frustrating for him to not be able to communicate. Thanks.

  • Caryn October 25, 2013, 3:55 pm

    I’m a SLP in the schools and I have a student in the 6th grade who has a questionable dx of apraxia. One previous SLP thought it was more of a dysarthria, so we’re not really sure. He has imprecise articulation, mostly on /l/ and /r/, and speech is hard to understand, especially when he speaks fast. Due to the apraxia documentation on his IEP however, he gets accommodations. He struggles academically, although he had an educational evaluation recently and it showed he did NOT qualify for a learning disability. The resource teacher is now questioning if it’s ADHD and is asking me if apraxia can mimic ADHD characteristics or if she should recommend to the family to look into ADHD testing with their doctor. Can you please advise me on this? Again, the apraxia dx is questionable; however, it’s been what has kept him getting speech services and accommodations all these years.

  • Nicole B. October 30, 2013, 12:35 am

    My daughter is two and half years old. This past January she started speech therapy due to fluid in her ears. Since then her ears have cleared up. She says a couple of words but not much. She tends to grunt more than anything. Her therapist is beginning to think she may have apraxia. She still is unable to throw or kick a ball. She’s is still wobbly when she runs and is very clumsy. I just wanted to know if I should get her checked by a doctor or just continue the therapy.

  • Isa Marrs November 21, 2013, 12:23 pm

    After reading your post I have to question your daughter’s initial diagnosis of CAS. I have never seen a child with CAS have no speech issues remaining at 3 years old. It may be that the early speech delay was somehow associated with the difficulties you are describing now. I would recommend a full Neuro-Psych Evaluation which would be conducted by a Psychologist.

  • Isa Marrs November 21, 2013, 12:24 pm

    At 3 years 3 months a child who is not talking should be getting more direct intense speech language therapy. You might want to consider a different Speech Language Pathologist. If it is possible you also might want to take him to one of the bigger cities for an evaluation. This way you have the report for the treating therapist. Please let me know how it all turns out.

  • Isa Marrs November 21, 2013, 12:26 pm

    CAS would not mimic ADHD however the two can coexist. Many children with CAS will have other disabilities. It is rare to find a child with a pure CAS and no other disabilities. Can this child get a Neuro-Psych evaluation from a Psychologist? This way it can be determined if attention is a real issue or if there is something else going on.

  • Isa Marrs November 21, 2013, 12:28 pm

    Nicole B.,
    You might want to consider both an Occupational Therapy Evaluation and a Physical Therapy evaluation. If your daughter has difficulty with motor planning it is often seen in other areas such as gross and fine motor. If she has no medical concerns or regression a medical doctor would not be necessary. I would ask your Speech Language Pathologist her opinion on this matter as well.

  • Dee November 21, 2013, 1:52 pm

    Hello again,

    I wrote a post with questions back in Oct 2012. I wanted to give an update and ask a question or two. My son started a early childhood intervention preschool Jan 2013. There he received speech 2x week and OT 2x week. He did not seem to progress much from that point until the end of the school year. They asked if we wanted services over summer break, and after praying a lot I declined. The only thing I had not tried was a supportive nothing. Well, thank God for weighing on my heart, because he blossomed a ton. He seemed to attempt to speak and experiment with sounds and words without prompting for the first time, so I encourage subtlety and setup situations in advance. So, he talks now! Praise Jesus! He is hard for many to understand, but some are able to understand some of what he is saying now.

    Okay, so my problem is at the beginning of the school year sept. 2013, he started speech with a new teacher (old left). This teacher is saying that now that he is making more sounds and able to say more words that he sounds like he has a phonological sequence issue. She did not say directly that she does not think he has apraxia, like the other speech and psychologist did, but she did imply it. I am not an expert, but I have read all the material I could find and he fit the description to the tee. Could he have fit everything and all of a sudden outgrow the symptoms? He still struggles to get his mouth to move while speaking, he cannot lift his tongue up without using his bottom lip. I do not think the therapy for the phonological sequencing will hurt, because he does do that too; however, I am concerned with him not being able to get future help if needed. He will be 4 on April 1st 2014.

    I know I am unable to give you all the background, but I am curious what your opinion would be and what you think I should do. He has his IEP on Dec 18,2013.
    Thank you very much-Dee

  • kate November 30, 2013, 9:40 pm


    I have an almost four year old son who is only saying 7 words but can understand so much more than he can speak.

    He cannot imitate speech, infact he has only started to imitate speech but obviously not correctly at all. He mainly uses non-verbal communication to communicate via using natural gestures i.e. hands rubbing together means wash hands, facial expressions..sounds.

    He does a lot of groping with his mouth but no words come out, he can imitate words well which he knows i.e. ” ball” would be “bow” ( does not pronounce the “L”). But if I tell him to say a word which he hasn’t said before e.g.. ” open”, he would either say ” ba” ” grrr” but he mainly says the word” ba” when imitating any type of word. He has been doing this groping along with the puzzled expression from when he was 15 months old. Now that he is nearly four and is still doing this with the simplest of words I am worried.

    I am too worried about autism as he does stim.. like pacing when he is excited, making noises when he is excited, melt downs when frustrated. Though he has very good play skills, even though this is delayed and no obsessions, routine etc. He is being evaluated for autism too.

    My son has a speech therapist and I did ask her if she could check or refer my son too see if he has some kind of speech. She said no, not right ow as my son has a very limited vocabulary and this would be hard to diagnose.

    What should my next steps be?

  • Isa Marrs December 2, 2013, 4:56 pm

    Thanks for the update on your son. I am so happy to hear that he has improved so much. Sometimes it is true that CAS is suspected and then the child proves us wrong. It is so great when that happens. From your report you still see difficulty with motor planning however. It is important to determine whether or not your son is still struggling with motor planning because proper treatment will lead to the best outcome.

  • Isa Marrs December 3, 2013, 3:07 pm

    In your letter you wrote that you asked your son’s therapist if your son could have “some kind of speech”. Did you mean speech disorder? If that is what you meant then I agree with you. Your son’s difficulties are not developmental at this point there is a “disorder” of some kind. Your Speech Language Pathologist should have some idea of a diagnosis when it comes to speech. If not you may want to look for a different Speech Pathologist?? I would recommend also seeing a Developmental Psychologist, and an Occupational Therapist. Please keep me posted.

  • Dee December 3, 2013, 3:10 pm

    What do you recommend as far as my involvement in the IEP to ensure that the motor planning is accounted for when the speach teacher sets his new goals? My son almost sounds like a deaf person when he speaks, there is barely any, if any articulation. To me, this proves his motor planning is weak, is that true based off my statement?

    Thank you so much! You are amazing for assisting all of us. -Dee

  • Isa Marrs December 4, 2013, 2:56 pm

    With that brief description it is impossible for me to determine if your son has CAS. Regardless, it sounds like he does have a severe speech disorder . I would recommend seeking a 2nd opinion outside of school. I always feel it is helpful to get an unbiased opinion and a therapist who could follow and track your son’s progress as he moves through school therapists over the years.

  • Susan December 12, 2013, 5:12 pm

    My son is 2 years and 9 months and has been going to a speech therapist once weekly for 6 months now with little progress. He makes some gutteral “g” , “ow” sounds and “dee-dah” sounds while pointing at what he wants. He says “baba” for papa “Ja” for yes and “n” for no. Apart from that he makes very few sounds and we are worried he may have apraxia of speech which the speech therapist hasnt ruled out yet of course. He is intelligent and quick to learn and has no obvious delays in other areas. He is bi-lingual. He can blow bubbles although he makes more of an “f” sound as the air comes through his lips. Do you think this could be apraxia or is it just a speech delay which we are hoping will rectify itself?
    Thank you very much for your blog!

  • Isa Marrs December 17, 2013, 3:31 pm

    Given your description it is not possible to give my opinion on a diagnosis. It sounds as if your son’s speech is very delayed and I would recommend at least 3 short weekly therapy sessions. With this frequency of therapy your son should make progress more quickly. If you are happy with your therapist and you feel she understands CAS she should be able to give you a more definitive diagnosis in the next 6 months to a year.

  • sharon December 24, 2013, 1:05 pm

    Just wondering what your thoughts are for a 3 year old child with diagnosed CAS ( not making a lot of progress with speech therapy) Recently, has a new baby sitter who speaks only Spanish. Parent spoke both Spanish and English to her in home prior to this. Her speech therapist speaks only English and is not able to do any reinforcement of therapy with her.

  • kate December 28, 2013, 11:51 am


    Thanks for your reply.

    We saw a developmental ped when he was two….not really helpful, she did a various of test i.e. getting ears tested, blood tests etc. But not much related to speech.

    I have decided to take my notes to my local GP.

    My son now does not do much groping now…but when saying the word he still would say “ba”. He can now do the “sss” sound but cannot say this within a word i.e. “so”.

    He keeps on adding these made-up signs, like I mentioned before about the natural gestures. I have realised that this is contributing to his learning style. i.e. if he sees a person reading a physical book in this hand…he would then imitate the opening of a book gesture without a physical book in hand. He also uses these gestures when communicating to me. Are the gestures…. made up sins common with kids who have a speech disorder?

    He has started to use a bunch of phrases speech-like sounds when trying to “explain” something to me…while using body- language. But again the sounds are not understandable at all.

    He uses sounds like “oooooh”, then looks at me when he hears someone knocking at our door.

    The speech therapist wants to assess for any type of speech disorder when he is 6 as my son has a short attention span and this would be hard when testing him.

    I forgot to mention in my last post. But my son was evaluated for autism, he did have a diagnosis but 4 weeks later they changed his diagnoses to inconclusive as they were somethings that they weren’t sure about so he is having a re-assessment for autism. My son had another speech therapist who is really good, but sadly left. Suggested that my son may have some learning disability…but not autism perhaps.

  • kate December 28, 2013, 11:55 am


    Forgot to mention…my son has a limited speech repertoire (if that’s the right word) can only pronounce “b m (sometimes d) 0”.

    I feel like his symptoms are similar to childhood apraxia ( verbal dyspraxia in the uk).

  • Ashley January 3, 2014, 3:24 am

    My son is 2 years and 5 months old. He babbled as a baby and had about 6 words at 18 months. When he turned 2 I noticed he began lagging behind other children his age. He had only 8 words. He has been in Early steps for 3 months. Both OT and ST twice a week. He is making slow progress but has new words. The words he does say is never a complete word. Tree is ee, mouse is mom, Ect. Either the beginning or the end of the word is absent. Sometimes he makes movement with his lips like he wants to say the word but it will not come out. He still does not use utensils to eat. I have to cut up his food and he has a very sensatve gag reflex. He is somewhat clumsy. The ST is reluctant to give a diagnosis. His receptive language is much further than his expressive. He points and makes noises, high pitch squeals. He acts like he wants to talk. He sometimes even imitates hopping like a frog then points to a pic of a frog. He can spontaneously say words so clearly. He has said teacher and back pack. But if he has to think about it he can not or will not say it. He sometimes says two word combinations like nite bed or bye book. My family keeps asking if he’s Autistic bc of his speech delay. He is social, plays with other kids and does not have any other issues.

  • Ashley January 3, 2014, 4:06 am

    My son is almost 2.5 years old. He’s been in early steps for 3 months. He receives ST and OT twice a week. He babbled as a baby. He had about 6 words at 18 months. From that point to his 2nd birthday I noticed he was lagging behind other toddlers his age. He had only about 10 words. He is making very slow progress. He has new sounds and words. His words are difficult to understand. He pronounces only part of the word, either leaving off the the beginning or end. Tree is ee, ball is ba, book is boo. He communicates his needs non verbally. He goes to the fridge, points to the pantry, and brings me items he wants. His receptive language is much more advanced than his expressive. He sometimes attempts to speak but the words get stuck. He will place his lips correctly but no sounds come out. Spontaneously he has said difficult words so clearly. Like teacher and back-pack. But he can not or will not repeat it. If it requires any thought it seems to get stuck. Or he will not attempt. He is still unable to use utensils. I have to cut up his food. He doesn’t understand how to drink from a straw and is just now exploring how to take a bite from food items. He has a extremely sensitive gag reflex. Even as a baby if he didn’t like the taste or texture of a food item he would expell all gastric contents. He never put toys or his hands in his mouth until recently. He is a bit clumsy. The ST is wonderful and my son engages with her and enjoys their playtime. But she’s reluctant to give a diagnosis. I have family that’s concerned. Does this sound like apraxia? Are children typically able to function in a normal classroom with peers? If this is apraxia will he need ST indefinitely?

  • Isa Marrs January 7, 2014, 3:13 pm

    I would need to know what the parents primary language is. If the parents primary language is Spanish the SLP should be Spanish speaking. If the primary language is English it would be better for the child to have a Nanny who spoke English.

  • Isa Marrs January 7, 2014, 3:19 pm

    It definitely sounds like Childhood Apraxia of Speech is a possibility and something to be explored. I don’t understand why your SLP would suggest waiting until your son is 6. What is being done in terms of therapy?

  • Reyna Sankey January 7, 2014, 6:12 pm

    Sharon, my daughter comes from a bilingual household. I speak English and Spanish to her. My husband speaks English to her and my mom (who watches her during the day) only speaks Spanish to her. When she was in Early Intervention and getting speech therapy, her therapy was in English. The way I understand things, is that any sounds (words, blends, etc.) that kids can learn, will help them in the long run. I had even started my daughter (2 1/2 years old) in Mandarin Chinese because her older sister was also going. It seemed that no matter which language was spoken or whatever we practiced, it all helped. In Mandarin class they repeat quite a bit and that helped her a lot. Anyway, my opinion is that whatever practice your child is getting is good….no matter in what Language. Also, just remember that bilingual brains have more gray matter- meaning they always do better in the long run. So please keep both languages! 🙂

  • kate January 7, 2014, 7:15 pm

    Hi Isa

    Thanks for replying.

    My speech therapist said it will be hard to test as he uses limited amount of words, plus his attention skills are not that great. She is hoping that by the time he is about 5-6 he will say more words.

  • kate January 7, 2014, 7:17 pm

    In terms with therapy. It’s the usual, commenting when child is playing..follow child’s lead.

  • Isa Marrs January 9, 2014, 3:56 pm

    Getting an exact diagnosis can be difficult at such a young age. However I would assume she suspects what the difficulty could be related to. I would recommend a more direct approach to therapy if CAS is suspected. PROMPT would be one method that could speed up progress if there is a motor speech component. A therapist needs to be working directly on sound production.

  • Isa Marrs January 9, 2014, 4:01 pm

    Your son is a bit young to give a true diagnosis of CAS however sometimes it is called “Suspected CAS”. Often these young children with “Suspected CAS” grow out of it and begin making huge progress with therapy. The most important thing you could do is make sure your child is getting high quality therapy from an experienced therapist.

  • Isa Marrs January 9, 2014, 5:03 pm

    While I do agree that both languages should be continued Speech Language therapy should be provided in the family’s dominant language. If the dominant language is English and therapy is provided in English it would be beneficial for the therapist to be able to discuss progress and goals for carry over with the sitter if she is the main caregiver. If this is not possible progress will be slower.

  • Lisa Keatley January 28, 2014, 8:21 pm

    My son is 20 months old and we have been referred to a birth to 3 program because he is not talking. He is super smart. He knows his letters, numbers, shapes etc and can do puzzles like no other. He didn’t babble much as an infant and he is always chewing/biting things. The word apraxia came up and has scared the crap out of me. He doesn’t have any other delays so I was just wondering if CAP could be a possibility? They said other than speech he is at a 3 year old level. We have our final meeting in a couple days to decide what actions to take.

  • Isa Marrs February 1, 2014, 10:30 am

    Hi Lisa,
    Many children with CAS do have other delays however it is not always the case. Make sure he receives a minimum of 2 weekly speech sessions with a qualified provider.

  • Tania March 31, 2014, 6:48 am

    My son just turned 2. He receives 2 Sessions for speech and 3 sessions of PT per week. He pretty much has 4 words and some animal sounds. He has been receiving Early Intervention therapies since 7 months of age due to gross motor delays and torticolis. My question is why is it so difficult for him to imitate speech sounds? Why are the vowels such a challenge for him? He can’t say oo, oh, ee, ai… Pretty much his only vowels are ah and eh. He has not been diagnosed with CAS yet. He did have feeding problems but that has improved considerably and he has a gross motor delay and wears orthotics. My third and last question: when should I ask for a CAS evaluation? Thanks in advance.

  • Deepak April 2, 2014, 4:18 am

    My son 2.5 yrs old. A month ago I was surfing internet to find out the reasons of speech delay and I stumbled across Autism. It was quite new to me. Then, I started following the symtoms and started matching them with my son. He had most of them. Probably, because we let him grew that way. We threw him in front of TV, laptops and mobiles with loud music, rhymes. and given him lots of blocks to play with. But, never sat with him for an hour.

    The moment we understood what autism is, we changed the routine completely and in a week we noticed that he was not much interested in lining those blocks or play alone. It was us who probably forced him.

    We now get his diagnose done and doctor says he is in mild to moderate spectrum. We took lot of videos to explain how he behaves and to suggest us accordingly but in India no doctor really cares.

    Symptoms why we think he may be a late talker or not much autistic: he can read easily (He learnt A-Z and 1-20 in 3 days), loves music, can stay 2-3 hours at dj, he does mix up with other kids (but tendency remain to be alone because he doesn’t understand the social rules), Memorize all the ways to our home, park, temple (I mean he knows where is he going and will give expression accordingly, he is very much attentive to surroundings ), he can say ‘water” when he is thirsty, he can say ‘juice’when he wants juice. he has good eye contact with everybody. He laughs, smile and cry. If he is in need of something he can go to anybody in crowd of 100s of people and ask for the help (Non verbal though, he will pick someones hand and will take to somewhere he needs the help). He has no problem if other kids are playing where he is playing.

    Symptoms which suggests he may have mild autism, he doesn’t pay attention to what we are saying. Doesn’t react to his name always (2 times out of 10). He is very selective to what he wants to respond, for example if we say ‘take juice’, he will immediately turn back with smile and expanding his hands. but, if we tell him ‘look dog’ he would never look, not even if we say alound 20 time. Has 6-7 words so far which he uses to communicate. But, can sing 20 songs, 30 rhymes and play drum. Music draws his attention immediately (because music is all he has listen to b/w 15-30 months of age).

    Just 2 days ago he was found extreme deficient in Vitamin D (6.49 ng/ml). We are very confused what should we do. We don’t want to wait and watch. We want to act to provide what is the best for him. Any suggestions…

  • Isa Marrs April 10, 2014, 9:22 am

    Your son is a too young to give a firm diagnosis of CAS however a therapist can say it is “suspected” if he is displaying some of the signs. With all the other motor deficits he has it is likely that his speech delays are motor based. PROMPT therapy could be a beneficial therapy for your son if there are motor speech impairments. You might also want to increase his therapy to 3x a week. If you are working with a qualified Speech Language Pathologist she will make a diagnosis when feels confident.

  • Isa Marrs April 10, 2014, 9:36 am

    I definitely would put his nutrition first. This can make a huge difference in his development. find a good nutritionist who works with children who have special needs and make sure he is getting what he needs. Next I agree with what you have done. For a young child who is diagnosed with an autism Spectrum Disorder I recommend no screen time. Try to interact with him as much as possible. Establishing shared emotion and joint attention is crucial. It is also extremely important to get him high quality therapy. Some of therapies that could be beneficial are speech therapy, behavioral therapy, and occupational therapy. Be very proactive, now is the time!

  • Mary Ann Martorana April 22, 2014, 12:04 pm

    My grandson turns 3 on May 4. Before he was 2 we made the fatal mistake of seeking help from Alta Regional because he seemed to be having some issues that my daughter was worried about. He was almost instantly labelled as having autistic spectrum disorder and the hell began. The psychologist who made this “diagnosis” seemed poorly credentialed and rather fly by night. Most of the issues we were concerned about disappeared by themselves but my grandson has become more and more frustrated and cannot properly form or pronounce words. He tries mightily but his speech is basically not understandable although his meaning and intent is crystal clear and he will make himself understood through signs and pointing. He seeks out explanations of what things are and nods when he understands fully and have a conversation with you complete with expressive facial expressions and appropriate nods. We are also pretty sure he can now read some words and is fascinated with letters and numbers. The “experts’ refuse to consider that he may have been misdiagnosed and that he has many many of the signs of verbal apraxia. They keep assigning autistic features to him he doesn’t actually have and trying to treat him with Applied Behavior Analysis which causes him severe anxiety and frustration. Now at three, the school department is trying to bus him off to a nursery school for developmentally disabled children and trying to strong arm my daughter and I to force us into it. We want him evaluated by a speech language pathologist who is qualified and experienced with this disorder. Unfortunately my grandson only has Medi-Cal and it will not pay for a real expert to evaluate him and these so-called poorly credentialed experts absolutely refuse to consider anything for him but autistic spectrum disorder. We are very frustrated and sorry we ever got involved with these people.

  • Christine Zola April 27, 2014, 8:56 pm

    Hi my son is 22 months. We have a feeling he might have Apraxia. My son understands what we are saying. He can speak about 3-4 words. He speaks in Gibberish. He has been in early intervention now for 2 months. He gets speech twice a week, O.T. once a week, and as a teacher once a week. He didn’t point until about 19 months, and just started clapping last month. We’ve been finding we have had a lot of tantrums due to not being able to comunicate with us. We also do some sign language. It just seems like he is blocked… It is just so frustrating. Are these signs of Apraxia? He is a great eater BTW Thanks, Christine

  • Dheeraj May 3, 2014, 1:36 am

    Hi Deepak,
    My son will be 3 next month and he does pretty much same what you described. He has got bit more words and vocab but he still uses limited words or two words combination. He does not frame any sentences as such. Please keep me informed with the progress of your son and treatment and therapy if you have started any.

  • sabrina May 4, 2014, 6:51 am

    I have a daughter in the spectrum (diagnosed at 2yrs) and is going to pre-k and is getting Behavioral therapy after school but seems like she’s having little to no verbal skills. She also does not eat any solids nor puraded foods. Only liquids. She gags and vomits to any foods. And since she is non verbal, and does not eat, I suspect she may have Aproxia. Not sure how or who to go to, to have her evaluated, until your site. (especially after going to two pediatricians that dont seem to have a clue about her and her diagnosis) She recieves speech and occupational therapy but is very little therapy. Like 30 minutes twice a week. My question is, how much therapy should she get and how can I get more therapy for her? It seems difficult to get more therarpy since we’re now going thru the school district vs regional center.

  • Pamela Giraud May 4, 2014, 5:27 pm

    I am a speech pathologist who has been providing therapy to a child who supposedly was diagnosed with CAS about age 3. The child is almost 12 and has been receiving speech therapy 5x/wk/individual/30 minutes. The child uses spontaneous language freely and at this time only the sh and ch sounds are emitted laterally. I feel I have done all I can and do not think therapy is changing anything. I have been working with her for just about six years. Therapy is provided 12 months a year. She does have learning difficulties in the area of reading comprehension and written expression. Am I wrong or is the diagnosis of CAS still viable? She has no difficulty with oral motor movements even if she is modeling articulatory placements.

  • Isa Marrs May 13, 2014, 4:02 pm

    I am so sorry to hear your story and your frustration.Something for you to talk to your school about is that even if they still feel that your Grandson has Autism, he can still have Childhood Apraxia of Speech. Getting high quality therapy for his speech disorder is crucial.

  • Isa Marrs May 22, 2014, 5:32 pm

    While I wold love to guide you this is not enough information about your son’s speech to say if he could have CAS. Was the lack of pointing and clapping due to motor planning deficits? If so, it could point to difficulty with motor planning for speech however that is not always the case. If CAS is suspected by the treating therapist and you I would be sure he is getting the right kind of therapy. You also need to make sure that your therapist is experienced with motor speech disorders and has a good rapport with your son. It is possible as well that he is a late talker.

  • Isa Marrs May 22, 2014, 5:38 pm

    Hi Sabrina,
    Twice weekly sessions for a child who is as impaired as your daughter is not sufficient. I would recommend talking to your SLP and asking her to make a request for an increase in services. Usually this request needs to come from the treating therapist. You might also want to find a therapist privately to supplement the services you are getting through the school district.
    Good Luck!

  • Isa Marrs May 22, 2014, 5:43 pm

    Hi Pamela,
    You are correct that the CAS diagnosis would no longer be accurate if your student no longer exhibits any of the characteristics of CAS. However I would strongly encourage you not to give up on the lateral productions of /sh/ and /ch/. These lateral productions negatively impact the overall quality of speech. It would be a shame for her to get this far and be left with these speech errors.
    Let me know what you decide.

  • Pamela Giraud May 22, 2014, 6:15 pm


    Thank you for your response. I have no intention on giving up now! We are almost family members. I administered a Goldman-Fristoe the other day and as she now has braces there is a distortion of /s/ and /z/ sounds (mostly lateral emissions). I also assessed auditory processing using the TAPS-3 and results indicate low scores in phonological blending and segmentation in addition to auditory memory skills. Results of the CELF yielded scores in the average range for all indices except language memory.
    While CAS is no longer a legitimate diagnosis and she would be classified as speech impaired, I do not think I can professionally substantiate five individual, thirty minute sessions per week and an ESY. Am I wrong? How do I convince her mother this diagnosis is no longer appropriate? She feels my student is a CAS child and every academic issue stems from CAS. She even makes my student wear a medical identification bracelet which starts she has CAS. Any advice?



  • kate June 2, 2014, 10:48 pm


    I posted on here before, but just to ask a few more questions.

    My son is four and has a severe delay in his speech, he can say 15 words now. Though as he is getting better at imitating words, I am worried that this will turn into echolalia.

    For example, he does this occasionally, but when I tell him “out” and I point to the direction for him to go to. He would then look at and say “out”, point to the direction I want him to to go and then he would go. When he hears the word “out”, he confuses this by the word “ouch”, so he would then say “ouch” and hold onto his head, like his head is hurting. Also, when I tell him off and I say the word “no”, he would then reply back “booooo (no)”, shake his head and wag his finger.

    Sometimes when I sneeze and say the word “AHCHOO”, he would then say “ACHOO too”. When he watches a programme on TV and he loves using gestures, if he sees a character folding his arms, he would fold his arms too.

    This is not repetitive, as he does this rarely. But are these the example of echolalia and echopraxia? Is this typical for my son to do? I am worried about autism as my son would most probably get a diagnosis.

    Also, my son has been using a lot of jargon, even when “conversing to me”, just to add the words he currently uses are not clear. Is this because of is delayed language that he is using a lot of jargon.


  • Rajani June 3, 2014, 9:03 am

    Hi Dheeraj and Deepak,
    My son is 2.5 years old now and he is also speech delayed. He was exposed to so much of cartoons and suddenly at 2.2 years I realized tht he was going around talking(unintelligible) the scripts of Dora. Immediately I switched off all cartoons for him and started playing and talking with him more. Now he sings quite a lot of rhymes (mostly clear) but still uses single words to ask for his needs. He is struggling with word combines but sings rhymes, this is puzzling. otherwise he does have eye contact and responds to his name.
    Please let me know how to go abt with his speech devt.

  • Isa Marrs June 18, 2014, 2:57 pm

    Hi Pamela,
    As you know children with CAS often have other language and learning issues associated with the disorder. Unfortunately I can’t help with school services because I don’t know what you can and can’t do when it comes to school services in your district. I know ESY is used to prevent regression. Will she regress without summer services? I always feel that you need to give as many services needed to meet the child’s goals.

  • Isa Marrs June 18, 2014, 4:41 pm

    Hi Kate,
    What you are describing does not sound like echolalia as children do need to imitate in order to learn. In regards to Autism, if you have concerns, I would strongly recommend getting an evaluation as the earlier the diagnosis the better the prognosis.

  • Meg July 2, 2014, 9:17 pm

    My son is 4 1/2 and has been in many therapies since 8 months old. My son cannot chew and has extreme gag reflex extending to the center of his tongue. His doctors, many specialists, and OTs PTs just want me to give him pedisure and rub a brush over his mouth which is chaos and mostly ends with him crying and gagging and honestly making things worse. He has never been given this diagnosis just sent home on our way with pedisure and told to blend foods until he starts performing chewing motions then increase texture. Well I’ve been doing this for years now with no success in my child chewing. I’m so frustrated with our doctors and angry that they will not do more to help him!! I’m afraid he will end up being tube fed the rest of his life. Single mother who is crying out for help for her son!!!

  • Isa Marrs July 3, 2014, 1:50 pm

    Hi Meg,
    I am so sorry to hear about your frustrations! Has anyone ever used a motor based feeding approach with your son. He may need to be directly taught the steps required for chewing. Using sensory strategies to address a motor based feeding disorder will get him no where! I suggest seeing a feeding therapist who is experienced with oral-motor feeding therapy.

  • Kelly July 17, 2014, 7:58 pm

    My son just turned 3 June 29th. He will talk and sometimes tell you stories about say my dad for instance, and all that you will understand is Papa. But, he knows exactly what he said. He also gets very frustrated when he wants something from me or his father and we don’t know what he is saying. It’s so bad sometimes he throws fits because we don’t understand him. He had a frenulectomy at 6mos. and tubes in at 1 2/2. His hearing tested fine after the tubes and was just in for a check up a month or so ago and they were still in and looked good so we know he can hear. He is very smart. When you ask him is body parts, eyes, feet, ears, nose and even his hair he can show you. you ask him his name he can’t say it. He can copy drawing a line or a circle no problem. We have been working with the school district as well as a speech therapist until this last Feb when the speech lady let us go. We continued working with the school district and they recently redid his IEP and he did not qualify in the speech area and just barely in the social. The reason they said he didn’t qualify in speech is because he was able to communicate his needs to us one way or another. He is starting preschool in the fall and I’m worried that he’s going to have major issues because they aren’t’ going to know what he is saying or wants.He just had his 3yr old check up yesterday and the dr was very concerned that he was released in Feb from speech at the clinic. She made a referral to rehab services located at the local hospital and they called right away. We were seen today and she gave him a diagnosis of Apraxia. After reading as watching videos of other children his age I’m still up in the air. I’m happy at least we have a direction to move in and someone is once again working with him. But, after reading this article I wonder if he has it or not. He has words but only simple ones; mama, daaee, for daddy, papa, cu for cup, kee ca for kitty cat, he calls the garbage truck eeww, eesee for please, okee for ok(this is a new word for him in the last 2 weeks or so), cow, caa for car and maybe a couple other words are all he says. The rest of his talking just sounds like a bunch of babbling. . . . .

  • Isa Marrs July 22, 2014, 1:32 pm

    I am happy to hear that your pediatrician made the recommendation and that your son is receiving therapy once again. Most often children with CAS don’t babble however without hearing your son’s speech it is impossible for me to give my opinion. Regardless, with so few words, it is important that he receive high quality, intensive, individual speech therapy. Please let us know how he progresses.

  • Liz August 13, 2014, 2:47 pm

    My son is 32 months. He has very limited speech. He can say Ma’s for mom, cars, no, oooo is cat, ba is bottle, buzz, and ow for ouch. He has started pointing to his mouth for a drink. He is doing more active behavior to communicate with us. He eats fine, has age appropriate motor skills. I don’t know what more I can do to help his speech. He has no interest in repeating after me. When someone counts 1, 2, 3 he responds with duh, duh, duh. I think in his mind he is saying the correct word. He is going to be evaluated by a speech therapist next week. I was told not to worry until he is 3 from our pediatrician. He said since he was the third child he has the older kids speak for him. He does not babble or speech gibberish.

  • RESHMA September 3, 2014, 3:27 am

    hi, i have a 25 month old boy who doesnt say much.
    he had grommets put in twice, last one being last month.
    he plays, laughs, understands everything we say, says a few words, dada, baba, mama, up, more daddy.
    should i be worried about him .. i dont know what to do.
    i am concerned he has an older brother at home with him, but he plays with him,
    when he wants somethings he points or goes and fetches himself.

    let me know what to do

  • KathyKay September 12, 2014, 5:28 pm

    My son is turning 5 the coming December and I am worried because he is a three word boy. He does not chew his food, he grind his teeth pretty badly. He eat selected foods but not relish like us in zambia who love nshima with chicken beef or fish. He can only drink soup juices. No tea, bread or anything. He goes to schools for two years now bit I have not seen any improvement. He enjoy playing alone bit he can too play with selected friends he is used to but communication still is limited. He is so scared of jumping castles such that he can even pee and shivers a lot. He knows everything to detail and can point. He can say mummy, daddy, a car, a bus,I am jumping and also counting. He knows his name and his teachers name. His teacher is Ruth but he says Fufi. Please help me as I adore my little son. I am a mother of two.

  • Mimoza September 24, 2014, 10:16 pm

    Hello my son just turned 3 years in august and he was diagnosed with verbal apraxia and expressive language delayed …when they tested him he was 2.5 years old…know why is he having an expressive language delay because of apraxia or something else…I guess nobody will ever know why he can’t expresse him self in words…also we speak two languages with him…could he be just a late talker..he has some words but each day he is starting to imitate sounds and words but for his age he is behind on speech like a 12-15 months old…. He is in pre k and receiving speech therapy I know he has the words and deep in my heart I know he will talk sooner or later..they told us he will talk 99.99% but with therapy ..but as a mom I feel so hopeless sometimes it’s breaks my heart why my son..they told us is genetic hmm we don’t have anybody in our family with apraxia..I didnt even know what apraxia means …also how it’s possible to be diagnosed with aparaxia and expressive language delaye…so this means what he has booth of them I thought when you have verbal apraxia the expressive language delaye it’s inclusive with apraxia…what’s the different between aparaxia and expressive language delaye…?..could be maybe he just has an expressive language delay and not aparxia …a lot of kids are misdiagnosed with late talker and apraxia because they have a similar symptoms ….I am sorry for my broken English ….thank you so much for this article from Mimoza

  • Isa Marrs September 28, 2014, 10:32 am

    Hi Liz, Hopefully by now you had your Speech and Language Evaluation. I am glad that you followed your instinct instead of waiting. If a child needs therapy the earlier it starts the better the outcome. If you had an evaluation by one of the 0-3 programs and he didn’ qualify, make sure you look at all the numbers. Any government program needs a child to have a signifigant delay in order to qualify for services. Just because they don’t qualify doesnt mean they don’t need it. Please let us know what happened with the evaluation.

  • Isa Marrs September 28, 2014, 10:39 am

    Hi Reshma, It sounds like you are already concerned. I always tell parents that if they are at all concerned that it does not hurt at all to have a child evaluated by a Speech Language Pathologist. Please let us know how it goes.

  • Isa Marrs October 2, 2014, 3:43 pm

    Hi Mimoza,
    Thank you for your letter. Childhood Apraxia of Speech is a motor speech disorder. The words and thoughts are in the brain however the message does not get to the mouth properly to form the sounds and words. An expressive language disorder has nothing to do with the actual production of sounds. A child with an expressive language delay may have a limited vocabulary and/or shorter sentences than what would be expected. Speech Pathologists are trained to tell the difference between these 2 different types of speech language impairments. Children can have both a motor speech impairment and an expressive language delay. I am happy to hear that you are getting your son speech therapy. If you are not receiving the results you want and your child is not making progress it does not hurt to get a second opinion.

  • Rachel October 5, 2014, 6:54 pm

    My daughter just turned 3 in Sept. Her medical doctor as well as myself was concerned with her speech. She could only pronounce a few words and wasn’t able to pronounce certain letters. Also, when she would say a word I would ask her to repeat it. She would pronounce it differently each time. Sometime it would be mom. Other times mum. Three weeks ago she was diagnosed with apraxia by a speech therapist who was highly recommended. She has two sessions a week. It has helped tremendously. The speech therapist said we are getting good results because we also practice the same words at home. She loves to learn and is willing to do the extra work. Most of the time. 🙂 Stickers help a lot. She still struggles with letters, but I know in her head she knows what she wants to say. It’s just not coming out the way it should. She use to use a lot of hand gestures. Since speech therapy she doesn’t as much since we understand her better. She no longer gets frustrated with us since we can understand her. Knowing her diagnosis now and getting the help needed has helped us all. If you think your child has apraxia see a speech therapist right away. There is no cure for it. You can’t solve the problem on your own. Only the right diagnosis and specialist will help your child improve. Also make sure you bring the exercises home as you them through out the day. I hope this helps someone.

  • Isa Marrs October 6, 2014, 2:38 pm

    Thanks Rachel for your insight!

  • Ethel February 19, 2015, 12:20 am

    Hello. I am really worried about my son. He is 2 and a half years old. He knows what to I’m talking about when I talk to him. He will spontaneously say words, but when you make him repeat it, he doesn’t. I’m getting worried about any other serious illness, but maybe I’m just paranoid. He will say, “no, oh no, boo boo, this, that.” He’ll say bye bye “ba ba” or “daday”. He knows how say mama, but will never call me mama or his dad dada. But he knows who we are. And he will say it, but not because he’s calling us, only babbled it. He’s in speech twice a week. Sometimes I don’t know if he hears us, or he has selective hearing because I’ll call him and he doesn’t look. He likes to play blocks, cars, he will try to sing, but just say o or ee sounds. I just don’t know what to do. I think he’ll be fine. But I just want to know how long will it take for him to start talking to us. I am hoping you can answer this, even if it’s a long time now. Thanks in advance.

  • Rossi April 13, 2015, 2:55 am

    Dear Isa,

    Thanks for this site, very informative. I am from Malaysia, my 40 months old boy is diagnosed as High Functioning Autism, and until now he is non-verbal. I find that it is a huge double challenge to get speech out from him. I do not know if my boy is considered Childhood Apraxia of Speech.

    We do see hourly weekly speech therapist (2 months ago) and occupational therapist.

    At the moment, the Speech Therapist is using PECS method to encourage him to speak, which is not working yet.

    Week 1 – 2 – Refusal to use the card, but end of session reluctantly agree with handing over card actions

    Week 3 – Been more consistent in using PECS

    Week 4 – 5 – Able to discriminate different PECS for different items very well.

    During use of PECS, only once he said the word “ball”.

    My son is on autistic spectrum, (not all though, quite a few areas of him are very normal)

    – Auditory reception, I think he is typical autistic here, sometimes do not respond to calls.
    And at certain times, even the slightest sound of aircond vents attract his attention. I guess he has problem prioritizing correct sound to listen to.
    Quite hard to make him understand new instructions.
    – Lack of communication skills.

    He pulls our hand to get things he wants, he does not know how to point.

    – Eye contact to strangers are lacking
    – Disobedient

    Other part of him being normal –

    – He likes to socialize with family members, love humours.
    And I think most importantly, he has got normal or decent motor skills.

    – He understands most social rules, what can be done, what cannot be allowed, whom to look for (grand dad, grand mom) when wanting to be spoilt or pampered.
    – He has natural feelings of fear at the correct things (eg. sound of thunder, or when seeing violent / gory scenes on TV), and his reaction to fear is normal, which is get very close to us and holding us tightly.

    Gross motor, he seems very fine here, he can do the hardest climb in and out of baby cord. He can jump down from sofa arm rest with ease. Or he can walk up a slide (front direction or reverse direction) with his hands full of toys.
    Fine motor, according to both the SLP and OT, they say he has got quite a good fine motor skills, he can stack up blocks gently until it is very tall, he can insert string through holes.
    And he is able to multi task working with two hands at the same time.
    The biggest problem is that, my boy is considered non-verbal.
    Even calling us papa or mama, is very very rare. Only lets say once a month he did look into our eyes and call “pa” or “ma” when he is crying.
    Other words he says rarely is maybe “bubble” when we blew bubbles, or when he sees bubbles in the bathtub.
    Only other word heard is “rice”, whereby the pronunciation is missing the “r” word.
    Babbling, he does it on and off, sometimes when he does it, you can hear it frequently, then you don’t hear it for quite awhile, before he starts again many days later. Its the usual “ba…ba.. da..da”
    Listening to ABC music, he does sing following the tone, instead of ABC, he sings “ba ba ba ba”…but follows the tone of the music. Once in a while he does other song in the same manner.
    When we dance, sometimes, he moves his body as well.
    After looking at my boy’s characteristics, do you think he is classified as Childhood Apraxia of Speech?
    Our speech therapist is not sure yet, she thinks there could be possibility.
    When using the PECS, when moving on to another level of using the word “I Want” followed by objects, if he stil doesn’t say a word by then, she says my boy could be possibly CAS.
    If my boy is Childhood Apraxia of Speech, how can we help him at him?
    Will some hand coordination movement helps his overall brain coordinations?

  • Isa Marrs April 21, 2015, 1:59 pm

    Thank you Rossi. Unfortunately, I can’t say whether or not I think your son has CAS from your description. However, PECS is not the correct program to use to help your son talk if Childhood Apraxia of Speech is suspected. A program that directly works on speech production would be a better fit. PECS works on the communicative exchange not speech production and using PECS to determine whether your son has CAS does not make sense. I would talk to your SLP about working on speech. I would also reccomend getting a second opinion. Good luck.

  • Rose May 21, 2015, 2:38 pm

    Dear Is a,
    Can a child be diagnosed with CAS if they do not have words only a few sounds?

  • Isa Marrs June 13, 2015, 6:25 am

    How old is the child?

  • Rose June 13, 2015, 7:52 am

    He turned 3 on November and was diagnosed a little before that.

  • Isa Marrs June 15, 2015, 6:47 am

    Who gave him the diagnosis? Is he trying to talk?

  • Rose June 15, 2015, 9:23 am

    His developmental pediatrician. He is somewhat unmotivated. He’s content grunting.

  • Isa Marrs July 13, 2015, 2:47 pm

    I would suggest seeing a Speech Language Pathologist who has experience with CAS. Often when a child is very young and still not trying to talk much “Suspected CAS” is often stated.

  • Isa Marrs July 13, 2015, 3:03 pm

    Yes it is. Often times children have both.

  • Isa Marrs July 13, 2015, 3:11 pm

    There is a wide range of normal development and from your description it seems as though she is in that range. If you have concerns I would definitely recommend getting her evaluated by a Speech Language Pathologist just to be sure. It is great that you read to her often. One tip to help expand her language is use the words she says in two word phrases and keep it simple. For example if she says “apple” when she wants an apple you should say “more apple”. If she says “shoe” when you are putting her shoe on you should model “shoe on”. Remember to make a short simple phrase for her to imitate.

  • Audrie B July 31, 2015, 5:11 pm

    Hello! Have you caught on to all the hype with fish oils/omega 3s aiding in CAS? Do you have an opinion on this?

    Our little girl is turning 2 next month with only 15 words. She won’t even attempt to mimic us, and all her other words have been spontaneous. Her receptive speech is great though. We don’t have a diagnosis as she is not yet old enough but my heart is telling me it’s CAS and im wondering if I should give the Fish oils a try.

  • Isa Marrs August 20, 2015, 9:09 am

    Hi Audrie,
    In my opinion Fish Oils are good for everyone. I don’t have a strong opinion in regards to Fish Oil and CAS. A strong SLP is the most important factor!

  • Isa Marrs August 20, 2015, 9:23 am

    Hi Jacqueline,
    Sometimes children will have some minor motor planning difficulties that impact vowel production. These issues do resolve with little to no residual delays. I always say however, that if there is a “suspected CAS” or even some CAS symptoms it should be treated as CAS.

  • Isa Marrs August 20, 2015, 9:27 am

    In regards to the “tongue tie” articulation is minimally impacted. Feeding is where we see more difficulties. Tongue Tie also impacts dental health in that a child can’t clean the food that collects while eating between the teeth and cheeks. This can lead to more cavities.

  • Isa Marrs August 20, 2015, 9:30 am

    Hi Julia,
    I don’t know what you mean by “talking in the back of her mouth”. Is she “backing’ all her sounds and not using her tongue?

  • Isa Marrs October 7, 2015, 10:48 am

    Hi Lindy,
    I would recommend and increase in speech therapy. I would say at a minimum you should do 2x weekly. Also talk to your therapist about goals and make sure you are carrying over his goals in your home too.

  • Isa Marrs October 7, 2015, 11:00 am

    Hi Christina,
    From your description it sounds like a suspected CAS however without seeing her, this is in no way formal. It also sounds like there could also be difficulty with oral motor planning. In regards to the delayed Myelination, it has been cited as a possible cause however I have not had an abundance of clients with this diagnosis. I do not have a therapist to refer you to however you should definitely question any therapist you work with about their knowledge and experience. Any good therapist will welcome the questions and not be offended at all. I get this all the time.

  • Isa Marrs October 8, 2016, 10:14 am

    Drooling and open mouth posture does not mean Apraxia. There are very specific things we look for in speech production that will tell us if a child has CAS. I think that it is good that the therapists are not rushing to a diagnosis. Just make sure he is getting lots of speech language therapy with a quality therapist. And keep in touch and let me know how he progresses.

  • Isa Marrs October 8, 2016, 11:08 am

    It is possible for a child to have CAS in isolation. It is also still possible that your son is a Late Talker and will start to talk soon. Keep up the speech therapy. Make sure he is getting at least 2 sessions a week with a quality Speech Language Pathologist.

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