Speech & Communication

Signs of Childhood Apraxia of Speech (CAS)

Medically reviewed by Dr. Emily Torres, PhD, CCC-SLP · Pediatric Speech-Language Pathologist

Content reviewed against published ASHA, AAP, NIH guidelines

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Speech and communication milestones vary widely, and worries about signs of childhood apraxia of speech (cas), here is what you need to know.

The short answer

Childhood apraxia of speech (CAS) is a motor speech disorder where the brain has difficulty coordinating the movements needed for speech. Signs include inconsistent sound errors, difficulty imitating words, limited babbling as a baby, and groping mouth movements when trying to speak. CAS requires specialized speech therapy with a therapist experienced in motor speech disorders. Early diagnosis and intensive therapy lead to the best outcomes.

Key takeaways

  • Childhood apraxia of speech (CAS) is a motor speech disorder where the brain has difficulty coordinating the movements needed for speech. Signs include inconsistent sound errors, difficulty imitating words, limited babbling as a baby, and groping mouth movements when trying to speak. CAS requires specialized speech therapy with a therapist experienced in motor speech disorders. Early diagnosis and intensive therapy lead to the best outcomes.
  • Usually normal when: Your toddler makes typical speech errors that are consistent and follow predictable patterns
  • Call your doctor if: Your child was using words and has lost them, combined with difficulty producing speech sounds
  • Varies by age — see the age-by-age breakdown below

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What Parents Should Know

According to ASHA, AAP, NIH guidelines, childhood apraxia of speech (CAS) is a motor speech disorder where the brain has difficulty coordinating the movements needed for speech. Signs include inconsistent sound errors, difficulty imitating words, limited babbling as a baby, and groping mouth movements when trying to speak. CAS requires specialized speech therapy with a therapist experienced in motor speech disorders. Early diagnosis and intensive therapy lead to the best outcomes. At 0-12 months, early signs may include very limited babbling, few consonant sounds, and delayed cooing. Some babies with CAS are very quiet overall. These early signs are subtle and are often only recognized in retrospect after a later diagnosis. It is generally considered normal when your toddler makes typical speech errors that are consistent and follow predictable patterns. However, you should contact your pediatrician promptly if your child was using words and has lost them, combined with difficulty producing speech sounds.

Sources: [1], [2], [3]

Normal vs. Concerning

Usually Normal
Worth Discussing
Your toddler makes typical speech errors that are consistent and follow predictable patterns
Your child was using words and has lost them, combined with difficulty producing speech sounds
Your child makes errors but can consistently repeat words the same way each time
Your child is over 2 with almost no words, visible struggle when trying to speak, and strong comprehension
Your child's speech errors are improving steadily with age
Your child says the same word differently each time they try (inconsistent errors)
Your child has a few sound errors but overall speech development is on track
Your child seems to struggle or grope with their mouth when trying to talk

By Age

What to expect by age

0-12 months

Early signs may include very limited babbling, few consonant sounds, and delayed cooing. Some babies with CAS are very quiet overall. These early signs are subtle and are often only recognized in retrospect after a later diagnosis.

12-18 months

Children who will later be diagnosed with CAS often have very few or no words at this age. They may have limited babbling variety and difficulty imitating sounds. First words may be significantly delayed.

18-24 months

Key warning signs include having few or no words, a gap between what the child understands and what they can say, and visible struggle or groping when trying to produce words. The child may seem to know what they want to say but cannot coordinate the movements.

24-36 months

CAS becomes more identifiable as speech demands increase. Characteristic signs include inconsistent errors on the same word, difficulty with longer words, loss of words that were previously used, and vowel distortions. A speech evaluation with a specialist in motor speech disorders is recommended.

3-5 years

CAS can be more reliably diagnosed at this age. Intensive, frequent speech therapy with a focus on motor planning is the gold standard treatment. Children with CAS benefit from therapy multiple times per week. Progress may be slower than with other speech disorders, but with consistent therapy, significant improvement is possible.

What to Tell Your Pediatrician

  • Describe when you first noticed signs of childhood apraxia of speech (cas) and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your child says the same word differently each time they try (inconsistent errors).
  • Mention if your child seems to struggle or grope with their mouth when trying to talk.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

What Should You Do?

When to take action

Probably normal when...
  • Your toddler makes typical speech errors that are consistent and follow predictable patterns
  • Your child makes errors but can consistently repeat words the same way each time
  • Your child's speech errors are improving steadily with age
  • Your child has a few sound errors but overall speech development is on track
Mention at your next visit when...
  • Your child says the same word differently each time they try (inconsistent errors)
  • Your child seems to struggle or grope with their mouth when trying to talk
  • Your child had very limited babbling as a baby and now has very few words
  • There is a large gap between what your child understands and what they can say
Act now when...
  • Your child was using words and has lost them, combined with difficulty producing speech sounds
  • Your child is over 2 with almost no words, visible struggle when trying to speak, and strong comprehension

What You Can Do at Home

  • Keep track of when you notice signs of childhood apraxia of speech (cas) — noting the time of day, duration, and any triggers can help your pediatrician.
  • Remember that your toddler makes typical speech errors that are consistent and follow predictable patterns — this is generally within the range of normal.
  • At 0-12 months, focus on observation rather than intervention unless your pediatrician advises otherwise.
  • Talk, read, and sing to your baby frequently. Narrate daily activities to build language exposure.
  • While monitoring at home, seek immediate care if your child was using words and has lost them, combined with difficulty producing speech sounds.

Toddler Has Multiple Speech Sound Errors

A speech sound disorder involves difficulty producing speech sounds correctly, making a child harder to understand than expected for their age. While individual sound errors are common in toddlers, having many sound errors that significantly reduce intelligibility may indicate a speech sound disorder that benefits from speech therapy. Early evaluation and treatment lead to the best outcomes.

My Child Is a Late Talker

Late talkers are children who have fewer than 50 words or aren't combining words by age 2, but are developing normally in other areas. About half of late talkers catch up on their own by age 3, but the other half go on to have lasting language delays. Early evaluation and speech therapy can make a big difference, so it's worth acting even if you're told to "wait and see."

Toddler Has Weak Mouth Muscles for Speech

Oral motor weakness affects the muscles of the lips, tongue, jaw, and cheeks, which can impact both feeding and speech. Signs include excessive drooling past age 2, difficulty chewing, messy eating, and unclear speech. If you notice these signs together, a speech-language pathologist who specializes in oral motor skills can evaluate and provide targeted exercises.

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Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is signs of childhood apraxia of speech (cas) normal?
Childhood apraxia of speech (CAS) is a motor speech disorder where the brain has difficulty coordinating the movements needed for speech. Signs include inconsistent sound errors, difficulty imitating words, limited babbling as a baby, and groping mouth movements when trying to speak. CAS requires specialized speech therapy with a therapist experienced in motor speech disorders. Early diagnosis and intensive therapy lead to the best outcomes.
When should I call the doctor about signs of childhood apraxia of speech (cas)?
Your child was using words and has lost them, combined with difficulty producing speech sounds Your child is over 2 with almost no words, visible struggle when trying to speak, and strong comprehension
When is signs of childhood apraxia of speech (cas) normal?
Your toddler makes typical speech errors that are consistent and follow predictable patterns Your child makes errors but can consistently repeat words the same way each time Your child's speech errors are improving steadily with age
What causes signs of childhood apraxia of speech (cas)?
Childhood apraxia of speech (CAS) is a motor speech disorder where the brain has difficulty coordinating the movements needed for speech. Signs include inconsistent sound errors, difficulty imitating words, limited babbling as a baby, and groping mouth movements when trying to speak. CAS requires specialized speech therapy with a therapist experienced in motor speech disorders. Early diagnosis and intensive therapy lead to the best outcomes. Common explanations include: Your toddler makes typical speech errors that are consistent and follow predictable patterns. Your child makes errors but can consistently repeat words the same way each time.
What should I mention to my pediatrician about signs of childhood apraxia of speech (cas)?
You should mention signs of childhood apraxia of speech (cas) at your next visit if: Your child says the same word differently each time they try (inconsistent errors). Your child seems to struggle or grope with their mouth when trying to talk. Your child had very limited babbling as a baby and now has very few words.
Is signs of childhood apraxia of speech (cas) normal at 0-12 months?
Early signs may include very limited babbling, few consonant sounds, and delayed cooing. Some babies with CAS are very quiet overall. These early signs are subtle and are often only recognized in retrospect after a later diagnosis.
Is signs of childhood apraxia of speech (cas) normal at 12-18 months?
Children who will later be diagnosed with CAS often have very few or no words at this age. They may have limited babbling variety and difficulty imitating sounds. First words may be significantly delayed.
Should I go to the ER for signs of childhood apraxia of speech (cas)?
Seek emergency care if your child was using words and has lost them, combined with difficulty producing speech sounds, or if your child is over 2 with almost no words, visible struggle when trying to speak, and strong comprehension. When in doubt, call your pediatrician's after-hours line for guidance.
Does signs of childhood apraxia of speech (cas) go away on its own?
In many cases, signs of childhood apraxia of speech (cas) resolves on its own, especially when your toddler makes typical speech errors that are consistent and follow predictable patterns. By 3-5 years, cAS can be more reliably diagnosed at this age. Intensive, frequent speech therapy with a focus on motor planning is the gold standard treatment. Children with CAS benefit from therapy multiple times per week. Progress may be slower than with other speech disorders, but with consistent therapy, significant improvement is possible.
ASHAAAPNIH

References

  1. [1]American Speech-Language-Hearing Association. Childhood Apraxia of Speech. ASHA
  2. [2]American Academy of Pediatrics. Apraxia of Speech in Children. HealthyChildren.org. AAP
  3. [3]National Institute on Deafness and Other Communication Disorders. Apraxia of Speech. NIH

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Signs of Childhood Apraxia of Speech (CAS).

Things to mention

  • Describe when you first noticed signs of childhood apraxia of speech (cas) and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your child says the same word differently each time they try (inconsistent errors).
  • Mention if your child seems to struggle or grope with their mouth when trying to talk.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

Observations to share

  • Your child says the same word differently each time they try (inconsistent errors)
  • Your child seems to struggle or grope with their mouth when trying to talk
  • Your child had very limited babbling as a baby and now has very few words

Urgent signs to report immediately

  • Your child was using words and has lost them, combined with difficulty producing speech sounds
  • Your child is over 2 with almost no words, visible struggle when trying to speak, and strong comprehension

My notes

From ismybabyalright.com — free, evidence-based baby health guides

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members

Related Resources

Milestone ChecklistsEarly Intervention DirectoryDevelopmental ActivitiesBaby Sign Language GuideBaby Tracker

Bottom line

Most cases of signs of childhood apraxia of speech (cas) are normal. Talk to your pediatrician if your child was using words and has lost them, combined with difficulty producing speech sounds.

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

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Related Speech Concerns

Toddler Has Multiple Speech Sound Errors

A speech sound disorder involves difficulty producing speech sounds correctly, making a child harder to understand than expected for their age. While individual sound errors are common in toddlers, having many sound errors that significantly reduce intelligibility may indicate a speech sound disorder that benefits from speech therapy. Early evaluation and treatment lead to the best outcomes.

My Child Is a Late Talker

Late talkers are children who have fewer than 50 words or aren't combining words by age 2, but are developing normally in other areas. About half of late talkers catch up on their own by age 3, but the other half go on to have lasting language delays. Early evaluation and speech therapy can make a big difference, so it's worth acting even if you're told to "wait and see."

Toddler Has Weak Mouth Muscles for Speech

Oral motor weakness affects the muscles of the lips, tongue, jaw, and cheeks, which can impact both feeding and speech. Signs include excessive drooling past age 2, difficulty chewing, messy eating, and unclear speech. If you notice these signs together, a speech-language pathologist who specializes in oral motor skills can evaluate and provide targeted exercises.

Accent vs Speech Disorder in Bilingual Toddlers

When toddlers grow up hearing more than one language, they naturally blend sounds, patterns, and accents from both languages. This is normal and healthy, not a speech disorder. A bilingual child may pronounce some sounds differently than monolingual peers because they are learning the sound systems of two languages simultaneously. True speech disorders affect both languages equally, while accent influence appears only in specific sounds borrowed from one language to another.

Ear Fluid Affecting Baby's Speech Development

Chronic or recurrent middle ear fluid (otitis media with effusion) can temporarily reduce hearing by 15 to 40 decibels, which is like hearing through water. During critical periods of language learning, this muffled hearing can impact speech and language development. If your baby has frequent ear infections or persistent fluid, discuss the potential speech impact with your pediatrician.

Will Ear Tubes Help My Child's Speech?

Ear tubes (tympanostomy tubes) can restore normal hearing by draining persistent fluid from the middle ear. Many children show speech and language improvement within weeks to months after tube placement, particularly if hearing loss from fluid was contributing to their speech delay. However, ear tubes alone may not resolve all speech delays, and some children benefit from speech therapy alongside tube placement.