Childhood Apraxia of Speech (CAS) is a motor speech disorder in which the brain has difficulty planning and coordinating the precise, sequenced movements needed for speech — even though the muscles themselves are not weak.
What CAS Looks Like
Children with CAS often show inconsistent speech sound errors — the same word may come out differently from one attempt to the next — along with difficulty sequencing the movements needed to move from sound to syllable to word, and visible groping or trial-and-error as they search for the right articulatory placement. Prosody is often affected too, with speech that can sound flat or monotone. Because CAS is a motor planning disorder rather than a muscle weakness, standard imitation-based therapy frequently falls short, and some children present with a dual diagnosis — CAS alongside dysarthria or another oral motor difference — that calls for a different treatment path entirely.
Some children come to evaluation with limited or no functional speech. When that's the case, we may recommend augmentative and alternative communication (AAC) or sign language alongside therapy — not as a replacement for spoken language, but as a bridge that reduces frustration while verbal skills are being built. Verbal communication remains the goal; AAC supports the process, it doesn't end it.
How We Approach It
Because CAS is fundamentally a movement-planning disorder, our evaluation looks at movement first: what movement patterns a child can access, imitate, and stabilize, before deciding how to build toward accurate, consistent speech. This is core to why the BRIDGE Clinical Reasoning Framework™ exists — CAS rarely responds to imitation-only approaches, and children often need a rebuilt learning pathway rather than more repetition of the same approach.