Could My Child Have Apraxia? Signs of CAS That Get Missed in Older Kids

If your child is school-aged and still hard to understand — but no one has ever mentioned Childhood Apraxia of Speech — it's worth a closer look.

CAS is a motor speech disorder that affects how the brain plans and sequences the movements needed to produce speech. It's well-known in toddlers, but in older kids it often goes unrecognized — sometimes labeled as a language delay, an expressive language disorder, or a general articulation issue.

Here's why that matters.

Why CAS often goes unrecognized

Research shows that many SLPs report inadequate training in CAS, and that CAS remains one of the more difficult speech disorders to diagnose. A 2025 survey of 346 ASHA-certified SLPs (Hutchins et al., American Journal of Speech-Language Pathology) found a clear gap between everyday clinical training and the specialized knowledge needed to identify and treat CAS.

A few honest reasons CAS gets missed:

• Specialized motor speech training isn't standard in every graduate program
• School caseloads make the recommended high-frequency treatment difficult to provide
• CAS can look like other speech and language disorders on the surface

In my own experience working in public schools and now in private practice, I've evaluated several older children who had been in therapy for years before CAS was recognized.

What CAS can look like in older kids

The signs are different than in toddlers. By age 5, 7, or older, the pattern often looks like this:

Speech is unclear, and traditional articulation therapy isn't working. They've been in therapy for years. Same goals. Slow or inconsistent progress.

Inconsistent errors — especially on vowels and longer words. A child with a typical articulation disorder usually says a sound wrong the same way each time. A child with CAS may say the same word three different ways in a row. Vowels are often distorted unpredictably. Multisyllabic words (hippopotamus, spaghetti) come out scrambled. These inconsistent errors and disrupted transitions are part of the ASHA-recognized diagnostic features of CAS.

A small set of clear, familiar words. They may say certain words beautifully — Mom. Dad. Yes. Good. These are stored, well-practiced motor plans. When they have to generate something new — describe their day, answer an open-ended question, tell a story — speech falls apart.

Limited verbal expression. Parents and teachers often think a child is shy or just doesn't talk much. Often, talking is so effortful the child has learned to stay quiet. Conversations look like this:

"How was your day?" — Good.

"How do you feel?" — Ok.

"What do you want to eat?" — (shoulder shrug)

This isn't disinterest. It's a child managing the cost of speaking.

Social and reading challenges. Children with CAS sometimes have trouble making peer friendships because they're hard to understand or talk less. Longitudinal research (Lewis et al., 2004; 2011) also shows children with CAS are at elevated risk for later reading and literacy difficulties.

Why the right diagnosis matters

CAS responds best to motor-based therapy delivered at high frequency by a specialist. Approaches like DTTC (Dynamic Temporal and Tactile Cueing) and ReST (Rapid Syllable Transition Treatment) are evidence-based and look very different from traditional articulation therapy.

When a child with CAS is treated as if they have a language delay or a generic articulation disorder, progress is slow. Not because the child can't learn — because the wrong tool is being used.

What parents can do

• Request a motor speech evaluation from an SLP with specialized training in CAS. The Apraxia Kids Professional Directory is one place to find SLPs who have completed continuing education in CAS evaluation and treatment.
• Connect with an Apraxia advocate. Apraxia Kids has trained advocates who help families navigate school IEPs and push for the right level of service.
• Ask about accommodations. Children with CAS often need alternative response formats for verbal assessments — they may know the answer but can't say it clearly enough to be scored fairly.
• Don't wait. The longer a child practices an incorrect motor pattern, the harder it becomes to remediate.

If you're wondering whether your child might have CAS

I'm listed in the Apraxia Kids Professional Directory and specialize in evaluating and treating older children with CAS — including kids who've been in years of therapy without breakthrough. If you're not sure where to start, a free 30-minute consultation can give you clarity on whether a full motor speech evaluation is the right next step.

Schedule a free consultation →

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References

• American Speech-Language-Hearing Association. (2007). Childhood apraxia of speech [Position statement]. asha.org
• Hutchins, T. L., Gerety, K. W., & Mulligan, M. (2025). Training on Childhood Apraxia of Speech: Experiences of Speech-Language Pathologists. American Journal of Speech-Language Pathology.
• Lewis, B. A., Freebairn, L. A., Hansen, A. J., Iyengar, S. K., & Taylor, H. G. (2004). School-age follow-up of children with childhood apraxia of speech. Language, Speech, and Hearing Services in Schools, 35(2), 122–140.
• Lewis, B. A., Avrich, A. A., Freebairn, L. A., Hansen, A. J., Sucheston, L. E., Kuo, I., Taylor, H. G., Iyengar, S. K., & Stein, C. M. (2011). Literacy outcomes of children with early childhood speech sound disorders. Journal of Speech, Language, and Hearing Research, 54(6), 1628–1643.
• Apraxia Kids. Professional Directory and Parent Advocacy programs. apraxia-kids.org