Childhood apraxia of speech (CAS) can feel like one of the more intimidating diagnoses on your caseload. There’s a lot to know, and a lot of it doesn’t work the way typical articulation therapy does. Here’s the good news: once you understand the shift in thinking CAS requires, the actual session-to-session work becomes a lot more manageable.
CAS is a motor speech disorder that falls under the umbrella of speech sound disorders, but it’s fundamentally different from a typical articulation or phonological disorder. The breakdown isn’t in an individual “speech sound.” It’s in motor planning, the ability to plan and sequence the movements needed to produce speech. That means your thinking has to shift from working on sounds to working on movements.
This is a simplified overview to help you get oriented. If you’re actively treating a student with CAS, additional training (there are several free options linked below) is well worth the time.
Start With Dynamic Assessment
Dynamic assessment is the first real step, because it tells you two things: which stimulus set to start with, and what kind of cueing and feedback actually helps this specific student.
During assessment, you’ll have the student attempt a range of syllable shapes, CV, VC, CVC, CVCV, and multisyllabic words, to see where the motor breakdown happens. The point isn’t which sounds are wrong. It’s where the plan falls apart. A student might nail a CV shape but fall apart the moment you add a second consonant. That’s your signal.
While you’re assessing, you’re also watching for the core characteristics of CAS. Strand and McCauley (2018) note that four or more of the following across three assessment tasks is a strong indicator:
- Inconsistent errors on consonants and vowels across repeated productions
- Lengthened or disrupted transitions between sounds and syllables
- Inappropriate prosody
- Vowel errors
- Increasing difficulty with longer or more complex words
- Articulatory groping
Choosing Your Initial Stimulus Set
There’s no ready-made stimulus list here, targets need to be individualized for each student based on what the dynamic assessment showed you.
For students with more severe CAS, start small. Choose a limited set of difficult-but-achievable movements, and give frequent, specific feedback about how to make the movement (this is called knowledge of performance). As students gain success, you’ll expand the set and shift toward knowledge of results, feedback about whether the production was correct, with less frequent feedback overall.
One thing that matters more than people expect: choose words that are meaningful to the student and their family. Early wins on functional words build buy-in fast.
Choosing a Treatment Method
A few well-supported, evidence-based options, most with free training available:
Dynamic Temporal and Tactile Cueing (DTTC): Developed by Edythe Strand, appropriate for moderate to severe CAS, ages 2+. Free training is available through the Callier Center for Communication Disorders at UT Dallas.
ReSt / TEMPO: Developed at the University of Sydney, appropriate for CAS and ataxic dysarthria, ages 4-12.
Integrated Phonological Awareness Training (Moriarty & Gillon, 2006): Appropriate for speech-language impairment, ages 4-12.
NDP3 Program (Williams & Stephens, 2004): Evidence-backed, not free. Requires the student to have solid attention skills, imitation ability, and readiness for cueing before starting.
DTTC tends to be the most widely used of these because it leans on core principles of motor learning that generalize well across speech sound disorders, not just CAS. One caveat: DTTC asks students to attend closely to the clinician’s face, which can be a barrier for some autistic students. It’s worth having a workaround in your back pocket, or considering a different method if sustained face-gaze isn’t realistic for a given student.
Principles of Motor Learning
Whatever method you choose, these principles show up across all of them, and they’re worth knowing cold:
- Practice as much as possible. Repetition is the engine of motor learning.
- Build a relationship with the student. Trust affects effort and attention.
- Give clear instructions. The student should always know what’s expected.
- Vary the distribution of practice based on progress and severity.
- Attend to prosody, not just segmental accuracy.
- Slow the rate down to support motor planning.
- Vary feedback type and frequency based on performance.
Session Ideas That Don’t Require Anything Fancy
CAS treatment lives and dies on trial volume, not materials complexity. A few low-prep ways to rack up repetitions:
- A racetrack where a car moves forward after every 10 trials
- Mystery bags that open after 10 trials
- Plastic eggs that pop open after 10 trials
Dr. Strand also recommends avoiding pictures or cards early in treatment, since you want the student’s visual attention on your face for motor-planning input, not split between your face and a card.
What About Non-Speech Oral Motor Exercises?
Skip them. CAS is a planning disorder, not a strength or muscle-weakness disorder, so exercises like tongue strengthening don’t transfer to speech production (McCauley et al., 2009). Time spent there is time not spent on the actual motor planning work that moves the needle.
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FAQ: Treating Childhood Apraxia of Speech
How is CAS different from a phonological disorder? CAS is a motor planning disorder, errors are inconsistent, and prosody is often affected. Phonological disorders tend to show consistent, rule-based error patterns with intact prosody. A student can present with features of both, which is part of why dynamic assessment matters so much.
How many trials does a CAS session actually need? More than most other speech sound disorders. High-repetition practice (aim for as many trials as the session structure allows) is one of the most consistent findings across CAS treatment research.
Do I need specialized training to treat CAS? You don’t need a certification to start, but additional training meaningfully improves outcomes given how different CAS treatment is from standard articulation therapy. Free training options are linked below.
Resources for Further Learning
Free Training: Presented by Edythe Strand, Callier Center for Communication Disorders, UT Dallas
Free Resources: Apraxia Kids · Child Apraxia Treatment · ASHA Evidence Map for CAS
SLP Now members get access to a full CAS skill pack, including a dynamic assessment tool, do’s-and-don’ts reference, and session materials built around these principles.
Start your free trial to access the CAS skill pack →
References
American Speech-Language-Hearing Association. (n.d.). Childhood apraxia of speech [Evidence map]. https://www2.asha.org/EvidenceMapLanding.aspx?id=8589936369
McCauley, R. J., Strand, E. A., Lof, G. L., Schooling, T., & Frymark, T. (2009). Evidence-based systematic review: Effects of nonspeech oral motor exercises on speech. American Journal of Speech-Language Pathology, 18, 343-360.
Moriarty, B. C., & Gillon, G. T. (2006). Phonological awareness intervention for children with childhood apraxia of speech. International Journal of Language & Communication Disorders, 41(6), 713-734.
Murray, E., McCabe, P., & Ballard, K. J. (2015). A randomized controlled trial for children with Childhood Apraxia of Speech: Comparing Rapid Syllable Transition Treatment and the Nuffield Dyspraxia Programme. Journal of Speech, Language, and Hearing Research, 58(3), 669-686.
Strand, E. A. (2020). Dynamic Temporal and Tactile Cueing: A treatment strategy for childhood apraxia of speech. American Journal of Speech-Language Pathology, 29(1), 30-48.
Strand, E. A., & McCauley, R. J. (2018). Differential diagnosis of severe speech impairment in young children. The ASHA Leader.
Williams, P., & Stephens, H. (2004). Nuffield Dyspraxia Programme. Windsor, England: The Miracle Factory.
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