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Speech Sounds childhood Apraxia of speech Little Star Speech Therapy

Children often make errors saying sounds especially when they are learning new words. These errors can be typical and do not require therapy if it is within the normal age range. However, a speech sound disorder may occur when these errors continue past a certain age. This includes difficulties with articulation (saying particular sounds) or phonological processes (difficulties with sound patterns).


Childhood apraxia of speech (CAS) is a motor speech disorder. Clients’ diagnosed with CAS have difficulties saying sounds, syllables and multi-syallabic words. The problem is not due to muscle weakness but rather the brain cannot execute the ‘plan’ to move the speech articulators (ex. tongue, lips, jaw) required for speech. The client may know what they want to say, but the brain has difficulty coordinating the movements of the articulators.


If speech sound disorders and CAS are left untreated, the client may have difficulties with learning to talk, problems with clarity, confidence/self-esteem, social relationships or academic performance (ex. literacy skills).


Characteristics of speech sound problems:


Phonological delay/disorder

  • A phonological process delay/disorder involves difficulties with patterns of sounds. Some children may substitute all sounds made with the back of the tongue like “k” and “g” with sounds made with the front of the tongue like “t” and “d” (ex. cat----tat, goose---doose)


Articulation delay/disorder

  • An articulation delay/disorder involves difficulties making the sound. The sound could be substituted (ex. red---wed), left off (ex. brush---bush) or changed (ex. shoe---soe). If the errors continue past a certain age range, the client may have an articulation disorder


Childhood Apraxia of Speech (CAS)

  • Common characteristics of CAS are listed below

    • Inconsistent sound errors (vowels or consonants)

    • Difficulties imitating speech

    • May appear to be ‘groping’ when trying to say sounds

    • Difficulties saying multisyllabic words

    • Stresses the wrong syllable, monotonous speech

    • Very difficult to understand


What can be done?

Assessment: During an assessment, the clinician will gather case history information, perform an oral-motor evaluation, deliver a standardised assessment tool, score the results and write all of the information into a report. The information gathered from the assessment will determine if the child has an articulation or phonological delay/disorder. The assessment can also determine if the child has characteristics indicative of CAS. Typically, the assessment lasts one hour. The clinician will recommend the best treatment approach based on information gathered from the assessment.


  • Phonological/Articulation Treatment: Weekly treatment is usually recommended for articulation or phonological delay/disorder. The therapist will choose goals based on age appropriateness, stimulability (ability to produce the sound) and parent feedback. Treatment techniques includes a demonstrating how to produce the correct sound and practicing the sound in words, phrases, sentences etc...

  • Phonological processes treatment involves teaching the rules of speech. Once the child starts to generalise the new speech sound to daily environments, the target sound is achieved. Home practice activities are given during each clinic visits.

  • CAS: Research indicates that children with CAS are more successful when receiving multiple/intensive treatment sessions per week. Initially, children seen one-on-one tend to do better than treatment in groups. The intervention focuses on improving the motor planning, coordination and sequencing of muscle movements. It is important to know that treatment of CAS takes time and commitment. Home practice is essential and the therapist will give treatment material to carry out goals in the home environment.


If you are unsure if your child has a communication problem, please phone us at Little Star to speak directly to a speech therapist regarding your questions

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