Childhood Apraxia of Speech: Signs and first steps (2–5 years)

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If you’ve found yourself wondering ‘Why can my child say a word one day, but not at all the next?’ it might be that your child has a motor speech difficulty. This means the challenge isn’t that your child doesn’t know what they want to say; it’s that their brain finds it harder to plan and coordinate the movements needed for clear speech. This speech difficulty is called Childhood Apraxia of Speech (CAS)

Sonja showing power words on a board

In this post, I’ll explain what CAS can look like in 2–5 year olds, what an assessment usually involves, and what you can start doing at home to support your child without turning life into ‘speech homework all day long’.

What is childhood apraxia of speech (CAS)?

Children with CAS often have lots to communicate about (and strong ideas!) but their speech may come out as:

  • Unclear
  • inconsistent
  • hard to ‘copy’ on demand
  • frustrating for them and for you

CAS is not caused by laziness and it is not a parenting issue. It is also not something children simply ‘grow out of’ without support. But with the right therapy approach, children can absolutely build clearer speech over time.

If you’d like to read more about verbal dyspraxia, you may also find this helpful: Supporting children and families living with verbal dyspraxia.

Why is CAS such a big topic right now?

Many families come to me after months (or years) of being told:

  • ‘She’ll talk when she is ready’
  • ‘He’s just shy’
  • ‘It’s probably a speech delay’
  • ‘It’s normal for toddlers’

And sometimes it is a general delay. But sometimes it’s something more specific, like CAS.

There’s also been a huge rise in parents seeking information online, and CAS is often mentioned alongside speech sound difficulties such as:

  • phonological delay (pattern-based speech errors)
  • articulation difficulties (one sound that won’t come out clearly)
  • inconsistent speech disorder

These can look similar at first glance, which is why a specialist assessment matters.

Signs of childhood apraxia of speech in 2–5 year olds

Children develop speech at different rates, and not every unclear speaker has CAS. But here are some common features that may raise a flag, especially when you notice several together.

1) Inconsistent speech errors

Your child might say the same word in different ways:

  • ‘banana’ → nana / baba / mana
  • ‘daddy’ → gaga / daddy / dadi

This inconsistency is one of the biggest clues.

2) Difficulty copying words on request

Some children speak more easily in natural play, but when asked ‘Say ___’, they freeze or the word becomes much harder.

3) Limited sound repertoire

They may use only a small set of consonants (like /M/, /N/, /B/, /D/) and avoid others.

4) Vowel distortions

Many children with typical delays mainly struggle with consonants. But in CAS, vowels can also sound ‘off’ or change between attempts.

5) Speech that sounds effortful

You might notice your child:

  • pauses between sounds
  • tries multiple times
  • looks like they’re ‘searching’ for the right mouth movement

6) Longer words are much harder

‘Car’ might be easier than ‘carry’, and ‘carry’ easier than ‘caterpillar’.

7) Prosody differences (rhythm and stress)

Some children with CAS sound a little unusual in their speech rhythm, stress, or intonation.

8) Frustration or reduced confidence

When a child is frequently misunderstood, they may:

  • talk less
  • use gestures more
  • become upset when asked to repeat themselves

Important note: none of these signs alone prove CAS but they are a strong reason to seek a speech assessment rather than waiting.

CAS vs phonological delay vs articulation difficulty (quick guide)

These are some of the most common questions I hear.

If it’s mainly an articulation difficulty…

A child may consistently say one sound incorrectly (for example, ‘thun’ for ‘sun’- lisp- but everything else is developing well.

If it’s mainly a phonological delay…

You might notice clear patterns, like:

  • leaving off the ends of words (‘ca’ for ‘cat’)
  • swapping back sounds for front sounds (‘tar’ for ‘car’)

Patterns are often consistent and respond well to phonology-based therapy.

If it might be CAS…

Speech often feels less predictable, harder to imitate, and more impacted by word length and complexity.

If you’re unsure, that’s completely normal, and exactly why assessment matters.

What happens in a CAS assessment?

A high-quality speech assessment for possible CAS usually includes:

1) Parent discussion and developmental history

We talk about:

  • pregnancy and birth history (where relevant)
  • feeding history
  • early sounds and babbling
  • first words and how speech has progressed
  • family history of speech/language needs

2) A speech sound assessment

Your child might be shown pictures or play-based prompts so we can hear:

  • what sounds they can say
  • what they simplify
  • whether errors are consistent or inconsistent

3) An oral-motor and movement check

This isn’t about ‘strength’. It’s about coordination and planning. We look at how your child manages speech movements and transitions.

4) Stimulability testing

This means: how easily can your child learn a new sound or word with support?

For CAS, we often explore how they respond to:

  • slowed-down speech
  • visual cues
  • rhythm/tapping
  • short, simple syllable shapes

5) Functional communication and confidence

We look at how speech impacts daily life:

  • being understood at nursery
  • joining in with peers
  • asking for help
  • managing emotions when misunderstood

At the end, you should leave with:

  • a clear explanation of what we think is going on
  • a therapy plan
  • practical home strategies
  • realistic next steps

What parents can do at home

Here are CAS-friendly strategies you can start right away.

1) Choose ‘power words’

Pick 1–2 words that matter most in your child’s daily life, such as:

  • more
  • help
  • mummy
  • again
  • stop
  • open

These words are motivating and functional.

2) Keep it short and successful

For many children with CAS, the goal is quality over quantity.

Try five minutes a day rather than 30 minutes of struggle.

3) Support speech with rhythm

Some children benefit from:

  • tapping a beat on the table
  • clapping syllables
  • using a gentle ‘marching’ rhythm

This can help the brain organise the sequence of movements.

4) Celebrate approximations

If your child says ‘moh’ for ‘more’, that’s communication!

We want them to feel:

  • safe
  • understood
  • proud to try again

Confidence is a key part of progress.

A short parent story (anonymised)

One mum said to me:

‘We kept being told to wait. But I could see my child understood everything; they just couldn’t get the words out. Once we had an assessment and a plan, it felt like we finally knew what to do. The biggest change was his confidence. He started trying more.’

When should you seek support?

You don’t need to wait until school.

It’s worth getting an assessment if your child is:

  • hard to understand compared with peers
  • becoming frustrated or withdrawing from talking
  • inconsistent with words they used to say
  • struggling to imitate speech sounds
  • showing signs that match CAS

Early support can reduce stress for the whole family and help your child feel successful in communication.

Here’s how I can help:

✅ A detailed speech assessment (including whether CAS is likely)

✅ A clear therapy plan with realistic goals

✅ Practical home strategies you can use immediately

✅ Support for nurseries and schools (where needed)

✅ In-person sessions in North-West London and online options

Book your consultation here.

Final gentle reminder

You are not overreacting. Trust your instincts.

Your child is communicating the best way they can, and with the right support, speech can become easier, clearer, and more confident.

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of The London Speech and Feeding Practice.


Health Professions Council registered
Royal College of Speech & Language Therapists Member
Member of ASLTIP

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    Early Intervention Speech and Language Therapist

    Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

    The London Speech and Feeding Practice


    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    Early Intervention Speech and Language Therapist

    Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

    The London Speech and Feeding Practice


    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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  • What is FRONTING?

    Kids Speech Therapist London

    Does your child say “Dough” instead of “Go”? Or “Tea” instead of “Key”? Do you hear a /Sh/ instead of an /S/ does “see” sound more like “she”?

    We Speechies call this a Fronting Pattern which means that a sound that should be produced at the back of the throat with the back of the tongue, like K or G , is said at the front of the mouth with the tip of the tongue, like a T or a D or SH. When this happens speech can be really hard to make out because these sounds are literally everywhere in everyday sentences. Just think how many K’s and G’s we hear in a simple sentence?

    For example, I heard my little student say earlier today: “I know what game we can play in your garden? It’s the one with cones and rings and cushions! I know where it is I can get it.”

    But it sounded like:

    “I know what DAME we DAN play in the DARDEN! It’s the one with TONES and rings and TUSHIONS! I know where it is I TAN DED it.”

    If that sounds familiar to you, here is a little overview of what we can do about it:

    First up it’s always good to start with general speech sounds awareness: does a child hear syllables and intonation? Do they know words that rhyme? Can they follow or copy a simple beat with a drum? Can they listen and hear quiet sounds and loud sounds and can they copy those? Can they follow mouth and tongue movements:, for example : stick out your tongue, lick your lips, click your tongue, blow raspberries?

    Then it really helps to talk about BACK and FRONT of things and to draw attention to the back of the mouth and the back of the tongue and the front tip of the tongue and how sounds are made in the mouth. I often use a puppet to show this or a model of a mouth like this one here in the picture.

    Next we try and listen to words starting with a BACK sounds like a K or a G , and I read out a list of words with those sounds: COW, CORE, CAT, CONE, KEY etc or ARK, EEK, OAK, ACHE…

    Or GOO GUY GUM GONE

    After that we try and see if a student can actually produce a single sound like a K or a G just by itself. If they can, that’s a really great start and if they can’t I help them to produce one – over a few sessions we usually get there. We call this Sound production in isolation.

    Once a child can produce a sound correctly, on its own, we try and start working on very simple words that are really powerful like “GO”!!!!! in a motivating game or “CAR” for little ones who love a car racing track.

    Now that we have established the back sounds and are using it in short words, we can gradually re-train brain pathways and oral- motor/movement pathways to use these new sounds in many words and then short phrases. That can take time!! This is called generalisation and it is not uncommon for it to take up a whole year for fluent speech to be error-free .

    Why does it take so long? Being able to produce a correct and clear K or G sound does not mean it will be used easily. Our brain pathways are fixated or habituated to the error sound. It takes time for habits to change. A child might be able to hear the word TIGER with a G in the middle and she knows that it is not a TIDER but when saying it her tongue automatically moves forward rather than lifts up at the back. It’s a bit like a person who has a rounded back: the brain knows to stand upright and how not to slouch, but when we don’t focus on it, ooops we have slouched again because that is what we are comfortable doing and our body moves with our habit.

    It takes effort and motivation to change our movement patterns and that includes our tongue and lip patterns! We usually get there through a huge variety of games and practice. Lots and lots of repetition is key as is motivation to change.

    Parents and carers are crucial in the success of Speech Therapy!

    We need your feedback at home, the regular short and sweet exercises, the constant positive encouragement and great modelling of speech sounds. We often find that parents are tuned into their child’s error sounds and can understand them much better than anyone else. This is great of course in many ways, however, it also means that the child has less motivation to change: if mummy understands me then my world is ok.

    I will give you a short outline of what different speech therapy models I use in my practice, be it in clinic face to face or on-line in my future blogs soon.


    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

  • · ·

    Speech prompts and strategies I use in Speech Sound Therapy

    This particular student has a mild motor planning difficulty and six weeks ago he came to me with a very strong lisp. In addition to the lisp he is struggling to produce a number of sounds, SH and L on its own and all the clusters (FL/BL/KL/PL) but also CH together with some vowel difficulties.

    The prompts are a mix partially from the DTTC (Dynamic Temporal and Tactile Cueing) model by Dr Edythe Strand as well as phonological models I have learned over the years, and some of them are my own.

    Visual/picture prompts and Images

    Here I use the ‘Flat Tyre’ Sound, to offer as an image for a new S sound and the ‘Tick Tock’ Sound for a new image of the T sound. Both cards are from the Bjorem Speech Sound Deck, which I love and use almost daily.

    Gestural Cues

    I like to use all the ‘cued articulation’ hand cues by Jane Passy for consonants and fricatives. Here we use our fingers and hand to illustrate what our tongue does, and we also show whether a sound is voiced or voiceless. When I use one finger it is voiceless (k/f/s/p) and when I use two fingers for the same cue it means that the voice needs to be turned on: (g/v/z/b/n/m). For vowels I like to use Pam Marshalla’s cue system.

    Simultaneous production

    We say the word together.

    Direct imitation

    I say the word and my student copies me directly.

    Imitation after a delay

    I say the word and then after a little wait my student says the word.

    Spontaneous production

    My student has now learned to say the word by him/herself.

    Offering feedback

    It sounds like… I just heard… I didn’t hear the first sound there? Can you try again?

    Letting the student reflect

    By just shaking my head or by looking quizzical so that my student realises something didn’t quite go right.

    Postitive reinforcement

    ‘Yes that was it, do it again, nice one…’

    Cognitive reframing

    This is a technique where we identify different semantic cues and metaphors or imagery cues, so instead of teaching or focusing on a sound we try out viewing each syllable from a different point of view.

    For example: ‘yellow’. I have had great success with this one: we start with just saying ‘yeah yeah yeah’. I might make a little joke and say something like ‘imagine your mum says tidy your bedroom, what do you say or what do you think?’ Answer: ‘yeah yeah yeah’. Then we practice ‘low’ together, I might blow some bubbles high and low and we talk about ‘low’. And then we put ‘Yeah’ and ‘Low’ together and now we have YELLOW!! It might at first still sound a bit odd, like ‘yea-low’ but we soon shape that up and have the real word.

    Each student is different and having a great rapport is crucial to our success.

    Then a little game break after some 7–10 or so repetitions and always trying to finish on a positive note.

    What game breaks do I use:

    Very quick ones! Students can post something, place a counter in a game, take out a Jenga block from the tower, pop in a counter for ‘connect 4’, stick a sword into the Pop the Pirate barrel or add a couple of Lego blocks to something they are building.

    I hope this is helpful, please contact me for any questions.

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

    Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

    The London Speech and Feeding Practice


    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    Let’s relax about making EYE CONTACT already…

    There’s been a long tradition with teaching staff and with Speech and Language Therapists working in schools that eye contact should be a goal. It is well known that Autistic individuals (whether that be children or adults) mostly avoid eye contact. Whilst it’s part of the way we communicate, it shouldn’t be used as a necessity for an individual who feels that it is uncomfortable. Whilst it does show that you’re listening and showing an interest, it’s not a fair expectation for neurodiverse children.

    Autistic children can find making and maintaining eye contact physically and emotionally uncomfortable as well as unnatural. It adds an extra layer of stress and has been reported to increase distractions rather than reduce them. Children who engage in conversations in their own way (i.e., with reduced eye contact) are not shown to suffer with schooling, work, or social interaction.

    By having fun through meaningful activities, I often experience that ‘BINGO’ moment (a phrase coined by Alex @meaningfulspeech) where the child is enjoying themselves and naturally makes eye contact. There is no demand on them, they are in a fun, engaging environment which suit their strengths and supports their needs.

    Following this, I often reflect on this question ‘Should we make eye contact as a goal?’

    It very much depends on the situation. If it places more demands on the child and becomes stressful. Then no. There are many strategies we can use which gain eye contact without placing extra demands on the child. We need to be mindful to adapt the environment and not place neurotypical expectations to meet the needs of neurodiverse children.

    How can you encourage eye contact without demand?

    • If you’re using toys, try holding them up to your eye level.
    • You can adjust your position, try sitting face to face during play.
    • Always get down to your child’s level. This might mean that you lay on the floor if your child is positioned in this way.
    • During play, waiting is extremely powerful. Before a key part of the activity, wait and see if your child looks at you. Remember silence is golden!
    • The best way I find is: do something unusual during play. It might be that you spray shaving foam with the lid still on. Or you bring out a wow toy and make it spin/light up or make a noise. A balloon can be good – see video clip. Use the excitement of the activity, and wait to see if you achieve that ‘BINGO’ moment.
    • Create opportunities when there are no toys involved such as during ‘tickles’ or ‘hide and seek’. Autistic children find it difficult to shift their attention between a toy and an adult. So by removing one option, you’re setting them up to succeed.

    Remember, it takes practice and time for you to develop these skills. Try one at a time and experiment, see which works best for your child. If you need speech, language or communication support or advice, I am always here to help.


    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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