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

ByLondon Speech and Feeding
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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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    How do we play with our Gestalt Language Processors?

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    Murray, D., Lesser, M., & Lawson, W. (2005). Attention, monotropism and the diagnostic criteria for autism. Autism, 9(2), 139-156.

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    This still does not answer your original question of: why would I want to do this, I want my child to talk!? You are a SPEECH Therapist, please help my child TALK, not point to pictures, that is not what I had in mind.

    Let Me Explain

    When speech is difficult for a child it doesn’t mean that there is nothing to talk about! Of course, we want all our children and all people to speak because it is the easiest and most effective way of communicating, no doubt! However, sometimes this is very hard for some children and whilst we are always working towards speech where possible, we also want to make sure that whilst figuring out how to speak, your child has a MEANS TO COMMUNICATE. Using a board like this might well be a temporary strategy but whilst you are using it and working on their speech you will find a reduction in tantrums and frustration as you child is able to express themselves more effectively.

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    Here is what one of my parents says about the core board we use with her little boy:

    “the board has been a game changer, my son is a visual learner so it really helps to have the board as he associates communication so much easier this way. We have incorporated his twin sister who models it’s use and have definitely seen improvement in speech through its support and his frustration around being unable to verbally communicate at times has definitely lessened”

    K Connolly, Mother of Tom (aged 3.5 years).

    Reading and hearing this makes me so happy!

    In addition to general core board above I also sometimes use a Core Board that is specific to an activity, such as for example BLOWING BUBBLES. Below is an example of such a board, which you can use very nicely during a bubble blowing activity and sometimes it is a nice place to start for newcomers, this can be an easy introduction. You can download this and many similar boards on www.widgit.com for free!

    Using a Core Vocabulary Board

    There is so much more to say about AAC and using Coreboards, visit my Instagram you can find a bit more information on how I use them.

    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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    Transforming Mealtimes

    ByLondon Speech and Feeding
    Speech Therpaist in London

    Transforming Mealtimes

    Below are two reviews I got from grateful clients over the past 4-6 weeks; this blog is more about how Feeding Therapy can help you than blowing my own trumpet…. though that said, it is always so nice and gratifying to hear when parents are happy and hopeful about their little one’s feeding journey. Feeding Therapy is a substantial part of my work as a Children’s Speech and Language Therapist. One of my specialist subjects is Autism and we find that many children on the Autism Spectrum are very specific about eating, and will often refuse a range of typical family foods in favour of a narrow range of foods/snacks.

    Mostly, feeding difficulties are a combination and complex cocktail of factors that have contributed to the current status quo: sure, there may have been some physical problems to start off with, such as reflux causing the baby discomfort, constipation, a very tight tongue tie or a swallowing problem caused by neurological difficulties and of course sensory processing difficulties are also very physical experiences. We always begin with a very thorough case history taking and information gathering, followed by an oral assessment and observation of the actual swallow to establish what might have been – or still might be – the cause for the feeding difficulties.

    In most of the cases I see in my practice, the original obvious cause is no longer present, especially with older children. So, if the swallowing is fine, the reflux is no longer present, the tongue was divided (twice!) why are they still not eating much, refusing to try new foods, only accept certain textures etc.

    The answer is extremely complex and multi-faceted and this little blog is not covering any factors in detail (we would be here all night) -I mentioned sensory processing difficulties earlier on. These are mostly still present but often not acknowledged or recognised by parents. And it is certainly the case that one of the contributors is parental anxiety; this tends to run very high and has been for many months, sometimes years. This in turn often leads to very tense and unpleasant, endlessly long meal times and many times children are force-fed several times a day in order to “get something down there” as otherwise they would probably starve themselves.

    Additionally, parents end up only offering a very narrow range of foods because that is all their child will eat. This ends up in a vicious cycle of children being fed porridge-style food for all meal times and of course they won’t progress to more mature foods if these mature foods are never on offer.

    In order to help address and disentangle some of the issues I often introduce the “Division of Responsibility in Feeding” as researched and recommended by Ellyn Satter (The Satter Feeding Dynamics Model)

    Here are the main points of her approach:

    Children have a natural ability with eating, they eat as much as they need and they grow in the way that is right for them and they learn to eat what their parents eat. (E Satter). The parent is responsible for WHAT the child eats, WHERE and WHEN the child eats. The child is responsible for HOW MUCH they eat or WHETHER to eat. Satter proposes that parents should guide their child’s transition from nipple feeding through semi-solids, then thick and lumpy foods to finger foods and then on to normal family meals.

    Please note: this model is only appropriate for children where the original physical cause is no longer present!

    Of course it’s not easy! It requires a huge shift in thinking about feeding and it requires to trust our children to know what is best for them. This is very big for most parents, as it is not how we were brought up and it is not commonly known that babies and children know what is good for them!

    However, it is certainly true that parents who follow this particular approach and make small, steady changes in the way the offer foods, and in the way they create family meal times differently, children make very nice, pleasing progress and over some months we often see remarkable positive changes.

    I like to work in a team and especially for this type of problem it is essential to have a multi-disciplinary approach. A knowledgeable dietician is an enormous plus in any feeding team as is of course a

    Paediatrician and/ or a Gastroenterologist and the most important people in the team are the parents!

    Feeding Therapy is all about collaboration and a ‘team around the child” approach. When we have this in place and there is trust amongst the team members then we make fantastic progress.

    Do get in touch with me if you would like some help with your tricky feeder.

    Lovely Reviews

    I visited London Speech and Feeding a couple of days ago with my 8-month-old granddaughter and her mother. Sonja made us feel comfortable and at ease from our first introductions. She was able to pinpoint my granddaughter’s mum’s anxiety around weaning very quickly. She not only gave her the tools to do this successfully, but also really encouraged my granddaughter’s mum and instilled confidence that she had everything she needed to make this sometimes-difficult transition without further anxiety.

    Sonja was very thorough in her initial assessment of my granddaughter’s physical milestones and her developing speech. My granddaughter felt very comfortable with Sonja and happily played along with her. Then came the big moment – trying out various foods! We were amazed to see just how easily my granddaughter, with Sonja’s expert encouragement, took to sampling the wonderful array of different delicious morsels Sonja had prepared for the session. My granddaughter even drank from a cup for the first time! Wonderful!

    Sonja then emailed a summary of the session and an extensive array of resources with suggestions for my granddaughter’s mum which she has now put into action. My granddaughter’s mum couldn’t thank Sonja enough for her caring attitude, extensive knowledge, and warm professionalism. I have no hesitation in recommending Sonja, she’s a fantastic Feeding Therapist!

    –

    Sonja (and her lovely colleague, Sandra) were stupendous. I had brought my one-year-old son to see them as I was concerned that he wasn’t eating enough. They looked at his history and we ate together to make sure they had all the information they needed to give an accurate diagnosis. Whilst our outcome was that Henry was in fact doing brilliantly (and I just needed to chill out a bit!), I would imagine if there was something more serious going on, Sonja would make you feel just as supported and empowered as she did with us. Excellent follow-ups too. Money well spent for a bit of reassurance for a stressed out mama. Thank you, Sonja!

    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.

  • · ·

    Chaining: A powerful tool for phonological development

    ByLondon Speech and Feeding

    Understanding chaining

    Chaining is a therapeutic technique I like to use in my speech therapy work with children who have Childhood Apraxia of Speech (CAS) or phonological speech sound difficulties. It helps to break down a complex target behaviour into smaller, more manageable steps. By systematically teaching and reinforcing each step, I can help my students achieve their communication goals.

    There are two types of chaining: Forward and backward chaining

    Today I am going to show and talk about backward chaining. This technique involves starting with the last step and working backward to the first. This approach can be particularly effective for children with persistent speech sound difficulties where combining consonants into clusters, such as /BL/ or /FR/ or /SHR/ is very difficult.

    Backward chaining allows my student to experience immediate success and build his confidence.

    In my video I show you how I applied backward chaining to the words ‘Shriek’, ‘Shrub’, ‘Shrimp’ etc

    My student struggles with both the /SH/ and the /R/ sounds and we have been working on both sounds for some weeks now. He has mild Childhood Apraxia of Speech and he has difficulties with coordinating his tongue movements, breathing and using his jaw effectively to make words. His sound repertoire has grown a lot since we started working together last year. Today in this session I show you how we pulled both the sound /SH/ together with /REEK/ to make ‘SHRIEK’. I love using the pictures and therapy materials from Adventures in Speech Pathology.

    This is also part of the Complexity approach which I will explain in a separate blog post.

    • Step 1 (not shown in the video): I explain what the word means; I find that when my student understands what a word means he is much better at saying it. It increases his confidence and motivation to say a word that he knows the meaning of. Often this student does not tell me that he does not know what a word means, so I always remind myself to check that out first.
    • Step 2 (not shown in the video): We do a little rhyming game and think about what any one word rhymes with: ‘Shriek’ – ‘meek’, ‘weak’, ‘seek’.
    • Step 3: I show my student that there are two parts to this word /reek/ and the sound /SH/.
    • Step 3: We practise the easier part: /reek/ /reek/ /reek/.
    • Step 4: We add the /SH/ sound and pull it together to make our target word ‘Shriek’.

    /REEK/ /REEK/ /REEK/ + /SH/ = ‘SHRIEK’
    /RUB/ /RUB/ /RUB/ + /SH/ = ‘SHRUB’
    /RUG/ /RUG/ /RUG/ + /SH/ = ‘SHRUG’

    By breaking down the word into smaller, manageable steps, my student can focus on each syllable individually, get that right and then gradually build up to the full word. This approach can help to reduce frustration and increase motivation.

    Forward chaining

    Forward chaining is the same process but in reverse: we start with the front sound or syllable and work forward towards the next/last part of the word:

    /SH/ + /REEK/ = ‘SHRIEK’
    /SH/ + /RUB/ = ‘SHRUB’
    /SH/ + /RUG/ = ‘SHRUG’

    Benefits of chaining

    • Increased motivation: By starting with the last step, my student experiences success, which boosts his motivation to continue trying to say the word and trying other words.
    • Reduced frustration: Breaking down the target behaviour into smaller steps can make the task less overwhelming, reducing frustration and anxiety.
    • Improved confidence: As the little learner masters each of the step, his confidence and self-esteem increases. Again, this leads to increased motivation.
    • Faster learning: By focusing on the final step first, and practising lots of chaining (forward and backward), a student can quickly learn to generalise to other words.

    Backward chaining (and forward chaining) is a really great tool for teaching complex speech sounds and words to children with phonological disorders.

    Watch out for my next blog which is all about the complexity approach in Phonology.

    Do get in touch if your child has a speech sound disorder, I would love to help.

    Any questions or need help with supporting your little one’s language please contact me via my contact form, or you could also check out www.hanen.org for advice and lots of inspiration.

    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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