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.

3

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    • High-tech systems: Apps on tablets that speak aloud when pictures or words are tapped

    AAC is not just for children who will never talk. It’s for anyone whose speech isn’t meeting their communication needs right now.

    🤔 When to introduce AAC

    There’s a common myth that you should only try AAC after ‘exhausting’ other speech therapy options. In fact, AAC can be introduced at any stage, even alongside speech development.

    Here are some helpful signs that AAC might support your child:

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    • They rely on gestures, sounds, or behaviour to communicate.
    • They become frustrated trying to express themselves.
    • You find yourself ‘reading their mind’ to interpret needs.
    • Speech progress feels slow or inconsistent.

    If you recognise these patterns, AAC isn’t a ‘last resort’. It’s a communication support, not a replacement for speech.

    Recent research consistently shows that AAC does not stop children from talking. In fact, it can encourage speech to develop. A 2024 systematic review and meta-analysis published in the Journal of Autism and Developmental Disorders found that children who received interventions combining naturalistic developmental behavioural approaches with aided AAC showed improved language outcomes, and that AAC ‘does not negatively impact speech development and may even facilitate spoken language growth’ (Smith et al., 2024).

    🌉 How AAC supports speech development

    Speech and AAC aren’t competing paths: they’re parallel tracks that often feed each other.

    Here’s how AAC helps speech grow:

    1. Reduces frustration: When a child can express their needs, they’re more relaxed and ready to learn.
    2. Provides a visual model: Seeing symbols or words while hearing spoken language strengthens understanding and word recall.
    3. Builds consistent language structure: AAC systems follow the same grammar and word order as speech, helping children internalise how sentences work.
    4. Encourages turn-taking and social connection: AAC lets children join conversations even before speech is fluent, giving them more practice in real communication.

    AAC is not ‘giving up on speech’. It’s giving a child more ways to succeed while speech continues to develop.

    🧩 How to introduce AAC gently and effectively

    1. Start small and meaningful: Begin with a few key messages your child wants to say, not just what adults want to hear. Think ‘I want’, ‘stop’, ‘help’, ‘more’, ‘all done’, ‘no’, ‘again’. These are powerful words for real interaction and autonomy.
    2. Model, model, model: The most important part of AAC success is modelling—using the system yourself as you talk. For example: ‘You want banana 🍌’ and you tap the ‘want’ and ‘banana’ symbols. Children need to see and hear AAC used naturally before they try it themselves.
    3. Use it throughout the day: AAC isn’t a therapy tool to take out once a week. It’s a living part of communication. Model a few words during mealtimes, play, and routines. The more consistently it’s embedded, the more fluent both you and your child will become.
    4. Keep it accessible: If using a device or picture board, make sure it’s always nearby. If it’s in a bag or drawer, it can’t be used in real moments.
    5. Celebrate all communication: If your child points, signs, uses a sound, or taps a symbol, it all counts. Respond warmly and naturally to reinforce communication in any form.

    🧠 What parents often worry about

    • ‘Won’t AAC stop them from talking?’: No. Research shows AAC use either has no negative effect on speech or leads to increased spoken output (Smith et al., 2024). When children feel understood, their motivation to communicate grows.
    • ‘What if I model it wrong?’: There’s no perfect way to start. Your effort and consistency matter far more than accuracy.
    • ‘Will they get ‘stuck’ using pictures?’:  Some children do continue using AAC long-term; others move naturally toward more spoken language. The goal is always functional communication, not replacing one form with another.

    🪞 Bringing AAC into daily life

    Here are a few simple, parent-friendly ideas:

    • Create visual spaces: Post symbols or core words on the fridge, mirror, or play area.
    • Narrate routines: Use AAC during toothbrushing, dressing, or mealtimes; consistent contexts build understanding.
    • Pair speech and touch: Always say the word aloud when you point to or tap a symbol.
    • Involve siblings and friends: Model how they can respond to AAC too. ‘Oh, you said go! Let’s go fast!’
    • Use shared books and songs: Pause and model key words in stories or songs.

    🌱 The takeaway

    AAC doesn’t mean giving up on speech; it means opening more doors to communication. When words don’t come easily, AAC gives children a way to connect, share, and be heard.

    It helps parents move from guessing to understanding, and gives children the power to express themselves on their own terms.

    If you’re unsure where to start, reach out to a speech and language therapist experienced in AAC. Together, you can find a system that fits your child’s strengths, build confidence in modelling, and help every word (spoken or tapped) feel like a step forward.

    And download and print my one page summary.

    Because when communication is possible, everything else begins to grow.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    📚 Reference

    Smith, K., et al. (2024). The Effect of Naturalistic Developmental Behavioral Interventions and Aided AAC on the Language Development of Children on the Autism Spectrum with Minimal Speech: A Systematic Review and Meta‑Analysis. Journal of Autism and Developmental Disorders, 55, 3078–3099. https://doi.org/10.1007/s10803-024-06382-7

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

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    From ‘Nailed it!’ in therapy to ‘Whoops!’ at home: Why generalising speech sounds is tricky

    ByLondon Speech and Feeding

    As a parent, you’ve likely experienced the triumphant feeling when your child, who’s been working so hard on his or her /S/ sound, produces it perfectly in a therapy session. He or she is rocking those ‘sun’ and ‘socks’ words, his or her lisp seemingly a distant memory. You leave feeling elated, confident that all that hard work is finally paying off.

    Then you get home. And within minutes, you hear it: ‘Thooper!’ instead of ‘Super!’ Or maybe the clear /R/ in ‘rabbit’ from therapy reverts to a ‘wabbit’ when his or she is playing with his or her toys. It’s frustrating, confusing, and can feel like you’re back to square one.

    So, what’s going on? Why is it so difficult for children to take those amazing skills learned in a focused therapy session and seamlessly apply them to their everyday conversations? You’re not alone in wondering this. It’s a common challenge in speech therapy and understanding the ‘why’ can help both parents and children navigate this crucial stage.

    The brain’s habits: Old pathways are strong pathways

    Think of your child’s brain as having established ‘pathways’ for how he or she produces certain sounds. If he or she has been lisping his or her /S/ sound for years, that neural pathway is deeply ingrained. It’s like a well-worn path through a field: easy to follow because it’s always been there.

    In therapy, we’re essentially trying to forge a new path. We’re teaching him or her a new, more accurate way to make the sound. This new path is initially faint, like a barely visible trail. It takes conscious effort and repeated practice to strengthen it. Outside of the structured therapy environment, his or her brain often defaults to the old, comfortable, and well-established pathway, even if it’s not the most accurate.

    The demands of daily conversation: A multitasking challenge

    Therapy sessions are designed to be focused and controlled. We isolate sounds, practice them in specific words, and provide immediate feedback. There are minimal distractions, and your child’s full attention is on his or her speech production.

    Now, consider daily conversation:

    • Speed: We speak much faster in natural conversation than we do during structured practice. There is less time to think about individual sounds.
    • Cognitive load: Children are simultaneously thinking about what they want to say, understanding what others are saying, processing social cues, and managing their emotions. Adding the conscious effort of producing a new speech sound correctly on top of all that is a huge cognitive demand.
    • Variety of contexts: In therapy, we might practise ‘sun’ and ‘socks’. In real life, the /S/ sound appears in countless words, in different positions within words, and alongside a vast array of other sounds. Each new word and phonetic context present a fresh challenge.
    • Lack of immediate feedback: In therapy, the speech therapist is right there to provide instant correction and reinforcement. In a playground, during a family dinner, or while playing with friends, that immediate, consistent feedback isn’t present.

    The role of automaticity: Making it second nature

    The ultimate goal of speech therapy isn’t just correct sound production; it’s automaticity. This means producing the sound correctly without having to consciously think about it. It’s like learning to ride a bike. Initially, every pedal stroke and steering adjustment is deliberate. Eventually, it becomes second nature.

    Generalisation is the process of moving from conscious, controlled production to unconscious, automatic production. This takes time, consistent practice, and exposure to a wide variety of real-life speaking situations.

    How can we help? Bridging the gap

    So, what can parents do to help their children bridge this gap between therapy success and everyday speech?

    1. Be patient and positive: This is a marathon, not a sprint. Celebrate the small victories and avoid getting discouraged by setbacks. Your positive reinforcement is crucial.
    2. Practise little and often: Instead of long, infrequent practice sessions, aim for short, consistent bursts throughout the day. ‘Sprinkle’ in opportunities to practise their target sounds in natural conversations.
    3. Create ‘sound awareness’ moments: Gently draw your child’s attention to his or her target sounds in everyday words. For example, if he or she is working on /R/, you might say, ‘Oh, you said ‘wabbit.’ Can you try to make your /RRR/ sound for ‘rabbit’?’
    4. Model correct production: Continue to model the correct production of their target sounds in your own speech.
    5. Collaborate with your speech therapist: Your therapist is your best resource! Ask them for specific strategies and activities you can do at home to support generalisation. They can also provide guidance on when and how to gently correct your child.

    Tips and tricks

    Below I have listed a few good tips and tricks that can help the transition from therapy room to daily life:

    Empowering your child as the ‘sound detective’:

    • ‘Secret sound listener’: Instead of you doing the correcting, make your child the detective. When you’re having a conversation, say ‘your /S/ sounds are sometimes a bit “slippery”’ (or whatever fun, non-judgmental term you like). Ask your child to quietly listen for your /S/ sounds. You can even purposely make a few ‘slippery’ ones (or correct yourself immediately after) and see if they notice. This shifts the focus from being corrected to actively listening and identifying the sound in a non-threatening way.
    • ‘Sound scorecard’: For a short period (maybe 10–15 minutes during a specific activity, like dinner or a game), provide a small notepad and pencil. Explain that your child is going to listen for his or her /S/ sounds and gently mark a tally every time he or she uses it correctly. The goal isn’t perfection, but awareness. This gives your child agency and a visual representation of progress. You can even make it a game: ‘Let’s see how many /S/ sounds we can catch in five minutes!’
    • /S/ sound song/rhyme creation: Work together to create silly songs or rhymes that are packed with /S/ sounds. The sillier, the better! You can sing them in the car, while doing chores, etc.
    • /S/ sound superpower: Frame the new sound skill as a ‘superpower’. ‘You’re getting so good at using your /S/ superpower! It’s going to help you speak so clearly and confidently.’
    • Highlighting successes: Always go out of your way to acknowledge and praise successful /S/ productions in natural conversation. ‘I really understood you clearly when you said ”s_top”.’ or ‘That /S/ sound was perfect when you told me about the “s_tory”!’

    Important considerations:

    • Keep it low-pressure: The goal is generalisation, not perfection. If your child is feeling pressured, he or she will likely revert to old patterns.
    • Focus on awareness, not just correction: Help your child become aware of his or her own speech rather than relying on you for corrections.
    • Short, frequent bursts: A few minutes of subtle focus multiple times a day is more effective than one long, forced session.
    • Acknowledge feelings: If your child expresses frustration about ‘being corrected’, validate these feelings. ‘I understand it can feel like a lot of listening, but we’re just trying to help you use that super /S/ sound all the time!’

    By incorporating these strategies, you can help your child naturally integrate the new /S/ sound into daily speech, fostering independence and confidence without it feeling like constant ‘testing’ or ‘correction’. Generalising new speech sounds is arguably the hardest part of speech therapy, but it’s also the most rewarding. With patience, consistent effort, and a collaborative approach between parents and therapists, children can successfully integrate their new, clearer speech sounds into every aspect of their daily lives.

    Any comments or if you need help and support with your child’s speech please do not hesitate to get in touch with me: simply fill out the contact form here on the website. I endeavour to reply within 48 hours.

    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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