Apraxia of speech is a motor-speech disorder where the brain loses its ability to plan and program speech movements. It can occur suddenly after stroke or injury (acquired apraxia) or develop in children (childhood apraxia of speech/CAS). Treatment requires specialized speech therapy using motor-programming approaches, with early intervention critical for best outcomes.
What would it feel like to suddenly lose your ability to communicate? To have been a perfectly well-functioning professional who suddenly finds themselves met with blank stares or uncomfortable side glances when they speak?
Apraxia of speech affects many individuals across age groups. For speech-language pathologists, understanding and treating this complex disorder represents both a challenging specialization and a profoundly rewarding career path. When you work with individuals who have apraxia, you don’t just help them communicate their needs more effectively—you help them re-enter society and better connect with their families and loved ones.
- Emerson College - Master's in Speech-Language Pathology online - Prepare to become an SLP in as few as 20 months. No GRE required. Scholarships available.
- Grand Canyon University - Online Master of Science in Speech-Language Pathology. - This STEM program focuses on training aspiring speech-language pathologists to offer compassionate, effective services to individuals with communication disorders
- Arizona State University - Online - Online Bachelor of Science in Speech and Hearing Science - Designed to prepare graduates to work in behavioral health settings or transition to graduate programs in speech-language pathology and audiology.
- NYU Steinhardt - NYU Steinhardt's Master of Science in Communicative Sciences and Disorders online - ASHA-accredited. Bachelor's degree required. Graduate prepared to pursue licensure.
- Pepperdine University - Embark on a transformative professional and personal journey in the online Master of Science in Speech-Language Pathology program from Pepperdine University. Our program brings together rigorous academics, research-driven faculty teaching, and robust clinical experiences, all wrapped within our Christian mission to serve our communities and improve the lives of others.
What is Apraxia of Speech?
Apraxia of speech is a neurological motor-speech disorder in which the brain cannot properly plan the sequence of movements needed for speech production, despite intact speech muscles. Unlike muscle weakness or paralysis, the muscles themselves work normally. The problem lies in the brain’s ability to coordinate and sequence the precise movements required for clear speech.
This disorder disrupts the pathway between what a person wants to say and their ability to produce those sounds correctly. The individual knows exactly what they want to communicate, but the message gets distorted as it travels from the language centers of the brain to the motor cortex region responsible for coordinating speech movements.
How Apraxia Affects Speech Production
The Brain-Mouth Connection
Understanding apraxia requires understanding how speech normally works. When you speak, your brain sends precise instructions to organize your tongue, lips, jaw, breathing, palate, and voice box to work in harmony so the right sounds come out. This happens automatically and almost instantaneously.
For someone with apraxia, damage to the motor cortex region confuses the messages the brain sends out. Think of a conductor wanting an orchestra to play Beethoven’s Ninth Symphony. The conductor knows exactly what should be played and hands out the sheet music, not realizing it has severe water damage and the sheets are out of order. When the conductor signals the orchestra to play, the music is unclear and disorganized, so what comes out sounds nothing like Beethoven’s Ninth.
The person with apraxia is like the conductor. They know exactly what they want to say, and they pass that message to the motor cortex region of the brain. The message is like the sheet music, which the motor cortex is supposed to organize and pass to the muscles (the orchestra). Unfortunately, the message gets distorted in the damaged motor cortex region. When the distorted message reaches the muscles, each part plays out of order or doesn’t play at all.
The Challenge of Self-Awareness
Perhaps the most frustrating aspect of apraxia is that speakers sometimes can’t tell they are mispronouncing words. Jason Knotts, a YouTuber living with apraxia, explains: “What frustrated me the most is that I thought I was talking perfect. I thought everyone could understand me. But no one could. It took a while for me to realize that what sounds right in my head wasn’t necessarily coming out right.”
Types of Apraxia
Apraxia of speech appears in two primary forms, each with distinct causes and characteristics. Understanding these differences is essential for diagnosis and treatment planning.
| Characteristic | Acquired Apraxia | Childhood Apraxia (CAS) |
|---|---|---|
| Age of Onset | Adults (any age) | Birth to early childhood |
| Typical Cause | Stroke, brain injury, tumor, neurodegenerative disease | Often unknown; sometimes genetic or metabolic |
| Brain Damage Visible | Usually yes (on imaging) | Typically no |
| Onset Pattern | Sudden or gradual decline | Developmental delay |
| Previous Speech Skills | Normal speech before the incident | Never developed typical speech |
| Diagnosis Timing | Immediate after the incident | Around age 3 (after ruling out other delays) |
Acquired Apraxia of Speech
Acquired apraxia occurs when brain damage disrupts previously normal speech abilities. Gina, a mother whose life changed after an unexpected stroke, describes the experience: “Sometimes people think I’m not smart, but I am. I just can’t get my words out.”
When working with individuals like Gina, you work with people facing the frustration of relearning a skill that was once natural. Depending on the type of trauma, these individuals may struggle with other brain injuries affecting their physical or cognitive abilities, but many retain the same mental skills they had before the incident.
Events that can trigger acquired apraxia include:
- Traumatic brain injury from accidents or falls
- Stroke affecting motor speech areas
- Brain tumor growth or surgical removal
- Surgical trauma during brain procedures
- Dementia and progressive cognitive decline
- Neurodegenerative illnesses such as progressive supranuclear palsy
For those with dementia or neurodegenerative illness, apraxia develops gradually. Dr. Joseph Duffy, a prominent researcher in motor speech disorders, explains that patients first notice they aren’t speaking as clearly, starting to mix up words, or finding they must speak more slowly than before.
Progress through acquired apraxia can be slow, but each step toward improvement represents a step into more normal relations with family and friends. Gina chronicled her experience online, including her surprise pregnancy and journey learning to communicate with her new baby, demonstrating the resilience many individuals show in their recovery.
Childhood Apraxia of Speech (CAS)
Childhood apraxia of speech presents a more mysterious picture. While some cases result from genetic disorders, metabolic conditions, or specific syndromes, in many cases, the underlying cause remains unknown. Unlike acquired apraxia, doctors usually cannot see brain damage on imaging studies.
Most parents begin noticing symptoms during the first year or two of life. The child might not start speaking as early as expected, or the number of sounds they produce seems limited to only a few vowel and consonant sounds. Jason Knotts recalls his mother knowing something wasn’t right when he was about one year old. He would launch into long stories that sounded like gibberish, sometimes appearing to tell jokes and breaking into laughter even though others had no idea what he was saying.
CAS often occurs alongside other speech or developmental disorders, so as a provider, you need to watch for multiple signs. It’s not something that will simply “go away with time.” Because early intervention is one of the most important factors in success, you must stress this reality when speaking with parents.
Symptoms and Diagnosis
Recognizing Apraxia Symptoms
The symptoms of apraxia differ from other speech disorders, making an accurate diagnosis essential for effective treatment.
| Symptom Category | Acquired Apraxia | Childhood Apraxia (CAS) |
|---|---|---|
| Speech Sound Errors | Inconsistent errors; the same word is pronounced differently each time | Inconsistent errors; limited phonetic diversity |
| Sound Production | Groping for sounds; visible struggle to position articulators | Limited babbling; loss of words previously used |
| Prosody Issues | Inaccurate stress on syllables or words | Limited intonation patterns |
| Vowel/Consonant Patterns | Distorted vowels; omitted beginning and ending consonants | Vowel errors are less common compared to consonant errors in typical development |
| Attempts at Speech | Repeatedly attempts the same word with different results | Different production of the same word in each attempt |
| Associated Challenges | May have other cognitive or physical impacts from injury | Often accompanied by feeding difficulties |
The Challenge of Diagnosing Childhood Apraxia
Unfortunately, no definitive test or checklist confirms childhood apraxia. In young children, it can be mistaken for autism or dysarthria (poor muscle tone affecting speech). Conversely, other disorders can resemble CAS, leading practitioners to make the diagnosis incorrectly.
CAS can often be more reliably diagnosed around age 3, though concerns may be identified earlier. Experts recommend this timing to allow sufficient time to rule out other speech delays and observe speech development patterns. However, this doesn’t mean delaying treatment. Practitioners often work from a “soft diagnosis” of apraxia, adjusting their methods as they work with children under three until they find approaches that work best for each individual child. Through this process, the child’s speech can improve, and the provider is more likely to identify the root cause.
Early intervention remains the key to success.
Treatment Approaches for Apraxia
When treating apraxia or any speech disorder, it’s tempting to look for a “silver bullet” treatment. The internet offers countless blogs and articles promoting one approach over another, but what produces outstanding results in one person may bring only minimal progress for another.
Evidence-Based Treatment Categories
The American Speech-Language-Hearing Association (ASHA) divides apraxia treatment options into four main categories:
- Motor-Programming Approaches – Focus on practicing speech movement patterns repeatedly to build motor plans
- Linguistic Approaches – Target phonological processes and sound system organization
- Sensory Cueing Methods – Use tactile, visual, or auditory cues to guide correct movements
- Rhythmic and Prosodic Techniques – Incorporate rhythm, melody, and stress patterns to facilitate speech
- Combination Approaches – Integrate motor-programming with one or more methods above
The Importance of Specialized Training
One issue parents and individuals with apraxia frequently express is the difficulty in finding therapists well-versed in various apraxia-specific approaches. Nicole, a speech therapist and mother of a child with apraxia, shares her experience: “No matter what I did, no matter what anybody did, it just didn’t seem to help. He needed a very specific type of therapy and therapist to motivate him to keep going.”
Nicole’s son finally started making significant progress when they found a therapist trained by Apraxia Kids. While apraxia will be covered in your graduate training, research, and clinical consensus suggest that additional specialized training can significantly improve treatment outcomes.
Augmentative and Alternative Communication (AAC)
Living in a home where a child or spouse can’t easily communicate basic needs creates significant stress for families. Offering assistive technologies enables more fluid communication during the treatment process.
Common AAC methods include:
- Sign language systems adapted for speech disorders
- Tablets with communication apps designed for apraxia
- Speech-generating devices with programmed phrases
- Communication books with pictures and symbols
Some parents and caregivers worry these technologies will prevent language learning, but research shows this isn’t the case. AAC is typically used in early intervention stages, and as the individual’s speech improves, they usually choose speech over AAC naturally. While some individuals with severe apraxia may continue using AAC methods long-term, this should be viewed as the exception rather than the rule.
Bilingual Considerations in Apraxia Treatment
Well-meaning SLPs sometimes encourage parents or caregivers to choose one language and stick with it. However, when working with children, this advice may put families at an unnecessary disadvantage.
Research indicates bilingual exposure does not worsen childhood apraxia of speech. Children can learn two languages without added speech delays. For example, if the family speaks Spanish at home and the child speaks English at school and with friends, you, as an SLP, should encourage this practice to continue. Maintaining cultural connections and family communication patterns supports overall development.
With adults, the situation is more complex. Experts note parallel issues between first and second language damage and recovery, but other factors, such as pre-apraxia proficiency in both languages, influence progress. While evidence-based studies examining this issue remain limited, current trends lean toward encouraging families to maintain both languages rather than restricting communication.
Specializing in Apraxia Treatment as an SLP
Your graduate program will introduce you to apraxia, but many families and individuals seek therapists with advanced, specialized training. Additional education in apraxia treatment can significantly enhance your ability to serve this population and potentially differentiate your practice.
Professional Development Options
Apraxia Kids (formerly CASANA)
Apraxia Kids offers extensive on-demand webinars covering assessment, treatment techniques, and case management strategies. Many SLPs find this training invaluable for developing competence in apraxia intervention.
The Kaufman Speech to Language Protocol
This four-hour training program focuses on the evaluation and treatment of childhood apraxia using the Kaufman approach. The course qualifies for ASHA continuing education credits.
The PROMPT Method
PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) is used with patients facing a range of motor speech disorders, including apraxia. ASHA offers continuing education credits for this training, which emphasizes tactile-kinesthetic techniques.
Nuffield Dyspraxia Programme
These one- to two-day training courses and educational packages prepare you to use a “bottom-up” approach that begins with single speech sounds and simple syllables to systematically build speech capabilities.
Rapid Syllable Transition Treatment (ReST)
This newer treatment method targets children ages 4-12. Based at the University of Sydney, the program offers training packages for practitioners working with childhood apraxia, focusing on improving the planning and programming of speech movements.
Board Certification in Neurologic Communication Disorders
For SLPs seeking advanced specialization, the Academy of Neurologic Communication Disorders and Sciences (ANCDS) offers board certification, representing an advanced, highly respected credential demonstrating expertise in treating neurologic communication disorders, including apraxia.
Eligibility requirements include:
- Current CCC-SLP certification from ASHA
- Five years of clinical experience with neurologic communication disorders
- Current CV or resume
- Three letters of recommendation from healthcare professionals familiar with your skills
- Completed Board Certification Candidacy Application with applicable fees
The certification process involves submitting two detailed case studies, delivering an oral presentation, and participating in a discussion following your presentation. Reviewers evaluate your work and either grant certification or identify areas that don’t yet meet standards.
Learning from specialists in apraxia and neurologic disorders empowers you to help patients improve with greater speed and potentially achieve fuller recovery of their language abilities, making the time investment worthwhile for your career and your future clients.
Frequently Asked Questions
What causes apraxia of speech?
Acquired apraxia in adults typically results from stroke, traumatic brain injury, brain tumor, or neurodegenerative diseases affecting the motor speech areas of the brain. Childhood apraxia of speech (CAS) often has no identifiable cause, though some cases involve genetic factors, metabolic conditions, or specific syndromes. Unlike acquired apraxia, brain imaging in children with CAS typically shows no visible damage.
How is apraxia different from aphasia or dysarthria?
Apraxia is a motor planning disorder where the brain can’t properly coordinate speech movements, even though the muscles work normally. Aphasia involves difficulty with language itself—understanding or producing words and sentences. Dysarthria results from muscle weakness or poor muscle tone affecting speech. A person with apraxia knows what they want to say and their muscles are strong, but the brain can’t send the correct movement instructions.
Can apraxia of speech be cured?
Apraxia is typically managed rather than “cured.” Many individuals, especially children who receive early intervention, can achieve functional communication and significant improvement in speech clarity. Adults with acquired apraxia may experience substantial recovery, though progress depends on the severity and cause of the brain damage. Consistent, specialized speech therapy offers the best outcomes, with some individuals achieving near-normal speech while others may continue to use augmentative communication methods.
How long does apraxia therapy typically take?
Treatment duration varies significantly based on severity, age, and individual factors. Children with CAS often benefit from frequent, intensive therapy (often multiple sessions per week). Adults with acquired apraxia may see improvement over months to years, with the most significant gains usually occurring in the first six months post-injury. Consistent, specialized intervention produces better outcomes than infrequent or generalized speech therapy.
Do speech-language pathologists need special training to treat apraxia?
While graduate programs cover apraxia basics, research and clinical consensus suggest that specialized training often improves treatment effectiveness. Many families report better outcomes with therapists who have completed specific apraxia training through organizations like Apraxia Kids, or who are trained in evidence-based approaches such as PROMPT, Kaufman, or Nuffield methods. SLPs serious about treating apraxia often pursue continuing education and may seek board certification through ANCDS (Academy of Neurologic Communication Disorders and Sciences).
Is childhood apraxia of speech a learning disability?
Childhood apraxia of speech is classified as a motor speech disorder, not a learning disability. However, children with CAS may face academic challenges related to speech and language development, which can affect reading and writing skills. CAS often co-occurs with other developmental conditions, and children may qualify for special education services under the speech-language impairment category. Early intervention helps minimize potential academic impacts.
Will using sign language or AAC devices delay speech development?
Research clearly shows that augmentative and alternative communication (AAC) does not delay or prevent speech development. In fact, AAC often reduces frustration and supports language development while speech skills are emerging. Most children naturally transition to using speech more as their abilities improve, self-selecting verbal communication over AAC. For individuals with severe apraxia, AAC provides essential communication access throughout their lives.
Key Takeaways
- Apraxia is a motor planning disorder affecting the brain’s ability to coordinate speech movements, not a problem with muscle strength or language comprehension.
- Two main types exist: acquired apraxia (occurring after brain injury in adults) and childhood apraxia of speech (CAS), which is developmental and often has no identifiable cause.
- Early intervention is critical for the best outcomes, particularly for children with CAS who benefit most from starting therapy before age three.
- Specialized training matters: Research and clinical consensus suggest that SLPs with apraxia-specific training often achieve better treatment outcomes than those using only general speech therapy approaches.
- Treatment requires patience and persistence: Progress can be slow, and what works for one individual may not work for another, requiring therapists to adapt approaches based on each person’s response.
- AAC supports communication: Augmentative communication methods don’t delay speech development and provide essential communication access during therapy and for those with severe apraxia.
- Emerson College - Master's in Speech-Language Pathology online - Prepare to become an SLP in as few as 20 months. No GRE required. Scholarships available.
- Grand Canyon University - Online Master of Science in Speech-Language Pathology. - This STEM program focuses on training aspiring speech-language pathologists to offer compassionate, effective services to individuals with communication disorders
- Arizona State University - Online - Online Bachelor of Science in Speech and Hearing Science - Designed to prepare graduates to work in behavioral health settings or transition to graduate programs in speech-language pathology and audiology.
- NYU Steinhardt - NYU Steinhardt's Master of Science in Communicative Sciences and Disorders online - ASHA-accredited. Bachelor's degree required. Graduate prepared to pursue licensure.
- Pepperdine University - Embark on a transformative professional and personal journey in the online Master of Science in Speech-Language Pathology program from Pepperdine University. Our program brings together rigorous academics, research-driven faculty teaching, and robust clinical experiences, all wrapped within our Christian mission to serve our communities and improve the lives of others.
Ready to Specialize in Communication Disorders?
If working with individuals who have apraxia and other speech disorders interests you, explore speech-language pathology graduate programs that offer specialized training in motor speech disorders and neurogenic communication.
This content is for educational purposes only and does not constitute medical advice. Individuals experiencing speech difficulties should consult with a licensed speech-language pathologist or medical professional for proper diagnosis and treatment recommendations. Information provided here does not substitute for professional medical evaluation and care.