great little parenting blog

What is Childhood Apraxia of Speech?

July 16, 2025

Childhood apraxia of speech (CAS) is a tricky speech disorder. It’s tricky to explain and also tricky to treat. So if you’re hearing about it for the first time and you’re confused, there is good reason.

Definition

Childhood apraxia, sometimes called dyspraxia, is a developmental disorder that results in speech that is extremely difficult to understand. The very basic explanation is that there is a breakdown between what a person wants to say and the motor planning and execution of the plan. A child with apraxia knows what they want to say, but when attempting to say the message, there is a breakdown making their speech unclear. It is estimated that 1 in 1000 or .1 percent of children exhibit childhood apraxia of speech (Shriberg et al, 2019).

Apraxia can be somewhat confounding. Often, when a child is learning to talk, they change words to make them easier to say. For example, a child may say “tar” for “car.” The “t” sound is typically easier to say, so the child’s little developing system replaces the /k/ sound with a /t/ sound. The sounds are similar, but the /t/ is a little easier to produce. (For more information on speech and language development, check out the GLP post here) A child with apraxia on the other hand will often use a more motorically difficult replacement. This often makes the word harder to say and more difficult to understand. They can generally produce shorter words more easily than longer words.

In addition, children whose speech is influenced by apraxia are not consistent in their productions of certain words. For example, a child may say “Dada” one day and “Gaga” another. Their system is mixed up and often therapy includes many repetitions of target words to strengthen the pathways used to link sounds together.

Signs of CAS

Inconsistent errors when repeating a word or phrase
- A child saying “Dada” multiple times may say something like: Dada, Gaga, gadee. Saying a word in an inconsistent way is unusual and a sign of CAS
Disrupted prosody or an unusual rhythm to their speech
- A child with CAS may emphasize the wrong part of a word or phrase, such as “polk-A-dot” instead of “POLK-a-dot”
Have a slower rate of speech or seem to struggle to form the words (“groping”)
- A child with CAS has trouble forming the speech sounds and linking them together, so they may actually appear to be searching for the right motor movements
Vowel errors or consonant distortions
- A child who has difficulty with vowel sounds, e.g., “eeple” for “apple,” or makes unusual replacements for consonant sounds, such as producing a [k] sound for a /sh/ sound as in “kine” for “shine”
Longer words are less clear
- This can be true for many early speakers, but a child with CAS will often have trouble with sounds they can say in shorter words, such as the /b/ sound in “baby” may be distorted in “banana.”
In severe cases, difficulty saying any sounds at all

If you think your child is showing some signs of verbal apraxia, please don’t wait to get support. A speech language pathologist can help. Children making unusual replacements or errors not typically seen in development rarely “grow out” of these patterns without support. Speech therapy’s goal is to make communication easier and more productive for your child.

Citations:

asha.com, Childhood Apraxia of Speech

Shriberg LD, Kwiatkowski J, Mabie HL. Estimates of the prevalence of motor speech disorders in children with idiopathic speech delay. Clin Linguist Phon. 2019;33(8):679-706. doi: 10.1080/02699206.2019.1595731. Epub 2019 Apr 15. Erratum in: Clin Linguist Phon. 2019;33(8):815-816. doi: 10.1080/02699206.2019.1616869. PMID: 30987467; PMCID: PMC6633906.

First Steps to Takes When You Have Concerns About Your Child’s Development

November 10, 2024

Sometimes as parents, we have a feeling that something is just not right. As a mom, I know there were times when I was really in it and just feeling overwhelmed and exhausted. I’ve written about this in A Really Hard Day blog post. In my heart, I knew my son was having a terrible time and I wasn’t sure how to help him. Having an outline of some simple steps to take when I had concerns about my child’s development would have been so helpful.

It’s really important to to note, having concerns about your child’s development is not a criticism of your child or of your parenting. I see getting appropriate support, such as speech therapy, as a way to help reduce frustration and increase your child’s ability to interact successfully and develop a joy of life and learning. All children are amazing and can learn in an incredible variety of ways. Getting help early can help you as a parent figure out how your child can learn best.

1) Observe

Watch your child and make note of what you are concerned about. Sometimes little ones are having a bad day (just like we moms do!) or they may be getting sick. Write down your notes to help organize your thoughts. Generally speaking, we think of challenges in different areas in one of 5 categories: Social/Emotional Development, Cognitive Development, Language Skills, Motor Skills and/or Self-Help Skills. (For a more in-depth description of each area, see 5 Areas of Early Child Development.) Using these as a way to organize your concerns about what is going on with your little.

For my son, my concerns were with his Social/Emotional development. He had a great deal of difficulty with change and flexibility. He became distraught and cried for long periods every day.

2) Reach out to Your Pediatrician

Your pediatrician is generally a good early step if you have concerns. They will often ask some follow up questions and can ask some screening questions to help you determine what would be the best way to proceed. Is testing required? They generally can suggest appropriate resources in your area.

For my son, we began therapy with a play therapist in our area. Her help was invaluable and I’m so grateful to our pediatrician for connecting us.

3) Early Intervention Services

Your pediatrician may give specific suggestions as in my family’s case, or they may suggest a more general next step, such as Early Intervention Services. If your child is under 3, you can reach out to your state’s early intervention services program. (See your state’s Early Intervention Contact Information) A state’s Early Intervention Program provides evaluations and therapy in natural environments, such as your family’s home or your child’s childcare center. They will typically do a complete developmental evaluation to assess all developmental areas and provide information about your child’s development noting any areas of concern. Generally, they will provide recommendations and services if appropriate. Different states implement services slightly differently.

I have worked for Early Intervention programs as a speech therapist in two different states and have loved working with children and families. In both places, we worked closely with the families’ goals for their children.

4) School System

If your child is 3 or over, generally your local school system provides support for educational development. You can reach out to your town’s school system for more information on the procedure. Unfortunately, school systems can be very different from one another. Starting with your school system’s website is a good start, but who you reach out to may vary depending on your district. In some school systems you may reach out directly to their preschool or early childhood department while others may have you contact their related services department or special education department. If you’re unsure, you can always contact a main number, and they should be able to send you in the right direction. Depending on your system, they may screen your child or provide a complete evaluation. Generally, they will provide services if your child has significant delays. If they find that your child does not qualify for school services, they should be able to provide information for other resources in your community.

5) Insurance/Private Pay

Sometimes a child’s needs may not fit neatly into an educational category or your child may not qualify for services based on whatever evaluation was done. If you still have concerns about your child’s development, some families pursue private therapy on their own. There are private speech therapists, occupational therapists, physical therapists and counselors who can assist with a wide variety of concerns. Again, your pediatrician can be a good resource for information. Often your school system will have information on local clinics and programs as well.

For my son, we found a private counselor who accepted our insurance to help him work through many of his challenges. Again, our pediatrician provided her information.

6) Community Groups

Consider joining a local parenting group, either online or through a local resource such as a public library. Other parents can provide so much support and information. I’ve said this in other posts as well- our parent friends were absolutely essential to our parenting. As the saying goes, “It takes a village!” Support and love from other families who are going through similar experiences can help on so many levels; from practical advice to emotional understanding. However, please be careful when taking advice from other families. One child and family’s experience can be very different from another’s.

Finally, you are your child’s first teacher and best advocate. Your child is wonderful and unique and deserves the best. Getting help is not criticism of a child. I see it as a way to help and support them in learning to love life and learning.

I’m rooting for you and your family- always in your corner. I wish you love and all the best in your parenting journey.

What are the 5 Areas of Early Childhood Development?

October 20, 2024

As parents, our children are growing and changing so rapidly every day! It can be overwhelming at times to think about all your little needs to learn. I know I still worry with my own big kids- did I teach them all they need to know? Areas of development help us as parents and professionals to organize our thoughts on how a child is growing and developing. We generally think of child development as divided into five main categories:

Social Emotional Development
Cognitive Development
Language Skills (Receptive & Expressive)
Motor Skills (Gross & Fine Motor)
Self-Help Skills

At pediatrician visits, your practitioner will likely use a screening tool that asks a question or two for each area to determine whether your child is developing appropriately. Dividing the skills into different areas can help us assess a child’s development and understand if a bit of help, such as support from a physical therapist, may benefit our little. Please keep in mind that while separating these areas help to conceptualize the different skills, we are all human and there is a lot of overlap and messiness in the areas.

Social Emotional Development

Put simply, this area addresses a child’s ability to interact with their families and others, as well as their developing ability to emotionally regulate their feelings and bodies. Early on, children generally recognize their parents and by 18 months often experience separation anxiety from preferred caregivers. This is normal and speaks to our strong bond with our children. Social Emotional Development includes developing confidence, empathy and the ability to build relationships. Our job as parents is to love them, model for them and let them know- even though they may experience some big- we can help them through it all.

Cognitive Development

Very simply, this area includes a child’s ability to solve problems. Early cognitive development is often exploring behavior, such as looking at shapes or bold colors. As their motor skills increase, littles often use all their senses to explore and experiment- everything is a sensorimotor experience. They may put objects in their mouths, rub their hands or feet on toys, move them up and down to experiment. As they start to understand their bodies more, they typically move on from exploring to more problem solving- placing objects in and out of containers, building skills toward simple puzzles. The ability to problem solve and to show persistence are linked to later success in academic areas.

Language

Language Skills (or Communication Skills) are typically divided into two areas: Receptive and Expressive Language. Receptive Language is what a child can understand. Do they respond to their name? If you say, “Where’s Mama?” do they look toward their mom? Do they show understanding when you ask if they want their favorite treat or toy? Can they follow very simple instructions such as “Give me cup,” when you hold your hand out?

Expressive Language includes what a child is able to communicate. For babies, you may notice eye gaze at first. You may ask if they hear the dog and they glance toward the puppy. For our very little children, it can include pointing or gesturing to a desired object.

Motor Skills

Often the area of Motor Skills is divided into two areas: Gross Motor & Fine Motor Skills. Gross motor skills involve large motor movements, such as rolling over, crawling and walking. Fine Motor skills include more refined movements, such as using a spoon to feed themselves or moving puzzle pieces. Fine motor skills include skills such as coloring or writing as well.

There is a lot of overlap in this area. If a child is not able to sit up well, it’s difficult to develop the strength and coordination needed to hold a crayon and color. It’s so important that littles be given lots of time to move and strengthen all their muscles in order to develop the stamina required for life. While a wiggly toddler is a lot of work, long term it’s better for them to wiggle, learn and develop all the skills they need to be successful.

Self Help Skills

Self Help Skills, sometimes called “Adaptive Skills,” are just what they sound like. Can your child do some things for themselves? For a one-year-old, that may look like feeding themselves small pieces of food or holding their own cup. For an older child, they may be expected to put on or remove a piece of clothing. These tiny steps lead to independence one day.

Supporting Overall Development

You may have noticed that a lot of these areas of development can overlap, creating some messiness. Especially early on, a child’s skills are so interdependent. If a child has some trouble with their motor skills, it may be difficult for them to point (considered a language/communication skill). If a child has a delay in their language skills, it may be hard for them to call their mom (which could be considered a social emotional skill).

This interconnectedness is really a good thing because as you interact with your baby or toddler, by being truly present and following their lead, you are helping all areas to develop. Singing “The Ants Go Marching” as you help your little to toddle around the room of course helps their motor development as they practice their balance and motor movements. However, it also strengthens their social emotional development by fostering the child-caregiver bond. It supports their language because they are hearing new combinations of words and new vocabulary. They are integrating both sides of their brain with music and movement. Their cognition is also growing as they begin to understand their size and ability to navigate the world around them. Their ability to walk will allow them to do more for themselves and become more independent.

For more information on areas of development, developmental milestones and suggested strategies for parents, please see the CDC’s Developmental Milestones.

Concerns

If you have concerns about your child’s development, please reach out to your pediatrician. For more information, see the GLP Blog post First Steps to Take If You Have Concerns About Your Child’s Development.

Sending Your Little with Needs to School

July 25, 2024

Preschool is typically a really wonderful, fun time for littles. However, sending your baby to school can be a really intimidating experience. If your own little learns a little differently than many other children and may benefit from special education services, this almost universal experience can be close to terrifying. There are more components when a preschooler is going to school and receiving special education supports, such as speech therapy, through the school system. There are typically more meetings to develop a plan that will serve your child’s learning the best.

Through my years as an early intervention speech therapist, so many of the parents I worked with had incredible stress thinking about their child being unable to communicate with their school team. Or what would happen if their child did not follow the teacher’s directions. Or if their school staff would know how to comfort or redirect their child in the best way. This experience is fraught with scenarios that can be overwhelming and it’s impossible to plan and problem solve every eventuality that can arise. However, there are some good basics to keep in mind to help manage the transition.

Communication

Of course, the speech therapist/communication specialist would think that communication is the most important item to keep in mind for anything! But seriously, so many problems can be avoided with good communication- definitely not all, but many. Communication exchanges, such as emails, can be so easily misinterpreted. Take your time as you compose your message- how you phrase a question can make a difference in the response you get. Being super clear in what you’re looking for and who your child is can help everyone be on the same page.

I’ve had the privilege of sitting on both sides of the table- as an educator and as a parent. I personally found sitting on the parent side to be much more stressful than the educator side, as the meeting was about my baby. However, in my experience, most educators do love their students and want to do what’s best. If you can approach your communication thinking with the mindset that the school is trying to do what is best for all, the path can be smoother. Sometimes teachers and administrators send a communication quickly and the message could be more terse or cold than their intent. Communication can be frustrating, but it’s really helpful when both parties can assume the best.

Once your child starts school, continue to communicate with the teacher and the team. Personally, I want the school to communicate a lot. I let them know they can call/text/message as often as they want. In my experience, it creates less stress across the board. If the school can message about a small problem, there is less stress and more understanding if/when a big problem arises.

Know the Rules

Every school district runs slightly differently and can have various special education procedures. There are set standards that the entire US must follow, but individual school systems interpret them differently. The Individuals with Disabilities Education Act (IDEA) states that children with disabilities receive a free appropriate public education throughout the nation. (Read more about IDEA here) This law was put into place to protect a child’s right to the services necessary to grow and learn at school. However, different districts can interpret this slightly differently, so a friend’s child in the next town may have a program that contrasts from your child’s program even if the two children learn similarly. Check out your school district’s web page to learn more in advance of any meetings with the school. It can also be challenging because, as parents, we’d like good clear answers, but often the issues are more nuanced.

Another note, the school district’s job is to provide an education for your child. They typically address educational issues. Your child may have a developmental concern, such as a difficulty eating foods with different textures, that may not affect their ability to perform in school. The district may not address this in the school setting. This does not mean that your child’s struggle is not important, it just may be something for an outside therapy to focus on. If you meet with your school and they do not take on every one of your developmental concerns for your child, speak to your pediatrician about outside therapies.

Sometimes, there can be challenges or even significant issues with your district. By knowing the rules, you can address them in an appropriate way. If you do come across a situation where you feel the district is at fault, please find help- either through a parent support groups or advocates. There are many resources out there. In most cases, these situations can be avoided, but, again, every child and circumstances are unique.

Find a Community

It’s so easy to find FB groups, Instagram, local groups. It can be so affirming to connect with other parents that are going through similar struggles and have a place to share successes as well. My mom friends have gotten me through some of our toughest times- just having someone to reach out to chat about issues and get an outside perspective. Sometimes a suggestion that you never would have thought of will come up and that makes such a difference in how you approach a meeting or a situation with your child.

However, please be careful. I’m a parent member of a few different parent groups. I have found incredible solace, but also be aware that another person’s experience, both negative or positive, may not be your experience. Take any advice with a grain of salt, different parents’ backgrounds can influence their experiences. Fellow parents can be a tremendous resource, but there are times when parents can stir the proverbial pot, which does not generally lead to solutions, just more upset feelings.

“Labels:” the Good, the Bad, the Ugly

Parents and families often fear placing a label or specific diagnosis on their child, especially at a young age. We don’t want our children defined by their label or diagnosis. I really didn’t want my daughter to be labeled as a “behavior issue” when she was younger as we were working through the diagnostic process of PANS. (Read more about PANS here) I worked hard to communicate with the school about the steps we were taking as a family and they gave some grace as we worked with her specialists to come up with an appropriate treatment plan. She did receive a label of PANS with OCD and anxiety, which we felt was appropriate and led to a better understanding and experience for Kinsley and the school.

Labels or diagnoses are not necessarily a “bad” thing. The appropriate diagnosis can lead to getting the support that will most benefit your child. If the school or your pediatrician would like to do further testing, ask questions. Make sure you understand what the purpose of the assessments are and what they hope to learn from it. Ask how your child will benefit from the assessments. Again, you know your child best and you are their most important advocate, but please be open to learning.

I’m embarrassed to share that because I had experience as a special education teacher and early interventionist when I had my first child, I kind of thought I knew it all. I knew behavior strategies, child development norms, and all about play based therapy. My baby-who-made-me-a-Mama, Ani, quickly disavowed me of that notion. Even the “experts” can learn a lot.

Be Prepared

Preschool is often a child’s first significant time away from family or very close friends, such as a childcare provider. If you can help prepare your child by talking about the change, that can help a lot. As parents, we know basically what school is like. For our little, it’s a completely new experience. Does the school offer a chance to visit the classroom and meet the teacher? Can you take a few pictures to share with your child as the first day approaches?

Asking questions about the daily routine can also help you as a parent smooth the transition for your child. Does the class eat and nap at certain times? Starting to get your child somewhat on the same schedule can ease the transition for both you and your child. Are there songs or books the class may sing or read each day? Exposing your child to music and materials they will hear and see in the classroom can also create a feeling of familiarity and security.

Many classes request certain items from home, such as a backpack, sippy cup or blanket, but some do not. Don’t wait until the last minute to get the required items! Having what you need will reduce the stress for both you and your child.

Long Term Relationship

You are in your child’s life for the long haul. You’ve been helping that baby all along the way and will be supporting them always. Remember that school will be around for a long time too. Maybe not an individual teacher, but often students are in the same school system for a long time. Figuring out how to work with the district is important. That does not mean you shouldn’t advocate for your child, but just keep the long-term nature of your relationship in mind. This is something I try to take into account. If I’m frustrated with something about the school, I try to think it through before commenting in front of my child, as the old saying goes, “Little pitchers have big ears.” As a teacher, my students have shared more than their parents may have wanted.

I wish you the best as you begin your educational journey with your little one! Hopefully it will be a wonderful partnership between school and home with lots of growth for your child academically, socially and emotionally.

This suggestion list is not exhaustive by any means. It’s merely a starting point to begin a positive exchange in what can be an exciting transitional time. You’ll still have a lot of time with your little at home and will continue to connect and grow along with them. For more on connecting with your child, see the GLP post here.

I hope the information provided here was helpful! Please take what was useful and share anything that may help another parent! It really takes a village!