Apraxia of Speech

Apraxia, sometimes referred to as dyspraxia, is a motor disorder resulting from neurological damage. It is characterized by an inability to execute purposeful movements despite having normal muscle tone and coordination. The muscles are capable of normal functioning but faulty programming from the brain prevents the completion of precise, purposeful movement. Oral apraxia refers to the inability to use the oral structures for nonspeech movements such as tongue protruding or lip smacking. Verbal apraxia is the inability to position and sequence oral-facial structures in order to produce sounds.

Children with oral or verbal apraxia may demonstrate the following difficulties with speech production:

  • The child will be unable to perform oral movement on demand such as "Round your lips," "Puff your cheeks" or "Stick out your tongue."
  • The inability to articulate sounds increases as the complexity of the word or speech task increases.
  • Misarticulation occurs on both consonants and vowels. Consonant clusters such as broom, slide and flower are more difficult to pronounce than single consonant words such as bus, table or car.
  • Errors are more frequent in the first sound of a word rather than the middle or the end of the word.
  • Errors are more common in sounds that occur less frequently in speech such as q, zh (such as measure).
  • The most frequent misarticulations are substitutions of one sound for another (pish for fish) or omissions of sounds (eat for seat).
  • Struggle behaviors or "groping" of the oral structures is sometimes present when the child attempts to produce speech sounds. These behaviors increase as the complexity of the target word, phrase or sentence increases.
  • Rote speech tasks such as counting or reciting the alphabet are often easier and with limited to no errors. Responsive speech (such as "Hello" or "I'm fine") is also easier for children with apraxia to produce.
  • Severity of apraxia varies from child to child. Some children may have difficulties making a vowel sound while other children may not have difficulty until the attempt to produce a motorically difficult word such as "watermelon."
  • The child uses a sound correctly in one word, but rnisarticulates it in another word. The child is inconsistent in the pronunciation of a word. He/she may say the word "cookie" correctly on one occasion and mispronounce it on another.
  • The intonation ("melody") of speech is often affected.

Once your child has been diagnosed with apraxia, treatment is typically recommended. The focus of treatment usually involves:

  • Repetition and drill of errors, speech sound or patterns
  • Correction and feedback by the therapist on the appropriate placement of oral structures in production of target sounds
  • Use of intonation or rhythm in speech tasks

These activities are typically incorporated into play activities that are highly motivating for the child. These children need frequent one-on-one therapy and lots of repetition of sounds, sound sequences and movement patterns in order to incorporate them and make them automatic. It is essential the family work with the therapist to provide this intervention when the child is not with his/her speech therapist. In some cases where children are very difficult to understand, the speech therapist may suggest "augmenting" or supplementing the child's speech in order for him/her to be a more independent or successful communicator. These supplements may include sign language, picture books or a voice-output device.

It is important that family members are involved in carrying over therapy activities at home. Your involvement, along with your speech-language pathologist, will greatly increase your child's success in improving his/her speech skills.

Articulation is the process by which we produce sounds, syllables and words. An articulation disorder/impairment refers to the inability of a person to accurately produce speech sounds. A phonological disorder is a disorder in which a person is unable to produce a particular group of sounds. Phonological disorders can be more serious than articulation disorders because they affect more sounds ( e.g., deletion of final consonants -- "ca" for "cat," "cu" for "cup"). An articulation/phonological disorder is usually correctable and should be treated as necessary by a speech/language pathologist. Consistent parental involvement in therapy is very important for carryover into the child's familiar environment. Unintelligible speech can sometimes lead to frustration, behavior problems and withdrawal. An articulation impairment that is not addressed can eventually affect a child's self esteem, social skills and educational status. The longer articulation errors exist beyond the age of mastery, the more difficult they are to correct.

Some articulation impairments are caused by problems such as cleft palate, cerebral palsy, mental retardation and hearing loss, affecting the ability of the child's oral musculature to produce and/or combine sounds. However, the majority of articulation problems cannot be directly linked to any of these disorders. Chronic otitis media experienced during infancy can interfere with a child's ability to listen, prohibiting them from acquiring some speech sounds. It is important to have your child's hearing tested if you have concerns regarding their speech development.

Articulation disorders can range in severity from mild (affecting only a few sounds) to severe (rendering a child unintelligible). Parents can often understand their child's speech but should pay close attention to how well extended family members and others understand the child.

Most articulation errors can be classified into three categories:

  • Omissions -- "op" for "top"
  • Substitutions -- "tat" for "cat"
  • Distortions -- sound produced inaccurately but resembles the actual sound

Production of speech sounds is based on development. A child is not considered delayed if he/she does not accurately produce sounds that are not developmentally appropriate for his/her age. By age 3, a child's speech intelligibility should be approximately 75%. By age 4, a child's speech intelligibility should be between 90-100%. The following is a list of speech sounds and their corresponding ages for mastery. It should be noted that opinions differ among professionals regarding the ages at which sounds are mastered. These are the opinions of the speech/language pathologists at this facility.

  • 3 years: p, b, m, h, w, vowels
  • 4 years: t, d, k, g, f, y, n
  • 5-6 years: l, s, z, sh, v, r, ch
  • 7 years: j, th

Some children will outgrow their speech problems and become more intelligible with age and maturity. However, some children will require enrollment in speech therapy to eliminate their sound errors.


  • Present a good, slow speech model.
  • Emphasize misarticulated words in phrases/sentences correctly.
  • Have your child look closely at your face and mouth, when possible, so he/she can see how you form your sounds.