Apraxia of Speech: Signs in Adults and Children

01Motor planning

What speech motor planning means

The NIDCD explains that apraxia of speech is a neurological disorder affecting the brain pathways involved in planning the sequence of movements needed to produce speech. The brain knows what it wants to say but cannot properly plan and sequence the required movements, so the person has trouble saying what they want correctly and consistently.

It is not caused by weakness or paralysis of the speech muscles. Severity varies: it can be so mild that it affects only a few sounds or long, multi-syllable words, or so severe that a person cannot communicate effectively by speaking and needs other ways of communicating.

02Adults

Acquired apraxia of speech in adults

According to the NIDCD, acquired apraxia of speech can occur at any age but most often affects adults. It is caused by damage to the parts of the brain involved in speaking and involves the loss or impairment of speech abilities a person already had. It may result from a stroke, head injury, tumor or other illness affecting the brain.

Acquired apraxia of speech often occurs together with other conditions caused by nervous system damage, such as dysarthria, a speech disorder caused by muscle weakness, or aphasia, a language disorder. The NIDCD notes that some people recover some or all of their speech abilities on their own, which is called spontaneous recovery; those who do not need speech-language therapy.

03Children

Childhood apraxia of speech

Childhood apraxia of speech (CAS) is present from early childhood. Mayo Clinic describes it as a rare speech disorder in which the brain is not able to direct the lips, jaw and tongue to produce speech sounds clearly or at the proper speed, even though the muscles are not weak. Signs may include babbling less as a baby, saying first words late, using a limited number of consonants and vowels, leaving out sounds and speech that is hard to understand. These are usually noticed between 18 months and 2 years, when a professional may describe “suspected CAS” and recommend ongoing assessment alongside speech therapy.

The NIDCD notes that the causes are not well understood and that imaging usually does not show brain differences. Mayo Clinic explains that CAS is linked to gene differences in about one-third of children, can be part of some genetic or metabolic conditions, and can occasionally result from brain injury or infection. Children with CAS do not outgrow it on their own. If you are concerned about a child’s speech, Mayo Clinic advises having a speech-language pathologist evaluate the child as soon as you notice any issues. See also speech sound development chart.

04Signs

Inconsistent sounds, transitions and prosody

The NIDCD and Mayo Clinic describe characteristic signs in both forms:

• distorted sounds, especially vowels, with longer or more complex words being harder
• inconsistent errors: saying a word correctly once and then having trouble repeating it, or saying the same word differently each time
• groping: visible searching movements of the jaw, lips or tongue to find the right sound
• difficulty moving smoothly from one sound, syllable or word to the next
• errors in stress, rhythm and intonation, such as equal stress on all syllables or pauses between syllables
• difficulty imitating simple words, in children

The NIDCD notes that children with apraxia of speech generally understand language much better than they can use it.

05Differences

Apraxia, dysarthria, aphasia and speech delay

Apraxia of speech is distinct from several conditions it can be confused with. Dysarthria is caused by weakness of the speech muscles, which may produce slurred, slow, soft or strained speech; the NIDCD notes that some people have both, which makes diagnosis harder. Aphasia is a language disorder that affects finding, understanding or using words, rather than planning speech movements.

In children, Mayo Clinic explains that articulation and phonological disorders, which are more common, involve trouble learning to make or use specific sounds without difficulty planning movements. Speech delay means following the typical path of speech development more slowly, whereas CAS does not follow the usual pattern and does not go away with age. See speech delay vs autism for other differences.

06Urgent

Sudden adult speech change versus ongoing assessment

In an adult, a new difficulty speaking that appears suddenly is not something to book a routine appointment for: it can be a sign of a stroke and needs emergency care, especially with facial drooping, arm or leg weakness, confusion or trouble understanding.

Once any acute cause has been treated, ongoing speech difficulties can be assessed by a speech-language pathologist, who can identify whether apraxia, dysarthria, aphasia or a combination is present and plan therapy.

07Diagnosis

How speech-language assessment builds a diagnosis

The NIDCD explains that speech-language pathologists play a key role in diagnosing apraxia of speech. Because no single symptom or test can confirm it, the diagnosis is based on finding several characteristic signs and ruling out other conditions such as muscle weakness or aphasia.

Testing may involve repeating a word several times or repeating words of increasing length, such as “love, loving, lovingly”. For acquired apraxia, the assessment may also look at conversation, reading, writing and non-speech movements. For children, the NIDCD notes that speech may need to be observed over a period of time, and Mayo Clinic adds that CAS can be hard to diagnose when a child also has signs of other speech or language disorders.

08Therapy

Individual speech practice and therapy goals

The NIDCD explains that speech-language pathologists use different approaches and that no single approach has been proven most effective. Therapy is tailored to the individual and also addresses any other speech or language problems. Frequent, intensive, one-to-one sessions are usually needed for both children and adults, because the repetitive practice and personal attention involved are hard to provide in groups. Children with severe CAS may need intensive therapy for years alongside school.

Mayo Clinic notes that in speech therapy, the child practices saying sounds, syllables, words and phrases correctly. Progress varies, and some people make more progress than others. For adults with acquired apraxia of speech, our speech therapy practice in Bilbao can provide assessment and individual therapy once the medical cause has been assessed (consultations are in Spanish).

09Sources

Where the sources differ

The NIDCD page (last updated October 2017) covers both acquired and childhood apraxia of speech and gives detail on diagnosis, therapy and alternative communication. Mayo Clinic (December 2025) focuses on childhood apraxia and gives more recent information on genetics, describing gene differences in about one-third of children, whereas the NIDCD states only that genetic factors may play a role. Genetic testing is not needed for everyone; the care team decides when it is useful.

The NIDCD describes the use of alternative communication when speech is very limited, such as sign language, picture or word books and electronic devices, noting that these can support language and literacy. Neither source describes non-speech exercises such as blowing or tongue strengthening as a treatment for speech planning problems, or promises recovery within a set time.

10Summary

In summary

Apraxia of speech is a difficulty planning and sequencing speech movements, not a muscle weakness or a language problem. In adults it usually follows brain damage such as a stroke; in children it is present from early on, often without a clear cause. Typical signs include distorted vowels, inconsistent errors, groping and unusual stress or rhythm.

Diagnosis is made by a speech-language pathologist from several signs together, after ruling out other conditions. Therapy is individual, frequent and intensive, and communication aids can be used alongside speech practice and can support language and literacy. Family support and home practice matter. A record of the communication situations that matter most and the supports that work helps set shared therapy goals.