Childhood apraxia of speech

Also called Developmental verbal dyspraxia, DVD, CAS, Verbal dyspraxia

A child who understands everything and struggles to get the sounds out in order: what verbal dyspraxia is and why AAC alongside therapy speeds speech up rather than slowing it.

What it is

Childhood apraxia of speech, which UK therapists have long called developmental verbal dyspraxia, is a difficulty planning the movements of speech that's present from the start rather than acquired. The child knows what they want to say. Their understanding is usually strong. But the sequence of tongue, lip and jaw movements that turns a word into sound won't come reliably, and errors shift from one attempt to the next.

It's uncommon: a small fraction of children with speech difficulties, and far fewer than the number who get the label from a worried search. It often sits alongside the wider motor coordination difference that the Health A-Z covers as dyspraxia, though a child can have one without the other.

Who it can help

Children whose speech is very hard to understand past the age of three, who have few consonants, who visibly grope for sounds, and whose longer words fall apart. Parents and teachers who need to know that the child is not being lazy or stubborn.

It's the wrong label for a child who's simply late to talk and then catches up, or for a child with a phonological delay, where errors are consistent and follow a pattern. A speech and language therapist makes the distinction and it takes more than one session.

How it works

Diagnosis rests on three things seen together: inconsistent errors on the same word, difficulty moving between sounds and syllables, and odd stress and rhythm. Vowels are often affected, which is unusual in other speech sound difficulties.

Therapy is frequent, intensive motor practice, ideally several short sessions a week, using cues the child can see and feel: a hand on the jaw, a gesture for each sound, a picture of the mouth shape. Sound-by-sound work matters because the child needs to build each movement before chaining them. Progress tends to be slow and steady rather than sudden.

Because speech can take years to become clear, the child needs another way to say things now: signing such as Makaton, a core board or a speech-generating app. The evidence is clear that using AAC doesn't delay speech. It gives the child language to practise with, and the frustration goes down.

Getting started

Ask the nursery or school to refer to speech and language therapy now, and ask the GP as well; the two routes don't cancel each other out. Write down ten words your child wants most and ask the therapist to make them the first targets.

At home, keep talking normally and don't drill. Say the word back correctly without asking for a repeat. Accept every attempt at communication, in whatever form, and respond to the meaning. Learn a few signs together for the daily essentials.

Try a symbol board for choices at snack time and bedtime. A phonics keyboard can also help an older child hear a word built sound by sound, which is exactly the level the therapy works at.

Where to get help

NHS speech and language therapy through the GP, health visitor or school; the RCSLT explains the route. Speech and Language UK runs a helpline for parents, and Dyspraxia UK covers the wider motor picture. If the difficulty is affecting learning, communication support at school explains what to ask for and when an EHCP comes into it.