Grades 4-6

This page contains specific information on children who are using sentences and routinely trying to converse with others. There are still errors in their speech and language and they may be difficult to understand at times. They may or may not have reading or other academic challenges or be dealing with additional comorbid disorders.

Speech Therapy/Diagnosis

Therapy for Older Children

Sometimes children have a milder form of CAS and may not be identified with motor planning challenges until later in school when they continue to have errors that traditional articulation therapy does not remediate. On the other hand, children who are diagnosed at a younger age and have made progress in speech therapy may fall into this category sometime in late elementary or into junior high school. Click below to see what therapy priorities change as the child becomes older.

Therapy For Residual Errors

As a child progresses through speech therapy, their speech becomes more intelligible and they become a more competent communicator. There are some speech sounds that seem to be harder for children to acquire (not just those with CAS). These sounds include /r/, /l/, /s/ and /z/. A child with CAS may have acquired motor plans for production of all but 1 or 2 sounds. Usually, their speech is mostly understood by others, but these residual errors are noticeable. A child may not acquire these last sounds until late elementary, middle or high school, or even into young adulthood.

Therapy Burnout

Has your 5th grader stopped being cooperative in speech therapy or decided they would rather be doing something else? Is it ok to take a break from intensive speech therapy? Will they regress? Find the answers to these questions below!

Advice to Parents from Mark Lippert

Mark Lippert, a young adult with CAS, has advice for parents about talking to your child about attending speech therapy.

As your child gets older, and when there might be a hint that your child might move on from speech therapy in the near future, sit down with your child about what the endpoint of speech therapy looks like for them. There are two reasons why I’m bringing it up.

The first one is that it’s a significant accomplishment for your child and your whole family because you all have been on the speech therapy journey for years at this point together. You, as parents, have sat in waiting rooms filling out endless amounts of paperwork over the years. Your child has been forced to dedicate some part of their childhood going to speech therapy, as well as other types of therapy maybe. Together, you and your child deserve an equal amount of credit in the speech therapy journey. After so many years of continuously going to speech therapy appointments, it’s so ingrained in us. When they go to their last speech therapy session one day the next day, it’s all over. That’s it.

The second reason is that my parents and I never really talked about the endpoint of speech therapy for me because I didn’t really mind going to speech therapy as I got older. (I didn’t go to speech therapy as I got older during the school year, only during the summertime.) As I said before, I didn’t mind going to speech therapy. Since my mom got really involved with Apraxia Kids when they were founded in the year 2000 (known as CASANA at the time), in the back of my head I knew that other kids were going to speech therapy and dealing with the same stuff I was going through. So those two things have probably majorly skewed the results of it.

Your child might be more proactive in wanting to stop going to speech therapy. Still, I suggest that you sit down with your child and have a totally honest conversation talking about the steps for them to stop attending speech therapy.


What is an IEP?

Going to your first IEP, fourth or tenth IEP meeting can be nerve-racking. The resources below will help guide you along the way from preparing for one, figuring out what all of the letters mean, to what kind of accommodations or modifications are reasonable.

This article answers some of the most frequent questions we hear from parents new to the IEP process.

This lists the most common acronyms heard by school staff during the IEP process along with links for additional information.

This article describes tips for preparing for an IEP meeting so that it will be a positive and productive experience.

Still have questions or need more information? This document has additional resources and links to help you advocate for your child.

Part of the IEP meeting includes discussing what types of accommodations will help your child be successful in school. Be prepared with your input so that your child’s needs can be met.

This session, by a clinical psychologist who advocates with parents for school based services, explains the Individualized Education Plan (IEP) process including terms, acronyms, and parents’ rights. She includes tips for parents for navigating this often daunting process.

What if My Child No Longer Qualifies for an IEP?

Sometimes children “graduate” from speech therapy as their articulation is age appropriate and very intelligible. But they may still need some supports in their classroom. A 504 plan can help bridge the gap from speech therapy to no services.


10 Parenting Tips for Parenting Preteens and Tweens

This blog post from Child Mind Institute gives tips for staying close with your child as they move to adolescence.

Check out additional articles related to parenting teenagers, mental health of teens and going to college.

Psychosocial Effects of CAS in Adolescents and Adults

Children with severe speech sound disorders that persist beyond elementary school age are at increased risk for anxiety, depression, inattention, and social problems. If there is a comorbid language difficulty, the risk is even higher. Read a summary of several articles which looked at psychosocial challenges in groups of adolescents and adults diagnosed with CAS.

Resources for Mental Health in Children and Adolescents and Adults

This website by iReviews has published (2022) a list and description of apps, websites and services for helping children through adults be proactive and overcome challenges around mental health including stress, anxiety, depression and other concerns.

45 Tools and Resources for Student Mental Health

Tessa McEvoy describes how being a teen with CAS was difficult but she learned to be creative and rely on her strengths.

Words of Advice from Teens/Young Adults with CAS

Below are words from young adults with CAS who responded to the question: “What would you tell your younger self?

Mikey Akers

“I’m not going to lie, living with a diagnosis of verbal dyspraxia/apraxia is tough. Growing up having to fight for every word. The feelings of frustration when you can’t make yourself understood. The loneliness because no one truly understands what the diagnosis you live with entails. The hours in speech therapy when your peers are having fun. The slow progress with your speech. For some, the struggle in school due to poor literacy skills. The co-occurring diagnoses that can run alongside verbal dyspraxia/apraxia. I could go on but I guess you’re getting the picture.

It’s hard, it’s frustrating, it can be soul destroying at times but I promise you, these feelings are temporary. With hard work, determination, and support, a lot of the struggles that come with verbal dyspraxia/apraxia can be overcome.

Will they go away totally? No, but it will improve. As we grow older we also become more accepting of our diagnosis, we understand it more ourselves, and we find coping strategies.

Verbal dyspraxia/apraxia is a life-long diagnosis that presents itself differently over time and, yes, it’s tough, but so are you!”

Mark Lippert

If I could go back in time and say something to my past self, I would say that there will be an endpoint in your speech therapy journey. Once you do something over and over again continuously for years at a time, it could get ingrained in yourself if you like it or not.

Apraxia of speech is hard to live with, and you are not alone. Also, you might be living with other disabilities, as well. I will first admit it’s hard to be scared of teachers calling on you if you can’t get out what you are trying to say. You feel horrible about yourself and think what’s wrong with yourself. You will probably feel bad for the rest of the day. Because in your mind, the words you were trying to say comes out clear as day. When you needed it, you couldn’t get the words out.

Tessa McEvoy

“Everything will be okay. By the time that you are 22, you would have visited Las Vegas 4 times, Choctaw casino twice, Biloxi, Florida, Detroit, and Canada. You have a loyal group of friends who love you. These friends will not be able to see you in-person often, but they will invite you places. I know this is hard to see right now with the bullying you are currently experiencing. It’s rough thinking that out of a class of 37, half of your peers blocked you on Instagram. The other half make plans then cancel because something better came up. These people are NOT your friends. No matter how hard you try, their actions already show their true colors by the way they treat you and other classmates with disabilities. They are not worth your time either. Continue embracing Space Cadet Wannabe, the online comic you are currently working on. By the way, you will be a keynote speaker at the International Manufacturing Summit in 2018 for winning the 24 Under 24 Leaders and Innovators in STEAM and Space award. There will be a lot going for you. The people you make friends with will not judge your inabilities. They will embrace your talents, passions, and interests. Oh, got to go before my time machine breaks the space-time continuum…uhhh, I just narrated my future, but for the better.”

*A giant blackhole forms in the middle of the room. The time machine wraps around its gravitational pull propelling the machine back to the future. See you again in 2015…no…wait…2022! The blackhole spits out a self-tying shoe for 15-year-old Tessa to remember this moment by.

Aly Taylor

I’d tell my younger self that 1) You do not need fixing, and 2) You’re allowed to still dream. In having Apraxia, the self-esteem associated with not being able to talk like your peers is challenging and overwhelming. Reminding those with Apraxia and even my younger self that we don’t need to be fixed, but we just need to practice our speech, would go a long way.

Also, I’d tell myself that I’m allowed to have the same dreams as my peers. As a young girl I never dreamt of getting married or even having a date to prom because I felt those dreams belonged to others that had it all – or at least could talk correctly. Reminding my younger self that I am allowed to have those dreams and that I would find myself among peers that valued my commentary – even with a speech disorder – would be reassuring.

Natalie Yoder

Do not back down when something is not right. You might have to fight for what you need and do not feel sorry for that. There is a light at the end of the tunnel. There are ups and downs with having CAS.

Developmental, Academic, and Learning Challenges

Study Tips

Children with CAS often need help with assignments which can be in the form of things you can do to help them successfully complete homework as well as accommodations that can be put into place in all of their classrooms as well as at home. Click the link below for some tips and strategies.

When there are concerns outside of speech and communication, neuropsychological testing can be done by the school district or at a private clinic and looks at many different areas to determine a child’s strengths and weaknesses so that appropriate support can be provided.

What Is Neuropsychological Testing?

Neuropsychological testing is a wide range of tests, surveys, and activities, normally administered by a psychologist or specific therapist, which can be used to reveal academic, behavioral, communication, and cognitive strengths or challenges. What tests that are administered to a child depend on their age and the areas of concern

How Can I Get A Neuropsychological Test For My Child?

For children who are 3 years of age or older, the school district should provide testing in all areas of concern for that child. This includes communication, cognition, behavior, and gross and fine motor. Because the child is so young, the testing is based mostly on observations, surveys and completing some activities with the child. Once the child becomes school age (kindergarten) additional testing is done to see what strengths and challenges the child has in academic and cognitive areas. However, learning disabilities may not be identified until the child is older. Academic and cognitive testing is more accurate and provides more useful information if the child is 5 years old or above. Parents can also seek testing with outside agencies (see below “How Can I Obtain an Independent Evaluation”).

When Should Neuropsychological Testing Occur?

Neuropsychological testing should be repeated every 2-3 years.  Often it is done as a child is entering Kindergarten and then every 3 years after that.  If significant changes occur or the results are not thought to be accurate, then testing can be requested before the 3 year mark.

How Is It Helpful For IEP Goals?

Neuropsychological testing can be helpful for IEP goals because IEP goals are developed based on a demonstrated need. Results from these tests can guide the IEP team in creating appropriate goals. For example, if a child’s performance on the decoding section of a neuropsychological test is well below average, the IEP team can create a reading fluency goal for them to address the deficit. These assessments can also help guide specific speech and language goals as well.

Can It Help Identify Other Challenges?

Yes! Neuropsychological testing can help identify challenges in academic areas such as math and reading, and with specific skills like memory and repetition. These tests can be used to help diagnose specific learning disabilities that are sometimes comorbid with CAS. Certain tests can also reveal behavior difficulties and provide evidence for processing disorders like SPD (sensory processing disorder), APD (auditory processing disorder), or attention disorders like ADHD (attention deficit hyperactivity disorder).

Is The School’s Evaluation Enough?

This depends on what tests the school is using and what your areas of concern are. Make sure you are clear about all of your areas of concern when talking to the school. If you have communication, academic, and behavioral concerns, that should require several tests to be done, possibly by different people. Ask which tests the school plans to use and what each assessment covers. Popular tests like the Woodcock Johnson and Wechsler Individual Achievement Test (WIAT) specifically measure academic skills, while tests like the Behavior Assessment System for Children (BASC) measure behavioral skills and focus.

How Can You Obtain And Pay For An Independent Evaluation?

If the school does not complete the testing you are asking for or if you do not agree with an evaluation done by your school, you can obtain an individual educational evaluation (IEE). The school district must provide you with information on how to obtain an IEE, and they should be required to cover the expense.

Language Processing/Comprehension

Children with CAS can also have language processing difficulties which includes their ability to follow new or multi-step directions, understand longer or more complex sentences, and follow conversations. These symptoms may not show themselves until the child becomes older and is expected to understand more sophisticated language in the classroom.

CAS and Literacy

i. Literacy problems are a common concern for families of children and adolescents with childhood apraxia of speech. We know that children with speech and language difficulties, such as CAS, are at-risk for associated literacy problems.

This webinar provided an overview regarding the nature of reading disorders to parents of children with motor speech sound disorders. It reviewed current controversies with respect to the dyslexia diagnosis, explained how reading-related deficits can manifest in children, reviewed select appropriate assessments for literacy evaluation purposes, as well as briefly discussed the strengths and limitations of popular reading programs.

Why Some Children Hate to Write

Handwriting is a skill that requires fine motor skills, perceptual skills as well as language skills. Just like with speech, we learn motor plans for making letters and going from one letter to the next. The inability to write can cause a cascade of academic, self-esteem and social issues.

Gross and Fine Motor Developments

Children with CAS are at increased risk for language impairments and fine and gross motor impairments which can increase academic, social, and even vocational challenges. This session will discuss the details and clinical applications of Dr. Iuzzini-Seigel’s study which compared gross and fine motor skills of children with CAS both with and without comorbid language disorders with children who did not have CAS.


IEP Resource Guide

The world of IEPs and 504s and all of the other alphabet soup of special education can be overwhelming and very confusing! There’s tons of helpful information out there, but even that can be difficult to navigate. Apraxia Kids has compiled this guide about IEPs to help you navigate this process!

Summer Speech & Language Camps For Apraxia

Each year, we collect some ideas for summer camps and programs that include a speech and language component to help children with apraxia continue to make progress and practice. This list is meant to be a helpful search tool for your summer planning. We cannot guarantee that each listed camp still has space or dates available this year. Please check each camp’s website for the most up to date information on dates, availability, prices, and program details.

School-based Training for Speech Pathologists

School-based speech pathologists evaluate, diagnose, and treat a diverse variety of disorders in the schools. Childhood apraxia of speech is one of those disorders which is frequently not adequately addressed in graduate programs. These sessions will offer ongoing training in a variety of ages to help school based therapists recognize and treat children with apraxia of speech.

Links to Give to Your Child’s SLP

Apraxia Kids Professional Supports
slp kit parent portal

Available Services for Children with Disabilities

Most states have websites with information in that state on services available for parents of children with disabilities. The one below in Massachusetts provides parent training and information to help families with children with disabilities from birth to adulthood in the areas of education, transitions, and family engagement among others. Parents should search for sites in their state.

Federation for Children with Special Needs