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NIDCD Fact Sheet | Voice, Speech, and Language

Apraxia of Speech

What is apraxia of speech?

Apraxia of speech (AOS)—also known as acquired apraxia
of speech, verbal apraxia, or childhood apraxia of speech
(CAS) when diagnosed in children—is a speech sound
disorder. Someone with AOS has trouble saying what
he or she wants to say correctly and consistently. AOS is
a neurological disorder that affects the brain pathways
involved in planning the sequence of movements involved
in producing speech. The brain knows what it wants to
say, but cannot properly plan and sequence the required
speech sound movements.

AOS is not caused by weakness or paralysis of the

speech muscles (the muscles of the jaw, tongue, or lips).
Weakness or paralysis of the speech muscles results in
a separate speech disorder, known as dysarthria. Some
people have both dysarthria and AOS, which can make
diagnosis of the two conditions more difficult.

The severity of AOS varies from person to person. It

can be so mild that it causes trouble with only a few
speech sounds or with pronunciation of words that
have many syllables. In the most severe cases, someone } Acquired AOS can affect someone at any age,
with AOS might not be able to communicate effectively although it most typically occurs in adults. Acquired AOS
by speaking, and may need the help of alternative is caused by damage to the parts of the brain that are
communication methods. involved in speaking and involves the loss or impairment
of existing speech abilities. It may result from a stroke,
What are the types and causes of head injury, tumor, or other illness affecting the brain.
apraxia of speech? Acquired AOS may occur together with other conditions
that are caused by damage to the nervous system. One
There are two main types of AOS: acquired apraxia of of these is dysarthria, as mentioned earlier. Another
speech and childhood apraxia of speech.

NIDCD...Improving the lives of people with communication disorders

 is aphasia, which is a language disorder. (For more What are the symptoms of apraxia
information, see the NIDCD fact sheet “Aphasia” at of speech?
https://www.nidcd.nih.gov/health/aphasia.)
}} Childhood AOS is present from birth. This condition People with either form of AOS may have a number of
is also known as developmental apraxia of speech, different speech characteristics, or symptoms:
developmental verbal apraxia, or articulatory apraxia. } Distorting sounds. People with AOS may have difficulty
Childhood AOS is not the same as developmental delays pronouncing words correctly. Sounds, especially vowels,
in speech, in which a child follows the typical path of are often distorted. Because the speaker may not place
speech development but does so more slowly than the speech structures (e.g., tongue, jaw) quite in the
is typical. The causes of childhood AOS are not well right place, the sound comes out wrong. Longer or
understood. Imaging and other studies have not been more complex words are usually harder to say than
able to find evidence of brain damage or differences in shorter or simpler words. Sound substitutions might
the brain structure of children with AOS. Children with also occur when AOS is accompanied by aphasia.
AOS often have family members who have a history
} Making inconsistent errors in speech. For example,
of a communication disorder or a learning disability.
someone with AOS may say a difficult word correctly
This observation and recent research findings suggest
but then have trouble repeating it, or may be able to
that genetic factors may play a role in the disorder.
say a particular sound one day and have trouble with
Childhood AOS appears to affect more boys than girls.
the same sound the next day.
} Groping for sounds. People with AOS often appear to
be groping for the right sound or word, and may try
saying a word several times before they say it correctly.
People with either form } Making errors in tone, stress, or rhythm. Another
common characteristic of AOS is the incorrect use
of AOS may have a of prosody. Prosody is the rhythm and inflection of
speech that we use to help express meaning. Someone
number of different who has trouble with prosody might use equal stress,
segment syllables in a word, omit syllables in words and
speech characteristics, phrases, or pause inappropriately while speaking.

Children with AOS generally understand language much

or symptoms, such as better than they are able to use it. Some children with the
disorder may also have other speech problems, expressive
distorting sounds, making language problems, or motor-skill problems.

inconsistent errors in How is apraxia of speech diagnosed?

speech, groping for sounds, Professionals known as speech-language pathologists play

a key role in diagnosing and treating AOS. Because there

or making errors in tone, is no single symptom or test that can be used to diagnose
AOS, the person making the diagnosis generally looks for
the presence of several of a group of symptoms, including
stress, or rhythm. those described earlier. Ruling out other conditions, such
as muscle weakness or language production problems
(e.g., aphasia), can help with the diagnostic process.

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In formal testing for both acquired and childhood AOS, spoken language by stimulating areas of the brain
a speech-language pathologist may ask the patient to involved in language and literacy.
perform speech tasks such as repeating a particular word
several times or repeating a list of words of increasing Some adults and children will make more progress during
length (for example, love, loving, lovingly). For acquired treatment than others. Support and encouragement from
AOS, a speech-language pathologist may also examine family members and friends and extra practice in the
the patient’s ability to converse, read, write, and perform home environment are important.
nonspeech movements. To diagnose childhood AOS,
parents and professionals may need to observe a child’s What research is being done to better
speech over a period of time. understand apraxia of speech?
How is apraxia of speech treated? Researchers are searching for the causes of childhood
AOS, including the possible role of abnormalities in the
In some cases, people with acquired AOS recover some brain or other parts of the nervous system. They are
or all of their speech abilities on their own. This is called also looking for genetic factors that may play a role in
spontaneous recovery. childhood AOS. Other research on childhood AOS aims
to identify more specific criteria and new techniques to
Children with AOS will not outgrow the problem on their diagnose the disorder and to distinguish it from other
own. They also do not acquire the basics of speech just communication disorders.
by being around other children, such as in a classroom.
Therefore, speech-language therapy is necessary for Research on acquired AOS includes studies to pinpoint the
children with AOS as well as for people with acquired specific areas of the brain that are involved in the disorder.
AOS who do not spontaneously recover all of their In addition, researchers are studying the effectiveness
speech abilities. of various treatment approaches for both acquired and
childhood AOS.
Speech-language pathologists use different approaches
to treat AOS, and no single approach has been proven to
be the most effective. Therapy is tailored to the individual
and is designed to treat other speech or language
problems that may occur together with AOS. Frequent, Speech-language therapy
intensive, one-on-one speech-language therapy sessions
are needed for both children and adults with AOS. (The is necessary for children
repetitive exercises and personal attention needed to
improve AOS are difficult to deliver in group therapy.) with apraxia of speech as
Children with severe AOS may need intensive speech-
language therapy for years, in parallel with normal well as for people with
schooling, to obtain adequate speech abilities.

In severe cases, adults and children with AOS may need

acquired apraxia of speech
to find other ways to express themselves. These might
include formal or informal sign language; a notebook who do not recover all of
with pictures or written words that can be pointed to and
shown to other people; or an electronic communication their speech abilities on
device—such as a smartphone, tablet, or laptop
computer—that can be used to write or produce speech. their own.
Such assistive communication methods can also help
children with AOS learn to read and better understand

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Where can I find additional For more information, contact us at:

information about apraxia of speech?

NIDCD Information Clearinghouse
The NIDCD maintains a directory of organizations that 1 Communication Avenue
provide information on the normal and disordered Bethesda, MD 20892-3456
processes of hearing, balance, taste, smell, voice, Toll-free voice: (800) 241-1044
speech, and language. Visit the NIDCD website at Toll-free TTY: (800) 241-1055
Email: [email protected]
https://www.nidcd.nih.gov/directory to search the
directory. https://www.nidcd.nih.gov

More NIDCD fact sheets on Voice, Speech, Follow the NIDCD on Twitter at @NIDCD
and Language:
} Aphasia
The NIDCD supports and conducts research and
} Speech and Language Developmental Milestones
research training on the normal and disordered
} Specific Language Impairment processes of hearing, balance, taste, smell, voice,
} Assistive Devices for People with Hearing, Voice, speech, and language and provides health information,
Speech, or Language Disorders based upon scientific discovery, to the public.

Visit the NIDCD website at https://www.nidcd.nih.gov to

read, print, or download fact sheets.

Apraxia of Speech
NIH Pub. No. 13-7466
September 2016

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