Children with childhood apraxia of speech (CAS) may have many speech symptoms or characteristics that vary depending on their age and the severity of their speech problems. CAS can be associated with: CAS 
Delayed onset of first words
A limited number of spoken words
The ability to form only a few consonant or vowel sounds
 These symptoms are usually noticed between ages 18 months and 2 years, and may indicate suspected CAS. CAS As children produce more speech, usually between ages 2 and 4, characteristics that likely indicate CAS include: CAS 
Vowel and consonant distortions
Separation of syllables in or between words
Voicing errors, such as "pie" sounding like "bye"
 Many children with CAS have difficulty getting their jaws, lips and tongues to the correct positions to make a sound, and they may have difficulty moving smoothly to the next sound. CAS Many children with CAS also have language problems, such as reduced vocabulary or difficulty with word order. CAS Some symptoms may be unique to children with CAS and can be helpful to diagnose the problem. However, some symptoms of CAS are also symptoms of other types of speech or language disorders. It's difficult to diagnose CAS if a child has only symptoms that are found both in CAS and in other types of speech or language disorders. CAS CAS CAS CAS Some characteristics, sometimes called markers, help distinguish CAS from other types of speech disorders. Those particularly associated with CAS include: CAS CAS 
Difficulty moving smoothly from one sound, syllable or word to another
Groping movements with the jaw, lips or tongue to make the correct movement for speech sounds
Vowel distortions, such as attempting to use the correct vowel, but saying it incorrectly
Using the wrong stress in a word, such as pronouncing "banana" as "BUH-nan-uh" instead of "buh-NAN-uh"
Using equal emphasis on all syllables, such as saying "BUH-NAN-UH"
Separation of syllables, such as putting a pause or gap between syllables
Inconsistency, such as making different errors when trying to say the same word a second time
Difficulty imitating simple words
Inconsistent voicing errors, such as saying "down" instead of "town"
 Other characteristics are seen in most children with speech or language problems and aren't helpful in distinguishing CAS. Characteristics seen both in children with CAS and in children with other types of speech or language disorders include: CAS CAS 
Babbling less or making fewer vocal sounds than is typical between the ages of 7 to 12 months old
Speaking first words late (after ages 12 to 18 months old)
Using a limited number of consonants and vowels
Frequently leaving out (omitting) sounds
Using speech that is difficult to understand speech
 Other speech disorders sometimes confused with CAS Some speech sound disorders often get confused with CAS because some of the characteristics may overlap. These speech sound disorders include articulation disorders, phonological disorders and dysarthria. CAS A child who has trouble learning how to make specific sounds, but doesn't have trouble planning or coordinating the movements to speak, may have an articulation or phonological disorder. Articulation and phonological disorders are more common than CAS. CAS Articulation or phonological speech errors may include: 
Substituting sounds, such as saying "fum" instead of "thumb," "wabbit" instead of "rabbit" or "tup" instead of "cup"
Leaving out (omitting) final consonants, such as saying "duh" instead of "duck" or "uh" instead of "up"
Stopping the airstream, such as saying "tun" instead of "sun" or "doo" instead of "zoo"
Simplifying sound combinations, such as saying "ting" instead of "string" or "fog" instead of "frog"
 Dysarthria is a motor speech disorder that is due to weakness, spasticity or inability to control the speech muscles. Making speech sounds is difficult because the speech muscles can't move as far, as quickly or as strongly as normal. People with dysarthria may also have a hoarse, soft or even strained voice, or slurred or slow speech. Dysarthria is often easier to identify than CAS. However, when dysarthria is caused by damage to certain areas of the brain that affect coordination, it can be difficult to determine the differences between CAS and dysarthria.