Building Momentum in CAS Diagnosis: Examining Factors Influencing Speech-Language Pathologists’ Diagnostic Confidence

Date of Submission

Spring 2026

Document Type

Closed Research Project

Degree Name

Master of Science in Speech-Language Pathology

Department

Speech-Language Pathology

First Advisor

Maria Centeno-Vazquez, PhD, CCC-SLP, BCS-S

Abstract

Background: Childhood Apraxia of Speech (CAS) is a complex pediatric motor speech disorder that is challenging to diagnose due to symptom variability and overlap with other speech sound disorders. Objective: This study aimed to examine speech-language pathologists’ (SLPs) confidence in diagnosing CAS and to identify factors influencing diagnostic confidence, including training, clinical experience, and assessment practices. Methods: Forty-three certified SLPs participated in an online survey consisting of Likert-scale items, multiple-choice questions, and open-ended responses. Response rates varied across items due to optional participation. Descriptive statistics were used to analyze quantitative data, while qualitative responses were thematically analyzed to identify factors influencing diagnostic confidence. Results: Findings indicated moderate clinician confidence, with mean ratings ranging from 3.24 to 3.54 on a five-point scale. While most participants reported completing graduate coursework in motor speech disorders, fewer had received specialized training in CAS diagnosis. Clinicians reported using a combination of standardized tools, such as the Kaufman Speech Praxis Test (KSPT) and the Dynamic Evaluation of Motor Speech Skills (DEMSS), along with informal measures including speech samples, clinical observation, and caregiver reports. However, no consistent diagnostic protocol was identified. Increased confidence was associated with greater clinical experience, continuing education, access to assessment tools, and familiarity with core CAS characteristics (e.g., inconsistent errors, disrupted transitions, inappropriate prosody). Diagnostic uncertainty was linked to comorbid conditions, overlap with other disorders, limited expressive output in young children, and insufficient training. Conclusions: SLPs demonstrate moderate confidence in diagnosing CAS; however, variability in training and assessment practices contributes to ongoing uncertainty. These findings highlight the need for expanded specialized training, improved access to evidence-based assessment tools, and the development of standardized diagnostic frameworks to support clinical decision-making and improve diagnostic accuracy.

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