Is it Apraxia or a Phonological Disorder? Sorting out the Differences in Toddlers & Preschoolers

Many parents who start researching speech disorders have questions about the differences in apraxia, or motor planning difficulties, as compared to a phonological disorder.  “They sound the same to me,” is what many parents tell me. Actually many professionals have questions too! This is a common debate during the diagnostic process for many clinicians. First, I’ll provide a brief overview of both disorders, then I’ll give you my clinical opinion.

Apraxia/Verbal Dyspraxia

Apraxia is a neurological speech disorder that affects a child’s ability to plan, execute, and sequence the movements of the mouth necessary for intelligible speech. Apraxia can also be referred to as developmental verbal apraxia, childhood apraxia of speech, or verbal dyspraxia. Most SLPs use the terms interchangeably. Characteristics of apraxia include:

  • Limited babbling is present in infancy. These are quiet babies.
  • Few or no words when other babies are talking by age 2
  • Poor ability to imitate sounds and words
  • Child substitutes and/or omits vowel and consonant sounds in words. Errors with vowel sounds are not common with other speech disorders.
  • His word attempts are off-target and may not be understood even by parents.
  • He may use a sound such as  da for everything.
  • Often his errors are inconsistent, or he may be able to say a word once and then never again. The child understands much more than he can say.
  • There is sometimes (but not always) a family history of communication difficulty.  (i.e. All the boys in our family talk late, or My husband’s grandfather still has trouble pronouncing some hard words.)

Phonological Disorders

A phonological disorder is difficulty with the rules or patterns for combining sounds intelligibly in speech in English. For example, phonological processes patterns include prevocalic consonant deletion (leaving off consonant sounds that precede a vowel such as at for hat), syllable reduction (producing only one syllable in a multisyllabic word such as bay for baby), or reduplication (simplifying a multisyllabic word to a duplicated pattern such as saying bubu for bubble or even dog dog for doggie).

There are many patterns for analyzing a child’s speech according to a phonological processes model. All of these processes are common in typically developing children as well. It becomes a problem when most children are maturing in their patterns of production, and a child is not. For example, final consonant deletion (leaving off ending consonant sounds in words) typically disappears between 2 1/2 to 3 years of age. If a child is not including final consonants by this age, it would be considered disordered or atypical since most of his same-age peers are now using a more mature pattern.

A child with only a phonological disorder exhibits typically developing language, meaning that his vocabulary and utterance length are the same as his peers, but he continues to exhibit patterns that are consistent with a younger child’s speech errors.

Important Diagnostic Differences

1.Vowel Sounds– Indicators for me always include a child’s vowel sounds. Both children with apraxia and phonological disorders make errors with consonant sounds. Children with apraxia also substitute, or in some cases omit, vowel sounds too. For the most part, children with a phonological disorder?use consistently accurate vowel sounds. (Remember that vowels are A, E, I, O, U, and sometimes Y. Consonants are the other remaining letters of the alphabet.)

2.Consistency in Errors – Children with phonological disorders are generally consistent with their errors. This means that if they mess up a word, they usually mess it up all or most of the time, and usually in the same manner (until they start learning new pattern in therapy, and then they will likely revert between their “old” way of saying a word and their “new” way.)

Children with apraxia are very inconsistent. This means that they may say a word correctly once, and say it incorrectly a minute later. Words may be so “off-target” that the intended word is unrecognizable. For minimally verbal apraxic children, they may say the word once, and then you may not hear it again for a long time.

Children with a phonological disorder exhibit patterns with errors. For example, a child may omit final consonant sounds all of the time. A child with apraxia may include a final consonant sound in one word, but not be able to produce the same final consonant sound in the same word or the same sound in another word.

3. Language Skills– Children with apraxia almost always have delayed expressive language skills (especially before therapy starts.) They do not have the same vocabulary size and utterance length as children their age.

Children with a phonological disorder may have expressive language skills within or closer to the normal range. They use lots of words and try to combine them into phrases like their same-age peers, but you may not be able to understand very much. (This is different than jargon, or “baby talk.” Children with a phonological disorder are saying real words, but they substitute or leave off so many consonant sounds that you don’t know what they are saying.)

4. Other Characteristics while Speaking– Children with apraxia often look like they are “groping” for words. Things parents say to describe this include:

  • “He sometimes opens his mouth to talk, but then it looks like he forgot what he was going to say.”
  • “She doesn’t know what to do with her tongue when she talks.”
  • “I see him watching my mouth closely, and he tries to move his mouth in funny ways to copy mine, but he can’t.”

Children with phonological disorders do not have these issues.  For the most part, they can and do try to repeat what you’ve said to them without the hesitations.

5. Verbal Imitative Abilities– Children with apraxia have major difficulties imitating or repeating what you’ve said (especially before therapy begins). Children with a phonological disorder can repeat you, but the word may not be accurate.

6.Oral Imitative Abilities– Children with apraxia have difficulties with using their mouths?to talk or to imitate or perform certain movements on request, but not in other activities like eating or if the activity is “automatic.” For example:

  • “He can stick his tongue out when he’s licking a sucker, but he can’t do it when I show him.”
  • “She blew out her birthday candles last week. I don’t understand why she won’t blow for you.”

Children with phonological disorders are more consistent with what they can and can’t do with their mouths.


Hopefully this helped sort out some of the questions for you. I hope it doesn’t leave you more confused! Be sure to discuss these things with your child’s speech-language pathologist. He or she should be able to give you good reasons why or why not he/she believes a diagnosis is or isn’t appropriate for your child.

Need treatment ideas? Get my DVD Teach Me To Talk with Apraxia and Phonological Disorders

Posted in



  1. Laura on March 16, 2008 at 8:09 pm

    Don’t forget to check our ARCHIVES for other articles! You can also SEARCH for what you’re looking for! Look under the logo and click the option. If you can’t find what you’re looking for, send me a comment, and I’ll do my best to help you.

  2. danamoore on April 4, 2008 at 12:39 pm

    Hi Laura,

    What a wonderful site! Someone at Seven Counties Services told me about this site today. I’m surely giving the site link to all my fellow SLP’s and preschool teacher friends to check out. Lots of good common sense strategies that parents can understand and do. Sometimes I think we get too involved in special education speak and lose the parents.

    Thanks for the information.

    Dana Moore

  3. Laura on April 4, 2008 at 5:46 pm

    Thanks so much Dana! I hope you’ll share this site often – especially since you’re in Louisville like us! It’s so nice that Seven Counties is helping spread the word too. Last night we got word that our site has been recommended by another state’s early intervention program as a resource for families, and we are thrilled! I hope that all of our readers, whether they be other SLPs like you, as well as moms, will continue to pass our site along to anyone who may need practical suggestions for home. These are the same strategies that I recommend for parents everyday, so I know they work! Thanks again! Laura

  4. Erika on September 1, 2008 at 1:13 am

    Great article! Still not sure where my son falls though. His errors are very consistant (meaning he says “mame” for “game” and “baball” for baseball but it is always that it’s never anything else and he doesn’t “grope” for words) and he eventually corrects them. His vowels aren’t the problem it connecting the consinents into more syllables or words. For instance at 24 months I was “ma” unless he was really upset I was “mamamama” and then I was “mom” and now I can be “mom” or “mama” but he can’t say “mommy” if I say “Hi Mommy” he repeats “Hi mmy” or “Hi mama.” But he was very delayed. He had 4 true words and several “environmental” sounds at age 2 which were mostly vowel realted like “ooh,” “eeh,” “whee” “whoa” etc. His last evaluation before transitioning to the elementary school system said his language skills were at 24 month with scattered skills to 36 months. So confusing yet enlightening!! As a side note, he has really responded to the suggestion (I believe it was last Friday’s radio show) to clapping or tapping the floor or his hand whatever…to break down syllables almost immediately…he can now say “all right” on command without the clapping and “thank you” clear as day.

  5. Laura on September 1, 2008 at 8:01 am

    Erika – I think the important thing is that he’s getting better – regardless of what his “diagnosis” is. Glad the clapping and patting worked to help him with syllables! We’ll be talking about more of these issues related to intelligibility in 2 & 3 year olds in this Friday’s (September 5) show. I’d love to have you join us for that! Call in if you can! We’d love to hear from you! Laura

  6. Erika on September 1, 2008 at 11:40 am

    I agree completely! Diagnosis isn’t as important as just getting the help as early as possible! It helps not only speech but their emotional state as well. I find that if he feels heard, he is more willing to attempt words and it really boosts his confidence.

    I will see if I can listen to the show on Friday and call in….I have dial-up and have just been downloading later.

  7. Laura on September 1, 2008 at 12:06 pm

    Erika – You don’t have to be listening live to call in. As a matter of fact, it’s best if you’re not because the Listen Live version is on about a 10 second delay, and it’s so distracting to hear what you’ve just said from your computer’s speakers! Then you can go back and “hear” yourself later, although I still haven’t gotten used to that yet!!!

    The call in number is toll free and 1-718-766-4332. Hope it works out for you! I LOVE to get callers, especially when I know a little background about your situation already. Hope to talk to you on Friday! Laura

  8. Erika on September 2, 2008 at 1:00 am

    Laura-That sounds great! If I am home and my little guy is cooperating I will give that a try! I would love to join in! Thank you!


  9. Tammy on March 9, 2009 at 4:41 pm

    My daughter was diagnosed with severe phonological delay when she was 2 1/2. She is now 6 1/2. I had to translate everything she said until she was 4 1/2. She also has some oral motor issues. (not tongue-tied) She can’t lick all around her lips, and can’t figure out how to lick stuff off of her bottom lip. I had looked at apraxia of speech, but while some aspects fit her many aspects didn’t. (She definitely was NOT a quiet baby).

    Over the years, it hasn’t seemed like speech has done much to help her, as opposed to just maturation. I did teach her to read, and it was one of the only things that has had an enormous impact. (Her consonant blends came into her conversational speech within 3 weeks).

    These days, she is definitely much clearer, but she can still be difficult to understand. To convolute matters, she has also been diagnosed as gifted. Her mind and her mouth go at about 5000 mph. Trying to get her to SLOW DOWN, has always been very difficult and next to impossible, and that only makes understanding her that much more difficult.

    Considering she has been in speech for 4 years, I’m beginning to wonder when and if things will clear up. I recognize the improvement, but it is very slow going. Is 30 minutes a week through the school district enough?

    What is the best technique to use to help her at home? How do you get these sorts of kids to slow down?


  10. Laura on March 9, 2009 at 8:05 pm

    Tammy – So sorry therapy hasn’t helped her significantly in 4 years. I have to remind parents (and myself) that therapy is really not magic or voodoo. Fortunately most of the time, parents can usually cite progress, but when any disorder is classified as “severe,” the issues are usually not going to go away for a long, long time, maybe never.

    Part of the slow progress could possibly be attributed to the intensity of therapy. 30 minutes/week is usually not enough for any issue, speech or language (or even motor issues) that are classified as “severe.” I’d revisit this with your IEP team. Certainly her teachers should be wanting more help with this too and can probably be a good advocate for her concerning this.

    I’d also advise you to revisit her diagnosis. Although some SLPs are reluctant to diagnose apraxia in young children, some of the things you’re describing, especially the oral stuff she can’t do, lack of consistent progress in therapy, AND combined with her rate problem, really would make me think twice about a straight phonological disorder diagnosis. That being said, I haven’t seen her and your SLP(s) have, but if you can afford it or have insurance coverage, I’d recommend that you take her to be evaluated by a person in private practice who can give you an objective, unbiased evaluation. Sometimes school SLPs’ hands are tied within the diagnostic realm since more complicated diagnoses require more intensive treatment. Sometimes this is feasible for school districts, Unfortunately, those considerations are things that do happen most everywhere, most everyday.

    Clapping and using a sing-song style of speaking can help some kids to slow down. Since she’s reading you may also try to do some “pacing” with her pointing to written words as she says them to “practice” using a slower rate. However, I don’t treat school-aged kids, so please know that there are probably many other effective techniques that can and should be explored. Again, I think a private eval with an experienced SLP with a wonderful reputation is really the way to go. Laura

  11. ananymous on March 13, 2010 at 12:57 am

    My son is 20 months old and has been receiving speech therapy since he was 15 months old. So far he uses about 30-40 words and is combining them. He has only one major issue, his vowel sounds. He has many consonants down and only struggles with k/g. He has a difficult time combining vowels with consonants. He cannot say “no” he says “na” or can imitate “na oh”. Can’t say “moo” for cow, but can imitate “ma oo” and the word “wow” is not there. He was 17 months old before he could say the “oh” sound. It seems like his vowels are coming in after his consonants. He has made significant progress and has just started imitating random words when I ask him to. Some of the words he imitates sound alike as well. He can say many vowel sounds in isolation, but has a hard time putting it into a word correctly. It’s confusing because he has many words for a diagnosis such as apraxia, or is that still a possibility? And he imitates pretty good. He also doesn’t seem to lose words. He does seem to change the way he says a word many times, but that’s only when it’s new. He was a very quiet baby and has many red flags for Apraxia, can’t lick lips or blow bubbles, but his progress has stumped many people. Any ideas of what this could be? I bought both of your Dvd’s, “Teach me to talk” and “phonological/apraxia” and they were fantastic and extremely motivating. His progress did take off after watching them! Thank you.

  12. cara on December 8, 2010 at 11:06 am

    Hi Laura,
    I have posted here before about my twin boys. I also bought your DVD Teach Me to Talk. I am happy and proud to announce that at almost age 3 my son Jake has caught up to his peers and now speaks age appropriately. He does not qualify for therapy! He does have a tongue thrust and a lisp and we will adrress that separately, but I am overjoyed.

    My other twin son Cole is making great progress as well but just qualified for speech therapy through the school. They mentioned Phonological Processing Disroder because the SLP noticed fronting and stopping and atypical consonant substitutions (p/k etc). However, she wrote that he did not make these phonological mistake more than 40% of the time so they coulnd’t say that is was an “active process”. What does this mean? Does this mean that maybe he does not have phonological processing disorder and that with time and some help these issues will resolve? I am a little confused about that 40% comment. Overall, Cole is very hard to understand – he will be 3 in 2 weeks and is about 50% understandable. I am glade he is getting therapy but I also don’t want to put a label on him if its not warranted.

    Any advice would be appreciated!

  13. April on March 21, 2017 at 10:32 am

    My daughter is almost 6 and has had speech therapy for 4 years now has an slp through the school and has told me in person she has “apraxia and a phonological issue” but as for anything on paper for a diagnosis gave me nothing other than “speech delay” she is actually tongue tied I know there’s a medical term for it just off the top of my head I cant remember what it is. Is it possible for my daughter to have both of these conditions? I’ve called a couple different slp’s and can’t see her without a referall but I can’t seem to get one without an actual diagnosis its rather frustrating I’ve suspected apraxia since she was 2 too early to diagnose I know her birth-3 speech therapist informed me about it. I’m about the only one who understands her and its not lack of trying she does try so hard to get it its just not there for her. Sorry ranting its upsetting.

  14. Stephanie on July 23, 2017 at 6:00 pm

    Hi Laura,

    I have a 5 year old boy, who at 2 was diagnosed with Autism. I really had no knowledge about Autism until his diagnoses. He has had occupational therapy, speech therapy, and early intervention. He’s also had an IEP from the school he attends. I have noticed that he has a hard time with letters that requires him to close his mouth such as b, f, m, p, v, and others. When he was diagnosed with Autism they never mentioned speech apraxia, but I just wonder if that’s the problem he is having. He especially hates brushing his teeth, and since birth has had trouble closing his mouth. He also had trouble breast feeding, and since his mouth is constantly open his teeth and lips get very dry. My question is should I set up an appointment with a speech pathologist?

Leave a Comment

Teach Me To Talk Testimonials

Happy Therapists, Teachers, Parents & Children

"Gosh, I love all of your emails/podcast/website, just everything!! I work in early intervention as a behavior analyst and am learning so much from you!"

Thank you!




I love your work! I am a professor of early childhood special education and a speech language pathologist! I have worked to help children learn to communicate and I know how valuable the information you share is for both early interventionists and pediatric speech language pathologists!

Thank you for systematically organizing and explaining essential steps for young children to learn and develop. You are having a great impact on our profession, the ECE profession and families!"



"Thank you.

If this is Laura herself reading this email let me take this opportunity to thank you from the bottom of my heart for all that you have put forth for us professionals. I own every manual (except the autism manual) and have watched every course on DVD. I have listened to countless podcasts. All of what I’ve come to be as an Early Intervention speech therapist was absolutely to your credit. With your resources at my side I have never needed to scramble for answers and strategies and above all the clear language I use when communicating with parents. My fun, animated affect and key phrases I use have been learned through watching your example. So….thank you! May you be blessed."


"I just wanted to thank you so much for your incredible help! You are so kind and lovely and every time I implement something you've taught in your manuals or videos it is always a success, I cannot thank you enough. I really appreciate how specific you are in giving us examples of wording to use and how to use a toy in therapy with your videos, it is exactly what I need to properly help my little students. I also really appreciate your list of books of list of toys. I have seen my little students make significant progress thanks to you. I'm looking forward to watching more of your videos, taking more of your CEU's, and reading more of your materials. From the bottom of my heart: thank you so much again!!"


"Dear Laura,

What an inspiration!

Thank you for helping me be a better Developmental Therapist. I often listen to your podcasts which help me help families.

Your enthusiasm, professionalism and
the sheer volume of information is so great.

You are part of my team.

I just wanted you to know I appreciate you."


"Dear Laura,

Thank you for your generosity in sharing so much knowledge in such a clear and enthusiastic way.

As a retired audiologist with a fabulous and language delayed grandson, I used your podcasts and outstanding publication, The Autism Workbook, to inspire and guide me over the past year.

It works!! He went from barely verbal, no gestures, didn't respond to his name etc etc to a verbal, social, curious, ready to imitate anything, fill in the blanks on familiar "set" speech, generate his own totally appropriate and mostly understandable sentences...not just short phrases anymore... full little paragraphs...about imaginary things, what he did during the day, what he wants. True communication!

You make a powerful difference in this world! ❤"

With gratitude,

"Laura Mize, you are a Godsend. I don’t know how one human can have so many helpful things to say in a beautifully organized way, so often. Always amazes me when another super helpful email comes from you, and for free. With free YouTube videos and cheap CEUs. THANK YOU!!!"

Sheila, Canada

"I purchased the book on autism and have watched the #400s series podcasts. Laura Mize has been more effective in teaching autistic tendencies, than many professors, shadowing professions, and the 100s of books, articles and classes or videos, or live workshop speakers, have been at teaching effective practices for a child with ASD. Some of the many lessons she has taught, which I will now use, to be a more effective Interventionist, include but are not limited to: red flags, typical behaviors, self-stimulating behaviors, not taking away toys, rather showing child to play with toy appropriately. She gives examples of child's actions, "inappropriate," explains the reason for: why the child is engaging in these behaviors and how they can be replaced with more appropriate, effective fuctional and age-appropriate skills."

"I’m sure Laura gets these messages all the time, but I thought I’d share. I stumbled across Laura‘s "Autism or Speech Delay?" YouTube video when I really needed it. This video finally listed and explained some of the red flags my son was showing for autism. I share the link anytime a parent is questioning in my FB autism group. This mother I don’t even know said Laura's video changed her life. I know exactly how she feels because It changed families too. Thank you to everyone at Teach Me To Talk."


"Good Morning Laura,
I received your book (The Autism Workbook) yesterday and it is absolutely amazing! As I evaluate young children (0-3) for developmental delays and write plans for them with their parents, there are a ton of ideas that are ready to use. Others that reinforce what I have been doing, and saying, all along. Thank you so, so much for writing this incredible book and pulling everything together in one place!"


"Thank you very much for sharing your knowledge, experience, and guidance.
I’m a parent who bought the autism workbook and it’s the only clear resource I found to make a change in my son. I’m really thankful to Ms. Laura for helping out people like us all over the world."

"Laura Mize, all I have to say is that ALL YOUR STRATEGIES WORK."

ANNE, YouTube viewer

"We have 7 SLPs in our preschool (public) program for special needs children (ages 3-5) and we use your courses, books, and techniques every day! :-) We have seen our preschoolers make such great gains!"


"I just received Teach Me to Play With You, and it is ALREADY WORKING! WOW!

Girl…my son is 3 years old, and he NEVER asks for something using words. We were playing “Get Your Belly” (from Teach Me to Play WITH You), and after several times, he laughed and screamed "BEWIEEE!!!"  It was a hoot. And I can't believe he said it! I have played with him like this before, but this time I took your advice and acted CRAZY!! I will act like a total lunatic if it will get him to talk to me!  Now I can give him "the look" from across the room, and he will say it. That manual is so amazingly practical, and it is a GODSEND right now! Thank you SO MUCH!”

"I wanted to send you a quick email to say thank you. I started watching your videos/podcasts about 4 months ago. My son has gone from losing words he previously used, only having about 7 words at his 2 year check up in August (assessed at a blended 10 month language level) -- to now having so many words, increased social engagement, following commands, spontaneously requesting things, and naming letters & numbers (not in order) as well as colors. We had our monthly meeting with our SLP through the state infants & toddlers program and it felt like we were just bragging the whole time, but I knew in the back of my head it was because I have been using strategies you taught me.

We still have so much work to do with our sweet boy, but I know in my heart he would not have succeeded without the education you provided. I will continue to read your emails & watch videos as we go along this journey and face challenges, but credit is due to you, Laura.

Thank you so much, endlessly."


"I just want to tell how fortunate I feel to have found your website and you!! I became a special instructor in EI almost a year ago and I started with hardly any applicable training. I felt so lost and confused as how to help the kids I work with learn how to use words and play. Honestly, I didn't even understand the importance of play, although I always played with my kids. But, once I started to watch your podcasts and get some of your manuals I felt a weight had been lifted off my shoulders and that I could finally teach these kids and their families something of value from a real therapist and based on research!. Thank you so much for seeing the need to help other EI service providers and providing a forum to share your knowledge and years of valuable experience. I'm sure you get a lot of these emails every week if not every day, but I wanted to make I could add to those notes of gratitude!! THANK YOU again!!"


"Just wanted to say a HUGE thank you for these emails and your books, I have them all and they have seriously saved and improved my sessions with my kiddos. Huge thank you."


"I was very frustrated with how speech therapy was going for my child. I would take him and drop him off and not hear much of anything from his therapist and teachers other than, "He had a good (or a bad!) day." Your materials were invaluable for us because I learned how to work with him on his speech. I learned how to teach him to talk and play. I learned how to pay attention to his cues and work with him to teach him to communicate. Without it, I have no doubt he still wouldn’t talk."


"Hi! I just wanted to say (from an SLT perspective) how incredibly useful I am finding absolutely all of your articles, blogs and resources - I only discovered your site last month and have just received all your books which I feel I am learning more than on my entire university training course!! But also the way in which you give specific, realistic, fun, encouraging ideas for working with parents is really just fantastic, I only wish I have your site sooner! Thanks so much from the UK! Kind regards."


"I just wanted to reach out to say thank you for making things a little easier to manage for me this year. I made the transition from school SLP to private therapist about a year ago. While the change was welcome, it was a lot, and I was just getting my footing in the clinic when I began teletherapy full time. Your website has been a huge lifeline in helping me work with late talkers and coach their parents in an accessible but effective way, even remotely. I look forward to getting your emails each week. I am floored by the amount of valuable, free information that your website provides, and I’m looking forward to investing in your workbooks soon. A sincere thank you for all you do!"


"You are an inspiration! I am truly grateful for the way you put into words and writing how to do what we do as SLPs. At this time in my 13 years of practicing, I find your encouragement keeps me going. As a single mom, I find it a stretch to buy materials these days and I am so thankful for the freebies you so generously share that help me teach my families. I don’t have much time to put together lists or quick references for parents!! Much gratitude!!"


"I just really appreciate your courses! I have two new clinicians that I’m working with and have recommended these courses to both of them. I’ve watched quite a few and have learned so much about serving this population. To be honest, before I started implementing your strategies I was a little frustrated with the lack of progress. My skills with engaging these little ones have improved so much! Thank you so much for making these CEUs so valuable!" C, SLP