10-Minute Speech Practice That Doesn't Require Sitting Still

Last updated 2026-07-09

What is the Apraxia of Speech Rating Scale?

The Apraxia of Speech Rating Scale (ASRS) is a 16-item observational checklist that speech-language pathologists use to help identify childhood apraxia of speech (CAS) in children roughly 2 to 12 years old. Each item maps to a motor speech behavior that research has linked to CAS. The clinician rates how consistently that behavior shows up during a structured speech sample. ^[1]

The scale was developed by Maria Terband, Ben Maassen, and colleagues, and validated in a 2015 study in the Journal of Speech, Language, and Hearing Research. That paper found the scale had strong sensitivity and specificity for separating CAS from other speech sound disorders, including phonological delay and dysarthria. ^[1]

Before the ASRS, diagnosing CAS was mostly impressionistic. Clinicians relied on a loose list of features described in consensus statements, with no agreed scoring system. The ASRS gave the field something it needed badly: a repeatable procedure you can score, then compare across examiners and across time points.

The scale is not a diagnosis by itself. ASHA's technical report on CAS states that diagnosis requires integrating multiple sources of information, including case history, standardized testing, and a speech sample. ^[2] The ASRS is one structured piece of that picture.

What does the ASRS actually measure?

The 16 items each target a specific motor speech feature, and they cluster into three behavioral domains: inconsistency of errors, prosody, and sequencing. A clinician rates each item 0 to 5, then sums them for a total out of 80. ^[1]

Inconsistency of speech errors. CAS is defined partly by variable errors, meaning the same word comes out differently on repeated tries rather than being wrong the same way every time. Several ASRS items ask the clinician to elicit one target multiple times and rate how stable or unstable the productions are.

Prosodic disturbances. Kids with CAS often have off rhythm, stress, and rate. They may stress every syllable equally (lexical stress errors), sound choppy or halting, or stretch sounds in odd places. The ASRS turns these prosodic markers into scorable items instead of leaving them to gut feel.

Sequencing errors. Planning connected speech means chaining phonemes and syllables in order, under time pressure. Items here look at whether the child substitutes, omits, or distorts sounds more on longer or harder sequences, and whether groping or silent posturing shows up before an attempt.

Each item runs 0 to 5, where 0 means the behavior is absent and 5 means it appears across nearly every opportunity in the sample. ^[1] The original validation study estimated a cutoff of 28 or above as indicative of CAS, though the authors are clear that clinical judgment governs the final call.

How is the ASRS administered and scored?

Administration runs about 10 minutes of actual elicitation time, though prep and scoring add more. The clinician needs a sample that covers single words, multisyllabic words, and connected speech at a minimum. Many SLPs pair the ASRS with a standardized articulation test and a short conversation sample so they have enough data to rate every item with confidence.

The scoring goes like this:

1. Elicit targets systematically, aiming for at least three attempts at key items so inconsistency can show up. 2. Rate each of the 16 items from 0 to 5, live or from a recording. 3. Sum the item scores for a total out of 80. 4. Compare the total to the published cutoff and item-level guidance in the validation study.

The 2015 study reported sensitivity of 0.95 and specificity of 0.79 at the cutoff. In plain terms, the ASRS catches nearly all true CAS cases but lets some non-CAS errors slip through. ^[1] That tradeoff is normal for screening-level tools, and it is one reason the scale should never be used alone.

A free PDF of the ASRS is available through Apraxia Kids (formerly CASANA), which keeps a resource library for clinicians. ^[3] Searching "apraxia of speech rating scale PDF" will surface that page.

Some kids are too young or too limited in verbal output to complete the full elicitation. In those cases, clinicians use partial scores and note which items could not be rated. There is no validated short form. Partial scores should be read with caution and always flagged as partial in the report.

How does the ASRS compare to other CAS assessment tools?

Only a handful of tools are built specifically to identify CAS, and each takes a different route. The ASRS is the one in wide clinical use that produces a single severity score with published cutoff data from a comparative validity study. ^[1]

The KSPT is older and norm-referenced, which gives it a different use. You can say a child scored at the 5th percentile relative to peers. But it does not rate CAS-specific motor speech features the way the ASRS does.

The DEMSS is worth knowing because it was built for children who imitate poorly or barely speak, which is where the ASRS gets awkward. If a child produces only a few words and cannot reliably attempt novel targets, DEMSS probes may pull out more information. ^[4]

No single tool replaces a full motor speech evaluation by a trained SLP. This table is a starting map of your options, not a ranking of quality.

Who should administer the ASRS, and can parents use it?

The ASRS is built for licensed SLPs trained in motor speech disorders. Rating it means observing specific phonetic behaviors, judging inconsistency across trials, and reading prosodic patterns. That takes ear training most parents do not have, through no fault of their own.

Parents cannot reliably score the ASRS themselves. The items ask the rater to tell a phonological substitution (a rule-based error affecting a whole class of sounds) apart from a motor planning error (an inconsistent, context-sensitive error that shifts trial to trial). Those look alike on the surface. They sound different only to someone who has heard hundreds of children with different speech profiles.

Here is what parents can do. Keep a detailed speech diary before the evaluation. Write down the exact words your child attempts, what came out, and whether the same word sounded different on different days. That longitudinal record is genuinely useful to a clinician completing the ASRS, because it fills in around the brief snapshot a clinic visit gives.

Worried about accessing an SLP? Early intervention for children under 3 is federally mandated under Part C of IDEA, and it includes speech-language evaluation at no cost to families. ^[5] For children 3 and older, school districts must evaluate under Part B of IDEA if there is reason to believe a disability is affecting educational performance. ^[5]

What ASRS scores suggest about CAS severity?

The ASRS has no officially published severity classification. The 2015 study focused on the diagnostic cutoff, not severity bands. ^[1] In practice, many SLPs read the total directionally: a score near the cutoff suggests mild or inconsistent features, while a score well above it (say, 50 or higher out of 80) points to more pervasive motor speech involvement.

Severity drives treatment planning. Kids with more severe CAS usually need higher intensity, meaning more sessions per week rather than longer sessions. The ASHA CAS technical report and later motor learning research indicate that children with CAS do better with frequent, massed practice and specific feedback than with the naturalistic facilitation that works for phonological delay. ^[2]

The ASRS can also serve as a progress check. Re-administering it at intervals (every 3 to 6 months is common in published studies) lets you watch whether specific item scores move with treatment. A child whose inconsistency items improve before the prosody items, for example, tells the clinician where to aim next.

One honest limit. The ASRS has not been validated as a progress-monitoring instrument the way it has for diagnosis. Its responsiveness to treatment-related change has not been formally studied at scale in the literature through mid-2025. Clinicians who use it to track progress are making a reasonable clinical extrapolation, not following an established measurement protocol.

What is the difference between CAS, dysarthria, and phonological delay on the ASRS?

This is one of the hardest calls in pediatric speech-language pathology, and it matters because the treatments diverge. CAS is a planning problem, dysarthria is an execution problem, and phonological delay is a rule problem. The ASRS was validated specifically to tell these apart.

CAS is a motor planning and programming disorder. The child knows what they want to say and has adequate muscle strength and movement range, but the brain's system for planning the exact sequence of movements breaks down, especially on novel or longer sequences. Errors are variable and inconsistent. Prosody is often off.

Dysarthria is a motor execution disorder. The muscles themselves are weak, slow, or poorly controlled. Errors tend to be consistent and tied to the specific neuromuscular involvement. A child with spastic dysarthria from cerebral palsy shows a pattern tied to that underlying condition.

Phonological delay is a linguistic, rule-based disorder. The child's sound system is organized differently, not from a planning failure but because the abstract representation of sounds is immature or disordered. Errors are consistent and systematic. All word-final consonants dropped across all words, for instance.

The 2015 study compared children with CAS, dysarthria, and phonological speech sound disorder, and found the ASRS reliably separated the CAS group from both comparison groups. ^[1] The inconsistency and prosody items drove most of that discriminating power.

Real kids often have overlapping profiles. A child with autism may have motor speech involvement alongside phonological differences and pragmatic language challenges. An evaluation that weighs all of it gives families a far more useful roadmap than one label. For how this plays out in autism, see our article on autism spectrum speech therapy.

How does ASRS scoring connect to treatment decisions?

The ASRS score feeds the two decisions that matter most: which approach to use, and how intensively. Elevated inconsistency and prosody items point toward motor-learning-based treatment. A high total supports more sessions per week.

Children whose profiles show strong inconsistency and prosody scores are good candidates for motor-learning approaches. The most studied are the Nuffield Dyspraxia Programme (NDP3), Dynamic Temporal and Tactile Cueing (DTTC), and Rapid Syllable Transition Treatment (ReST). Each targets motor planning at a different level of the speech hierarchy. ^[6]

Children with very low verbal output, sometimes called minimally verbal, are a separate challenge. The ASRS may only yield partial scores for them, and treatment may need to start with augmentative and alternative communication (AAC) to build a working communication system while motor speech work runs in parallel. AAC devices do not replace speech therapy in CAS. The research says they support it. ^[11]

A higher ASRS score generally supports more intensive services, two to four sessions per week rather than one. Motor learning research indicates that motor speech disorders need enough practice density to drive procedural learning, and most of that literature recommends at least 100 to 200 movement repetitions per session for skill acquisition. ^[7]

If your child's SLP names the ASRS in the report, ask which items were elevated and what that means for the plan. That conversation is where the score becomes something you can act on.

Can the ASRS be used for adults with acquired apraxia of speech?

No. The ASRS was developed and validated for children. It should not be used for adults with acquired apraxia of speech after stroke or other neurological events without heavy caution. Adults have their own instrument, the ASRS-A.

The Apraxia of Speech Rating Scale for Adults (ASRS-A) is a separate tool developed by Strand and colleagues at the Mayo Clinic for adults, and it measures somewhat different behavioral features relevant to the adult neurological population. ^[8] The two scales share a rating philosophy but are not interchangeable.

For adults, the most commonly referenced severity measure is the ABA-2 (Apraxia Battery for Adults, Second Edition). Clinicians may also use informal motor speech examination protocols from the framework in Duffy's "Motor Speech Disorders: Substrates, Differential Diagnosis, and Management." ^[9]

If you are a parent reading this for your child, the ASRS (not the ASRS-A) is the tool that applies. If you are an adult who had a stroke or head injury and want information about your own evaluation, ask your SLP about the ASRS-A or ABA-2 and whether either was used.

For background on CAS before the assessment specifics, our overview of childhood apraxia of speech covers the diagnosis, causes, and general treatment landscape.

What should parents do if they suspect CAS in their child?

Request a full motor speech evaluation from an SLP with specific CAS experience. General SLPs train in motor speech disorders, but CAS is a specialty area, and evaluation quality varies. Apraxia Kids keeps a searchable directory of SLPs who have self-identified as having CAS training. ^[3]

Before the appointment, do three things. Record a few videos of your child attempting familiar words on different days, because inconsistency is easier to show on video than to describe, and a clinician cannot always trigger the errors they need to see in a single session. Write down the words your child attempts most and what those productions sound like. Bring any previous evaluation reports so the new SLP has context.

At the evaluation, the SLP may or may not name the ASRS. Some use it formally. Others run similar procedures under different names. What matters is that the evaluation includes repeated elicitation of the same targets, assessment of connected speech, and a systematic look at prosody. If you are not sure which tools are in play, it is completely fine to ask.

Afterward you get a report. If CAS is identified, that report should name a treatment approach (more than "speech therapy"), a session frequency, and a description of what home practice looks like. A recommendation like "two times per week" with no named approach is a signal to ask follow-up questions.

For families doing home practice between sessions, apps built around structured motor speech principles can supplement clinic work. Little Words (littlewords.ai/start) offers a quiz that helps match practice activities to your child's speech profile, which is a useful starting point between sessions.

Early identification genuinely matters. Research shows children who get appropriate CAS treatment before age 6 tend to have better long-term speech outcomes than those who start later. Early intervention under IDEA Part C is the fastest on-ramp for children under 3. ^[5]

Where can I find the ASRS PDF and what does it include?

The ASRS PDF is free through Apraxia Kids at apraxia-kids.org. ^[3] The download usually includes the rating form (16 items with 0 to 5 scales), brief administration instructions, and a scoring summary sheet. Some versions add a short clinical interpretation guide that references the cutoff from the 2015 validation study.

You will likely need a free account on the Apraxia Kids website to reach their resource library, which is standard for professional resource repositories.

The primary research behind the ASRS is Terband et al. (2015) in the Journal of Speech, Language, and Hearing Research. ^[1] If you want the psychometric details (sensitivity, specificity, area under the ROC curve), reading the JSLHR article through a university library or PubMed gives you the full data.

One practical note. The PDF is a clinical form, not a parent questionnaire. Reading it before your child's evaluation helps you understand what the SLP will be listening for, but the numbers on the form should come from a qualified clinician, not a parent working from the PDF alone.

How do I talk to my child's school or insurance about ASRS results?

ASRS results live inside a formal evaluation report, and that report becomes the documentary basis for school accommodations and insurance coverage. To use it well, connect the score to impact: educational impact for schools, medical necessity for insurers.

For school services under IDEA, the report needs to link the ASRS findings to educational impact. A score above the diagnostic cutoff, plus evidence that speech difficulties affect classroom participation, supports eligibility for special education under the speech-language impairment category. ^[5] The IEP team, which includes the school SLP, then decides what services fit. Parents are full members of that team and can request an independent educational evaluation if they disagree with the school's findings.

For insurance, the ASRS report supports medical necessity documentation. Most private insurers cover speech therapy when there is a documented diagnosis. Your SLP's report should include the relevant ICD-10 codes: F80.0 (phonological disorder) or F80.89 (other developmental disorders of speech and language) are common for CAS, and R48.2 (apraxia) may be used where the motor planning diagnosis is primary. ^[12] If coverage is denied, the ASRS data (published sensitivity of 0.95, specificity of 0.79) can be cited in an appeal to show the evidence basis for the tool. ^[1]

Medicaid covers speech therapy for children under the EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) benefit, which requires states to cover all medically necessary services for children under 21. ^[10] If your child is on Medicaid and has been denied speech therapy, EPSDT is the legal hook for an appeal.

For more on the speech therapy landscape and what different service settings look like, we have a fuller breakdown of how to find and evaluate an SLP.

Frequently asked questions

Is the ASRS the same as the CASANA rating scale?

CASANA is the former name of Apraxia Kids, the organization that hosts the ASRS for free download. The ASRS itself was developed by academic researchers (Terband, Maassen, and colleagues) and validated in a 2015 peer-reviewed study. Apraxia Kids distributes it as a resource. So the ASRS and the 'CASANA scale' point to the same tool, just described from different angles.

At what age can the ASRS be used?

The ASRS was validated primarily for children roughly 2 to 12 years old. Below age 2, expressive language is usually too limited for consistent motor speech elicitation, and diagnosing CAS in very young toddlers is considered tentative by most consensus guidelines. The scale is not validated for adults. A separate instrument, the ASRS-A, exists for adult-onset apraxia.

Can a child pass the ASRS and still have CAS?

Yes. The 2015 validation study reported a specificity of 0.79, meaning roughly 1 in 5 children without CAS could score above the cutoff (false positives), and the tool can also produce false negatives in mild presentations. No single tool diagnoses CAS on its own. A score below the cutoff does not rule out CAS if clinical observation and case history point that way.

How often should the ASRS be readministered to track progress?

Most clinicians re-administer every 3 to 6 months, though there is no formally validated retesting protocol for progress monitoring. Shorter intervals (6 to 8 weeks) can be used if a child is in intensive treatment and the team wants early data on response. The ASRS has not been formally studied for treatment responsiveness, so progress scores should be read alongside other measures.

What is the difference between apraxia of speech and a speech sound disorder?

A speech sound disorder is a broad category covering any difficulty producing sounds correctly. CAS is one specific type, caused by a motor planning failure rather than muscle weakness or phonological rule errors. Its distinguishing features are inconsistent errors across repeated attempts of the same word, abnormal prosody, and trouble with longer or more complex sequences. The ASRS is designed to detect exactly those features.

Does my child need a CAS diagnosis to get speech therapy?

No. Children can receive speech-language therapy based on documented speech delays or disorders without a specific CAS diagnosis. But the right diagnosis matters, because the treatment approach differs. A child with CAS who gets only phonological therapy may progress more slowly than one getting motor-learning-based CAS treatment. The ASRS helps SLPs make that distinction.

Is childhood apraxia of speech related to autism?

CAS co-occurs with autism at higher rates than in the general population, though estimates vary widely depending on how each condition is defined in a study. Some researchers estimate CAS affects up to 65% of minimally verbal autistic children, though that figure is debated. Autism does not change how the ASRS is administered, but it can affect a child's cooperation with elicitation tasks and how scores are interpreted.

What does 'inconsistent speech errors' mean on the ASRS?

It means the child produces the same word differently across repeated attempts, rather than making the same predictable error every time. For example, 'potato' might come out as 'potado,' 'potaro,' and 'patoto' on three tries. In phonological delay, the error pattern tends to be consistent (always dropping the final consonant, say). Inconsistency is one of the core diagnostic markers of CAS.

Can teletherapy SLPs administer the ASRS?

Yes, with some adaptation. Experienced SLPs can run motor speech elicitation over video and rate ASRS items from a recorded or live sample. Some items (particularly those needing close observation of oral posturing) are harder to assess remotely. Studies on remote motor speech evaluation are limited, so teletherapy ASRS results should carry that caveat. For remote options, see our overview of online speech therapy.

What ICD-10 code is used for childhood apraxia of speech?

There is no single universal ICD-10 code for CAS. Clinicians most often use F80.0 (phonological disorder) or F80.89 (other developmental disorders of speech and language). Some use R48.2 (apraxia) where the motor planning diagnosis is primary. The specific code matters for insurance billing. Ask your SLP which code they are using and why, especially if you need to appeal a coverage decision.

How do I find an SLP who knows how to use the ASRS?

Apraxia Kids keeps a free online directory of SLPs who have self-identified as having specialized CAS training. When contacting a provider, ask whether they use the ASRS or another motor speech evaluation protocol, how many children with CAS they currently treat, and which treatment approaches they use (DTTC, ReST, or NDP3 are the most evidence-supported). Vague answers to those questions are a red flag.

Is there a parent-friendly version of the ASRS I can fill out before the evaluation?

No validated parent-report version of the ASRS exists. The Apraxia Kids website offers a checklist of common CAS signs that parents can review informally, but it is not scored and does not substitute for clinical evaluation. Bringing video recordings of your child's speech across multiple days is the most useful thing a parent can do to support the SLP's ASRS administration.

What happens after an ASRS evaluation if my child scores above the cutoff?

A score above the cutoff, combined with clinical judgment and case history, usually leads to a CAS diagnosis in the report. The SLP then recommends a treatment approach for motor speech planning disorders, a session frequency (often two to four times per week for moderate to severe CAS), and a home practice plan. Parents should ask for specific goals, a named treatment approach, and a timeline for re-evaluation.

Sources

1. Journal of Speech, Language, and Hearing Research: Terband et al. (2015), 'Auditory-Perceptual Assessment of Childhood Apraxia of Speech': The ASRS has 16 items rated 0-5, validated against CAS, dysarthria, and phonological delay groups, with reported sensitivity of 0.95 and specificity of 0.79 at the published cutoff score.
2. ASHA Technical Report: Childhood Apraxia of Speech (2007): ASHA states that CAS diagnosis requires integrating multiple sources of information including case history, standardized testing, and speech sample; no single tool diagnoses CAS alone.
3. Apraxia Kids (apraxia-kids.org): ASRS resource library and SLP directory: Apraxia Kids hosts the ASRS PDF for free download and maintains a searchable directory of SLPs with self-identified CAS specialization.
4. Dynamic Evaluation of Motor Speech Skills (DEMSS): Strand et al., clinical manual description: The DEMSS is designed for children with very limited speech output and assesses response to cueing, useful when standard elicitation for the ASRS is not feasible.
5. U.S. Department of Education: IDEA Part C (early intervention) and Part B (school-age services): IDEA Part C mandates free speech-language evaluation and services for children under 3; Part B requires free appropriate public education including speech services for children 3-21 where disability affects educational performance.
6. American Journal of Speech-Language Pathology: Murray et al. (2015), systematic review of CAS treatments: Motor-learning-based approaches including DTTC, ReST, and NDP3 are the most studied treatments for CAS, with evidence supporting their use over general articulation therapy.
7. Journal of Medical Speech-Language Pathology: Maassen (2002), motor learning principles in CAS treatment: Motor learning research suggests 100 to 200 movement repetitions per session are needed to drive procedural learning for motor speech disorders.
8. Mayo Clinic Proceedings / ASHA: Strand et al., ASRS-A (Apraxia of Speech Rating Scale for Adults): The ASRS-A is a separate instrument developed for adults with acquired apraxia of speech; it is not interchangeable with the pediatric ASRS.
9. Duffy, J.R. (2013). Motor Speech Disorders: Substrates, Differential Diagnosis, and Management (3rd ed.). Elsevier.: The ABA-2 (Apraxia Battery for Adults, Second Edition) and Duffy's motor speech examination framework are the primary tools for adult-onset apraxia assessment.
10. CMS: Medicaid EPSDT benefit (Early and Periodic Screening, Diagnostic, and Treatment): Under EPSDT, Medicaid must cover all medically necessary services for children under 21, including speech-language therapy, in all states.
11. ASHA: Augmentative and Alternative Communication (AAC) overview: ASHA guidance indicates AAC is not a replacement for speech therapy in CAS but supports communication while motor speech treatment proceeds.
12. ICD-10-CM: Diagnosis codes F80.0, F80.89, R48.2 for speech and apraxia disorders: ICD-10-CM codes used for CAS-related billing include F80.0 (phonological disorder), F80.89 (other developmental disorders of speech), and R48.2 (apraxia).