Down Syndrome and Stuttering: Diagnostic Labels

By Pam Marshalla

Q: I have a student with Down syndrome who stutters. Her private SLP has diagnosed her as having apraxia, and insists that the fluency problem is part of the apraxia. Can this be right?

Many therapists assign the label of apraxia to children with Down syndrome, but I believe that this is an incorrect diagnosis. Dysarthria should be the assigned disorder. Please note the following definitions:


Dysarthria comprises a group of speech disorders resulting from disturbances in muscular control. Because there has been damage to the central or peripheral nervous system resulting in some degree of weakness, slowness, incoordination, or altered muscle tone. [From: Darley, F. L., & Aronson, A. E., & Brown, J. R. (1975) Motor speech disorders. Philadelphia: W. B. Saunders.]


Childhood apraxia of speech (CAS) is a neurological childhood (pediatric) speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g., abnormal reflexes, abnormal tone)…” [From: ASHA’s Childhood Apraxia of Speech].

Therefore a child with Down syndrome should carry a diagnosis of dysarthria. Down syndrome also is characterized by cognitive deficit.

None of these disorders––apraxia, dysarthria, or cognitive deficit––include stuttering as one of their characteristics.

Therefore, this child should be diagnosed with dysarthria and cognitive deficit related to Down syndrome, and stuttering. Stuttering should be considered a separate problem.

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