CAS can present first with delayed first words, limited number of words, or a child only being able to vocalize a few consonants or speech sounds. Sounds may also be distorted or voicing errors may be heard. Errors may be inconsistent on the same words (i.e. word dog: “dod” “god” “gog”). Often children with CAS have difficulty with oral and facial movements to produce accurate sounds or produce them sequentially (i.e. spaghetti “gaspetti”). There may also be language difficulties, including decreased vocabulary. An evaluation is recommended if any of the above signs are noted or child appears to have difficulty with imitating simple words, incorrect stress on syllables or separation of syllables, difficulty with sequencing sounds accurately after 1-2 attempts.