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Speech and language delay.

Last Updated October 2023 | This article was created by familydoctor.org editorial staff and reviewed by Kyle Bradford Jones, MD, FAAFP

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Every child develops at his or her own pace. But if your child doesn’t talk as much as most children of the same age, the problem may be speech delay.

What is a speech and language delay?

A speech and language delay is when a child isn’t developing speech and language at an expected rate. It’s a common developmental problem that affects as many as 10% of preschool children.

Symptoms of a speech and language delay

Your child may have a speech delay if they aren’t able to do these things:

• Say simple words (such as “mama” or “dada”) either clearly or unclearly by 12 to 15 months of age
• Understand simple words (such as “no” or “stop”) by 18 months of age
• Talk in short sentences by 3 years of age
• Tell a simple story at 4 to 5 years of age

What causes a speech and language delay?

The most common causes of speech delay include:

• Hearing loss
• Slow development
• Intellectual disability

Other developmental or genetic disorders include:

• Psychosocial deprivation (the child doesn’t spend enough time talking with adults)
• Being a twin
• Autism (a developmental disorder)
• Elective mutism (the child just doesn’t want to talk)
• Cerebral palsy (a movement disorder caused by brain damage)

Living in a bilingual home also may affect a child’s language and speech. The child’s brain has to work harder to interpret and use 2 languages. So, it may take longer for these children to start using one or both languages they’re learning. It’s not unusual for a bilingual child to use one language for a while.

How is a speech and language delay diagnosed?

Your doctor can help you recognize a speech and language delay. They will ask you what you have heard and can listen to your child’s speech and check your child’s mental development.

Your doctor may refer you to other specialists to determine why your child isn’t speaking. For example, if your doctor thinks your child may have trouble hearing, they may refer your child to an audiologist for a hearing test. This is a licensed health care professional who treats hearing problems.

Can a speech and language delay be prevented or avoided?

Depending on the cause of your child’s speech delay, you may not be able to prevent or avoid it.

Speech and language delay treatment

Your child may not need treatment. Some children just take more time to start talking. But if your child needs treatment, the type will depend on the cause of the speech delay. Your doctor will tell you the cause of your child’s issue and talk to you about treatment options. Your doctor may refer you to a speech and language pathologist. This person can show you how to help your child talk more and speak better, and also can teach your child how to listen or how to lip read.

Teaching young babies and children a version of sign language also can help them with their language development. Contrary to what some might think, using sign language with babies and young children does not delay their language development.

Other specialists your doctor may recommend you see include a psychologist (a specialist in behavior problems), an occupational therapist (for help with daily activities), or a social worker (who can help with family problems). Your doctor may also suggest early intervention programs in your area. Many are associated with your local school district

Living with a speech and language delay

If your child’s speech is delayed due to a hearing loss, hearing aids or cochlear implants may help your child hear speech. Once your child has access to sound (and speech), they may be able to develop language and even catch up to their hearing peers.

If your child hears and understands language, you can encourage them to speak by talking as much as you can around them. Describe what you’re doing as you do everyday activities. Keep talking. If your child speaks, confirm what they are saying. Always provide positive feedback.

Speech and language delays can be frustrating for parents and children. Children who can’t express their thoughts and emotions are more likely to act out. They anger easily. They may use unexpected behavior to get your attention. Try to remember your child does want to communicate with you. Read to your child and talk as much as you can. Encourage your child to speak. When they try to speak, praise their efforts.

Questions to ask your doctor

• Why is my child not talking yet?
• Should I talk to my child more to help them figure out how to talk?
• Is it normal for my child to not be speaking yet?
• My child seems to have trouble understanding what I’m saying. Is it possible they have hearing loss?
• Does my child have a developmental disability?
• What can I do to help my child speak or understand better?
• Do you have any materials I can read about speech and language delay?
• Will my child be able to attend school?
• Is there an early intervention program available in my area and would it be helpful?

National Institutes of Health, MedlinePlus: Speech and Language Problems in Children

Child-Psych.org: Will teaching my baby to sign delay his speech?

Last Updated: August 3, 2022

This article was contributed by: familydoctor.org editorial staff

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

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Language and Speech Disorders in Children

Helping children learn language, what to do if there are concerns.

• Detecting problems

Children are born ready to learn a language, but they need to learn the language or languages that their family and environment use. Learning a language takes time, and children vary in how quickly they master milestones in language and speech development. Typically developing children may have trouble with some sounds, words, and sentences while they are learning. However, most children can use language easily around 5 years of age.

Parents and caregivers are the most important teachers during a child’s early years. Children learn language by listening to others speak and by practicing. Even young babies notice when others repeat and respond to the noises and sounds they make. Children’s language and brain skills get stronger if they hear many different words. Parents can help their child learn in many different ways, such as

• Responding to the first sounds, gurgles, and gestures a baby makes.
• Repeating what the child says and adding to it.
• Talking about the things that a child sees.
• Asking questions and listening to the answers.
• Looking at or reading books.
• Telling stories.
• Singing songs and sharing rhymes.

This can happen both during playtime and during daily routines.

Parents can also observe the following:

• How their child hears and talks and compare it with typical milestones for communication skills external icon .
• How their child reacts to sounds and have their hearing tested if they have concerns .

Learn more about language milestones .  Watch milestones in action.

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Some languages are visual rather than spoken. American Sign Language uses visual signals, including gestures, facial expressions, and body movement to communicate.

Some children struggle with understanding and speaking and they need help. They may not master the language milestones at the same time as other children, and it may be a sign of a language or speech delay or disorder.

Language development has different parts, and children might have problems with one or more of the following:

• Not hearing the words (hearing loss).
• Not understanding the meaning of the words.
• Not knowing the words to use.
• Not knowing how to put words together.
• Knowing the words to use but not being able to express them.

Language and speech disorders can exist together or by themselves. Examples of problems with language and speech development include the following:

• Difficulty with forming specific words or sounds correctly.
• Difficulty with making words or sentences flow smoothly, like stuttering or stammering.
• Language delay – the ability to understand and speak develops more slowly than is typical
• Aphasia (difficulty understanding or speaking parts of language due to a brain injury or how the brain works).
• Auditory processing disorder (difficulty understanding the meaning of the sounds that the ear sends to the brain)

Learn more about language disorders external icon .

Language or speech disorders can occur with other learning disorders that affect reading and writing. Children with language disorders may feel frustrated that they cannot understand others or make themselves understood, and they may act out, act helpless, or withdraw. Language or speech disorders can also be present with emotional or behavioral disorders, such as attention-deficit/hyperactivity disorder (ADHD) or anxiety . Children with developmental disabilities including autism spectrum disorder may also have difficulties with speech and language. The combination of challenges can make it particularly hard for a child to succeed in school. Properly diagnosing a child’s disorder is crucial so that each child can get the right kind of help.

Detecting problems with language or speech

If a child has a problem with language or speech development, talk to a healthcare provider about an evaluation. An important first step is to find out if the child may have a hearing loss. Hearing loss may be difficult to notice particularly if a child has hearing loss only in one ear or has partial hearing loss, which means they can hear some sounds but not others. Learn more about hearing loss, screening, evaluation, and treatment .

A language development specialist like a speech-language pathologist external icon will conduct a careful assessment to determine what type of problem with language or speech the child may have.

Overall, learning more than one language does not cause language disorders, but children may not follow exactly the same developmental milestones as those who learn only one language. Developing the ability to understand and speak in two languages depends on how much practice the child has using both languages, and the kind of practice. If a child who is learning more than one language has difficulty with language development, careful assessment by a specialist who understands development of skills in more than one language may be needed.

Treatment for language or speech disorders and delays

Children with language problems often need extra help and special instruction. Speech-language pathologists can work directly with children and their parents, caregivers, and teachers.

Having a language or speech delay or disorder can qualify a child for early intervention external icon (for children up to 3 years of age) and special education services (for children aged 3 years and older). Schools can do their own testing for language or speech disorders to see if a child needs intervention. An evaluation by a healthcare professional is needed if there are other concerns about the child’s hearing, behavior, or emotions. Parents, healthcare providers, and the school can work together to find the right referrals and treatment.

What every parent should know

Children with specific learning disabilities, including language or speech disorders, are eligible for special education services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) external icon and Section 504 external icon , an anti-discrimination law.

Get help from your state’s Parent Training and Information Center external icon

The role of healthcare providers

Healthcare providers can play an important part in collaborating with schools to help a child with speech or language disorders and delay or other disabilities get the special services they need. The American Academy of Pediatrics has created a report that describes the roles that healthcare providers can have in helping children with disabilities external icon , including language or speech disorders.

More information

CDC Information on Hearing Loss

National Institute on Deafness and Other Communication Disorders external icon

Birth to 5: Watch me thrive external icon

The American Speech-Language-Hearing Association external icon

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Language Delays and Disorders

A language delay occurs when a child’s language skills are acquired in a typical sequence, but lag behind peers their own age. A language disorder is characterized by atypical language acquisition significantly disrupting communication across settings. If a child’s development of speech and language appears slower than normal, an appointment with a pediatrician is recommended in order to to ask about the child’s communication development and to learn whether a referral to a speech language pathologist is appropriate. For children with possible concerns with language the following questions are important to consider:

Does the child understand language? The ability to understand language, also referred to as receptive language, usually precedes expression and use. Skills can include following simple directions, responding to their name when called, pointing to pictures when named, and identifying body parts and clothing items.

How does the child use gestures? All children initially use gestures but generally outgrow them as they develop language.  Children may use gestures instead of words to communicate their intents. Take note of the different gestures a child uses and how they are used in functional and social situations. Gestures may include pointing to request, pointing to “show” others, waving hello and goodbye or giving a “high five.”

How many new words is the child adding to his vocabulary each month? Even though he or she may appear to be slow in language development, new words should still be added frequently at least several words a week and even when not directly taught.

Can you understand what your child says? Even very young children should be able to convey a message, tell a story and describe events or pictures.  Children should not experience extended communication frustration.

Does your child have difficulty in daycare/school? Some academic and/or behavioral issues may be related to language difficulties.

How does the child use non-verbal communication and socialize with others? Make note of social games that your child plays, as well as their interest in other children and adults. It is important make note of use of eye contact and overall social interest with other children and adults. Children with delayed or disordered language abilities have interest in play with other children, but may struggle to do so due to language deficits.

Remember, no two children are alike. Concerned parents should seek the counsel of a certified speech-language pathologist who can conduct an evaluation to assess any delays in communication and make recommendations for intervention. Children under three years of age can receive an evaluation through the Early Intervention program through the state of Illinois. For children over three years of age, evaluations can be conducted through the public school and/or in our center.

The Northwestern University Center for Audiology, Speech, Language, and Learning provides comprehensive evaluation and therapy services on the Evanston campus. Diagnostic evaluations determine the course of treatment, including frequency and appropriateness of individual and/or group therapy.

The Northwestern University Center for Audiology, Speech, Language, and Learning is a unique community resource that merges university research and innovative teaching with clinical services. Experts in the field – faculty who are nationally certified and state licensed speech-language pathologists – direct provision of clinical services, bringing exceptional knowledge and experience to our clients.

For more information, contact us at 847-491-3165 or [email protected] .

Speech Delay

Causes, signs and symptoms, and treatment of speech delay.

When it comes to your child’s speech and language development, many parents find themselves asking, “What’s normal?”

Children progress at different rates, and determining whether your child is just a "late bloomer" or needs professional help isn’t always easy. We put together this informational guide to help you better understand speech delays, common signs and symptoms, how a speech delay is diagnosed and treated, and more.

1 What is considered delayed speech?

2 What is the difference between a speech delay and a language delay?

3 Does your child have a speech delay?

4 How is a speech delay diagnosed?

5 What causes a speech delay?

6 Everyday tips to support your child's speech development

7 Helpful at-home exercises parents can use to improve speech delay

8 How does Expressable evaluate and treat speech delay?

9 Speech delay questions to ask your healthcare provider or speech therapist

What is considered delayed speech?

Speech and language skills begin with the slightest cooing of an infant. As the months pass, babies eventually begin to babble, which soon progresses to one of the most joyous moments for a parent: their child’s first understandable words. A typical 2-year-old can say about 50 words and speak in two-word sentences. By age 3, their vocabulary increases to as many as 1,000 words.

A speech delay is when a toddler doesn’t meet these typical speech milestones. It is a common developmental problem that affects as many as 10% of preschool children.

Because all children progress on their own timeline, it can be difficult for caregivers to tell whether their child is just a late talker (and will soon be chatting a million miles a minute), or whether there’s a problem that needs professional treatment.

This is why assessment and diagnosis by a certified speech-language pathologist, also known as a speech therapist, is so important. Speech delays can be effectively treated, and research has shown that earlier interventions lead to better outcomes.

What is the difference between a speech delay and a language delay?

While speech delays and language delays are often confused, and are difficult for untrained professionals to tell apart, there are important differences.

Speech is the physical act of producing sounds and saying words. A child with a speech delay is often hard to understand. While they may use words and phrases to express their ideas, they often have trouble forming the correct sounds. The inability to interpret your child can be frustrating and disheartening for a new parent.

Conversely, a toddler with a language delay may make the correct sounds and pronounce some words, but they can’t form phrases or sentences that make sense.

Some children have either a speech delay or a language delay, and some have both. Distinguishing between the two is important, as it will inform treatment decisions. If you think your child may have a speech or language delay, it’s important to seek help from a speech-language pathologist. They’re the most qualified professional to provide an evaluation and diagnosis.

Does your child have a speech delay?

As mentioned, it’s hard for caregivers to know if their child is simply taking a bit longer to reach a speech or language milestone, or if there's a deeper problem that needs attention. Here are some common signs and symptoms of speech delays broken out by age group.

By 12 months

Your child isn't using gestures, such as pointing or waving goodbye

Has trouble imitating sounds

By 18 months

Your child prefers making gestures over vocalizations (sounds) to communicate

Has trouble understanding simple verbal requests

By 24 months

Your child can only imitate speech or actions

Doesn’t produce words or phrases spontaneously

Says only some sounds or words repeatedly, and can't use words to communicate more than their immediate needs

Can't follow simple directions

Has an unusual tone of voice (such as raspy or nasal sounding)

By 36 months

Your child doesn’t use at least 200 words

Doesn’t ask for things by name

Is hard to understand even if you live with them

How are speech delays diagnosed?

If your child might have a problem, it's important to see a healthcare provider or speech therapist. During the initial evaluation, they will ask about your toddler’s speech and language capabilities, as well as other developmental milestones and behaviors to make the appropriate diagnosis.

More specifically, your speech therapist will evaluate:

What your child understands (called receptive language)

What your child can say (called expressive language)

Your child’s sound development and clarity of speech

Your child's oral-motor status (how the mouth, tongue, palate, etc., work together for speech as well as eating and swallowing)

Based on the results, the speech therapist may recommend speech therapy for your child.

What causes a speech delay?

A speech delay may mean that your child’s timetable is a little different and they’ll eventually catch up. But speech or language delays can also signal something about your child’s overall physical and intellectual development. Here are some common underlying causes of speech delays.

Oral impairment: Many kids with speech delays have oral-motor problems, which is a problem in the areas of the brain responsible for speech. This makes it hard to coordinate the lips, tongue, and jaw to make speech sounds. These children also might have other oral-motor problems, such as feeding problems.

Developmental speech and language disorder: Some speech and language disorders involve brain function and may be a sign of a learning disability. Your child may have trouble producing speech sounds, using spoken language to communicate, or understanding what other people are communicating. Speech and language problems are often the earliest sign of a learning disability.

Hearing loss: A toddler who can’t hear well, or hears distorted speech, is likely to have difficulty forming words. Hearing loss is often overlooked, but fortunately it’s also easily identifiable. One sign of hearing loss is that your child doesn’t acknowledge a person or object when you name them, but does if you use gestures. However, signs of hearing loss may be very subtle. Sometimes a speech or language delay may be the only noticeable sign.

Autism spectrum disorder: Speech, language, and communication problems can be early signs of autism.

Lack of stimulation: We learn to speak from those around us. Therefore, it’s hard for children to naturally pick up speech or words if they’re not actively engaged with language. Lack of verbal stimulation can keep a child from reaching developmental milestones.

Neurological problems: Certain neurological problems, like cerebral palsy, muscular dystrophy, and traumatic brain injury, can affect the muscles needed for speaking.

Everyday tips to support your child's speech development

It may sound (or feel) silly, but start talking to your child at birth. Even newborns benefit from hearing speech.

Respond to your baby’s coos and babbling with positive signals.

Play simple games with your baby like peek-a-boo and patty-cake.

Talk to your child a lot. Even a simple act like narrating what you’re doing can be helpful.

Read books aloud. If your kiddo loses interest, then just talk about the pictures.

Sing to your child and provide them with music. Learning new songs helps your child learn new words and also builds memory skills, listening skills, and expression of ideas with words.

Expand on what your child says. For example, if your child says, “Dora,” you can say, “Here is Dora!”

Describe for your child what they are doing, feeling, and hearing in the course of the day. For example, “You are hungry.”

Give your child your full attention when they’re talking to you. When you ask them a question, give them enough time to respond before filling in the silence.

Ask your child lots of questions.

Don’t point out or correct grammar mistakes. Instead, just model good grammar by saying phrases correctly.

Helpful at-home exercises parents can use to improve speech delay

Numerous studies show caregivers play an essential role in helping their child reach their speech and language goals. Caregivers spend the most time with their child, and considering children learn to communicate during everyday activities and conversations, no one is better positioned to help improve their speech delay.

Speech therapists should empower caregivers to take a more active role in their child’s progress, teaching them strategies, cues, and corrections that can be practiced daily. Expressable has also developed several instructional videos with helpful at-home exercises to get you started. You'll find the whole series here .

How does Expressable evaluate and treat speech delay?

Expressable matches families with a certified speech therapist trained to evaluate and treat speech delays and disorders. All therapy is delivered online via face-to-face video conferencing

Your child’s age and development will influence how your speech therapist interacts with them through these video sessions:

Ages 0-3: Caregivers attend sessions and work directly with their child's speech therapist to learn cues and at-home strategies. This way they can confidently practice with their child outside the session and improve their child's communication. Learn more about the importance of parental involvement in children’s speech therapy here .

Ages 3-6: Caregivers attend video sessions alongside their child so they both learn valuable skills from their speech therapist. Reinforcing these lessons outside the session will continue to promote at-home skill building.

Ages 7 and up: Most children attend video sessions independently, but caregivers are kept in the loop with updates and tips during each session.

Your Expressable speech therapist will perform a detailed evaluation to determine your child’s current communication strengths and differences. From there, they will build a treatment plan with goals tailored for your child.

Speech therapy is a partnership between the client, family, and speech therapist. All Expressable clients have access to our client portal , which features educational Learning Paths covering the strategies taught in therapy sessions. You can access examples, tips, demo videos, and more to help support your child at home. Plus, through the portal, you'll receive weekly home practice activities tailored to your child’s needs. The more you practice speech therapy techniques at home, between sessions, the faster your child will make progress!

Speech delay questions to ask your healthcare provider or speech therapist

Why is my child not talking yet?

Is it normal for my child to not be speaking yet at his age?

My child seems to have trouble understanding what I’m saying, but does respond to gestures. Is it possible they have hearing loss?

Could my child have a developmental disability?

What can I do to help my child speak or understand better?

What types of exercises, activities, or games can I do with my child to help encourage their speech development?

How will a speech delay affect my child’s school performance?

Watch learning jump (leap! spring! hop!) from your sessions into the real world.

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Delayed Speech or Language Development

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As with other skills and milestones, the age at which kids learn language and start talking can vary. Knowing a bit about speech and language development can help parents figure out if there's cause for concern.

How Do Speech and Language Differ?

• Speech is the verbal expression of language and includes articulation (the way we form sounds and words).
• Language is giving and getting information. It's understanding and being understood through communication — verbal, nonverbal, and written.

What Are Speech or Language Delays?

Speech and language problems differ, but often overlap. For example:

• A child with a language delay might say words well but only be able to put two words together.
• A child with a speech delay might use words and phrases to express ideas but be hard to understand.

What Are the Signs of a Speech or Language Delay?

A baby who doesn't respond to sound or vocalize should be checked by a doctor right away. But often, it's hard for parents to know if their child is taking a bit longer to reach a speech or language milestone, or if there's a problem.

Here are some things to watch for. Call your doctor if your child:

• by 12 months : isn't using gestures, such as pointing or waving bye-bye
• by 18 months : prefers gestures over vocalizations to communicate
• by 18 months: has trouble imitating sounds
• has trouble understanding simple verbal requests
• by 2 years : can only imitate speech or actions and doesn't produce words or phrases spontaneously
• by 2 years: says only some sounds or words repeatedly and can't use oral language to communicate more than their immediate needs
• by 2 years: can't follow simple directions
• by 2 years: has an unusual tone of voice (such as raspy or nasal sounding)

Also call the doctor if your child’s speech is harder to understand than expected for their age:

• Parents and regular caregivers should understand about 50% of a child's speech at 2 years and 75% of it at 3 years.
• By 4 years old , a child should be mostly understood, even by people who don't know the child.

What Causes Speech or Language Delays?

A speech delay might be due to:

• an oral impairment, like problems with the tongue or palate (the roof of the mouth)
• a short frenulum (the fold beneath the tongue), which can limit tongue movement

Many kids with speech delays have oral–motor problems. These happen when there's a problem in the areas of the brain responsible for speech. This makes it hard to coordinate the lips, tongue, and jaw to make speech sounds. These kids also might have other oral-motor problems, such as feeding problems.

Hearing problems also can affect speech. So an audiologist should test a child's hearing whenever there's a speech concern. Kids who have trouble hearing may have trouble saying, understanding, imitating, and using language.

Ear infections , especially chronic infections, can affect hearing. But as long as there is normal hearing in one ear, speech and language will develop normally.

How Are Speech or Language Delays Diagnosed?

If your child might have a problem, it's important to see a speech-language pathologist (SLP) right away. You can find a speech-language pathologist on your own, or ask your health care provider to refer you to one.

The SLP (or speech therapist) will check your child's speech and language skills. The pathologist will do standardized tests and look for milestones in speech and language development.

The SLP also will check:

• what your child understands (called receptive language)
• what your child can say (called expressive language)
• sound development and clarity of speech
• your child's oral–motor status (how the mouth, tongue, palate, etc., work together for speech as well as eating and swallowing)

Based on the test results, the speech-language pathologist might recommend speech therapy for your child.

How Does Speech Therapy Help?

The speech therapist will work with your child to improve speech and language skills, and show you what to do at home to help your child.

How Can Parents Help?

Parents are an important part of helping kids who have a speech or language problem.

Here are a few ways to encourage speech development at home:

• Focus on communication. Talk with your baby, sing, and encourage imitation of sounds and gestures.
• Read to your child. Start reading when your child is a baby. Look for age-appropriate soft or board books or picture books that encourage kids to look while you name the pictures.
• Use everyday situations. To build on your child's speech and language, talk your way through the day. Name foods at the grocery store, explain what you're doing as you cook a meal or clean a room, and point out objects around the house. Keep things simple, but avoid "baby talk."

Recognizing and treating speech and language delays early on is the best approach. Call your doctor if you have any concerns about your child’s speech or language development.

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Speech and Language Impairments

• En español | In Spanish
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Table of Contents

A Day in the Life of an SLP

Christina is a speech-language pathologist. She works with children and adults who have impairments in their speech, voice, or language skills. These impairments can take many forms, as her schedule today shows.

First comes Robbie. He’s a cutie pie in the first grade and has recently been diagnosed with childhood apraxia of speech—or CAS. CAS is a speech disorder marked by choppy speech. Robbie also talks in a monotone, making odd pauses as he tries to form words. Sometimes she can see him struggle. It’s not that the muscles of his tongue, lips, and jaw are weak. The difficulty lies in the brain and how it communicates to the muscles involved in producing speech. The muscles need to move in precise ways for speech to be intelligible. And that’s what she and Robbie are working on.

Next, Christina goes down the hall and meets with Pearl in her third grade classroom. While the other students are reading in small groups, she works with Pearl one on one, using the same storybook. Pearl has a speech disorder, too, but hers is called dysarthria. It causes Pearl’s speech to be slurred, very soft, breathy, and slow. Here, the cause is weak muscles of the tongue, lips, palate, and jaw. So that’s what Christina and Pearl work on—strengthening the muscles used to form sounds, words, and sentences, and improving Pearl’s articulation.

One more student to see—4th grader Mario , who has a stutter. She’s helping Mario learn to slow down his speech and control his breathing as he talks. Christina already sees improvement in his fluency.

Tomorrow she’ll go to a different school, and meet with different students. But for today, her day is…Robbie, Pearl, and Mario.

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There are many kinds of speech and language disorders that can affect children. In this fact sheet, we’ll talk about four major areas in which these impairments occur. These are the areas of:

Articulation | speech impairments where the child produces sounds incorrectly (e.g., lisp, difficulty articulating certain sounds, such as “l” or “r”);

Fluency | speech impairments where a child’s flow of speech is disrupted by sounds, syllables, and words that are repeated, prolonged, or avoided and where there may be silent blocks or inappropriate inhalation, exhalation, or phonation patterns;

Voice | speech impairments where the child’s voice has an abnormal quality to its pitch, resonance, or loudness; and

Language | language impairments where the child has problems expressing needs, ideas, or information, and/or in understanding what others say. ( 1 )

These areas are reflected in how “speech or language impairment” is defined by the nation’s special education law, the Individuals with Disabilities Education Act, given below. IDEA is the law that makes early intervention services available to infants and toddlers with disabilities, and special education available to school-aged children with disabilities.

Definition of “Speech or Language Impairment” under IDEA

The Individuals with Disabilities Education Act, or IDEA, defines the term “speech or language impairment” as follows:

Development of Speech and Language Skills in Childhood

Speech and language skills develop in childhood according to fairly well-defined milestones (see below). Parents and other caregivers may become concerned if a child’s language seems noticeably behind (or different from) the language of same-aged peers. This may motivate parents to investigate further and, eventually, to have the child evaluated by a professional.

______________________

More on the Milestones of Language Development

What are the milestones of typical speech-language development? What level of communication skill does a typical 8-month-old baby have, or a 18-month-old, or a child who’s just celebrated his or her fourth birthday?

You’ll find these expertly described in How Does Your Child Hear and Talk? , a series of resource pages available online at the American Speech-Language-Hearing Association (ASHA): http://www.asha.org/public/speech/development/chart.htm

Having the child’s hearing checked is a critical first step. The child may not have a speech or language impairment at all but, rather, a hearing impairment that is interfering with his or her development of language.

It’s important to realize that a language delay isn’t the same thing as a speech or language impairment. Language delay is a very common developmental problem—in fact, the most common, affecting 5-10% of children in preschool. ( 2 ) With language delay, children’s language is developing in the expected sequence, only at a slower rate. In contrast, speech and language disorder refers to abnormal language development. ( 3 )  Distinguishing between the two is most reliably done by a certified speech-language pathologist such as Christina, the SLP in our opening story.

Characteristics of Speech or Language Impairments

The characteristics of speech or language impairments will vary depending upon the type of impairment involved. There may also be a combination of several problems.

When a child has an articulation disorder , he or she has difficulty making certain sounds. These sounds may be left off, added, changed, or distorted, which makes it hard for people to understand the child.

Leaving out or changing certain sounds is common when young children are learning to talk, of course. A good example of this is saying “wabbit” for “rabbit.” The incorrect articulation isn’t necessarily a cause for concern unless it continues past the age where children are expected to produce such sounds correctly. ( 4 ) ( ASHA’s milestone resource pages , mentioned above, are useful here.)

Fluency refers to the flow of speech. A fluency disorder means that something is disrupting the rhythmic and forward flow of speech—usually, a stutter. As a result, the child’s speech contains an “abnormal number of repetitions, hesitations, prolongations, or disturbances. Tension may also be seen in the face, neck, shoulders, or fists.” ( 5 )

Voice is the sound that’s produced when air from the lungs pushes through the voice box in the throat (also called the larnyx), making the vocal folds within vibrate. From there, the sound generated travels up through the spaces of the throat, nose, and mouth, and emerges as our “voice.”

A voice disorder involves problems with the pitch, loudness, resonance, or quality of the voice. ( 6 )   The voice may be hoarse, raspy, or harsh. For some, it may sound quite nasal; others might seem as if they are “stuffed up.” People with voice problems often notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use. ( 7 )

Language has to do with meanings, rather than sounds. ( 8 )  A language disorder refers to an impaired ability to understand and/or use words in context. ( 9 ) A child may have an expressive language disorder (difficulty in expressing ideas or needs), a receptive language disorder (difficulty in understanding what others are saying), or a mixed language disorder (which involves both).

Some characteristics of language disorders include:

• improper use of words and their meanings,
• inability to express ideas,
• inappropriate grammatical patterns,
• reduced vocabulary, and
• inability to follow directions. ( 10 )

Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate. These symptoms can easily be mistaken for other disabilities such as autism or learning disabilities, so it’s very important to ensure that the child receives a thorough evaluation by a certified speech-language pathologist.

What Causes Speech and Language Disorders?

Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, intellectual disabilities, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.

Of the 6.1 million children with disabilities who received special education under IDEA in public schools in the 2005-2006 school year, more than 1.1 million were served under the category of speech or language impairment. ( 11 ) This estimate does not include children who have speech/language problems secondary to other conditions such as deafness, intellectual disability, autism, or cerebral palsy. Because many disabilities do impact the individual’s ability to communicate, the actual incidence of children with speech-language impairment is undoubtedly much higher.

Finding Help

Because all communication disorders carry the potential to isolate individuals from their social and educational surroundings, it is essential to provide help and support as soon as a problem is identified. While many speech and language patterns can be called “baby talk” and are part of children’s normal development, they can become problems if they are not outgrown as expected.

Therefore, it’s important to take action if you suspect that your child has a speech or language impairment (or other disability or delay). The next two sections in this fact sheet will tell you how to find this help.

Help for Babies and Toddlers 

Since we begin learning communication skills in infancy, it’s not surprising that parents are often the first to notice—and worry about—problems or delays in their child’s ability to communicate or understand. Parents should know that there is a lot of help available to address concerns that their young child may be delayed or impaired in developing communication skills. Of particular note is the the early intervention system that’s available in every state.

Early intervention is a system of services designed to help infants and toddlers with disabilities (until their 3rd birthday) and their families. It’s mandated by the IDEA. Through early intervention, parents can have their young one evaluated free of charge, to identify developmental delays or disabilities, including speech and language impairments.

If a child is found to have a delay or disability, staff work with the child’s family to develop what is known as an Individualized Family Services Plan , or IFSP . The IFSP will describe the child’s unique needs as well as the services he or she will receive to address those needs. The IFSP will also emphasize the unique needs of the family, so that parents and other family members will know how to support their young child’s needs. Early intervention services may be provided on a sliding-fee basis, meaning that the costs to the family will depend upon their income.

To identify the EI program in your neighborhood  | Ask your child’s pediatrician for a referral to early intervention or the Child Find in the state. You can also call the local hospital’s maternity ward or pediatric ward, and ask for the contact information of the local early intervention program.

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Help for School-Aged Children, including Preschoolers

Just as IDEA requires that early intervention be made available to babies and toddlers with disabilities, it requires that special education and related services be made available free of charge to every eligible child with a disability, including preschoolers (ages 3-21). These services are specially designed to address the child’s individual needs associated with the disability—in this case, a speech or language impairment.

Many children are identified as having a speech or language impairment after they enter the public school system. A teacher may notice difficulties in a child’s speech or communication skills and refer the child for evaluation. Parents may ask to have their child evaluated. This evaluation is provided free by the public school system.

If the child is found to have a disability under IDEA—such as a speech-language impairment—school staff will work with his or her parents to develop an Individualized Education Program , or IEP . The IEP is similar to an IFSP. It describes the child’s unique needs and the services that have been designed to meet those needs. Special education and related services are provided at no cost to parents.

There is a lot to know about the special education process, much of which you can learn at the Center for Parent Information and Resources (CPIR). We offer a wide range of publications and resource pages on the topic. Enter our special education information at: http://www.parentcenterhub.org/repository/schoolage/

Educational Considerations

Communication skills are at the heart of the education experience. Eligible students with speech or language impairments will want to take advantage of special education and related services that are available in public schools.

The types of supports and services provided can vary a great deal from student to student, just as speech-language impairments do. Special education and related services are planned and delivered based on each student’s individualized educational and developmental needs.

Most, if not all, students with a speech or language impairment will need speech-language pathology services . This related service is defined by IDEA as follows:

(15) Speech-language pathology services includes—

(i) Identification of children with speech or language impairments;

(ii) Diagnosis and appraisal of specific speech or language impairments;

(iii) Referral for medical or other professional attention necessary for the habilitation of speech or language impairments;

(iv) Provision of speech and language services for the habilitation or prevention of communicative impairments; and

Thus, in addition to diagnosing the nature of a child’s speech-language difficulties, speech-language pathologists also provide:

• individual therapy for the child;
• consult with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; and
• work closely with the family to develop goals and techniques for effective therapy in class and at home.

Speech and/or language therapy may continue throughout a student’s school years either in the form of direct therapy or on a consultant basis.

Assistive technology (AT) can also be very helpful to students, especially those whose physical conditions make communication difficult. Each student’s IEP team will need to consider if the student would benefit from AT such as an electronic communication system or other device. AT is often the key that helps students engage in the give and take of shared thought, complete school work, and demonstrate their learning.

Tips for Teachers

— Learn as much as you can about the student’s specific disability. Speech-language impairments differ considerably from one another, so it’s important to know the specific impairment and how it affects the student’s communication abilities.

— Recognize that you can make an enormous difference in this student’s life! Find out what the student’s strengths and interests are, and emphasize them. Create opportunities for success.

—If you are not part of the student’s IEP team, a sk for a copy of his or her IEP . The student’s educational goals will be listed there, as well as the services and classroom accommodations he or she is to receive.

— Make sure that needed accommodations are provided for classwork, homework, and testing. These will help the student learn successfully.

— Consult with others (e.g., special educators, the SLP) who can help you identify strategies for teaching and supporting this student, ways to adapt the curriculum, and how to address the student’s IEP goals in your classroom.

— Find out if your state or school district has materials or resources available to help educators address the learning needs of children with speech or language impairments. It’s amazing how many do!

— Communicate with the student’s parents . Regularly share information about how the student is doing at school and at home.

Tips for Parents

— Learn the specifics of your child’s speech or language impairment. The more you know, the more you can help yourself and your child.

— Be patient. Your child, like every child, has a whole lifetime to learn and grow.

— Meet with the school and develop an IEP to address your child’s needs. Be your child’s advocate. You know your son or daughter best, share what you know.

— Be well informed about the speech-language therapy your son or daughter is receiving. Talk with the SLP, find out how to augment and enrich the therapy at home and in other environments. Also find out what not to do!

— Give your child chores. Chores build confidence and ability. Keep your child’s age, attention span, and abilities in mind. Break down jobs into smaller steps. Explain what to do, step by step, until the job is done. Demonstrate. Provide help when it’s needed. Praise a job (or part of a job) well done.

— Listen to your child. Don’t rush to fill gaps or make corrections. Conversely, don’t force your child to speak. Be aware of the other ways in which communication takes place between people.

— Talk to other parents whose children have a similar speech or language impairment. Parents can share practical advice and emotional support. See if there’s a parent nearby by visiting the Parent to Parent USA program and using the interactive map.

— Keep in touch with your child’s teachers. Offer support. Demonstrate any assistive technology your child uses and provide any information teachers will need. Find out how you can augment your child’s school learning at home.

Readings and Articles

We urge you to read the articles identified in the References section. Each provides detailed and expert information on speech or language impairments. You may also be interested in:

Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2491683/

Organizations to Consult

ASHA | American Speech-Language-Hearing Association Information in Spanish | Información en español. 1.800.638.8255 | [email protected] | www.asha.org

NIDCD | National Institute on Deafness and Other Communication Disorders 1.800.241.1044 (Voice) | 1.800.241.1055 (TTY) [email protected] | http://www.nidcd.nih.gov/

American Cleft Palate and Craniofacial Association (ACPA) 1.800.242.5338 | https://acpacares.org/

Childhood Apraxia of Speech Association of North America | CASANA http://www.apraxia-kids.org

National Stuttering Foundation 1.800.937.8888 | [email protected] | http://www.nsastutter.org/

Stuttering Foundation 1.800.992.9392 | [email protected] | http://www.stuttersfa.org/

1 | Minnesota Department of Education. (2010). Speech or language impairments . Online at: http://education.state.mn.us/MDE/EdExc/SpecEdClass/DisabCateg/SpeechLangImpair/index.html

2 | Boyse, K. (2008). Speech and language delay and disorder . Retrieved from the University of Michigan Health System website: http://www.med.umich.edu/yourchild/topics/speech.htm

4 | American Speech-Language-Hearing Association. (n.d.). Speech sound disorders: Articulation and phonological processes . Online at: http://www.asha.org/public/speech/disorders/speechsounddisorders.htm

5 | Cincinnati Children’s Hospital. (n.d.). Speech disorders . Online at:  http://www.cincinnatichildrens.org/health/s/speech-disorder/

6 | National Institute on Deafness and Other Communication Disorders. (2002). What is voice? What is speech? What is language? Online at: http://www.nidcd.nih.gov/health/voice/pages/whatis_vsl.aspx

7 | American Academy of Otolaryngology — Head and Neck Surgery. (n.d.).   About your voice . Online at:  http://www.entnet.org/content/about-your-voice

8 | Boyse, K. (2008). Speech and language delay and disorder . Retrieved from the University of Michigan Health System website: http://www.med.umich.edu/yourchild/topics/speech.htm

9 | Encyclopedia of Nursing & Allied Health. (n.d.). Language disorders . Online at: http://www.enotes.com/nursing-encyclopedia/language-disorders

10 | Ibid .

11 | U.S. Department of Education. (2010, December). Twenty-ninth annual report to Congress on the Implementation of the Individuals with Disabilities Education Act: 2007 . Online at: http://www2.ed.gov/about/reports/annual/osep/2007/parts-b-c/index.html

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What Is a Language Delay?

Speech and language delays occur when a child isn’t developing their language and communication skills at the typical rate. Speech and language delays are a fairly common occurrence in young children in the early stages of their development. Many children who experience a speech or language delay will catch up to a developmentally appropriate level, but sometimes a delay is a sign of a greater underlying issue. It is important to understand the difference between a speech delay and a language delay, as well as to know when these delays may be indicative of another developmental disorder. 

Speech delay: A speech delay refers to when a child is struggling to produce the speech sounds and fluency that is expected for their age. For example, a child with a speech delay may have difficulty with the articulation or pronunciation of words or sounds. This can include difficulties with certain letter sounds, such as /r/ and /l/ sounds, or difficulty forming sounds physically in the mouth due to a developmental muscular delay.

Children who have difficulty with coordinating oral motor movements for speech may also experience difficulty feeding, such as issues with swallowing or chewing, due to a lack of oral coordination involving the tongue, lips, and other oral muscles. 

Language delay: A language delay refers to when a child has difficulty developing the ability to give and receive verbal and nonverbal communication at the developmentally appropriate rate. Whereas a speech delay affects a child’s ability to produce speech, a language delay impedes a child’s ability to understand and communicate through verbal and nonverbal communication. For example, older children with language delays may struggle to follow directions, such as, “Close the book and put it back on the shelf.” Younger children who experience language delays may present with challenges creating two- to third-word utterances to form early sentences expected of toddlers. 

Getting help: If you believe your child may have a speech and/or language delay, it may be beneficial to discuss your concerns with your pediatrician. As mentioned above, speech and language delays are not uncommon in young children, and many will grow out of them with some assistance by parents and therapists. A pediatrician will be able to determine whether further intervention is required to treat a delay. A pediatrician may recommend that a child see a speech-language pathologist (SLP) for a comprehensive language assessment and speech therapy. SLPs can work with children to strengthen their verbal and nonverbal communication skills and give parents recommendations to help mediate a child’s difficulties at home. 

Do you have questions about your child’s speech and language or other developmental skills? Contact the Goldman Center to speak with one of our specialists: (773) 998-8500.

References: 

Rev. by Harnett, Julia K., “Delayed Speech or Language Development.” KidsHealth, Nemours, 2019, https://kidshealth.org/en/parents/not-talk.html . 

“Delayed Speech or Language Development.” Health Library: Johns Hopkins All Children’s Hospital, Johns Hopkins Medicine, 2020, https://www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/Delayed-Speech-or-Language-Development .   

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• v.8(5); 2019 May

Speech and language delay in children: Prevalence and risk factors

Trisha sunderajan.

1 Department of Pediatrics, K.J. Somaiya Medical College, Hospital and Research Centre, Mumbai, Maharashtra, India

Sujata V. Kanhere

Intelligible speech and language is a useful marker for the child's overall development and intellect. Timely identification of delay by primary care physicians can allow early intervention and reduce disability. Data from India on this subject is limited.

To study the prevalence and risk factors of speech-language delay among children aged 1-12 years.

Settings and Design:

A cross sectional study was conducted at the Pediatric outpatient department of a teaching hospital.

Materials and Methods:

Eighty four children (42 children with delayed speech and 42 controls) aged 1-12 years were included. The guardians of these children were requested to answer a questionnaire. History of the child's morbidity pattern and the risk factors for speech delay were recorded. The child's developmental milestones were assessed.

Statistical Analysis Used:

Data entry was analyzed using SPSS software, version 16. Standard statistical tests were used. A p value of less than 0.05 was taken as statistically significant.

Speech and Language delay was found in 42 out of 1658 children who attended the OPD. The risk factors found to be significant were seizure disorder ( P =< 0.001)), birth asphyxia ( P =0.019), oro-pharyngeal deformity ( P =0.012), multilingual family environment ( P =< 0.001), family history ( P =0.013), low paternal education ( P =0.008), low maternal education ( P =< 0.001), consanguinity ( P =< 0.001) and inadequate stimulation ( P =< 0.001).

Conclusions:

The prevalence of speech and language delay was 2.53%. and the medical risk factors were birth asphyxia, seizure disorder and oro-pharyngeal deformity. The familial causes were low parental education, consanguinity, positive family history, multilingual environment and inadequate stimulation.

Developmental delay is diagnosed when a child does not attain normal developmental milestones at the expected age.[ 1 ] Speech is the sound produced, while language is a measure of comprehension.[ 2 ] The acquisition of intelligible speech and language is a useful marker for the child's overall development and intellect.[ 3 ] Speech delay is defined as when the child's conversational speech sample is either more incoherent than would be expected for age or is marked by speech sound error patterns not appropriate for age.[ 4 , 5 ]

Evidence implies that untreated speech and language delay can persist in 40%–60% of the children and these children are at a higher risk of social, emotional, behavioral, and cognitive problems in adulthood.[ 6 , 7 ] Prevalence of speech delay has been difficult to estimate because traditionally there is a belief that speech delay may run in families and it is not a cause of alarm. Often a “wait-and-watch” policy leads to late diagnosis and intervention for speech delay. Primary care clinicians and family physicians are the first point of contact for children with speech and language delay. It thus becomes their responsibility to identify obvious speech and language delay and address parental concerns.

Hearing loss is a well-documented etiology of speech delay.[ 8 , 9 ] However, the causes of speech–language delay are compound and represent an intricate relationship between the biological development and social environment in which the child learns to speak.[ 9 ]

Data on this subject from India are sparse compared with the West.[ 10 ] Thus, a cross-sectional study assessing the prevalence and factors affecting speech and language delay in children between 1 and 12 years was undertaken.

Materials and Methods

This cross-sectional study was conducted at the pediatric outpatient department (OPD) of a tertiary care teaching hospital during the month of January 2018 after obtaining approval from the Institutional ethics committee. Written informed consent was obtained from the guardians prior to enrolment of the children.

Every consecutive child (age 1–12 years) who was brought by caregivers for suspected delayed speech or who was referred specifically for speech delay or who was found to have delayed speech on DQ/IQ testing and every child undergoing speech therapy was included. Children whose caregivers did not give consent for participation in the study were excluded. A total of 42 children formed the study group and 42 children without speech-language delay were enrolled as the control group after obtaining consent from their guardians.

The caregivers of all these children were requested to answer a predesigned, pretested, and validated questionnaire. The questionnaire consisted of questions related to demographic data, birth history, history of the morbidity pattern of the child (any illness for which the child was treated either on an OPD basis or hospitalized), along with the high-risk factors for speech delay. The child's growth was assessed using anthropometry (weight, height, head circumference), and developmental milestones were examined at the time of contact and recorded in a data collection sheet.

Statistical analysis

Data entry was done using Microsoft Excel 2007 and was analyzed using Statistical Package for Social Sciences (SPSS) software, version 16. Descriptive analysis was presented as mean, standard deviation, and frequency. Statistical tests of significance used were unpaired t -test, Chi-square test, and Fisher's exact test. A P value of less than 0.05 was taken as statistically significant.

A total of 1658 children belonging to the age group 1–12 years attended the pediatric OPD during the study period [ Figure 1 ]. In all, 42 children (2.53%) were found to have speech and language delay. Of these children, one child had autistic features, one child had cerebral palsy, and another child had hearing loss as a comorbidity.

Flowchart showing children with speech delay attending the pediatric OPD

The study group and controls were compared for baseline characteristics, and there was no statistically significant difference between the two groups in terms of age, gender, religion, and socioeconomic status [ Table 1 ].

Comparison of baseline characteristics between study and control groups

*Chi-square test; **Unpaired t -test; ***= Fisher's exact test, P value <0.05 is statistically significant

Seven medical risk factors for speech–language delay were compared in both the groups [ Table 2 ]. There was a statistically significant difference between the two groups for three factors – seizure disorder, birth asphyxia, and physical (oro-pharyngeal) deformity, suggesting an association between these risk factors and speech–language delay.

Comparison of medical risk factors for speech-language delay between study and control groups

*Chi-square test; **Unpaired t -test; ***Fisher's exact test. Bold: P value <0.05 is statistically significant

Eleven family–based risk factors were also studied between the two groups [ Table 3 ]. Multilingual family environment, positive family history of speech–language delay, consanguinity, low paternal education, and low maternal education were found to be associated with speech–language delay. There was a statistically significant difference between the two groups for these five factors.

Comparison of family-based risk factors for speech-language delay between study and control groups

*Chi-square test; **Unpaired t -test; ***Fisher's exact test. Bold: P value < 0.05 is statistically significant

Environmental factors such as trauma, chronic noise exposure, television viewing >2 h, and inadequate stimulation were studied [ Table 4 ]. Of these, only inadequate stimulation was found to be statistically significantly different in the study group. Figure 2 summarizes the eight statistically significant risk factors associated with speech-language delay.

Comparison of environmental risk factors for speech-language delay

Significant risk factors associated with speech–language delay

In our study, speech–language delay was found in 2.53% of the children attending pediatric OPD. These results are similar to the prevalence reported from developed countries which ranges from 2% to 8%.[ 3 , 11 ] Other studies have shown a higher incidence of speech–language delay in males[ 12 ] and attributed it to the slower maturation of the central nervous system among boys and also by the influence of testosterone which stops cell death and makes proper connections difficult.[ 12 ] However, our study found no gender difference.

A number of medical factors related to language delay were assessed – hearing loss, persistent otitis media, seizure disorder, birth asphyxia, low birth weight, preterm birth, and physical (oro-pharyngeal) deformity. Birth asphyxia, seizure disorder, and physical (oro-pharyngeal) deformity were found to be statistically significant risk factors. The association between birth asphyxia and language delay has been well documented by other studies.[ 13 ] The effect of epilepsy on speech–language has been reported by Mehta B et al .[ 14 ] The hypoxic insult to the brain during a seizure could prove detrimental in various areas of development and can manifest as speech and language delay. The association of oral and pharyngeal abnormalities with speech–language delay has been reported.[ 15 ] Hearing loss has been implicated in delayed language acquisition by other studies.[ 8 , 9 ] However, it was not found to be a significant risk factor as only one child had hearing impairment in our study.

The nonmedical risk factors were divided into two groups – family-based risk factors and environmental risk factors. The family-based risk factors studied were as follows: multilingual family environment, high birth order, consanguinity, family history of speech–language disorders, large family size, family discord, low paternal education, low maternal education, maternal occupation, mother–child separation, and absence of father. Our study found multilingual family environment, consanguinity, a positive family history of speech–language disorder, low paternal education, and low maternal education to be significant factors associated with speech–language delay. A multilingual home environment, commonly seen in India, could confuse the child during the early stages of learning a language.

We found consanguinity to be a statistically significant risk factor. Other studies have documented the association between consanguinity as an important risk factor for hearing loss leading to speech delay.[ 16 ] Interestingly, in our study consanguinity was found to be a significant risk factor for speech–language delay even in the absence of hearing loss.

A positive family history of speech-reading disorders (stuttering, unclear speech, late speaking, poor vocabulary, dyslexia) with the affected member being a first-degree relative has been known to be associated with speech and language delay.[ 10 , 17 ] Parents with better education not only engage their children more but also use more complex words that in turn stimulate and enhance the language skills of their children.[ 3 ] A large family size being a significant factor in speech delay was documented by Karbasi et al .[ 18 ] In our study, large family size was found in both the groups, and hence family size was not found to be significant.

The environmental factors analyzed were as follows: trauma, chronic noise exposure >65 db, television viewing for more than 2 h, low socioeconomic status, and inadequate stimulation. We found inadequate stimulation to be statistically significant which is in agreement with other studies.[ 19 ] Although there is a considerable amount of literature demonstrating higher birth order and low socioeconomic status as a risk factor for communication problems,[ 10 , 20 ] our study failed to do so.

Strengths of the study

The strengths of the study are that we have studied a large number of risk factors not routinely examined by Indian authors. The results of this study can help family physicians and primary care clinicians identify risk factors to facilitate timely detection and provide early intervention for speech and language delay.

Limitations of the study

The limitations of this study are that our study population was small and strictly hospital-based which could cause some amount of sample bias. Second, only a cross-sectional assessment was made to diagnose speech–language delay in children.

Future directions

Large multicentric follow-up studies should be done for a better understanding of the factors influencing speech–language development.

The prevalence of speech and language delay was 2.53% and the risk factors associated with it were both biological and environmental. The medical risk factors were birth asphyxia, seizure disorder, and oro-pharyngeal deformity. The familial and environmental causes were low paternal education, low maternal education, consanguinity, positive family history, multilingual environment, and inadequate stimulation.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Acknowledgement

The authors would like to thank Dr. Satish Mali, Assistant Professor, Department of Community Medicine, K. J. Somaiya Medical College and Research Centre for statistical guidance.

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What is a language disorder?

An expressive language disorder is one in which the child struggles to get their meaning or messages across to other people. A receptive language disorder is one in which a child struggles to understand and process the messages and information they receive from others. Some children have a mixed receptive-expressive language disorder in which they have symptoms of both types of disorders.

Types of language delays

There are two major types of language disorders: receptive language disorders and expressive language disorders.

A receptive language delay happens when your child has difficulty understanding language. An expressive language disorder happens when your child has difficulty communicating verbally.

What causes language disorders or delays?

Frequently, a cause for a child’s developmental language disorder cannot be identified. Other times, it can be a symptom of an underlying developmental delay or disorder.

What are the symptoms of a language delay or disorder?

Children with language delays and disorders can struggle in social and academic situations. Those struggles can result in problems with behavior and acting out. It is important for caregivers to discuss any concerns regarding a child’s language development with the pediatrician. Caregivers who suspect a child has a language delay should refer to the speech and language milestones development chart by clicking here. While not all children will develop at the same rate, it serves as a good guide as to the development caregivers should see in children as they grow. Additionally, children with a receptive language disorder may have some or all of the following symptoms:

• Difficulty understanding what people have said to them.
• Struggle to follow directions that are spoken to them.
• Problems organizing their thoughts for speaking or writing.

Children with an expressive language disorder may have some or all of the following symptoms:

• Struggle to put words together into a sentence or may not string together words correctly in their sentences.
• Have difficulties finding the right words while speaking and use placeholder words like “um.”
• Have a low vocabulary level compared to other children the same age.
• Leave words out of sentences when talking.
• Use tenses (past, present, future) incorrectly.

These are some signs of language delay by age:

• 12 months: isn’t using gestures, such as pointing or waving bye-bye
• 18 months: prefers gestures over vocalizations to communicate, has trouble imitating sounds, has trouble understanding simple verbal requests
• by 2 years: can only imitate speech or actions and doesn’t produce words or phrases spontaneously, says only some sounds or words repeatedly and can’t use oral language to communicate more than their immediate needs, can’t follow simple directions, has an unusual tone of voice (such as raspy or nasal sounding)

How is a language disorder diagnosed?

Children with a suspected language disorder undergo a comprehensive assessment to identify the specific delay and disorder. The assessments may include an interview with the parent or caregiver regarding the child’s medical history, unstructured play with the child to see how the child uses and understands language in a natural environment, and several standardized tests. These tests help the child’s treatment team determine the presence or severity of a child’s language disorder.

How is a receptive or expressive language delay treated?

Specific treatment for dysphagia will be determined by the child’s health care team based on the following:

• The child’s age, overall health, and medical history.
• The extent of the swallowing disorder.
• The child’s tolerance for specific medications, procedures, or therapies.
• Expectations for the course of the swallowing disorder.
• The family’s opinion or preference.

The child’s therapist will put together an individualized treatment plan based upon the results of the child’s assessments. Through books, games and play, components of language are taught and practiced. A therapist will continue to work with a child until the child is able to produce and understand language naturally in a conversation without cues or until the child reaches their best potential for language.

How can I help if my child has a language disorder?

• Parents are an important part of helping kids who have a speech or language problem. Here are a few ways to encourage speech development at home:
• Focus on communication. Talk with your baby, sing, and encourage imitation of sounds and gestures.
• Read to your child. Start reading when your child is a baby. Look for age-appropriate soft or board books or picture books that encourage kids to look while you name the pictures.
• Use everyday situations. To build on your child’s speech and language, talk your way through the day. Name foods at the grocery store, explain what you’re doing as you cook a meal or clean a room, and point out objects around the house. Keep things simple, but avoid “baby talk.”

Recognizing and treating speech and language delays early on is the best approach. Call your doctor if you have any concerns about your child’s speech or language development.

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Expressive Language Delay and How to Deal With It

Language delays like expressive language delay can be challenging for children.

Those with this condition will find it difficult to relay information in all social situations, which can be extremely frustrating.

With the appropriate help, children can learn how to communicate to better their mental health effectively.

Expressive Speech Delay vs. Receptive Speech Delay

There are two types of language delays you’re likely to come across: expressive and receptive.

Although each fall under the same blanket term, they both have very different manifestations.

There are many instances where children will have to deal with both expressive and receptive language disorders.

What Is Expressive Language Disorder?

Expressive language delay, also referred to as expressive language disorder, is when children find it difficult to convey information.

This is when children will have challenges expressing themselves using writing, speech, gestures, or sign language.

More than that, it’s often that they will miss significant milestones in their first three years compared to their peers.

Many families refer to expressive language disorder as children being late talkers. They must receive speech therapy to assist them with learning positive communicative behaviors.

What Is Receptive Speech Delay?

Receptive speech delay is the opposite of expressive speech delay.

Those with this language disorder find it most challenging to listen to information, such as teachings and commands.

Receiving, understanding, and processing provided information will be significantly more challenging.

Does Expressive Language Delay Mean Autism?

Just because a child has expressive language delay does not mean that they have autism.

Both of these challenges can present themselves at the same time in some children. However, expressive language disorder is a specific condition to consider.

There are significant differences in children with autism and ELD compared to children with ELD alone.

Patterns of association significantly differ between patients with ELD and autism compared to those with ELD only.

There is also a difference in dampened brain activity in two language centers of the brain.

So, there are enough significant differences between these two disorders to be classified separately.

Nevertheless, it is best to get a professional diagnosis to ensure your children get the help they need.

What Are the Symptoms of Expressive Language Disorder?

Knowing when to talk to a doctor for expressive language disorder is essential for your child’s well-being.

In that case, what are the symptoms of expressive language disorder that you should watch out for?

There are several common signs and symptoms your children will show.

Improper Word Use

As your child speaks with ELD, they are far more likely to use the wrong words to express themselves.

In many situations, they might not even find the correct words to use to express their thoughts.

This issue can often result in extreme frustration, as the word may feel like it’s on the tip of their tongue.

Lack of Interest in Expression

The more challenging it is for children to explain their thoughts, the less likely they’ll be to do it.

You’re likely to see a significant difference between them and their peers in communicative situations.

Children with expressive language disorder will show a heightened lack of interest in talking. They will also actively avoid social situations, as it can be too hard to express themselves.

Often, they will become more withdrawn, which can lead to other detrimental mental health ailments.

Difficulty Rhyming

Rhyming is a sizeable developmental milestone for children, typically between the ages of three and four.

Individuals with language disorders will find that it’s challenging to recite poems or to sing songs.

As each word relates to the next in rhymed text, it can be near impossible for them to remember.

Challenges Naming Objects

If you were to read a book and ask your child to name the pictures, they would find it troubling with ELD.

It’s hard for them to come up with the right word for objects, so they might show a lack of interest.

They are also likely to get frustrated if they can’t come up with the proper term right away.

Written and Spoken Inconsistencies

It’s expected that families believe expressive language disorder is a solely verbal issue when, in fact, it can manifest as a written problem, as well.

This is because it’s an impairment in their language center of the brain. As a result, you might find that your children are unable to write down coherent thoughts and sentences.

Behavioral Issues

Behavior is a clear indicator of language disorders due to frustration.

Imagine feeling a certain way and being unable to convey that message to your peers or caregivers.

It’s far too often that children exhibit negative behaviors at school and home due to ELD.

Problems With Sequencing

Trouble with sequencing is common in children with this disorder because it’s hard for them to make logical sense.

If you were to ask them to tell you a series of events, they would be unlikely to do so in a logical order.

This issue can also make telling stories significantly more difficult for them and harder for you to understand.

Severe Grammatical Errors

Children with ELD won’t be able to use proper grammar when speaking.

They often avoid using grammatical markers, which can make their sentences sound telegraphic.

Most of their spoken and written work won’t contain smaller words that help to string sentences together.

What Causes Expressive Language Delay?

There are many causes of expressive language disorder in children.

However, even when you know what causes expressive language delay, the exact reason can remain unknown.

Instead, the disorder is only recognized by analyzing a child’s behavior. From trauma to illnesses, there are several risk factors to consider.

Brain Disorders

Brain disorders, such as autism, can put children at higher risk for developing ELD.

Physical Injury

Likely as a result of significant head trauma, ELD can occur from physical distress.

Children who have experienced a brain tumor, severe car accidents, or concussions could often experience it.

Birth Defects

Several congenital disabilities can cause this disorder, including cerebral palsy, fragile X syndrome, and Down syndrome.

It’s also important to note that natal malnutrition is a significant cause of language disorders.

Mothers who have poor nutrition or encourage fetal alcohol syndrome put their children at risk.

Children who are born prematurely or have a low birth weight are also at risk for these issues.

Family History

There are plenty of medical conditions that exist due to genetics .

If you know you have a family history of language disorders, it’s essential to notify your doctor.

They will begin screening your child at the appropriate milestones to gauge their development.

Hearing Loss

The inability to hear adequately or at all can significantly impact your child’s speech and language development.

Many families find that treating hearing loss can help children who have also been diagnosed with ELD.

The total effects of trauma on a child’s system are still being explored to this day.

Whether it be physical or emotional, traumatic experiences can cause children to experience severe regressions. This results in a significant reduction in their language abilities.

Will My Child Outgrow Expressive Language Disorder?

It’s not necessarily that your child will outgrow ELD, but more that they will be able to conquer it.

By using professional techniques from a speech-language pathologist, they can learn effective communicating mechanisms.

With early intervention, children can significantly improve the way that they communicate effectively.

Depending on the severity of your child’s expressive language disorder, they may experience lifelong problems.

Another factor that has a significant bearing on their improvement is how the disorder came to be.

Individuals with significant brain trauma, for example, are more likely to experience lifelong problems.

Speech Therapy Goals for Expressive Language Delay

As most parents do, it’s crucial to think about visiting a speech therapist or speech-language pathologist.

These professionals will establish a therapeutic schedule to help your child conquer their disorder. It is easily one of the most crucial aspects of raising a child with this disorder.

With specialized treatment, there are a ton of practical goals the therapist will set out to achieve.

Some of the most common speech therapy goals for expressive language delay include:

Speech-Related Goals

The following are the goals your child will achieve during speech therapy:

Development of Language

During the development of the language phase, your child will learn to explore categorizing information and objects.

They will also better understand the meaning of words and improve their ability to make comparisons.

Expanding Vocabulary

To have more effective conversations, children will work towards expanding their vocabulary. They will also find it easier to identify functions, synonyms, and the attributes of objects.

Improving Sequencing

When telling a story, children will find it’s easier to put events in the correct order.

Speech therapists will assist them in learning how word order affects the meaning of sentences. This process will also have a lot to do with discussing cause and effect.

Identifying Relevant Details

Whether in movies, music, or literature, speech therapists work with children to identify relevant details.

They will show the significance of the main characters, main ideas, and nonfiction and fiction literature problems.

Improving Everyday Speech

Overall, your child is bound to get the foundation necessary to contribute to well thought out conversations.

They’ll work on understanding possessives, plurals, tense markers, questions, positives and negatives, as well as pronouns.

Written-Based Goals

Along with speech therapy, speech-language pathologists can also assist with written goals, including:

Improved Text Formation

When writing a passage, children will learn the importance of spelling correctly, using punctuation, and capitalization.

They will also explore different sentence structures, why modifiers are essential, and use specific phrases.

Meaningful Communication

To help improve classroom performance, professionals help children with meaningful communication through written means.

Your child will learn about organizing their thoughts, using appropriate content, and how to add detail.

Above all else, they will show a significant improvement in the coherence of their written work.

Expressive Language Activities

There are plenty of great expressive language activities that you can do with your child at home to help with ELD. A few of our favorites include:

Encourage Talking

Your child should always be surrounded by healthy conversations at home as long as it is said correctly.

You can talk to them about their day, particular activities, or favorite movies and television shows.

It can also be beneficial to talk them through their daily routines, ensuring that you are always encouraging.

Since singing is one of the challenges for those with ELD, gently easing your child into the wonders of music is beneficial.

The more comfortable they become with reciting the lyrics to their favorite song, the more confident they’ll be.

This can also help them to learn how to convey their emotions to the world.

Specialized Toys

There are plenty of specialized toys for language disorders, especially speech disorders.

Created using scientific studies and research, they can help to make therapy more enjoyable for your child.

How to Live With Expressive Language Delay

With the right course of treatment and professional guidance, living with an expressive language disorder is manageable.

Children will begin to feel more confident in their abilities, which will show a significant positive shift in their behavior.