Knowing the signs of speech and language delays in children between birth to 4 years of age is essential in detecting communication disorders.
As with other skills and milestones, the age at which kids learn the language and start talking can vary.
A bit of knowledge about speech and language development can help parents figure out the cause for concern.
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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 Is a Language Delay?
A language delay is a type of communication disorder. Your child may have a language delay if they don’t meet the language developmental milestones for their age.
Their language abilities may be developing at a slower rate than most children’s. As a result, they may have trouble expressing themselves or understanding others.
Their delay may involve a combination of hearing, speech, and cognitive impairments.
Language delays are pretty standard. According to the University of Michigan Health System, delayed speech or language development affects 5 to 10 per cent of preschool-aged children.
Speech and language problems differ but often overlap. For example:
- A child with a language delay might say words well but only put two words together.
- A child with a speech delay might use words and phrases to express ideas but be hard to understand.
Language Delay, Speech Disorder or Developmental Language Disorder?
A language delay is different from a speech disorder or developmental language disorder.
A speech (sound) disorder is when children have difficulty pronouncing the sounds in words. This can make their address challenging to understand.
Children with a speech disorder might have otherwise good language skills. That is, they understand words and sentences well and can form sentences the right way.
If a child has a language delay that doesn’t go away, it might signify a developmental language disorder.
Children with a developmental language disorder have difficulties understanding and speaking. These difficulties affect their everyday lives.
Children with speech disorders don’t necessarily have a language delay or developmental language disorder.
And not all children who have language delays have problems with speech.
Children raised in bilingual families might start learning their languages more slowly than children speaking only one language.
This isn’t considered language delay. School-age bilingual children can learn to read and write English just as well as their peers.
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 language), 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 produce 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.
Autism. While not all children with autism have language delays, autism frequently affects communication.
Intellectual disability. A variety of intellectual disabilities can cause language delays. For instance, dyslexia and other learning disabilities lead to language delays in some cases.
Several psychosocial issues. These can cause language delays, as well. For example, severe neglect can lead to problems with language development.
Risk Factors for Language Delay
According to the U.S. Preventive Services Task Force, potential risk factors for speech and language problems include:
- being male
- being born prematurely
- having a low birth weight
- having a family history of speech or language problems
- having parents with lower levels of education
A language delay can be receptive, expressive, or a combination of both. A sensory language deficit happens when your child has difficulty understanding language.
An expressive language disorder happens when your child has difficulty communicating verbally.
What Are the Signs of a Speech or Language Delay?
A baby who doesn’t respond to sound or vocalise 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.
- Does not smile or interact with others (birth and older)
- Does not babble (4-7 months)
- Makes only a few sounds or gestures, like pointing (7-12 months)
- Does not understand what others say (7 months-2 years)
- Says only a few words (12-18 months)
- Comments are not easily understood (18 months-2 years)
- Does not put words together to make sentences (1.5-3 years)
- Has trouble playing and talking with other children (2-3 years)
- not babbling by the age of 15 months
- not talking by the age of 2 years
- an inability to speak in short sentences by the age of 3 years
- difficulty following directions
- poor pronunciation or articulation
- problem putting words together in a sentence
- leaving comments out of a sentence
- Has trouble with early reading and writing skills* (2.5-3 years)
*Early reading and writing skills include:
Eight months–1 year: Likes to hear you talk and read; looks at pictures in books when you read
1–2 years: Makes sounds or words when looking at pictures in books; points or touches pictures in books when you name them; turns pages in books
2–3 years: Knows that readers have a front and back; enjoys books that have rhymes; points to and names many pictures in books
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 vocalisations to communicate
- by 18 months: has trouble imitating sounds
- has trouble understanding simple verbal requests
- by two years: can only imitate speech or actions and doesn’t produce words or phrases spontaneously
- by two years: says only some sounds or words repeatedly and can’t use oral language to communicate more than their immediate needs
- by two years: can’t follow simple directions
- by two 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 two years and 75% of it at three years.
- A child should be understood mainly by four years old, even by people who don’t know the child.
How It’s Diagnosed
After conducting a thorough medical assessment, your child’s doctor will refer you to a speech-language pathologist.
They will perform a comprehensive assessment of your child’s expressive and receptive language to determine if they have a language delay.
The exam will focus on various forms of verbal and nonverbal communication and use standardised and informal measures.
If your child might have a problem, it’s essential 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 standardised 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)
After completing a speech and language evaluation, the language pathologist may recommend other exams.
For example, a hearing exam can help them determine if your child has a hearing impairment.
Your child may have hearing problems that have been overlooked, especially if they’re very young.
After diagnosis, your child’s treatment plan will likely involve speech and language therapy.
A licensed speech-language pathologist will complete an evaluation to determine the types of problems that your child is facing. This information will help them develop and implement a treatment plan.
If your child has underlying health conditions, their doctor may recommend other treatments as well. For example, they may recommend an evaluation by a neuropsychologist.
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 essential part of helping kids who have a speech or language problem.
Here are a few ways to encourage speech development at home:
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Children: Signs of a Speech Sound Disorder
- Says p, b, m, h, and w incorrectly in words (1-2 years)
- Says k, g, f, t, d, and n incorrectly in words (2-3 years)
- Produces unclear speech, even to familiar people (2-3 years)
Children Signs of Stuttering (disfluency)
- Repeats first sounds of words—”b-b-b-ball” for “ball.”
- Speech breaks while trying to say a word—”—–boy” for “boy.”
- Stretches sounds out—”ffffff-farm” for “farm”
- Shows frustration when trying to get words out
Children: Signs of a Voice Disorder
- Loss of voice
- Uses a hoarse or breathy voice
- Speaks with strain and effort
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. For example, 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.”
What Is the Outlook?
Your child’s outlook will vary depending on their specific condition and age. However, some children catch up to their peers and meet future language milestones.
Other children have more difficulty overcoming language delays and may face problems in later childhood.
Some children with language delays have reading or behaviour problems as a result of their delayed language development.
If your child is diagnosed with a language delay, it’s essential to start treatment quickly.
Early treatment can help prevent other problems from developing, such as social, learning, and emotional issues.
Tips for Encouraging Language Development
It may not be possible to prevent all language delays. In addition, hearing impairments and learning disabilities may not always be preventable.
Follow these tips to encourage language development in your child:
- Talk to your child from the time they’re born.
- Respond to your child’s babbling when they’re a baby.
- Sing to your child, even when they’re a baby.
- Read aloud to your child.
- Answer your child’s questions.
When to Get Help for Language Delay
Children develop language at different rates. So comparing your child to other children of the same age might not help you know whether your child has a language delay.
It’s best to seek professional advice if you see any of the following signs in your child at different ages.
By 12 Months
Your child isn’t trying to communicate with you using sounds, gestures and words, particularly when needing help or wanting something.
By 2 Years
- isn’t saying about 50 different words
- isn’t combining two or more words – for example, ‘More drink’, ‘Mum up’
- isn’t producing words spontaneously – that is, your child only copies words or phrases from others
- doesn’t seem to understand simple instructions or questions – for example, ‘Get your shoes’, ‘Want a drink?’ or ‘Where’s Daddy?’
By two years, about one in five children shows signs of having a language delay. These children are sometimes called ‘late talkers’.
Many of them will catch up as they get older. But some will continue to have trouble with language.
At About 3 Years
- isn’t combining words into longer phrases or sentences – for example, ‘Help me Mummy’ or ‘Want more drink.’
- doesn’t seem to understand more comprehensive instructions or questions – for example, ‘Get your shoes and put them in the box’ or ‘What do you want to eat for lunch today?’
- takes little or no interest in books
- Isn’t asking questions.
From 4-5 Years and Older
Some children still have difficulties with language by the time they start preschool or school.
If these difficulties can’t be explained by autism spectrum disorder (ASD) or hearing loss, it might be developmental language disorder.
Children with developmental language disorder:
- struggle to learn new words and make conversation
- use short, simple sentences, and often leave out essential words in sentences
- respond to just part of an instruction
- struggle to use past, present or future tense the right way – for example, they say ‘skip’ instead of ‘skipped’ when talking about activities they’ve already done
- find it hard to use the right words when talking and might use general terms like ‘stuff’ or ‘things’ instead
- Might not understand the meaning of words, sentences or stories.
At Any Age
- has been diagnosed with a hearing loss, developmental delay or syndrome in which language might be affected – for example, ASD and Down syndrome, or other syndromes like Fragile X
- She stops doing things she used to do – for example; she stops talking.
Children having difficulties with language need help as early as possible. You’re the best judge of your child’s language development.
Trust your instincts and speak with your GP, child and family health nurse, your child’s teacher, or a speech pathologist if you’re concerned.
If this professional isn’t concerned about your child, but you’re still worried, seek another opinion.
Where to Get Help for Language Delay
If you think your child is having trouble with language, talk to a professional – for example:
- teachers or educators at your child care centre, preschool or school
- a speech pathologist
- an audiologist
- a GP or paediatrician
- a child and family health nurse
- a psychologist.
If you think your child’s main problem is understanding and using language, you might want to visit a speech pathologist.
Speech pathologists can use language tests to assess how your child uses words and responds to requests, commands or questions.
If you think your child might be hard of hearing or have a hearing impairment, it’s best to have your child’s hearing checked by an audiologist.
Hearing loss could interfere with your child’s language development and communication.
Support for Children With Language Delay
If your child is diagnosed with language delay, the health professional you’re working with might recommend group programs that build language skills.
The professional might also help your child develop other ways to communicate, like using picture boards or books.
The professional might give you strategies that you can use at home to help your child communicate.
This might include giving your child lots of time to begin a conversation.
You can also help your child by responding and expanding on his efforts to communicate, whether it’s with words, actions or sounds.
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