Speech and language delay

Overview

Speech and language delay is relatively common in young children, where aspects of their speech, language and communication are not as advanced as we would expect at a particular age, when compared to other children. This can be concerning for parents, and children with these problems can have difficulties with other aspects of their development, their education and interactions with others.

These sorts of problems can be considered as follows:

Speech and language delay – where the development of speech and language has occurred through the normal steps, but it is slower overall than one would expect for a child of a particular age.

Speech disorder – where a child struggles to produce the speech sounds correctly and clearly.

Language disorder – where the child may find it difficult to understand what is being said (receptive language disorder) or when they find it difficult to express themselves and say what they would like to say (expressive language disorder).

These problems can occur on their own, without an obvious underlying cause (primary) or as a result of other conditions, including in conjunction with other developmental issues (secondary).

What is required for normal speech and language development?

The development of normal speech and the understanding of language is extremely complex, and requires a number of different factors to be in place. Problems in any of these areas may lead to difficulties with speech and language development.

For example, progress in speech and language relies heavily on generally normal development in other areas, and so it is important to consider a child’s other developmental milestones (communication, interactions, behaviour, smiling, eye contact, gross and fine motor skills, for example), and whether these have been reached at the appropriate time. We also consider whether any other factors, such as birth problems, prematurity or family history may have affected development.

There may also be some physical features which can affect normal speech and language development, for example abnormalities of the mouth and tongue (such as a tongue tie or palate problems).

Children also need to be able to hear clearly to develop speech and language properly, and so we also consider whether they have had a normal hearing test at birth and whether they might have any current hearing problems.

Otherwise, children also require a rich and stimulating environment to develop normal speech and language.

What do we expect at different ages?

Children develop speech through a series of phases:

Cooing - vowel like sounds

Babbling - production of consonant and vowel sounds: bababa, mumumum, etc.

Jargon - combinations of sounds which sound more like sentences

Single words - in and out of context: mama, no, dat

Word combinations - gimme dat, my car

Full sentences with increasing numbers of words and complexity

We can compare children’s progress against expectations at particular ages:

Under two months of age: babies will startle or wake up to loud noises and they cry when upset.

Between two and four months: babies will calm and respond to a familiar voice and will start to coo.

Between four and nine months: babies will begin to turn towards sounds that interest them and will begin to babble.

From 9 to 12 months: they will typically respond to simple commands such as ‘No!’ and they will use jargon and form words such as ‘mama’ and ‘dada’.

From about 10 months onwards: babies will start to respond to their name and produce single words.

By about 18 months: they will have built up a vocabulary of at least 10 words. After this, they may have a ‘word spurt’, where their vocabulary will expand rapidly towards 50 words.

From 18 months to 2 years: toddlers will point to pictures to respond to words, and will start to use two-word phrases and to imitate others.

By 2 to 2½ years of age: they will be able to listen to a story lasting 5 to 10 minutes and will have built up over vocabulary of up to 200+ words, including names, making 2- to 3-word sentences.

Between 2½ to 3 years of age: they should be able to follow two-step commands and to use more complex language, such as plurals and the past tense, express person eg “my” and making 3- to 5-word sentences.

Between three and four years of age: they will answer yes or now and ask questions, using longer sentences.

By 4 to 5 years of age: at the time of school entry, children should be understandable to strangers, with a clear voice and easy communication, understanding short stories.

What can I do if I think that my child has speech and language development problems?

Since a child’s speech and language development is so complex, requiring a number of factors to be in place, we have to consider some different areas. Often, these are looked at in combination.

Please consider talking to nursery teachers or other caregivers to ask for their opinion, in addition to your own impression about your child.

Hearing – your child should have had a normal newborn hearing screen, or where this was not the case, they should have had hearing tests organised as part of their audiological follow-up. If you suspect that your child may now have hearing problems, their hearing can often be assessed as part of an ENT consultation, or alternatively by your local audiology services, which are often based in a local community health centre. Your GP should be able to refer your child for a hearing test. Please bear in mind that it can be quite challenging to test young children, and this requires a specialist audiology team who are used to managing this age group.

Development – please consider your child’s overall development, milestones, interactions and behaviour. It is important to think about any difficulties during pregnancy or around the time of birth, as well as other subsequent problems, such as feeding or swallowing issues. There may be some other concerns in addition to their speech and language development, such as unusual behaviour or interactions.

While having a hearing assessment is a very sensible early step, there may also be benefit from review by a paediatrician with a specialist interest in child development, for a formal developmental assessment.

Clinical examination – it is important that your child is examined to check that their ears are healthy and that their mouth, palate and tongue appear normal.

Speech and language therapist review – speech and language therapists are experts in this area. Your GP may be able to help to refer your child locally, and in some areas there are self referral schemes where parents have concerns about their children’s speech development. The therapist will be able to assess your child’s speech, comparing this to their expectations for other children of a similar age, as well as offering very useful management advice.

Some important reasons to consider asking for a referral to the above services are:

If your child is not babbling by 12 months

If they are not using at least three words by 15 months

If they are not using simple words such as mama and dada by 18 months

If they are not using 25 words by two years of age or at least 200 words by three years of age

Summary and next steps

Speech and language development are very complex areas, and there is often a lot of variation between children, even if they are hearing well and developing normally.

It is important to consider various aspects of each child’s development, medical history, hearing and other factors.

If you have any concerns about your child’s speech development, please consider referral to one of the services discussed above.

Further information

There is an excellent article all about the causes and management of speech delay at:

12 minute consultation: evidence-based approach to the child with speech delay