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Delayed Speech and Language Development

As a child grows from infancy to toddlerhood, one of the most fascinating (and often entertaining) developments is when he or she begins to talk. It is usually during this time that we get our first glimpse into his or her unique personality. The first 3 years of life is a critical period for the development of speech and language. During this time, the brain is uniquely in tune to all the sights and sounds from a child’s environment, and is rapidly developing all the necessary connections for language and speech. In this article, we will explore the normal development of speech and language, signs of speech delay, some common causes of speech delay and the importance of early intervention and therapy.

Definitions:

Language: Socially shared rules which include what words mean (receptive language) and how to put words together to communicate with others (expressive language)

Speech: Verbal means of communicating that consists of articulation (how sounds are made) and fluency (rhythm of speech)

1. American Speech Language/Hearing Association

Normal Speech Development

Infants begin processing language and word associations at an amazingly young age. New research suggests infants recognize their own name at 4 months of age and although they may only use 1 or 2 words, they likely recognize hundreds of words by 12 months of age. Receptive language (what speech a child understands) is much superior than expressive language (what a child can articulate) in these first few years of life. It is important to remember that certain sounds are beyond the oral/motor capability of toddlers until they reach a certain age. In fact, certain sounds such as “th, sh, ch, k “ usually cannot be pronounced accurately until age 6 or 7. The following table is a short list of normal speech and language development by age and includes some common “red flags” pediatricians are on the lookout for that may indicate a child needs further professional evaluation.

Age What your child should be able to do Red Flags
1-3 months Responds to sounds, coos, chuckles
Moves body in response to voice
Does not startle to loud noises
4-6 months Laughs
Babbles more than 2 sounds
Imitates sounds like “ooh” and “ahh”
Responds to his or her name
9 months Says “Mama”, “Baba”, or “Dada”
12 months Says 1 or 2 words
Follows simple directions–waves bye-bye
Does not use single words like “Mama” or “Dada”
15 months Says 4 or 5 words
Will point to people and objects
18 months Knows names of things and people Does not use at least 15 words
24 months Uses 2 or 3 words together
Says “mine”
About half of speech is understandable
Does not follow simple instructions
36 months Speaks in at least 3 word sentences
Follows 2 requests
About 75% of speech is understandable
Does not use language to communicate more than his/her immediate needs
4 years 90% of speech should be understandable
Able to name objects/animals in pictures
Speech is still difficult to understand
5 years Speech should be totally understandable although he or she may have articulation problems
Understands common opposites–big/little, hard/soft

* For more extensive information, The American Speech-Language-Hearing Association offers a detailed chart of language development online at www.asha.org.

Some Common Causes of Speech Delay

Some common causes of speech delay/language delay include hearing problems, global developmental delay, speech processing problems, and oral/motor problems.
All children with speech and language problems should have a hearing evaluation. Children with a history of recurrent ear infections are at risk for hearing problems that can lead to language delay. Children with global developmental delays, which include autism-spectrum disorders to children with a history of prematurity, usually have language/speech delays as well as other delays such as motor delays and/or social delays requiring speech as well as other therapies. Speech/Language processing problems are disorders where the brain has not matured enough to produce speech. Usually these children have normal receptive language and only show delays in expressive language and speech. “Late talkers” usually fall under this category, but some children may have a significant expressive language delay that requires intervention to promote normal speech/language development and prevent other language-based learning disabilities in the future. Oral/motor problems primarily affect articulation and can be corrected with appropriate speech therapy by a licensed practitioner.

Early Intervention and Speech Therapy

Language development is one of the many aspects of childhood development that is closely monitored at each well child check. If there are any delays noted during the exam, children are referred to the appropriate specialist in the field who will conduct an extensive hearing and developmental exam based on the child’s age. If there are any concerns about how your child’s speech is developing, it should be brought to their physician’s attention as soon as possible. Early intervention is key to helping children with speech delay continue to develop language and communicate effectively in the future.

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