Speech Delay

Speech and language skills begin with the slightest cooing of an infant. As the months pass, toddlers eventually begin to babble which soon progresses into 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- and three-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 different for parents 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 serious problem that needs professional treatment.

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

Yes. While speech delays and language delays are often confused and 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 difficult to understand. While they may use words and phrases to express 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 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 administer an evaluation and diagnosis.

As mentioned, 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 deeper problem that needs attention. The table below highlights common signs and symptoms by age group of speech delays.

By 12 months

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

By 18 months

• Your child prefers gestures over vocalizations to communicate
• Has trouble imitating sounds
• 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 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)

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

If your child might have a problem, it's important to see a healthcare provider or speech-language pathologist. 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 SLP 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 SLP may recommend speech therapy for your child.

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 tell 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. 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 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 indicative 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. 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

• 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 they lose 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 uses 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

Numerous studies show parents play an essential role in helping their child reach their speech and language goals. Parents 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-language pathologists should empower parents to take a more active role in their child’s progress, teaching them strategies, cues, and corrections that can be practiced daily. Additionally, Expressable has developed several instructional videos with helpful at-home exercises to get started.

Expressable matches families with a certified speech therapist trained to effectively 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 chat capabilities.

Ages 0-3: Parents work directly with their speech therapist to learn cues and at-home strategies so they can confidently practice with their child outside the session and improve their communication. For more information on the importance of parental involvement in their child’s speech therapy, click here.

Ages 3-6: Parents 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 parents are kept in the loop with updates and tips during each session.

• Why is my child not talking yet
• Is it normal for my child to not be speaking yet for his age?
• My child seems to have trouble understanding what I’m saying, but does respond to gestures. Is it possible he/she has 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 or daily activities or game can I do with my child to help encourage their speech development
• How will a speech delay affect my child’s school performance?