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.
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- 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 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
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
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 chat capabilities.
Ages 0-3: Caregivers 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 caregiver 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.
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?