Speech Delay in Children
The brain of the baby is growing every single day. There are numerous neurons connections being established (“synapses”) and many unnecessary connections being disconnected (“synaptic pruning”). Each child develops at different rates and they are expected to do certain things at certain age. These expected activities are called “developmental milestones”. These milestones are mainly divided into four domains i.e gross motor, fine motor, speech & language and social domains. They differ in the rate of development as a whole, and in the rate and pattern of development within each domain.
Speech and language are different entities. Speech is about producing sounds and words, whereas language is about communication (verbal and non-verbal both). A child who can speak words still may have difficulty forming sentences that make sense. They may speak words but have difficulty understanding others. So language delay is broader term, it includes speech delay as well. Language delay not only means not able to produce sound, but also to understand and make sense of it.
Before understanding delay, parents should be aware of normal speech and language development. Language acquisition can be divided into verbal and non-verbal. Non-verbal means through gestural communication. Verbal communication can be further divided into expressive language (the ability to produce or use language) & receptive language (the ability to understand language).
What is the expected normal speech milestones?
The following are the expected speech milestones in children:
- Cooing—2 months
- Babbling—5-6 months
- Single syllable like “ma”, “da”—8-9 months
- One word other than “dada” and “mama”—12 months
- 10 to 50 words used meaningfully—16–20 months
- Two-word phrases—20–24 months
- Points to at least one body part and to named objects and people on command—20 months
- Vocabulary greater than 200 words—2 years
- Two-word combinations—2 years
- Follows two-part commands—2 years
- Sentences of three to four words—3 years
- Compound and complex sentences—4 years
How common is language/speech delay?
Approximately 10 to 15 % of two-year-old children have language delay, but only 4 to 5 percent remain delayed after three years. Approximately 6 to 8 percent of school-age children have specific language impairments (SLIs)(means language delay with normal development & intelligence)
Which children are at risk of language/speech delay?
The following group of children are at risk:
- Low birth weight or prematurity, including late-preterm (ie, 34 to 36 weeks)
- Family history of language delays, language disorders
- Less environmental stimulus in family
- Children with autism
- Boys are more at risk than girls
What are the cause of language/speech delay or impairment?
Following are some common causes:
- Maturational or constitutional language delay
- Hearing impairment
- Intrauterine infections, meningitis, recurrent otitis media
- Family history of language delay and learning problems
- Lack of language stimulation or disruption in parenting
- Autism spectrum disorder (ASD)
- Fluency disorder or stuttering
- Phonologic or articulation disorder
What are the “myths” about speech delay?
Here are some commons myths:
- He is a boy and boys talks later than girls
- His father and uncle also spoke late, but they are fine now
- He is not saying much but he understands everything
- His family speaks 2 languages, so he will take time
- His elder brother speaks for him
- He speaks at home but not in school
There are many misconceptions among parents about speech delay. There are multiple societal & cultural beliefs about speech delay. We are counselled by our elders and neighbours in family and given hope that the child will speak over the course of period. In bargain we may miss important period where the child could have benefitted from early evaluation and speech therapy. Its alwez advisable to take an expert opinion rather to miss early development period where appropriate therapies are helpful.
When should one consult an expert for speech delay?
The following are situations, called as “red flags”, where expert opinion is advised:
- Doesn’t babble at 6-8mths
- Doesn’t use “mama”, “papa” at 12-14mths
- Doesn’t use any other single word except ”mama”, “papa”, ”dada” at 15mths
- Doesn’t point to object at 15mths
- Doesn’t have at least 5 words used spontaneously to make request at 18mths
- Doesn’t follow familiar one-step direction without gesture at 18mths
- Doesn’t point to something in order to share enjoyment or excitement with another person (joint attention) at 18mths
- Less than 50 words vocabulary at 2yrs
- Doesn’t combine two words together to create new meaning at 2yrs
What tests are needed for children with speech delay?
The extent of investigation depends upon the possible underlying cause. In children with isolated language delay, who doesn’t have any neurological or genetic cause may not need detailed evaluation. Child with suspected neurological problem or children with global delay (means late walking, poor social interaction etc along with speech delay) may need detailed evaluation.
Hearing evaluation should be done in all children with speech delay. Some children needs EEG, MRI brain or rare genetic studies depending upon the possible underlying cause. A detailed evaluation by pediatric neurologist is advisable.
- Doesn’t babble at 6-8mths
- Doesn’t use “mama”, “papa” at 12-14mths
- Doesn’t use any other single word except ”mama”, “papa”, ”dada” at 15mths
- Doesn’t point to object at 15mths
- Doesn’t have at least 5 words used spontaneously to make request at 18mths
- Doesn’t follow familiar one-step direction without gesture at 18mths
- Doesn’t point to something in order to share enjoyment or excitement with another person (joint attention) at 18mths
- Less than 50 words vocabulary at 2yrs
- Doesn’t combine two words together to create new meaning at 2yrs
How are children with speech delay treated?
The treatment option is multimodal depending upon the age, finding from physical examination & hearing test, availability of resources etc.
Following are some treatment modalities:
- Early intervention services (for children from birth through 36 months of age)
- Early childhood special education services (for children ≥36 months of age) and special education services (for children beginning in kindergarten)
- Speech and language therapy
What would be the long term outcome for children with speech delay?
The prognosis for expressive language delay depends upon the underlying etiology. Children with speech and language problems that persist beyond five years of age may continue to have difficulty into adulthood. Children with isolated speech/language problem, average to above-average intelligence & no receptive language difficulties have been associated with resolution during the preschool years.Above all early intervention and speech therapy can change the course of development. Many children will outgrow if intervened at time.
What can I do as a parent to prevent speech delay in my child?
The following advise will be helpful for these motivated parents :
- Be aware of normal speech and language development in children
- Know the “red flags”. “Red flags” means, u need expert help. Earlier, the better
- Stimulating the baby from early infancy by speaking to them, conversing with them, singing etc
- Limiting or reducing media exposure
- Do not expose to more than 2 language at home. Best is to teach one language first
- Accompanying words with gestures to make them more understandable
- Use short sentences, eg 2 words sentences louder, repeat those sentences. Don’t give instructions in full sentences
- Imitate the sound , use gestures.
- Start age appropriate reading the child. Encourage them for repetition of words and small sentences.
- Use everyday situation eg naming foods, cookery items, naming animals , naming various objects at home, showing body parts etc.
- Be aware with false hopes coming from elderly and neighbours. Never hesitate to take an expert opinion.