How do you know if your child has a speech and/or language delay?

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Padrick is an adorable, happy, social, red headed, thirty-month-old child with a face full of freckles.  He runs into the kitchen where he finds his mom and starts pointing at the freezer.  His mom asks, “What do you want?” Padrick keeps pointing and reaching but then gets frustrated.  Sean, his twin brother runs and in and says “Padrick want juice pop.”  Padrick smiles and is rewarded with the treat but his mother worries why he is not talking.

This is a familiar scenario occurring in kitchens all over the world.  Language delay is one of the most common developmental concerns raised by parents.  Approximately 2% to 19% of preschool children have speech and/or language delay.  Speech refers to the mechanics of oral communication and includes conditions such a stuttering, voice quality differences, or articulation errors.  Language encompasses the broad ability to understand, process, and produce communication.  Children may have challenges in just one area or may have both speech and language difficulties.

How do I know if my child has speech or language delay?

Language skills unfold on an accepted timeline, however, there is a range of normal for each skill.  For example, one child may say five words at 11 months, while another child may not master five words until age 21 months.  Both children have language development in the normal range.  This makes language delay somewhat difficult for parents to identify. It can be helpful for parents to utilize a chart (like the one provided) to get a general feel for when milestones should be present.  Parents should be concerned if their child is not:

• Responding to name and engaging in reciprocal interactions 6 months
• Babbling and pointing with one finger by 12 months.
• Understanding simple commands such as “no” and “stop” by 18 months.
• Talking in short sentences such as “I want cookie” by 3 years old.
• Telling little stories by 4 years old.
• Being 100% clearly understood by age 4 years old.

Many parents only recognize expressive language delay (like Padrick), that is, a delay in the number of spoken words used, however, children can also have receptive language which is difficulty understanding basic vocabulary and sentences.  Pragmatic language delay is the term used for children who lack understanding of the social use of language such as reading social cues, understanding common sayings, or failing to interpret tone of voice or gestures (like a shrug of the shoulders).  Some children have developmental language delay, otherwise known as “late talkers.”  These children have normal intelligence, normal hearing, and strong social skills but are later than their peers in developing language.  Eventually these children catch up on go on to communicate well.

If parents have concerns about their child’s language development, they should bring their concerns to the attention of the health care provider.  The best way to determine if your child has a speech or language delay is to have them assessed.

Language Milestones

Birth to 3 months

• Makes pleasure sounds (cooing, gooing)
• Cries differently for different needs
• Smiles when sees you

6 months 

• Responds to his name
• Responds to human voices without visual cues by turning his head and eyes
• Responds appropriately to friendly and angry tones

12 Months

• Uses one or more words with meaning
• Understands simple instructions, especially if cues are given

18 Months

• Has vocabulary of approximately 5-20 words
• Vocabulary made up chiefly of nouns - e.g. dog, cup, car, baby
• Is able to follow simple commands e.g. pick up the ball

2 Years   

• Can name a number of objects common to his surroundings
• Is able to use at least two prepositions e.g. words like 'in' 'on' 'up' - "Milk in cup"
• Combines words into a short sentence-largely noun-verb combinations e.g. 'doggy run' 'kick ball'
• Approximately 2/3 of what child says should be easy to understand.

3 Years   

• Uses Pronouns -  I, you and me correctly
• Uses some plurals and past tenses e.g. plural - dogs, cars, toys  - past tense - liked, finished
• Knows at least three prepositions e.g. words like 'in' 'on' 'up'
• Handles three word sentences easily e.g. 'I like apples' 'Milk all gone'
• Has about 1000 words
• Approximately 75-90% of what your child says is easy to understand.
• Can give sex, name, and age.

Adapted from Child Development Institute at http://www.childdevelopmentinfo.com and The NIH National Institute on Deafness and Other communication Disorders at http://www.nidcd.nih.gov/health/voice/speechandlanguage.asp#mychild

What causes speech and language delay?

There are a variety of factors that may place a child at risk for language delay.   Genetic conditions such as fragile X syndrome and autism, prematurity, environmental issues such as poverty, abuse or neglect, and delayed cognitive development can play a role. Hearing impairment should always be considered in any child with language delay.  Although most children are now screened in the newborn nursery for congenital hearing loss, hearing loss can be acquired,so parents should ask their child’s care provider for a hearing test as a first step towards evaluation.  

What can parents do?

• Seek professional help if you are concerned.  Visit the pediatrician or nurse practitioner and ask for a speech and language evaluation.  Request a hearing test.  Do not take the “wait and see” approach because your child may miss months of important intervention if it is needed.
• Children need a language rich environment.  Communicate with your child, starting in infancy by talking, singing, rhyming, and playing little language games. Take a look at these articles for more information: Developing oral language skills and Toddler - Listening and talking
• Read, Read, Read.  Assisting your child to find the joy of reading provides a foundation for life long learning and exposes them to the rhythm of language, millions of vocabulary words, grammatical structure, and creative ideas. Check out - Reading with toddlers
• Limit television viewing; you are a much more effective language teacher.
• Encourage children to talk about their feelings and their experiences.  Be a good listener.
• If your child does have language delay, keep all therapy appointments and follow the therapists’ recommendations.

Resources for parents who suspect their child may have speech or language Delay

• The primary health care provider
• A Speech-Language Pathologist
• Early Intervention Screening Programs
• Evaluation at a Developmental Clinic
• Assessment by the school special education team
• American Speech-Language-Hearing Association - http://www.asha.org

Next: Toddler Listening and Talking

By Catharine Critz, PhD, CPNP, APRN