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How To Identify if Your Toddler’s Speech Delay Is a Concern

Every child develops at their own pace, but it's important to know when your toddler's speech delay may be something to be concerned about.

12 to 18 Months
18 to 24 Months
2 to 3 Years

There is a wide range of what's considered "normal" language development in toddlers. Children hit milestones at different times and many factors can influence how much or how clearly a young child speaks.

For instance, children who live in a bilingual home may take a little longer to become fluent in either language (but in the long run, may have significantly better verbal skills than their peers). Toddlers in a family with older children sometimes speak later because older siblings "talk for them." Research also shows that children with ovaries speak earlier than those with testes on average.

Sometimes, though, speaking later than expected or speech that is unclear can signal a developmental delay or a physical problem. The first step is to determine whether your child's speech is really off target for their age. Use this list of speech-related milestones and signs of possible speech delay in toddlers age 3 and under when considering whether your little one's speech is progressing as expected.

Parents / Michela Buttignol

12- to 18-Month Speech Milestones

Around the first birthday, baby babble starts to change. As little ones try harder to imitate the sounds around them, the noises they make start to take the shape of actual words.

At this age, toddlers have a wide range of speech sounds . You’ll probably be able to recognize at least one or two common words, such as "baba" (for "bottle") or "mama" (for "mom"). Nouns that are, in a child's view, essential to daily life are usually the first words that they master.

Aside from those key words, your child’s speech at 12 months will mostly be limited to babbling sounds. Over the following six months, though, you should start to see your child begin to develop more advanced communication, such as:

Trying to copy your words
Imitating the back-and-forth of real conversation
Inflecting speech to ask a question (saying "Ju?" when requesting juice) or make a demand (shouting "Ju!" when insisting on juice)
Spontaneously using words, rather than just responding to sounds you make
Using a combination of gestures and vocalized sounds to communicate

When evaluating your child's 12- to 18-months speech milestones it's important to pay attention to the words or sounds your child is making. Consider whether or not your toddler can follow simple one-step directions such as, "pick up the block."

18- to 24-Month Speech Milestones

There continues to be a wide range of normal in verbal skills during the 18-to 24-month period. Your child’s personality, temperament, and circumstances can play a role in how many words you hear and how often. On average, by the time your toddler reaches age 2, you can expect the following speech milestones:

Increasingly adding words to their vocabulary
Forming two-word phrases, although they won’t be grammatically correct (such as “no go,” “book read”)
Using words to identify pictures in a book or surroundings
Naming body parts and animals and sometimes making animal sounds (such as “moo” for cow)

It's still important to notice how well your child is able to comprehend what you say. Do they respond to you when you ask questions? Can they follow simple two-step commands by age 2? This is known as receptive language .

2- to 3-Year Speech Milestones

After the second birthday, there is usually an explosion in vocabulary and the use of more complex sentences. It's often said that a child's vocabulary grows to 200 or more words during this time. Some of the 2- to 3-year speech milestones to look for this year include:

Saying more words and picking up new words regularly
Combining three or more words into sentences (which may still be grammatically awkward)
Beginning to identify colors, shapes, and concepts, such as "more" or "less" and "big" versus "little"
Singing nursery rhymes and songs or repeating stories from books you've read often together
Beginning to express feelings with words ("I hungry," "Sam sad")

The total number of words your child learns during this time is less important than a consistent increase in the number of words they start to use week by week.

At this age, it's still common for people outside your immediate family or regular caregivers to be unable to understand your child as well as you can. In the coming year, your child’s speech should become clearer and clearer.

Key Takeaways

When determining whether your toddler has delayed speech, you should first evaluate if their speech is normal for their age. You can use speech-related milestones to look for signs of possible speech delay in toddlers. Milestones are broken up by age group and vary from copying words to identifying colors and shapes. Make sure to look through each milestone to determine if your little one's speech is progressing as expected. If you are concerned about your child's speech, talk to a pediatric health care provider about the causes of speech delays and ways you can support language development at home.

Sex Differences in Language Across Early Childhood: Family Socioeconomic Status does not Impact Boys and Girls Equally . Front. Psychol . 2015 .

Important Milestones: Your Child By One Year . Centers for Disease Control and Prevention . 2023.

Important milestones: Your child by eighteen months . Centers for Disease Control and Prevention . 2023.

Important milestones: Your child by two years . Centers for Disease Control and Prevention . June 2023.

The website may be down at times on Saturday, August 24, and Sunday, August 25, for maintenance.

Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone.

Am Fam Physician. 2023;108(2):online

Related article: Speech and Language Delay in Children

What is speech and language delay?

Speech and language delay can cause your child to have problems saying words and phrases, understanding what is being said, or putting feelings, thoughts, and ideas into words.

Every child develops at their own pace, but some children are behind in speech development compared with other children the same age because of speech and language delay. Your doctor may think that your child has speech delay if they aren't able to:

Use at least three words by 15 months of age

Follow one-step directions by 18 months of age

Use two-word phrases by two years of age

Follow two-step directions by two-and-a-half years of age

Speak well enough for others to understand them most of the time by three years of age

What causes speech and language delay?

The most common causes include developmental delays, hearing loss, or intellectual disability.

Other causes include:

Cerebral palsy (seh-REH-bral PAWL-zee): a movement disorder caused by damage to the brain

Dysarthria (diss-AR-three-uh): problems with the muscles used for speech

Selective mutism: not talking in certain settings

Autism: a developmental disorder

Will it affect my child if we speak two languages at home?

Children who are raised speaking two languages might mix up the two languages when first learning to talk, but they tend to meet the same milestones as children who speak only one language.

How will my doctor know if my child has speech and language delay?

Your doctor will evaluate your child's speech and mental and physical development. He or she may also test your child for hearing problems.

How is it treated?

Your doctor might refer your child to a speech therapist to help them learn to understand and speak better. A speech therapist can also teach you new ways to encourage your child. Your doctor might also refer your child to another specialist, such as an audiologist, if another condition is causing speech delay or if there is concern for hearing loss.

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More in AFP

How can I tell if my child has a speech or language delay?

Published on: June 13, 2023

A CHOC expert gives language developmental milestones, warning signs of speech delays and when to call the doctor.

Link: https://health.choc.org/how-can-i-tell-if-my-child-has-a-speech-or-language-delay/

Kids and speech problems

Young children often struggle with pronouncing words correctly as they learn language skills. There’s a wide range of what’s considered normal when it comes your child’s early language skills.

However, if you think your child is having trouble communicating, don’t ignore your concerns. It’s important for children to develop an early understanding and expression of language so that their other developmental skills — like play and social interaction skills — aren’t delayed.

Here, Melissa Gran, speech and language pathologist at CHOC , offers guidance speech and language developmental milestones, and teaches parents how to spot warning signs of speech or language delays.

How to encourage language development in young children

“Language learning can easily be incorporated into daily activities. Children are constantly learning language receptively and expressively in all environments,” says Melissa. “It is so important to talk to your children throughout the day, such as when getting them dressed, mealtime and bath time.”

Other ways that parents can encourage language development for their kids include:

Narrate routines and describe actions during daily tasks.
Sing songs and recite rhymes together.
Read together, tell stories and ask questions.
Play “I Spy” and naming games to expand vocabulary.
Talk about the world around them, like nature and the people they see.
Use picture books and flashcards to introduce new words.
Encourage storytelling and pretend play for language expression.
Play word games like “Simon says” or “Rhyming words.”
Use educational apps or online resources wisely.

Speech and language developmental milestones for kids

Knowing what is considered “normal” or not in speech and language development can help you determine if your child is developing on schedule, says Melissa.

The following milestones provide a framework for tracking a child’s language development and ensuring they are reaching appropriate milestones for their age.


	– Startles to loud sounds. – Quiets or smiles when spoken to. – Seems to recognize caregiver’s voice and quiets if crying. – When feeding, increases or decreases sucking behavior in response to sound.	– Makes pleasure sounds (cooing, gooing). – Cries differently for different needs. – Smiles when sees primary caregiver(s).
	– Moves eyes in the direction of sounds. – Responds to changes in the tone of the caregiver’s voice. – Notices toys that make sounds. – Pays attention to music.	– Babbling sounds more speech‐like with many different sounds, including and . – Chuckles and laughs. – Vocalizes excitement and displeasure. – Makes gurgling sounds when left alone and while playing with their caregiver.
	– Enjoys games like peek‐a‐boo and pat‐a‐cake. – Turns and looks in the direction of sounds. – Listens when spoken to. – Recognizes words for common items like “cup”, “shoe”, “book”, or “juice.” – Begins to respond to requests like “Come here” or “Want more?”	– Babbling has both long and short groups of sounds such as “Tata, upup, bibibibi.” – Uses speech or non‐crying sounds to get and keep attention. – Uses gestures to communicate (waving, holding arms to be picked up). – Imitates different speech sounds. – Has one or two words “Hi, dog, dada, mama” around first birthday, although sounds may not be clear.
	– Points to a few body parts when asked. – Follows simple commands and understands simple questions like “Roll the ball,” “Kiss the baby,” and “Where’s your shoe?” – Listens to simple stories, songs and rhymes. – Points to pictures in a book when named.	– Has a word for almost everything. – Uses two‐ or three-words to talk about and ask for things. – Uses and sounds. – Speech is understood by familiar listeners most of the time. – Often asks for or directs attention to objects by naming them.
	– Understands differences in meaning between “go‐stop,” “in‐on,” “big‐little,” and “up‐down.” – Able to follow two requests, like “Get the book and put it on the table.” – Listens to and enjoys hearing stories for longer periods of time.	– Has a word for almost everything. – Uses two‐ or three-word sentences to talk about and ask for things. – Uses and sounds. – Speech is understood by familiar listeners most of the time. – Often asks for or directs attention to objects by naming them.
	– Hears when someone calls them from another room. – Hears television or radio at the same loudness level as other family members. – Answers simple “who?,” “what?,” “where?” and “why?” questions.	– Talks about activities at school or at friends’ homes. – People outside of the family usually understand child’s speech. – Uses a lot of sentences that have four or more words. – Usually talks easily without repeating syllables or words.
	– Pays attention to a short story and answers simple questions about them. – Hears and understands most of what is said at home and in school.	– Uses sentences that give lots of details (“The biggest peach is mine”). – Tells stories that stick to topic. – Communicates easily with other children and adults. – Says most sounds correctly except a few like – Says rhyming words. – Names some letters and numbers. – Uses the same grammar as the rest of the family.

Signs of developmental delays in speech and language for kids

Recognizing the signs of speech or language delays in children is important for early intervention and support.

Here are some general signs that may indicate that your child has a speech and language delay:

Lack of babbling (around 6-9 months).
Limited vocabulary (by 18 months).
Difficulty combining words (around age 2).
Lack of response to verbal cues.
Limited social interaction.
Pronunciation difficulties.
Trouble understanding stories or instructions.

It’s important to discuss any concerns with your pediatrician at every routine well-check visit .

What to do if you think your child has a speech or language disorder

Again, make sure to always talk to your child’s doctor about any developmental concerns at every well-check visit.

First, your child’s hearing should be checked. This is to make sure that he or she isn’t simply hearing words and sounds incorrectly.

If hearing loss is ruled out, your child’s doctor may refer you to a speech-language pathologist. This is a speech expert who evaluates and treats children who are having problems with speech-language and communication.

The diagnosing process involves initial screening, case history, observation, formal assessment, language sample analysis and additional evaluations if necessary.

Learn more about motor speech disorders

When to seek speech or language therapy

There are many reasons a child should be referred for speech or language therapy . Many families are surprised to find out their child needs speech or language therapy , as they often chalk up their child’s speech-related problems to not listening or just a cute “quirk.”

It is also common for parents to be so focused on a child’s other medical conditions or therapy needs that they overlook those that require speech and language therapy.

Remember that you are an expert on your child, says Melissa. Use these speech and language developmental milestones for guidance but reach out to your pediatrician with any questions and concerns.

By addressing any potential delays early on, you’ll set your child up for getting the help they need to develop their communication skills successfully.

Learn more about speech and language pathology at CHOC

Speech and language pathology is specialized therapy that helps children develop or improve their speech, language, memory and attention, feeding and swallowing.

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Speech and language delay.

Last Updated October 2023 | This article was created by familydoctor.org editorial staff and reviewed by Kyle Bradford Jones, MD, FAAFP

Table of Contents

Every child develops at his or her own pace. But if your child doesn’t talk as much as most children of the same age, the problem may be speech delay.

What is a speech and language delay?

A speech and language delay is when a child isn’t developing speech and language at an expected rate. It’s a common developmental problem that affects as many as 10% of preschool children.

Symptoms of a speech and language delay

Your child may have a speech delay if they aren’t able to do these things:

Say simple words (such as “mama” or “dada”) either clearly or unclearly by 12 to 15 months of age
Understand simple words (such as “no” or “stop”) by 18 months of age
Talk in short sentences by 3 years of age
Tell a simple story at 4 to 5 years of age

What causes a speech and language delay?

The most common causes of speech delay include:

Hearing loss
Slow development
Intellectual disability

Other developmental or genetic disorders include:

Psychosocial deprivation (the child doesn’t spend enough time talking with adults)
Being a twin
Autism (a developmental disorder)
Elective mutism (the child just doesn’t want to talk)
Cerebral palsy (a movement disorder caused by brain damage)

Living in a bilingual home also may affect a child’s language and speech. The child’s brain has to work harder to interpret and use 2 languages. So, it may take longer for these children to start using one or both languages they’re learning. It’s not unusual for a bilingual child to use one language for a while.

How is a speech and language delay diagnosed?

Your doctor can help you recognize a speech and language delay. They will ask you what you have heard and can listen to your child’s speech and check your child’s mental development.

Your doctor may refer you to other specialists to determine why your child isn’t speaking. For example, if your doctor thinks your child may have trouble hearing, they may refer your child to an audiologist for a hearing test. This is a licensed health care professional who treats hearing problems.

Can a speech and language delay be prevented or avoided?

Depending on the cause of your child’s speech delay, you may not be able to prevent or avoid it.

Speech and language delay treatment

Your child may not need treatment. Some children just take more time to start talking. But if your child needs treatment, the type will depend on the cause of the speech delay. Your doctor will tell you the cause of your child’s issue and talk to you about treatment options. Your doctor may refer you to a speech and language pathologist. This person can show you how to help your child talk more and speak better, and also can teach your child how to listen or how to lip read.

Teaching young babies and children a version of sign language also can help them with their language development. Contrary to what some might think, using sign language with babies and young children does not delay their language development.

Other specialists your doctor may recommend you see include a psychologist (a specialist in behavior problems), an occupational therapist (for help with daily activities), or a social worker (who can help with family problems). Your doctor may also suggest early intervention programs in your area. Many are associated with your local school district

Living with a speech and language delay

If your child’s speech is delayed due to a hearing loss, hearing aids or cochlear implants may help your child hear speech. Once your child has access to sound (and speech), they may be able to develop language and even catch up to their hearing peers.

If your child hears and understands language, you can encourage them to speak by talking as much as you can around them. Describe what you’re doing as you do everyday activities. Keep talking. If your child speaks, confirm what they are saying. Always provide positive feedback.

Speech and language delays can be frustrating for parents and children. Children who can’t express their thoughts and emotions are more likely to act out. They anger easily. They may use unexpected behavior to get your attention. Try to remember your child does want to communicate with you. Read to your child and talk as much as you can. Encourage your child to speak. When they try to speak, praise their efforts.

Questions to ask your doctor

Why is my child not talking yet?
Should I talk to my child more to help them figure out how to talk?
Is it normal for my child to not be speaking yet?
My child seems to have trouble understanding what I’m saying. Is it possible they have hearing loss?
Does my child have a developmental disability?
What can I do to help my child speak or understand better?
Do you have any materials I can read about speech and language delay?
Will my child be able to attend school?
Is there an early intervention program available in my area and would it be helpful?

National Institutes of Health, MedlinePlus: Speech and Language Problems in Children

Child-Psych.org: Will teaching my baby to sign delay his speech?

Last Updated: August 3, 2022

This article was contributed by: familydoctor.org editorial staff

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

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DNC Final Night

What’s behind a spike in childhood speech development delays across the U.S.

Zac Schultz, Wisconsin Public Television Zac Schultz, Wisconsin Public Television

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Copy URL https://www.pbs.org/newshour/show/whats-behind-a-spike-in-childhood-speech-development-delays-across-the-u-s

Since the COVID pandemic, there has been a dramatic increase in the number of young children who are slow to develop language skills, with pediatric speech delays more than doubling for children aged 12 and younger. PBS Wisconsin's Zac Schultz reports on what’s behind the delays and whether schools have the resources to help teachers, students and caregivers.

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Notice: Transcripts are machine and human generated and lightly edited for accuracy. They may contain errors.

Since the COVID-19 pandemic, there's been a dramatic increase in the number of young children who have been slow to develop language skills. Pediatric speech delays more than doubled for children aged 12 and younger. PBS Wisconsin reporter Zac Schultz spent time with students and teachers to find out what's behind this increase and whether schools have the resources to help children speak up.

Zac Schultz:

The children in this early headstart classroom are your typical two to three year olds. But they were born during the COVID-19 pandemic and some are at risk of developing a speech delay.

Nichole Spooner, Director, Comprehensive Services, Next Door Foundation:

I believe we are definitely in a dire state right now.

Nichole Spooner is the director of comprehensive services at Next Door Foundation, a headstart program in Milwaukee. She says young children were severely impacted by the lockdown.

Nichole Spooner:

They were facing isolation, stress with their families, trauma, things of that nature. And so they're coming in now with really some challenging behaviors, speech delays, things of that nature. I think we're up about 10 percent right now and children who have speech delays diagnosed.

Across the state, it's the same story.

Megan Bohlken, Speech Language Pathologist:

There's just too many kids for me to fit in.

Megan Bohlken is one of four full time speech language pathologists at Platteville School District in southern Wisconsin. Each of their case loads is maxed out. And once a student is diagnosed with a speech delay, federal and state law mandates the district provide the services, whether they have the funding or not.

Megan Bohlken:

Are definitely kids who will just hand you stuff and expect that you know what they want to do with it and not say anything to you.

Rebecca Alper, University of Wisconsin at Madison: Early language skills are one of the best predictors of academic social vocational outcomes.

Rebecca Alper is an assistant professor and researcher at the University of Wisconsin at Madison studying early The Language and Literacy Intervention.

REBECCA ALPER:

We're really just kind of trying to get a sense for where the child's language levels are.

She says the COVID-19 pandemic highlighted a lot of existing health disparities along the lines of race, income, or even where someone lives and young children were no different.

Rebecca Alper:

It's very hard to focus on early language intervention when you're experiencing housing insecurity, food insecurity, all of those sorts of things.

Alper's team is studying how best to support caregivers of young children since language development starts at birth.

What would be the most supportive long term is to really help support early identification and early intervention? Because the earlier we can intervene, the better the long term prognosis are.

I have one for everybody. Peyton, would you like to put this on?

Back at Next Door in Milwaukee, they use a system called LENA to help identify kids with possible speech delay.

Shakeda Caldwell, Teacher:

These events are going to record the amount of interactions that we're having with each other, it's going to tell us how often we talk to each other because talking is very important.

It's like a superhero this time.

Shakeda Caldwell is the lead teacher in this classroom, and convinces the kids to wear vests that contain a small device that monitors and counts interactions between kids and teachers.

Shakeda Caldwell:

Well guess what is going to do, it's going to help you this talk more, and it's going to help your teachers talk to you more. And we're going to build lots of vocabulary together.

Tonya Hameister, Director of Education Services, Next Door: They are actually recording the frequency of the interactions between the teachers and the children.

Tonya Hameister is the Director of Education Services at Next Door. She says from the LENA device, they download the data, which creates a chart to show the number of times a student and teacher talk to each other, that lets the teachers know which students need more attention.

So if I have that child who scored lower who wasn't having many interactions, then I will plan to, okay, I'm going to have a one on one with this child. Maybe I'm going to read more books with him. I want him to name I'm going to ask him what does he see in the book so I can get those words out of hand.

Hameister says LENA started as a research program. But now next door has adopted it for all early headstart classrooms.

Tonya Hameister:

We saw an increase, especially in the children that were not as verbal that is expressive. We saw a pretty significant increase in the amount of interactions. So the teachers were doing very targeted interactions with children and trying to increase that opportunity for them to be expressive.

Hameister says Next Door is fortunate enough to have a lot of community support. But she worries about schools that are dealing with a budget crunch and a surge in speech referrals.

In the last state budget, Governor Tony Evers proposed using the budget surplus to put an extra billion dollars into special education funding, Republicans in the legislature only allotted an extra 107 million statewide over the next two years, just a 2 percent increase.

It's a challenge. It is a huge challenge. We know a lot of our systems are resource depleted, and they're tired.

Megan Bohlken says burnout in her industry is a real concern. And while they're doing okay right now, next February, they start screenings for the 4k students. The next wave of speech delays is waiting to be identified.

Those referrals keep coming as those kids are evaluated. And if they qualify, getting them added onto my schedule, that's when it's going to start to be okay, now I feel like I'm drowning. Now, what are we going to do.

For PBS News Weekend, I'm Zac Schultz in Platteville, Wisconsin.

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v.64(12); 2023 Dec
PMC10775292

Speech and language delay in children: a practical framework for primary care physicians

Wei hao kevin liang.

1 Department of Paediatric Medicine, KK Women’s and Children’s Hospital, Singapore

Lydea Wei En Gn

2 Speech Language Therapy Service, KK Women’s and Children’s Hospital, Singapore

Ying Chu Deborah Tan

3 SingHealth Polyclinics, Singapore

Guan Hao Tan

Opening Vignette

Aaron, an 18-month-old boy, was brought by his parents to your clinic for his 5-in-1 booster vaccination and developmental screen. His childcare teachers had raised concerns that he was ‘slower’ in his speech and language development as compared to his peers. His parents reported that he is able to use the words ‘papa’ and ‘mama’ specifically but say only two other single words. He can point and use gestures to indicate his wants. You assessed his receptive language to be age appropriate. He has no hearing problems or behavioural concerns suggestive of autism spectrum disorder. In general, he has been in good health and has no significant past medical problems of note. Your clinical examination of him was unremarkable. Aaron’s parents appeared anxious and were concerned that he will be at a disadvantage as compared to his peers when he grows up .

WHAT IS SPEECH AND LANGUAGE?

Speech and language are often mistaken to be synonymous. Speech is the articulation and production of speech sounds within the mouth, whereas language encompasses comprehension, processing and production of communication. Expressive language refers to the ability to communicate and convey meaning to others. Typically, this output is speech, but may be in the form of signs, gestures and written language. Receptive language refers to the ability to understand the communication of others, and encompasses auditory and visual skills. Apart from expressive and receptive language, other pertinent components of language development are necessary for children to develop effective communication. These include joint attention, play and social-pragmatic language (which refers to the way in which language is comprehended and applied in a social context).

The acquisition of normal speech and language skills is a key developmental milestone that most parents eagerly anticipate. Naturally, there are parental concerns and anxiety when there are deviations from parental expectations or perceived norms. Hence, the understanding of normal patterns of speech and language development and identification of delays is crucial in primary care.

The prevalence of isolated speech and language delays and disorders was estimated to be between 5% and 12% (median 6%) among children between 2 and 5 years of age in the United States.[ 1 ] Preschool children with untreated speech and language delay may be at a higher risk of learning disabilities. This may be exhibited in the form of diminished reading skills in grade school, poor verbal and spelling skills, behaviour problems and impaired psychosocial adjustment.[ 1 ] Consequently, this may constitute an overall academic underachievement[ 2 ] and may eventually lead to an impact on employment and even mental health.[ 3 ] As such, early identification of delays through developmental surveillance and screening, followed by prompt evaluation and intervention, is critical.

HOW RELEVANT IS THIS TO MY PRACTICE?

A local study on the profiles and outcomes of children who were referred to KK Women’s and Children’s Hospital Department of Child Development between 2003 and 2004 noted that the most common presenting concern was speech and language delay, and more than half the cohort was recommended for speech and language therapy after review by the paediatrician. Most of the children were around 2–4 years of age, consistent with the time at which speech and language delays may begin to appear more evident due to their impact on communication and social interaction.[ 4 ] In Singapore, structured childhood developmental screening is conducted at regular intervals in the primary care setting for all children aged 4 weeks to around 4–6 years. As part of preventive care, the primary care physician is also encouraged to use every encounter as an opportunity for developmental surveillance. Moreover, many children of this age group may not be enrolled in any formal education system, placing the primary care physician in a central role in identifying delays. Therefore, it is essential for them to have the knowledge and skills to assess speech and language appropriately and to provide appropriate counselling to caregivers on any issues identified.

WHAT ARE THE NORMAL DEVELOPMENTAL MILESTONES?

Development of speech and language arises from a complex interplay between genetic factors and environmental stimulation. In the first year of life, infants develop significant foundations that underpin speech and language development, and much of the language that they acquire is through listening and interacting with people around them. Within the first 3 years of life, children understand a lot more than they can express. Normal speech progresses through stages of cooing, babbling, words and forming different combinations of words. In language development, children go through stages of understanding and expressing more complex concepts. Table 1 describes the normal developmental milestones for speech and language in children.[ 5 ]

Receptive and expressive language milestones.[ 5 ]

Milestone type	Skill	Mean age (mth)	Normal range (mth)
Receptive	Alerts to sound	Newborn	N/A

	Orients to sound/turns to voice	4	3–6

	Responds to name	4	4–9

	Understands ‘no’	10	9–18

	Follows one-step command with gesture	12	10–16

	Follows one-step command without gesture	15	12–20

	Points to several body parts	18	12–24

	Follows two-step command with gesture	24	22–30

	Understands basic spatial terms (e.g. in, on, under)	28	27–30

	Follows three-step, unrelated directions	34	33–36

Expressive	Cooing (vowel sounds)	3	1–4

	Laughs	4	3–6

	Babbling (consonants added to vowel sounds)	6	5–9

	Dada/mama non-specifically	8	6–10

	Dada/mama specifically	10	9–14

	3–5-word vocabulary	12	–

	Immature jargoning (i.e. gibberish with inflection)	13	10–18

	Mature jargoning (i.e. gibberish with the occasional word)	18	16–24

	10–25-word vocabulary	18	–

	≥50-word vocabulary (50–300 words)	24 (minimum)	–

	Two-word phrases	24	20–30

	Uses pronouns indiscriminately	24	22–30

	States first name	34	30–40

	Uses pronouns appropriately (i.e. I, you, we, me, they)	36	30–42

	>200-word vocabulary (200–1000 words)	3 years	–

	75% of speech intelligible to strangers	3 years	–

	Three-word sentences	3 years	–

WHAT CAUSES SPEECH AND LANGUAGE DELAY?

There is a range of acquisition of normal language milestones, and a delay may be detected if the development falls outside of what is expected. A delay can be significant, especially if it persists into school age, limits communication and learning and/or impairs social development. Speech and language delay may be idiopathic or may occur as a facet of an underlying medical condition or a social–environmental problem. Examples of these causes are listed in Box 1 .[ 5 ]

Causes of delayed speech and language development and red flags.[ 5 ]

Causes of delayed speech and language development

1. Hearing impairment

2. Perinatal risk factors resulting in hearing impairment

3. Disorders of central nervous system processing:

(a) Global developmental delay

(b) Intellectual disability

4. Developmental language disorders

5. Disorders of speech production:

(a) Articulation disorder

(b) Dysarthria

6. Presence of anatomic abnormalities (e.g. cleft lip, cleft palate)

7. Environmental deprivation

1. Inconsistent or lack of response to auditory stimuli at any age

2. Regression in language or social skills at any age

3. No babbling by age 9 months

4. No pointing or gesturing by age 12 months

5. No intelligible single words by age 16 months

6. No joint attention (i.e. following the eye gaze of others) by age 15 months

7. No two-word spontaneous phrases by age 24 months

8. Inability to respond to simple directions or commands (e.g. ‘sit down’, ‘come here’) by age 24 months

9. Speech predominantly unintelligible at age 36 months

10. Hypernasality at any age

11. Inappropriate vocal quality, pitch or intensity at any age

Decreased hearing acuity, whether bilateral or unilateral, can significantly impact speech and language development in early childhood. The earlier hearing loss occurs in a child’s life, the bigger the impact on the child’s development. When the problem is identified as early as possible, this negative impact can be reduced. Hence, the Joint Committee on Infant Hearing endorses early detection of hearing loss and intervention for infants with hearing loss and recommends that infants confirmed to have hearing loss should receive appropriate interventions by 6 months of age.[ 6 ] It is crucial to note that hearing loss may be progressive, and hence, may not be identified upon newborn screening. In addition, hearing loss may be acquired due to causes such as persistent otitis media with effusion, bacterial meningitis, exposure to ototoxic medications or severe hyperbilirubinaemia. As such, primary care physicians must be vigilant to identify parental concerns; children suspected to have hearing impairment and/or significant speech and language delay should be referred for a formal hearing assessment.

It is also pertinent to look out for features of autism spectrum disorder (ASD) in children who present with speech and language delay. Although most significant delays will be noted in language and social–emotional domains, delays may also be present in other domains of development. Caregivers may raise associated behavioural concerns that involve problems with social–emotional reciprocity, non-verbal communication and difficulty developing, maintaining and understanding relationships.[ 7 ] For example, children with ASD often have difficulty maintaining eye contact and using gestures to express their intentions. They may appear socially insensitive and are often focused on their own topics of interest, rather than the interests of others. Other features include repetitive and stereotypic motor movements, need for sameness and routines, fixed interests of abnormal intensity or focus, as well as increased or decreased reactivity to sensory input.[ 7 ] For example, they may often have an obsession for sameness in household routines and be resistant to change. Children with ASD may also develop strong interests in certain topics such as letters and numbers. Though some may be able to read as early as 2 years of age, they have difficulties in communicating with others and understanding what they read. These features, where present, should prompt primary care physicians to refer the child to a developmental paediatrician.

Environmental deprivation may also be a contributing factor to speech and language delay. This includes less-than-desirable circumstances such as poverty, parents with limited knowledge of child development, victims of child neglect or abuse, and lack of warm and nurturing parent–child interactions.

WHEN SHOULD I REFER TO A SPECIALIST?

The prognosis for children with speech and language delays depends on the nature and severity of the underlying cause, and the supports and interventions they received. Children identified to have speech and language delays in the context of global developmental delay, cognitive delay or ASD should be referred promptly to the appropriate medical or allied health professionals for evaluation and early intervention services.

‘Red flags’ are noted at ages where 90% of typically developing children have achieved a developmental milestone. A useful resource would be the developmental checklist in the health booklet, which is based on the Denver Developmental Screening Test-Singapore (DDST-Singapore).[ 8 ] This is currently the only tool that is standardised for the local population. The cut-offs on DDST-Singapore indicate 90 th percentile norms of the population at the stated age (an item would be scored as ‘Delay’ when a child older than the 90 th percentile passing age failed the item). Importantly, red flags [ Box 1 ] may point towards an underlying cause of the child’s speech and language delay.[ 5 ] Knowing these can guide the primary care physician to initiate prompt and appropriate referrals to medical or allied health professionals in the tertiary institutions.

WHAT CAN I DO IN MY PRACTICE?

Early identification and appropriate management of developmental delays are essential and can positively alter the child’s developmental trajectory.[ 9 ] Parental concerns about developmental delays (be it perceived or true delays) should be addressed and promptly acted upon. Among all the developmental domains, speech and/or language concerns make up the most common presenting concern of parents, both locally and globally. This may be a result of concerns raised by childcare or preschool teachers and may arise from parents’ own observation of their children and comparison with other children, including the child’s siblings. Although it is pertinent for primary care physicians to be able to identify delays and make appropriate referrals where warranted, it is equally important for them to provide reassurance and allay parental anxiety in the absence of red flags.

Educating parents to make use of the health booklet’s developmental checklist is key as a first step towards early identification.[ 10 ] Apart from early identification, parents may also be taught to use the checklist as a guide to work towards the next milestone. Through developmental surveillance, parents must be encouraged to raise any concerns during each well-child visit.

As highlighted earlier, red flags identified through developmental surveillance and developmental screening should prompt an early specialist review. Some children may have a mild speech and/or language delay (but still remain within the 90 th percentile based on DDST-Singapore). In such cases, in the absence of red flags and with a normal clinical examination, parents can be counselled on the acceptable norm and appropriate stimulation activities [ Box 2 ].[ 11 , 12 ] Together, the primary care physician and parents can work on an action plan [ Box 3 ] and decide on goals which can be reviewed at the next follow-up visit. Figure 1 illustrates a framework for this process.[ 13 ]

General strategies for speech and language development.[ 11 , 12 ]

1. When your child starts an interaction through talking, gesture or behaviour, respond to it. Assume your child is talking back to you even if he/she makes sounds, babbles or simply paying attention to you.

2. Pause and give your child the opportunity to initiate or take his/her turn in the interaction.

3. Repeat what your child has said and expand on them. For example, if your child says ‘car’, you can say ‘blue car’ or ‘Daddy is in the car’.

4. Use opportunities in the daily routines. For example, teach body parts during bath time, teach colours/quantity of food during meals.

5. Talk about things as they happen (e.g. when you change your child, watch television, go to a shop) or whatever your child is interested in.

6. Expose your child to lots of different words in lots of different contexts (e.g. this is your cup, this is mummy’s cup, mummy’s cup is big, your cup is small).

7. Give choices (e.g. ‘Do you want to wear shoes or sandals?’).

8. Read and share books with your child from birth. Talk about the pictures and point to the words as you read them. Make it a daily routine if you can.

9. Sing songs and nursery rhymes, paired with actions as much as possible.

Parental counselling: a proposed action plan.

(a) Inform parents about normal speech and language development.

(b) Emphasise the potential red flags to look out for.

(c) Share on communication skills, which form the foundation for learning, play, social interaction and building relationships with others.

(a) Equip parents with general strategies to promote speech and language development and communication.

(b) Identify specific issue for the child, that is, receptive/expressive language or speech, and tailor advice towards it.

(a) Work on the milestone that the child had not been able to achieve.

(b) Work towards the next milestone based on the Denver developmental screening test.

(a) Arrange for follow-up visit in 3 months to review progress.

(b) Counsel parents that the child may need a specialist referral if there are red flags or if concerns of speech and language delay persist despite exposure.

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A framework for management of speech and language delay in the primary care setting.[ 13 ]

Concerns with speech and language delay inevitably lead to parental anxiety, and these must be adequately addressed. In cases where a referral is indicated, parents can still be counselled on appropriate stimulation activities. In such situations, the primary care physician should also counsel the parents on the potential evaluation and intervention that may take place in the tertiary setting. For example, this would usually include a hearing assessment and review by a general paediatrician and a speech and language therapist. In certain cases, a direct referral to a developmental paediatrician may be necessary.

In Singapore, many families speak more than one language at home. Evidence indicates that bilingualism does not result in language delays, but is associated with increased cognitive control such as improved executive function skills and mental flexibility.[ 14 ] The home language should be preserved wherever possible; an option would be the one person–one language model, where each parent is encouraged to use his or her own language with their child. This enables parents to connect with their children in their own native language and allows the child to hear and speak both languages too. When there are significant concerns of speech and language delay in a bilingual child, a specialist referral should be made. Each family is unique. Hence, a case-by-case approach is frequently taken, with consideration given to the family setup as well as the caregivers’ degree of confidence and proficiency in the spoken languages.

Last but not least, primary care physicians should actively reinforce recommendations on the use of digital media in early childhood. Studies show associations between excessive screen time in early childhood and cognitive, language and social–emotional delays that are likely secondary to reduced opportunities for parent–child interaction. As per the latest American Academy of Pediatrics guidelines,[ 15 ] children below 18 months of age should avoid use of screen media other than video chatting. For those between aged 18 months and 2 years, any media should be of high quality, and parents should watch these programmes with their children to help them understand the content. For children aged 2–5 years, screen usage should be limited to an hour of high-quality programmes per day, with adult supervision. In the primary care setting, it is also crucial to promote healthy habits within families with regard to the use of digital media.[ 15 ] Some examples include the following:

Avoid the use of digital media for both parents and children during mealtimes, before bedtime and during parent–child playtime.
Avoid the use of digital media as the only means of calming children down.
Switch off televisions and other devices when not in use.

Most importantly, digital media must not replace parent–child interaction. Caregivers should take every opportunity to interact, connect and communicate with their children.

TAKE HOME MESSAGES

Speech is the verbal production of language, whereas language encompasses the understanding, processing and production of communication.
Speech and language delay may be idiopathic or may occur as a facet of an underlying medical condition or a social–environmental problem.
Primary care physicians play a crucial role in early identification of speech and language delay, and specialist referrals should be initiated when red flags are present.
In instances where speech and language delay is mild with no red flags, the primary care physician should provide reassurance, discuss an action plan and monitor the child’s progress.
Parental counselling on the anticipated evaluation and intervention should be provided when specialist referrals are warranted.
Primary care physicians should actively counsel caregivers on the use of stimulation activities and strategies to promote speech and language development for their children.

Closing Vignette

You performed a full developmental assessment for Aaron. Aside from mild expressive language delay, you assessed that the rest of his developmental domains were age appropriate. Aaron had been meeting all his developmental milestones during the previous touchpoints of developmental screening. No red flags were identified thus far. You reassured his parents and allayed their anxiety. You educated them on normal speech and language development and the red flags they should look out for. Together with them, you worked on an action plan and provided them with strategies to improve Aaron’s language and communication skills. You arranged a follow-up visit in 3 months to review his speech and language development .

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Acknowledgement

We wish to acknowledge Dr Sylvia Choo Henn Tean (Senior Consultant, Department of Child Development, KK Women’s and Children’s Hospital, Singapore) and Ms Goh Siew Li (Head, Speech Language Therapy Service, KK Women’s and Children’s Hospital, Singapore) for their invaluable input and feedback in the writing of this article.

SMC CATEGORY 3B CME PROGRAMME

Online Quiz: https://www.sma.org.sg/cme-programme

Deadline for submission: 6 pm, 05 January 2024

Question	True	False
1. Speech and language concerns are the most common presenting developmental concerns from parents.

2. The use of signs and gesturing for communication is a form of expressive language.

3. Preschool children with untreated speech and language delay may be at higher risk of behavioural problems.

4. Speech and language development arises only from environmental stimulation.

5. Within the first 3 years of life, children express a lot more than they can understand.

6. Speech and language delay may occur as part of an underlying medical condition or social–environmental problem.

7. Unilateral hearing impairment can significantly affect speech development.

8. Infants with hearing loss should receive early intervention by 2 years of age.

9. A normal newborn hearing screen indicates that speech and language delay is not secondary to hearing impairment.

10. Autism spectrum disorder presents with delays in language and social domains only.

11. A social history should be taken for children with speech and language delays as environmental deprivation can be a contributing factor.

12. Children identified to have global developmental delay should be immediately referred for specialist review.

13. Children unable to achieve a milestone that 90% of the population at the stated age can achieve should be followed up again in 3 months for review and referred for specialist evaluation if the delay persists.

14. In cases where children are referred to a specialist for further evaluation of speech and language delay, parents should be advised to await specialist review before attempting stimulation activities at home.

15. Following commands is a form of receptive language development.

16. The average age range for children to respond to their name is 9–12 months.

17. The development of appropriate use of pronouns occurs at a mean age of 3 years.

18. The average age range for children to say their first name is 30–40 months.

19. Inconsistent or lack of response to auditory stimuli is a red flag at age 6 months and above.

20. No babbling by age 6 months is a red flag in speech and language development.

Speech Delay in Toddlers: When is Delayed Speech a Concern?

Katharine Chan, MSc, BSc, PMP

Parents often wonder what their little one’s first words will be and when they will start talking and sharing with them what they’re thinking and feeling.

Sometimes, it takes a little while for children to begin speaking. If you have a toddler between the ages of 2 to 4, you may be concerned if they haven’t begun talking yet or if they very rarely speak.

How do you know when it is considered a speech delay or normal development?

This article will provide you with the most current research and information to answer what a speech delay in toddlers is, provide some common reasons why it may occur, explain what the typical language and speech development milestones are for kids, and when delayed speech is an issue to address.

Related: The Complete Guide to Childhood Apraxia of Speech

What is a Speech Delay?

In terms of the ability to speak, there are two areas of focus: speech and language. Speech refers to how we form words and sounds and is the ability to verbally express language and articulate ourselves.

Language refers to how we communicate information between ourselves and others, ensuring we are being understood and that we understand what is being communicated. Language includes verbal, nonverbal and written communication.

A speech delay is when a child has an issue using words and phrases to verbally express themselves and their speech isn’t developing at an expected rate. They may be hard to understand.

It is estimated that 3 to 10 percent of children have a speech delay and it is more common in boys than girls.

At what age is speech considered delayed?

It can be difficult to know whether your toddler is taking longer than expected to reach their developmental milestones for speech.

According to the American Academy of Family Physicians , the normal pattern of speech development for age and achievements is the following:

1 to 6 months: Coos in response to voice
6 to 9 months: Babbling
10 to 11 months: Imitation of speech sounds; says “mama/dada” without meaning
12 months: Says “mama/dada” with meaning; often imitates two- and three-syllable words
13 to 15 months: Vocabulary of four to seven words in addition to jargon; < 20% of speech understood by strangers
16 to 18 months: Vocabulary of 10 words; some echolalia and extensive jargon; 20% to 25% of speech understood by strangers
19 to 21 months: Vocabulary of 20 words; 50% of speech understood by strangers
22 to 24 months: Vocabulary > 50 words; two-word phrases; dropping out of jargon; 60% to 70% of speech understood by strangers
2 to 2 and a half years of age: Vocabulary of 400 words, including names; two- to three-word phrases; use of pronouns; diminishing echolalia; 75% of speech understood by strangers
2 and a half to 3 years of age: Use of plurals and past tense; knows age and sex; counts three objects correctly; three to five words per sentence; 80% to 90% of speech understood by strangers
3 to 4 years of age: Three to six words per sentence; asks questions, converses, relates experiences, tells stories; almost all speech understood by strangers
4 to 5 years of age: Six to eight words per sentence; names four colors; counts 10 pennies correctly

What causes speech delay in toddlers?

It’s understandable for parents who have a toddler who has not begun to talk yet to worry about their child. Children do not all speak at the same time, but there are definite periods during which certain sounds and combinations of sounds should be produced.

The most common causes of speech delay in toddlers include the following:

Hearing Problems

When your child was an infant, they should have had their hearing tested to determine if they are developing normally and healthily. Hearing loss can have an impact on learning to speak.

Therefore, it’s important to have your child’s hearing checked regularly. A child who has difficulty hearing may have trouble talking, understanding, imitating and using language. Ear infections , especially persistent ones, can also affect hearing.

Oral Impairments

Your pediatrician should also assess whether the parts of your child’s mouth and throat that are necessary for speech are physically intact and functional. They can assess whether your child has an oral impairment such as issues with the roof of the mouth.

The child may also have difficulty moving their tongue if they have a short frenulum (the fold beneath the tongue). Checks like these ensure your child is physically capable of making sounds. For instance, as infants, they should respond to noise, make baby sounds, babble and vocalize concerns.

Some other causes that can cause speech delays in toddlers include the following:

Development disorders: Neurological and developmental disorders such as autism spectrum disorder , Down Syndrome or cerebral palsy can cause speech delay.
Maturation delay: This is also known as developmental language delay and refers to the parts of the brain that is required to produce speech maturing at a later time.
Bilingualism: A child who is raised in a bilingual home may have a temporary delay in using two languages. Their language skills are developing normally; however, they aren’t able to communicate in both languages proficiently until the age of 5.
Psychosocial deprivation: Children who grow up with psychosocial deprivation are more likely to have problems with speech development. Some examples include poverty, poor housing, malnutrition, abuse, emotional stress, neglect, and a lack of exposure to a variety of sounds and conversations.
Elective Mutism: This is when a child has the ability to speak but chooses not to. They may speak with their friends and sometimes with their parents or when they are alone; however, they do not talk at school, in public places or with people they do not know well.
Developmental Apraxia : This is a condition in which the child is unable to move the muscles involved in speech.

Lastly, there are some other, less serious explanations for speech delays in early childhood. Some children in big families don’t talk a lot because they don’t really have to.

Older brothers and sisters (or even the kids in a daycare center) may be hovering over them, doing all the talking for them. Sometimes adults give things to children too quickly and don’t give them a chance to ask for things.

When should I worry about toddler speech delay?

Some common signs and symptoms of a speech delay in young children may include the following:

12 months: Does not use gestures such as waving bye-bye or pointing
18 months: Gestures significantly more than vocalizing; has difficulty imitating sounds and understanding simple verbal requests
2 years: Cannot follow simple instructions; can only vocalize some words or says words repeatedly; can only imitate actions or speech; doesn’t say words or phrases spontaneously, without prompting; unable to use oral language to express more than their immediate needs; has an unusual tone of voice such as nasally or raspy sounding; caregivers understand less than 50% of what their child is saying.
3 years: Parents and caregivers understand less than 75% of what their child is saying
4 years: Those who interact with the child cannot understand mostly what they are saying.

When should you bring kids to speech therapy?

Speech therapist and little patient training articulation

It’s important for parents to speak with their pediatrician if they have any concerns about their child’s development . Early intervention for speech and language problems is critical and can be very effective.

If your child shows any of the signs or symptoms, you can take them to see a speech and language clinic at a children’s hospital. A speech therapist will have the latest equipment and more experience with lots of children with speech and language delays. The speech-language pathologists and neurologists there can also help you determine whether any other conditions might be causing language developmental delays.

How to help toddlers talk more and improve speech development

Parents want the best for their children. Although it can be frustrating to watch your child’s speech delay, it’s important to remain positive, supportive and patient.

Try not to compare your child’s speech development to another child’s, even a sibling’s. Everyone develops at their own pace. The constant comparisons may make your child feel inadequate and negatively affect their self-esteem. In addition, your child may have an underlying condition that requires medical treatment.

Do not force your child to speak, criticize or get angry with them if they aren’t responding to you. Do not threaten them by removing privileges or verbally abusing them. These actions are harmful and detrimental to a child’s development.

There are several ways to encourage your child to talk.

Read to your child

Take time every day to sit together and read . While you’re reading, be sure to point at pictures and verbalize what is going on so they can connect what they see with what they hear.

Lead by example

Talk to your child frequently and demonstrate good communication skills. Use simple words and phrases. Give eye contact. Use body language and facial expressions to communicate.

Narrate your actions and describe what is going on at the moment. For instance, if you’re putting on your jacket, say, “I’m about to go outside. I’m putting on this green rain jacket because it is cold.”

Be patient and compassionate

Encourage your child’s language development skills by asking them to imitate you or taking turns asking and answering questions. Give them time and space to respond. Don’t jump in immediately or interrupt them by saying the words or phrases for them. Be sure to praise their efforts.

Ask an Expert: Why is My Child’s Speech Delayed?

To understand more about how to address language delays in young children, one parent wrote to expert, Jerome Schultz, the founding clinical director of the Learning Lab @ Lesley University, a program that provides assessment, tutoring, and case management services for children with learning challenges.

Q: Hi, my name is Sandra. I have two children with speech delays. My son is three and only says a few words. My daughter is two and she does not say a single word. Both of them had their ears checked; no problem with them. My son has seen a speech therapist for over one year now. She helps him, but I am still feeling very hopeless because his progress is been very slow and I don't know what else I can do to help them. As far as I know, they don't have any other problems. Their doctor says they are very normal children with only a speech delay. I want to know why a problem like this happens with children like mine. Can this be genetic? A: Significant language delays, and certainly the absence of speech are reasons to be concerned. You have done the right thing by having the children's ears checked since hearing problems can definitely have an impact on learning to speak. Have any other children in your extended family, in this or other generations, exhibited speech problems or language delays? If so, share this information with your pediatrician, so he or she can rule out any genetic causes. It's also good that your son is being seen by a speech therapist. What does she think the cause of the problem is? Does she tell you that he is making acceptable progress, or does she feel that he should be improving at a more rapid rate? You can ask your pediatrician to refer you to an early intervention program that will help determine whether there are any identifiable reasons for the language delays. Children do not all speak at the same time, but there are definite periods during which certain sounds and combinations of sounds should be produced. Your daughter should be seen by a specialist in speech and language pathology.

Hartnett, J. K. (2017). Delayed Speech or Language Development (for Parents) — KidsHealth . Kidshealth.org . https://kidshealth.org/en/parents/not-talk.html

Leung, A. K. C., & Kao, C. P. (1999). Evaluation and Management of the Child with Speech Delay. American Family Physician , 59 (11), 3121–3128. https://www.aafp.org/pubs/afp/issues/1999/0601/p3121.html#:~:text=A%20delay%20in%20speech%20development

Mayo Clinic. (2017). Childhood apraxia of speech — Symptoms and causes . Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/childhood-apraxia-of-speech/symptoms-causes/syc-20352045

Speech and Language Problems in Children . (2019). Medlineplus.gov ; National Library of Medicine. https://medlineplus.gov/speechandlanguageproblemsinchildren.html

What if Your 2-Year-Old is Not Talking But Understands You? (n.d.). Connected Speech Pathology. Retrieved February 28, 2023, from https://connectedspeechpathology.com/blog/what-if-your-2-year-old-is-not-talking-but-understands-you

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Speech Delay: Causes, Symptoms, and Treatments

Speech delay occurs when a child does not meet speech and language milestones at the appropriate ages. This comprehensive guide is designed to shed light on what speech delay is, its various forms including specific language impairment, and the different types of speech delays that can affect young individuals. This article serves as an essential resource for anyone seeking to understand or address the complexities of speech delay in children.

What is Speech Delay?

What is Specific Language Impairment?

Types of Speech Delays

Speech delay symptoms, signs of speech delay in different age groups, speech delay diagnosis, cause of speech delay, speech delay treatment options, free speech delay resources: exceptional needs today.

A speech delay occurs when a child cannot use language appropriate for their specific age group.

Mild Speech Delay

A mild speech delay can occur in a typically developing child as children progress at different rates. Many factors can cause a mild delay. Sometimes, children raised in bilingual homes might progress more slowly with speech. Boys also commonly start speaking a little later than girls. Slight speech delays are not generally something to be concerned about. However, if your child is still not speaking by 24 months, talking to your pediatrician about an early intervention evaluation is a good idea.

Severe Speech Delay

A child with a severe speech delay may have trouble imitating sounds by 18 months and may appear not to understand or hear simple requests. By age two, a child should be saying phrases spontaneously and not just repeating, and they should be able to follow simple directions. Some of these missed milestones could indicate a severe speech delay.

What is a Specific Language Impairment?

A specific language impairment is a disorder that impedes a child’s language development in children with no hearing difficulties or neurological or intellectual disabilities . Specific language impairment is also referred to as developmental language disorder.

There are three main types of speech delays. They include:

Developmental Speech and Language Delay

Expressive language disorder, receptive language disorder.

Developmental speech and language delay is also referred to as developmental dysphasia and is found in around 1 in 14 children. Developmental speech and language delays affect how a child learns and processes language. A developmental speech and language delay diagnosis occurs when there are no other apparent reasons for language delays.

Expressive language disorder is when a child struggles to express themselves understandably to those around them. A child with an expressive language disorder may have a smaller vocabulary than peers, and they might speak without verbs or use the vocabulary they do have inaccurately.

Receptive language disorder is when a child does not process language coming in as easily as others their age. A person with receptive language disorder might hear you but process what you have said incorrectly, or your words might blend into other noises, making it challenging to understand you. A child with receptive language disorder might appear to hear you sometimes. This is unintentional.

Slow Speech

Late speech development, delayed talking.

Slow speech may occur if your child has weak muscles in the mouth. Weaker muscles can cause slower or more slurred speech. A speech therapist is a great resource to address any concerns.

Children with speech developmental delays might have a more challenging time understanding words and using their words to meet their needs. Children might not be responding when you call their names. They may seem to hear you occasionally and appear not to listen to you or others. If your child is still using gestures to meet their needs instead of their language by 18 months, they may be dealing with a speech delay. Children can also usually imitate words by 18 months and follow simple requests by age 2. If your child struggles in these areas, you may wish to bring it up to your pediatrician and ask for an early intervention evaluation.

Many children can have a later speech development than their peers, and there is little cause for concern. Later developing speech could be due to self-consciousness, growing up in a bilingual home may cause children to begin communicating later. Often, boys will build language later than girls. However, if you have any cause for concern, it is always best to speak to your pediatrician and have your child evaluated for early intervention . Early intervention gives your child a greater chance of success.

Delayed talking is a very common occurrence. Many children develop language later than their peers. As many as 13% of children at 24 months of age will have less than a 50-word vocabulary. If you have a late talker, it is best to talk to your pediatrician about early intervention. It is also important to note that it is not necessary to have a referral for early intervention. You may contact your state’s early intervention program to begin an evaluation.

There are different signs of speech delay in other age groups; seeing a speech delay at one stage does not mean you will see the same delays at each stage.

Speech Delays in Infants

Some signs of speech delay in infants might be not responding to sounds; a toddler by the age of 15 months should be using “baby jargon” or babbling to interact with those around them. A child should be able to say at least 50 words by age two.

Speech Delays in Preschoolers

A child should begin to use two-word phrases by age three, and by age four, they should start to form sentences. If there is any cause for concern, contact your pediatrician or an early intervention program. Your child may qualify for early intervention preschool by the age of three.

Your pediatrician can diagnose a speech delay, although they may refer you to a developmental pediatrician if you feel there is any serious cause for concern. A developmental pediatrician specializes in treating developmental disorders in childhood.

What are the different causes of speech delay? Some children may have issues with the structure of their mouth, such as a short frenulum (the stretchy piece under your tongue.) A speech delay can also be due to hearing impairment; still, some delays may just be due to your child progressing at their own rate. Some other causes of speech and language delay might be developmental disorders such as autism .

Autism and Speech Delay

Speech delays can sometimes indicate an autism diagnosis. Many autistic children struggle with language. Some will have minimal language skills early on and develop language much later than their peers. Other children on the spectrum will have a more extensive vocabulary but may not be able to use it in a functional way. Many children with autism benefit greatly from speech therapy at an early age.

Speech delays can be best served with speech therapy to address receptive and expressive language deficits. An occupational therapist might be brought in to assist with any sensory issues causing language deficits.

Speech Therapy for Speech Delay

Speech therapy is generally the best and first treatment option for a child with a speech delay. A speech pathologist can work with your child to strengthen muscles, engage in more functional language, and address auditory processing weaknesses.

Speech and Occupational Therapy

Often, speech therapy is introduced alongside occupational therapy . An occupational therapist can introduce your child to a “sensory diet, " a series of exercises and activities that address the need for either more or less sensory input. Sometimes, eliminating sensory issues can help make way for language development. Getting your child into an early intervention program will help get the appropriate people in place to help your child succeed.

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Exceptional Needs Today magazine is an award-winning different abilities publication that supports working together to promote awareness, acceptance, and inclusiveness for ALL. Visit our other articles for useful information about

Down Syndrome

Intellectual Disability

Speech Delay

Developmental Delay

Early Intervention

Individualized Education Program (IEP)

Speech Delay: Symptoms, Causes, and Treatments

Katie Foley is an advocate for The Arc of Northeastern Pennsylvania (TheArcNEPA.org), where she runs Sibshop, creates and presents content and trainings focused on assisting others in advocating for themselves or their loved ones and assists in individual advocacy in Luzerne County, Pennsylvania. Her education is in communications with a focus on theater, and she has a secondary degree in elementary education.

She also enjoys teaching an Acting class for Adults of all abilities that focuses on socialization and emotional understanding through Acting techniques. She has written You May Never Be French, a children's book that looks at autism through a cultural lens.

Katie has also written and contributed to other children's books and has been a contributing author for Autism Parenting Magazine and a guest blogger for other nonprofits. She is on the Family Advisory Board for Community Cares Behavioral Health in Pennsylvania and a founding board member of The Art's Alliance in Carbondale, Pennsylvania. Katie also enjoys volunteering for Equestrian Special Olympics; however, she is most grateful for her role as a parent of exceptional children who teach her new things about herself and life daily.

Dynamics of speech development for young children with delayed speech development in the conditions of parent involvement in speech therapy

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Sudden fame for Tim Walz's son focuses attention on challenges of people with learning disabilities

“that’s my dad” 17-year-old gus walz could be seen exclaiming wednesday night, and the high school senior's joy quickly went viral, by steve karnowski | associated press • published 4 hours ago • updated 4 hours ago.

An unexpected highlight of the Democratic National Convention on Night Three was an outburst of pride from the son of vice presidential candidate Tim Walz.

“That’s my dad!” 17-year-old Gus Walz could be seen exclaiming Wednesday night. He stood, tears streaming down his face, and pointed to his father, the governor of Minnesota, who accepted the party nomination for vice president .

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Gus wept through much of the 16-minute speech, and took the stage with his family afterward, wrapping his dad in a tight bear hug, burying his face in his shoulder.

The high school senior's joy quickly went viral. He was still trending Thursday on X, the social media platform formerly known as Twitter. And his newfound fame is focusing attention on the challenges of people with learning disabilities. His parents recently revealed to People magazine that Gus has ADHD, an anxiety disorder and something called a non-verbal learning disorder. Searches on Google have spiked since Wednesday night this week for the disorder and for the teen’s name.

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There’s no standard definition for non-verbal learning disorder. It doesn’t mean people with it can’t talk. But according to the NVLD Project at Columbia University, people with it “struggle with a range of conditions that include social and spatial disabilities. Often they are marginalized and isolated; consequently, they can experience social barriers throughout their lives.”

There has long been tension between Washington and local school districts over federal funding of special education. Federal law requires schools to provide special education services, but doesn't come close to covering the costs. When passed in 1975, the Individuals with Disabilities Education Act (IDEA) committed the federal government to paying 40% of the average per-pupil expenditure for special education. But currently it's more like 13%.

That's one reason the Democratic Party platform adopted at the convention this week says, "We support fully funding IDEA to prioritize students with disabilities and the special educator workforce.” This year's Republican Party platform doesn't mention special education. But dozens of national education groups have long called for fully funding the costs that IDEA imposes on local schools.

The actual prospects for more money under a Harris-Walz administration are unclear. Much would depend on the future federal budget picture and the composition of the next Congress. And platforms aren’t binding on candidates.

But Walz as governor has approved large increases in education funding, including special education. The two-year budget he signed in 2024 included a 6% increase in per-pupil funding for local schools, and it indexes future funding to inflation. It also included a large boost in state support for special education to help fill the gap in federal funding.

Securing full funding for special education on the national level is the “number one public policy priority” of the National Association of State Directors of Special Education, said John Eisenberg, the group's executive director. The association calls the federal act “first and foremost a civil rights law, meant to protect the right of students with disabilities to be educated in the nation’s public schools.”

‘That's my dad': Tim Walz's son overcome with emotion watching father's acceptance speech at DNC

‘Stand up and fight': Read Tim Walz's full speech to the Democratic National Convention

While bills to mandate full funding have attracted bipartisan support over the years, they've failed to become law.

Gov. Walz, a former social studies teacher, and first lady Gwen Walz, a former English teacher, revealed Gus' learning issues in a statement to People magazine that was published this week.

“When our youngest Gus was growing up, it became increasingly clear that he was different from his classmates,” they said. “Gus preferred video games and spending more time by himself.” They went on to say, "When he was becoming a teenager, we learned that Gus has a non-verbal learning disorder in addition to an anxiety disorder and ADHD, conditions that millions of Americans also have.”

The Walzes told People that it took time to figure out how to set Gus up for future success, "but what became so immediately clear to us was that Gus’ condition is not a setback — it’s his secret power.”

They also said he's “brilliant, hyper-aware of details that many of us pass by, and above all else, he’s an excellent son.” They didn't go into detail about how his condition has affected his life, however, and the Walz campaign did not immediately respond to a request for comment Thursday. They have previously noted that Gus got his driver's license last fall.

Associated Press reporter Heather Hollingsworth contributed to this story from Mission, Kansas.

This article tagged under:

IMAGES

Speech Delay in Children
Delayed Speech and Language Development
Speech Delay in Children
17 Tips To Help A Toddler With A Speech Delay
Understanding Speech and Language Delay in Children
What to Do During Delayed Speech or Language Development?

COMMENTS

Language Delay: Types, Symptoms, and Causes
According to the University of Michigan Health System, delayed speech or language development affects 5 to 10 percent of preschool-aged children. Types. A language delay can be receptive ...
Delayed Speech or Language in Toddlers
A speech delay may mean that their timetable is a little different, and they'll catch up. But speech or language delays can also tell something about overall physical and intellectual development.
Language Delays in Toddlers: Information for Parents
Delays in language are the most common types of developmental delay. One out of 5 children will learn to talk or use words later than other children their age. Some children will also show behavioral problems because they are frustrated when they can't express what they need or want. Simple speech delays are sometimes temporary.
Speech and Language Delay in Children
In the primary care setting, speech and language delay may be identified through milestone surveillance and the use of formal screening tools to assess milestone progression. Screening is the use ...
Delayed Speech or Language Development
A speech delay might be due to: an oral impairment, like problems with the tongue or palate (the roof of the mouth) a short frenulum (the fold beneath the tongue), which can limit tongue movement. 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.
Speech Delay in Toddler: Speech Milestones To Know
Sometimes, though, speaking later than expected or speech that is unclear can signal a developmental delay or a physical problem. The first step is to determine whether your child's speech is ...
Delayed Speech or Language Development
A speech delay might be due to: an oral impairment, like problems with the tongue or palate (the roof of the mouth) a short frenulum (the fold beneath the tongue), which can limit tongue movement. 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.
Delayed Speech or Language Development
A speech delay might be due to: an oral impairment, like problems with the tongue or palate (the roof of the mouth) a short frenulum (the fold beneath the tongue), which can limit tongue movement. 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.
Speech and Language Delay in Children
Every child develops at their own pace, but some children are behind in speech development compared with other children the same age because of speech and language delay. Your doctor may think ...
What Does a Speech Delay Mean for Your Child?
Most speech delays simply reflect the fact that children reach milestones at different ages. Most speech delays are not tied to autism and are no cause for concern. In fact, 95% of kids with a ...
How can I tell if my child has a speech or language delay?
Signs of developmental delays in speech and language for kids . Recognizing the signs of speech or language delays in children is important for early intervention and support. Here are some general signs that may indicate that your child has a speech and language delay: Lack of babbling (around 6-9 months). Limited vocabulary (by 18 months).
Speech and Language Delay
The most common causes of speech delay include: Hearing loss. Slow development. Intellectual disability. Other developmental or genetic disorders include: Psychosocial deprivation (the child doesn't spend enough time talking with adults) Being a twin. Autism (a developmental disorder) Elective mutism (the child just doesn't want to talk)
What's behind a spike in childhood speech development delays ...
Since the COVID-19 pandemic, there's been a dramatic increase in the number of young children who have been slow to develop language skills. Pediatric speech delays more than doubled for children ...
Speech and language delay in children: a practical framework for
A delay can be significant, especially if it persists into school age, limits communication and learning and/or impairs social development. Speech and language delay may be idiopathic or may occur as a facet of an underlying medical condition or a social-environmental problem. Examples of these causes are listed in Box 1.
Speech Delay in Toddlers: When is Delayed Speech a Concern?
Development disorders: Neurological and developmental disorders such as autism spectrum disorder, Down Syndrome or cerebral palsy can cause speech delay. Maturation delay: This is also known as developmental language delay and refers to the parts of the brain that is required to produce speech maturing at a later time.
Speech Delay: Symptoms, Causes, and Treatments
Developmental speech and language delay is also referred to as developmental dysphasia and is found in around 1 in 14 children. Developmental speech and language delays affect how a child learns and processes language. A developmental speech and language delay diagnosis occurs when there are no other apparent reasons for language delays.
Delayed speech development in children: Introduction to terminology
There is delay compensation with age, but mild deficiency often remains for life. Delayed speech development is more common in boys than in girls. Its etiology is unknown in most cases, so a child ...
Dynamics of speech development for young children with delayed speech
The need for speech development of young children with delayed speech development is indicated in theoretical and practical studies as prevention of the risk of general speech underdevelopment ...
Interaction of Mother and Toddler with Delayed Speech Development
In the group of mothers and children with delayed speech development the most common is the insecure attachment style; the mothers tend to have inadequate images of their children, reduced sensitivity in interaction, negative feelings, inability to affect the child's state of mind; disharmony of interpersonal and activity-mediated ...
Sudden fame for Tim Walz's son focuses attention on challenges of
Gus wept through much of the 16-minute speech, and took the stage with his family afterward, wrapping his dad in a tight bear hug, burying his face in his shoulder. The high school senior's joy ...
Full article: Australian SLPs' knowledge and actions regarding the
Speech-language pathologists (SLPs) are often among the first health professionals contacted by parents of children with communication and developmental delays. They are in an important position to help families make the connections between their children's communication difficulties and the supports and services that they need, particularly ...
Challenges and innovations in the field of communication skills development
Delayed speech development is a situation when a child does not achieve the expected development standards in the field of pronunciation of sounds, vocabulary, building grammatically correct sentences and understanding speech. This problem can have a variety of causes, including genetic factors, premature birth, hearing impairment, lack of ...