Parents often bring the concern of speech delay to the physician’s attention when they compare their young child with others of the same age (Table 10-9). The most common causes of the speech delay are MR, hearing impairment, social deprivation, autism, and oral-motor abnormalities. If a problem is suspected based on screening with tests such as Ages and Stages Questionnaires or the Parents’ Evaluation of Developmental Status test (see Chapter 8) or other standard screening test (Early Language Milestone Scale), a referral to a specialized hearing and speech center is indicated. While awaiting
Before 6 months, the child does not startle, blink, or change immediate activity in response to sudden, loud sounds. Before 6 months, the child does not attend to the human voice and is not soothed by his or her mother’s voice.
By 6 months, the child does not babble strings of consonant and vowel syllables or imitate gurgling or cooing sounds.
By 10 months, the child does not respond to his or her name.
At 10 months, the child’s sound-making is limited to shrieks, grunts, or sustained vowel production.
At 12 months, the child’s babbling or speech is limited to vowel sounds.
By 15 months, the child does not respond to “no,” “bye-bye,” or “bottle.”
By 15 months, the child does not imitate sounds or words.
By 18 months, the child is not consistently using at least six words with appropriate meaning.
By 21 months, the child does not respond correctly to “Give me . . . ,” “Sit down,” or “Come here” when spoken without gestural cues.
By 23 months, two-word phrases that are spoken as single units (e.g., “whatszit,” “thankyou,” “allgone”) have not emerged.
By 24 months, at least 50% of the child’s speech is not understood by familiar listeners.
By 24 months, the child does not point to body parts without gestural cues.
By 24 months, the child is not combining words into phrases (e.g., “go bye-bye,” “go car,” “want cookie”).
By 30 months, the child does not show understanding of spatial concepts: on, in, under, front, and back.
By 30 months, the child is not using short sentences (e.g., “Daddy went bye-bye”).
By 30 months, the child has not begun to ask questions (using where, what, why).
By 36 months, the child’s speech is not understood by unfamiliar listeners.
At any age, the child is consistently dysfluent with repetitions, hesitations; blocks or struggles to say words. Struggle may be accompanied by grimaces, eye blinks, or hand gestures.
Adapted and updated from Weiss CE, Lillywhite HE: Communication Disorders: a handbook for prevention and early detection, St Louis, 1976, Mosby.
the results of testing or initiation of speech-language therapy, parents should be advised to speak slowly and clearly to the child (and avoid baby talk). Parents and older siblings should read frequently to the speech-delayed child.
Speech disorders include articulation, fluency, and resonance disorders. Articulation disorders include difficulties producing sounds in syllables or saying words incorrectly tothe point that other people cannot understand what is beingsaid. Fluency disorders include problems such as stuttering,the condition in which the flow of speech is interrupted byabnormal stoppages, repetitions (st-st-stuttering), or prolonging sounds and syllables (ssssstuttering). Resonance or voice disorders include problems with the pitch, volume, or quality of achild’s voice that distract listeners from what is being said.
Language disorders can be either receptive or expressive. Receptive disorders refer to difficulties understanding or processing language. Expressive disorders include difficulty putting words together, limited vocabulary, or inability to use language in a socially appropriate way.