Parents’ Guide to Language Delays and Speech Disorders in Children
Nearly 1 in 12 U.S. children ages 3 to 17 has had a disorder related to voice, speech, language, or swallowing, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). While parents understand the importance of monitoring for potential signs of these issues, some may not be aware of exactly how early they should be on the lookout for delays in their child’s speech and language development.
Certain factors may predict future hurdles: Preschool-age children who were born preterm—before 37 weeks’ gestation—have an increased risk for developing language impairments, according to research from Diane Loeb, Ph.D., CCC-SLP, Baylor University professor and Martin Family Endowed Chair of the Department of Communication Sciences and Disorders, and colleagues. While many infants born preterm will not have any issues down the road, it is important for new parents to be aware of the potential risk factors, as well as signs to look for as their child gets older.
Early intervention is a method for addressing language delays and speech disorders in children ages 0 to 3 years old. When parents understand how to monitor their child’s development and how to seek help from a speech-language pathologist (SLP) during these early years, they can help their child develop language skills and minimize developmental delays.
Milestones in Early Speech and Language Development
One way to monitor a child’s development is to make note of speech and language milestones, explained Hillary Guest, M.S., CCC-SLP, a speech language pathologist based out of Austin, Texas. While missing a milestone is not a definitive sign that a child has a speech disorder or language delay, paying attention to the rate at which the child acquires language skills can be a helpful tool.
Guest highlighted the following milestones for children ages 0 to 3 years old.
At this age, infants generally become capable of holding joint attention, in which they can shift their focus between another person and an object or event. For example, when a parent points to a toy, the infant follows their gesture to look at the toy. “They’re able to engage in a shared experience,” Guest explained.
Now in the toddler phase, children at this age can typically say one to five words. They should also show behaviors of laughing and engaging with adults, imitating sounds, making gestures like waving and pointing, and exhibiting exploratory play.
At this point in development, children may use short phrases—two-word combinations—and understand basic commands such as, “Can you give me the ball?” Children at this age also begin to play alongside other children.
By the time a child turns 3 years old, they should be able to use three-word phrases and make consonant sounds like P, B, M, and D. Another behavior that typically manifests around this time is the ability to label favorite objects or toys.
How to Look for Potential Early Signs of Speech and Language Issues
As young children develop, they may struggle to learn speech and language skills and hit important milestones. Each child develops at a unique pace; some may exhibit signs of a potential speech impairment, language delay, or language disorder at a different phase than other child. The Centers for Disease Control and Prevention’s resource on language and speech disorders in children offers the following information on how these conditions differ:
Speech disorders affect the ability to form speech sounds needed to communicate. This can manifest in several ways, including problems with fluency, which is difficulty making words or sentences flow smoothly, such as with stuttering.
Language delay refers to when a child’s ability to understand and use language develops more slowly than their peers. This can occur as a result of a number of factors, such as hearing, speech, and cognitive impairments. Psychosocial issues can also play a role—for example, children who experience neglect as infants may deal with language delays.
Language disorders are conditions that affect an individual’s ability to express their thoughts or understand communication directed at them. Examples of language disorders include aphasia, which is difficulty in understanding or speaking parts of language as a result of brain injury or brain development. Auditory processing disorder is another language disorder that affects the ability to understand the meaning of sounds and words.
Speech and language disorders can affect a child’s expressive and receptive language skills.
- Expressive language refers to the ability to use words and gestures to convey meaning and messages to others.
- Receptive language is the ability to understand words and language communicated by another person.
Risk Factors for Speech Disorders and Language Delay
Not all causes for speech disorders and language delays are known, but some factors have been found to be more common among children who do experience these conditions.
Preterm birth, for example, is one potential risk factor. According to a study on language development, infants were more likely to experience language delays and other issues such as impaired cognitive development. In another study from 2019, researchers found that, from 23 to 36 weeks, each gestational week was associated with an 8.8% decrease in the likelihood of the child having a speech, language, and communication concern reported at 27 months of age.
As for why preterm birth may increase the likelihood of an infant developing a speech disorder or language delay as they grow, researchers of a study on language disorders published in Neural Plasticity offered this explanation: “When born [preterm], infants are prematurely led into a more invasive environment, which can have profound effects on the auditory brain maturation and subsequent speech and language acquisition.”
Comorbidities related to behavioral and developmental health are also common among children with speech and language issues, according to the CDC’s resource on language and speech disorders in children. Language and speech disorders can be present with emotional or behavioral disorders such as attention deficit hyperactivity disorder (ADHD) or anxiety; children with developmental disabilities including autism spectrum disorder (ASD) may also struggle with speech and language development.
Why Early Intervention Speech Therapy Is Beneficial
While working with an SLP can be helpful at any age, taking steps to address development concerns early in a child’s life can give them a head start in building speech and language skills.
In an article on predictors of language outcome for children born preterm (PDF, 243 KB), co-authored by Loeb, researchers write that “prevention is one aspect of a speech-language pathologist’s scope of practice in communication disorders that has been neglected.”
Loeb and the team explain that early delays can lead to issues later in development. For example, a child showing poor expressive and receptive language skills at age 2 is a predictor of poor expressive and receptive language skills at age 5.
Guest also emphasized the importance of early intervention, as children are generally more receptive to therapy during the early developmental stages.
“When you’re at that early intervention age, you have the benefit that these are young children whose brains are still growing, and they’re learning a ton,” Guest said. “You can take advantage of what we know about the brain and its development in those critical years.”
How to Find Early Intervention Speech Therapy
The American Speech-Language-Hearing Association (ASHA) defines early intervention as a program for children ages 0 to 3 that provides support for cognitive skills, communication, physical and sensory skills, social-emotional skills, and adaptive or self-help skills.
Parents who are concerned about their child’s development of speech and language skills can find their community’s early intervention office through multiple sources:
- Child’s pediatrician or child care provider (ask for a referral)
- State department of health or education
- Parent Training and Information Center in your state
- Pediatrics department of a local hospital
- Early Childhood Technical Assistance Center in your state
According to ASHA, while primary providers can help refer parents to an early intervention program, their referral is not required in order to schedule an early intervention speech evaluation.
Preparing for a Child’s Early Intervention Speech Evaluation
Parents may be nervous before their child’s first visit with an SLP. Taking steps to prepare for an early intervention speech evaluation can help calm those anxieties. Guest advises parents do the following before their child’s session.
Contact an insurance provider.
Some insurance plans do not cover speech-language pathology care in cases where the child’s condition is due to developmental issues such as autism spectrum disorder. Having a plan in place to cover the cost of care ahead of the first visit is critical.
Collect past medical information.
If a child has any documentation of their speech or language issues, such as an exam with a primary care provider or notes from a child care provider, this information can be factored into the SLP’s initial evaluation.
Gain an understanding of the process.
When a child has an early intervention speech evaluation, the process typically involves an initial assessment from the SLP, followed by a formal report. Next, the SLP will develop a plan of care, which can include ongoing therapy sessions as well as exercises for parents to use at home with their child.
Exercises to Address Speech Disorders and Language Delays in Children
Develop verbal routines.
Parents can strategically use the same words each time they do a particular action to associate the phrasing with what is happening.
Try this: During playtime, the parent can sing an instructive song each time they make a toy car go down a ramp to associate the action with words.
Use reading as an opportunity to build vocabulary.
Instead of just reading words on a page, parents can use the visuals of a book to ask questions and help a child learn new words.
Try this: While reading a story, the parent can point to a character and ask what action they are doing. Another strategy is to play “I Spy” and encourage the child to identify the object on the page by pointing.
Ask questions with choices to give them an opportunity to communicate.
Instead of using yes-or-no questions, a parent can provide alternative options to allow their child to practice communication.
Try this: During snack time, the parent should ask if their child wants crackers or yogurt and give them time to indicate their choice.
Practice modeling behavior.
Instead of repeating a word to teach it to a child, parents can model the object in different ways.
Try this: During playtime, a parent can point to a ball and ask the child to say what it is. In another instance, a parent can say descriptors of what a ball looks like and ask their child what object is being described.
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Citation for this content: The online speech pathology program from Baylor University's Robbins College of Health and Human Sciences