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Speech and Language Delay and Disorder

What are speech/language delays and disorders?
Speech is the sound that comes out of our mouths.  When it is not understood by others there is a problem.  Speech problems, such as stuttering and mispronunciation can be very frustrating. 

Language has to do with meanings, rather than sounds.  Language is a measure of intelligence and language delays are more serious than speech problems. 

Language delay is when a child’s language is developing in the right sequence, but at a slower rate.  Speech and language disorder describes abnormal language development.  Delayed speech or language development is the most common developmental problem.  It affects five to ten percent of preschool kids.

How can I tell if my child’s speech and language development is on track?
If your child is not on track with the following speech/language development milestones, you should talk to your pediatrician. 
Here are the milestones to look for in normal speech development:

Age Language Level

Birth

Cries

2-3 months

Cries differently in different circumstances; coos in response to you

3-4 months

Babbles randomly

5-6 months

Babbles rhythmically

6-11 months

Babbles in imitation of real speech, with expression

12 months

Says 1-2 words; recognizes name; imitates familiar sounds; understands simple instructions

18 months

Uses 5-20 words, including names

Between 1 and 2 years

Says 2-word sentences; vocabulary is growing; waves goodbye; makes “sounds” of familiar animals; uses words (like “more”) to make wants known; understands “no”

Between 2 and 3 years

Identifies body parts; calls self “me” instead of name; combines nouns and verbs; has a 450 word vocabulary; uses short sentences; matches 3-4 colors, knows big and little; likes to hear same story repeated; forms some plurals

Between 3 and 4 years

Can tell a story; sentence length of 4-5 words; vocabulary of about 1000 words; knows last name, name of street, several nursery rhymes

Between 4 and 5 years

Sentence length of 4-5 words; uses past tense; vocabulary of about 1500 words; identifies colors, shapes; asks many questions like “why?” and “who?”

Between 5 and 6 years

Sentence length of 5-6 words; vocabulary of about 2000 words; can tell you what objects are made of; knows spatial relations (like “on top” and “far”); knows address; understands same and different; identifies a penny, nickel and dime; counts ten things; knows right and left hand; uses all types of sentences

If your child is not meeting these milestones, the first step is to get their hearing checked.  Even if they seem to hear just fine, kids are experts at picking up visual cues to get by.  It’s important to catch hearing loss early, so that treatment begins as soon as possible.

How can I tell if my child has a language problem or is just "late-bloomer"
You can’t really tell whether a child with delayed speech is a late bloomer or has an expressive language disorder or other underlying cause of speech delay.  That’s why it’s worth seeking help.  The earlier your child gets help, the greater their progress will be.  And if they turn out to be a late bloomer, the extra attention to their speech will not have hurt in any way. Read this: Late Blooming or Language Problem? for ideas.

What causes speech and language problems?

How can my child communicate, if not verbally?
Children who are nonverbal, or not communicating well enough due to hearing loss, autism, apraxia, or similar problems, can use other methods.  These include sign language, the Picture Exchange Communication System (PECS), and Augmentative and Alternative Communication

The American Sign Language Browser can help you look up signs for words you need.  At the bottom of the screen, just click on the first letter of the word you want to look up, then scroll down the right hand side and click on the word you want.  A video will appear to demonstrate the sign, along with a written description.

How can I help my child with language development?
It is important to identify speech/language problems early, so your child can begin treatment. Many people believe that speech and language treatment cannot begin until a child starts talking.  This is not true.  Treatment can and should begin as soon as possible.  Research shows that children know a lot about language long before the first word is ever said.  If your child has any risk factors (for example low birth weight) or any of the problems listed above, they should be tested early and periodically for speech/language problems.  If your child needs treatment, it should be developmentally appropriate and individualized.  Your child’s treatment team might include a doctor, an audiologist, a speech-language pathologist, an occupational therapist, and/or a social worker. 

Here are some parenting tips for helping along your child’s speech and language:

What about stuttering, and how can parents help?
Stuttering (sometimes called stammering) is a speech disorder.  In stuttering, the normal flow of speech is broken up by repeating or lengthening the sounds, syllables, or words.  A person may also have trouble getting a word started.  Most kids outgrow stuttering.
Parents can help by:

The Stuttering Foundation has a helpful video called Stuttering and Your Child:  Help for Parents

Where can I find more information and support?
Information and organizations:

Books:

Written by a developmental behavioral pediatrician and a parent, this book can help parents get services and advocate for their children with communication delays.  It suggests which diagnostic codes are most likely to get health insurance companies to cover services for speech and language problems and provides resources for parents, including where to get legal aid, publications, and more information.

Related topics on YourChild:

Related services at at the University of Michigan:


References
American Speech-Language-Hearing Association.  Late Blooming or Language Problem?  Available at:  http://www.asha.org/public/speech/disorders/LateBlooming.htm.  Accessed 6 June 2008.

Coplan J.  Language Delays. In: Parker S, Zuckerman B, eds. Behavioral and Developmental Pediatrics.  Boston: Little, Brown, and Co.; 1995:195-199.

Guitar B, Belin-Frost G.  Stuttering.  In: Parker S, Zuckerman B, eds. Behavioral and Developmental Pediatrics.  Boston: Little, Brown, and Co.; 1995:294-296.

Leung AK, Kao CP. Evaluation and management of the child with speech delay.  Am Fam Physician. 1999 Jun;59(11):3121-8, 3135.

National Institute on Deafness and Other Communication Disorders.  Stuttering.  NIH Pub No 97-4232.   May 2002.  Available at:  http://www.nidcd.nih.gov/health/voice/stutter.asp.  Accessed 6 June 2008.

Written and compiled by Kyla Boyse, R.N.  Reviewed by faculty and staff at the University of Michigan
Updated November 2012

U-M Health System Related Sites:
U-M Pediatrics

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