Speech delay, also known as alalia, refers to a delay in the development or use of the mechanisms that produce speech. Speech, as distinct from language, refers to the actual process of making sounds, using such organs and structures as the lungs, vocal cords, mouth, tongue, teeth, etc. Language delay refers to a delay in the development or use of the knowledge of language.
Because language and speech are two independent stages, they may be individually delayed. For example, a child may be delayed in speech (i.e., unable to produce intelligible speech sounds), but not delayed in language. In this case, the child would be attempting to produce an age appropriate amount of language, but that language would be difficult or impossible to understand. Conversely, since a child with a language delay typically has not yet had the opportunity to produce speech sounds, it is likely to have a delay in speech as well.
Signs and symptoms
At the age of 12 months, there is cause for concern if the child is not able to do the following:
- Using gestures such as waving good-bye and pointing at objects
- Practicing the use of several different consonant sounds
- Vocalizing or communicating needs
Between the ages of 15 and 18 months children are at a higher risk for speech delay if they are displaying the following:
- Not saying "momma" and "dada"
- Not reciprocating when told "no", "hello", and "bye"
- Does not have a one to three word vocabulary at 12 months and up to 15 words by 18 months
- Is unable to identify body parts
- Displaying difficulties imitating sounds and actions
- Shows preference to gestures over verbalization
Additional signs of speech delay after the age of 2 years and up to the age of 4 include the following:
- Inability to spontaneously produce words and phrases
- Inability to follow simple directions and commands
- Cannot make two word connections
- Lacks consonant sounds at the beginning or end of words
- Is difficult to understand by close family members
- Is not able to display the tasks of common household objects
- Is unable to form simple 2 to 3 word sentences
Studies show that children diagnosed with speech delay are more likely to present with behavioral and social emotional problems both in childhood and as adults. Decreased receptive language, reading, and learning skills are common side effects for children that suffer from a speech delay and do not receive adequate intervention. Similar studies suggest that children with speech delays are more likely to have a difficult time communicating and bonding with peers, which could have negative effects on their psychosocial health later in life.
At times, speech delay and impairment is caused by a physical disruption in the mouth such as a deformed frenulum, lips, or palate. If the motion or ability to form words and appropriate sounds is disrupted, the child may be slow to pick up words and lack the ability to shape their mouth and tongue in the formation of words.
Other more serious concerns are those that can be caused by oral-motor issues. Oral-motor dysfunction refers to a lack or delay in the area of the brain that speech is formed and created and communicated to the mouth and tongue. While speech may be the only concern, this disorder can be highlighted with feeding issues as well.
Children that are having speech delay disorders could have the following characteristics (Shriberg 1982):
- Speech mechanism in which speech is associated with hearing, motor speech and craniofacial malfunction
- Cognitive-linguistic aspects in which the impairment is associated with the child's intellectual, receptive, expressive and linguistic ability.
- Psychosocial issues in which the impairment is associated with caregiver, school environment, and the child's self behaviors such as aggression and maturity
The many other causes of speech delay include bilingual children with phonological disorders autism spectrum disorders, childhood apraxia, Auditory processing disorder, prematurity, cognitive impairment and hearing loss. Broomfield and Dodd's (2004a) found out after survey that 6.4% of children who are perfectly normal showed speech difficulty while they lacked these disorders will often show early signs and are at times identified as "at risk" when the speech delay is diagnosed.
Therapies and treatments
After the initial diagnosis of speech delay, a hearing test will be administered to ensure that hearing loss or deafness is not an underlying cause of the delay. If a child has successfully completed the hearing test, the therapy or therapies used will be determined. There are many therapies available for children that have been diagnosed with a speech delay, and for every child, the treatment and therapies needed vary with the degree, severity, and cause of the delay. While speech therapy is the most common form of intervention, many children may benefit from additional help from occupational and physical therapies as well. Physical and occupational therapies can be used for a child that is suffering from speech delay due to physical malformations and children that have also been diagnosed with a developmental delay such as autism or a language processing delay. Children that have been identified with hearing loss can be taught simple sign language to build and improve their vocabulary in addition to attending speech therapy.
The parents of a delayed child are the first and most important tool in helping overcome the speech delay. The parent or caregiver of the child can provide the following activities at home, in addition to the techniques suggested by a speech therapist, to positively influence the growth of speech and vocabulary:
- Reading to the child regularly
- Use of questions and simple, clear language
- Positive reinforcement in addition to patience
For children that are suffering from physical disorder that is causing difficulty forming and pronouncing words, parents and caregivers suggest using and introducing different food textures to exercise and build jaw muscles while promoting new movements of the jaw while chewing. Another less studied technique used to combat and treat speech delay is a form of therapy using music to promote and facilitate speech and language development. It is important to understand that music therapy is in its infancy and has yet to be thoroughly studied and practiced on children suffering from speech delays and impediments.
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To have a better understanding of a child's communication skills, parents, teachers, speech therapists and language therapists have a greater chance of collecting data that will determine in which area the child needs to be assessed. Children with speech difficulties range from a variety of communication skills, the most common would be literacy and psychosocial. Improving the child's skill can enhance their communication. It all starts with the child and their guardians at home. There are several factor that contribute in their speech such as:
- Waiting until the child has finished speaking
- Refraining from excessive correction and from disproportionate emphasis on correction (lest the child's desire to avoid correction lead him/her to simply shut down speech-production efforts as a crude means of avoiding error generation)
- Providing praise when warranted
- Approaching the child as a communicator partner[clarification needed]
- Being an appropriate speaking model
- Exposing the child to literature
- Limiting exposure to television, especially during efforts at parent-child communication
- Asking questions
- Repeating words[when?]
- Providing explanations and drawing conclusions
- Auditory processing disorder
- Cleft Palate
- Developmental coordination disorder
- Developmental verbal dyspraxia
- Down Syndrome
- Language acquisition
- Lists of language disorders
- Speech sound disorder
- Dodd, Barbara (2013). Differential Diagnosis and Treatment of Children with Speech Disorder. John Wiley & Sons. p. 8. ISBN 1118713346.
- Nelsen, Amy. "Delayed Speech or Language Development". Retrieved 12 April 2012.
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- Mann, Denise. "Speech Delay in Kids Linked to Later Emotional Problems". Retrieved 2012-04-22.
- University of Michigan. "Speech and Language Delay and Disorder". Retrieved 2012-04-22.
- Keep Kids Healthy. "Speech Delay". Retrieved 2012-04-22.
- . p. 8. Missing or empty
- Dodd, Barbara (2013). Differential Diagnosis and Treatment of Children with Speech Disorder. Johan Wiley & Sons. p. 275. ISBN 1118713346.
- Dodd, Barbara (2013). Differential Diagnosis and Treatment of Children with Speech Disorder. John Wiley & Sons. p. 211. ISBN 1118713346.
- Dodd, Barbara (2013). Differential Diagnosis and Treatment of Children with Speech Disorder. John Wiley & Songs. p. 244. ISBN 1118713346.
- Grob, Wibke; Ulrike Linden; Thomas Ostermann (21 July 2010). "Effects of music therapy in the treatment of children with delayed speech development - results of a pilot study". BMC Complement Altern Med. 10: 39. doi:10.1186/1472-6882-10-39. PMC . PMID 20663139.
- Kennison, S. M. (2013). Introduction to Language Development. Los Angeles, CA: Sage.
- American Speech-Language-Hearing Association (ASHA): Different Issues in Speech and Language Development.
- KidsHealth:Delay in Speech and Language
- Early Identification of Speech-Language Delays and Disorders
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- YourChild: Speech and Language Delays and Disorders University of Michigan Health System
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