Speech Delay in Children

Speech delay is an everyday term for talking that develops more slowly than expected, and it can mean difficulty with speech, the sounds a child makes, with language, the words a child understands and uses, or with both. No cause is ever identified for most toddlers who start talking late, and when one is found, it is not parenting.

What you’ll learn

• Why speech and language are separate skills, and what the term speech delay covers
• How common a late start to talking is, and where speech delay comes from
• How a speech delay is identified, and why hearing is checked early
• Who to contact first, with or without a doctor’s referral

What Is Speech Delay in Children?

Speech delay is a broad term that covers several different situations: a child whose words are clear but few, a child with plenty to say whose sounds are hard to follow, or a child who is slow to understand as well as to talk. The American Speech-Language-Hearing Association (ASHA) treats speech and language as different skills and notes that a child can have trouble with one or both, so the first useful question about any speech delay is which of the two is meant.

Official names shift too. The National Institute on Deafness and Other Communication Disorders (NIDCD) notes that the ongoing condition now called developmental language disorder has also been called language delay, among other names. For a toddler who is slow to start talking, ASHA’s clinical term is late language emergence, meaning a late start to language with no other diagnosed disability and no delay in thinking or movement skills. ASHA notes that these toddlers may also be called late talkers. Late talker describes a pattern and is not a diagnosis.

A late start to talking is common. The American Academy of Pediatrics (AAP) describes language delays as the most common kind of developmental delay, and ASHA’s estimates for late language emergence among 2-year-olds mostly fall between 10 and 20 percent. How both skills grow over the early years is described in speech and language development.

Speech and Language: Two Separate Skills

ASHA describes speech as how sounds and words are said, with three parts to it: articulation, or how sounds are made with the mouth, lips and tongue; voice; and fluency, the rhythm of speech. NIDCD describes a speech disorder as trouble producing speech sounds correctly, or hesitating or stuttering when talking. ASHA also says it is normal for young children to say some sounds wrong, and that it may become a problem if a child keeps saying words that way while growing older.

Language is the words a child uses and how the child uses them to share ideas and get what they want, and it has two sides: receptive language, which is understanding what other people say, and expressive language, which is sharing thoughts. NIDCD says a child who has trouble on either side may have a language disorder.

From clinical practice

A first appointment for speech delay usually brings two worries under one name. One is whether a child says words clearly. The other is whether the words, and the understanding beneath them, are there at all. In a quiet toddler the two blur easily.

Understanding is the place to start. Does the child follow what is said? Does the child use gestures to get a message across? A toddler who takes in a great deal and says little stands somewhere very different from one who is also slow to understand, and that difference changes what the quiet means.

Looking Past the Word Count to Understanding

Whether a child understands what is said shapes how a clinician reads everything else about their talking. A toddler who follows what you say, points at things, brings objects over to show you and steers you toward what they want is getting a lot across with few words, which is the pattern people mean by a late talker. When understanding is slow along with talking, more of the language system is involved, and an evaluation looks well beyond words for exactly that reason.

None of this calls for testing at home. What helps is noticing, over ordinary days, how your child gets a message across and how much of what you say lands:

• How much of what you say your child acts on without a gesture to help
• How your child gets a message across when the word isn’t there: a sound, a point, a pull on your hand
• Whether your child brings things over simply to show you

Jotting down what you notice gives your child’s doctor or a speech-language pathologist a fuller picture than a word count, because a professional looking into a speech delay weighs understanding and gestures alongside words. If your child is around two and saying little, late talking in 2-year-olds covers word counts and everyday ways to help.

Where Speech Delay Comes From

For most toddlers who talk late, nobody ever identifies a cause, and an evaluation that ends with no known cause has still produced a real finding. When a reason does turn up, it generally falls into one of four groups: hearing, a difficulty with the movements of speech, a broader developmental difference such as autism, ADHD or sensory differences, or a family history of late talking. None of the four is something parenting brings about.

Late talking runs in families, and ASHA reports late language emergence in about 23 percent of children with a family history of it, against about 12 percent of children without one. ASHA also lists being born before 37 weeks, or well under the expected birth weight, among the factors linked with a higher chance of a late start.

A 2007 Journal of Speech, Language, and Hearing Research study of 1,766 two-year-olds found that late language emergence was not linked to parenting practices, parents’ mental health or how the family functioned.

Hearing is checked early in any speech concern, because a hearing problem can affect both speech and language, and NIDCD notes that hearing loss can begin at any age, so passing the newborn hearing check does not settle the question. Childhood apraxia of speech, one kind of difficulty with the movements of speech, is a relatively rare motor speech disorder that makes planning those movements hard, and ASHA notes that the mouth muscles of children with it are not weak.

Two languages at home are not a cause. According to ASHA, children raised with two languages meet their milestones on the same timeline, provided both languages are counted when their words are tallied. Screen time tends to go along with less back-and-forth talk, though research has not shown it to be a cause of speech delay. There is more on what does and does not cause a late start in the causes of speech delay.

Speech Delay as Part of a Bigger Picture

The AAP notes that a language delay is sometimes the first sign of something broader, such as hearing loss, a delay in other areas of development, or autism. Autism affects more than talking, which is why a clinician looking into a speech delay also watches how a child shares attention, responds when called and uses gestures.

Developmental language disorder is an ongoing difficulty learning, understanding and using language that is not explained by hearing loss, autism or a lack of exposure to language. NIDCD says it affects about 1 in 14 kindergarten children and that a child with it often has a history of late talking, which is one reason a late start is worth a professional look.

Certain signs are worth raising with your child’s pediatrician or a speech-language pathologist on their own, whatever the word count:

• Words or skills your child had and has stopped using
• Not responding when called by name
• Not pointing or using gestures to show you things
• Not seeming to understand what you say
• Not copying sounds, gestures or actions

Losing words is a reason to call your child’s doctor now, at any age, because a loss of skills is a different pattern from a slow start and needs looking into on its own.

How a Speech Delay Is Identified

Milestone lists are a starting point for conversation, though they are not tests. Among ASHA’s communication milestones for 19 to 24 months are using at least 50 words and putting two words together, and ASHA also says each child develops uniquely and may meet some milestones earlier or later.

The Centers for Disease Control and Prevention (CDC) says its own milestone checklists are not meant for diagnosing a delay. For late language emergence, professionals use a yardstick instead, fewer than 50 words and no two-word combinations by 24 months, which ASHA describes as an extensively used set of criteria. It belongs with a clinician weighing the whole child, not with a count at home.

A full evaluation by a speech-language pathologist goes well beyond counting. The professional looks at what a child says and at how well the child understands speech and gestures, and ASHA asks speech-language pathologists to consider hearing loss and look at the child’s whole development, including thinking, communication, the senses and movement. NIDCD notes that a hearing test is often part of the evaluation, and the AAP says that when what a child says is the only delay, parents may be given ideas to help at home.

Where to Start: The Doctor, Early Intervention or School

NIDCD advises talking to your child’s doctor about any concern, and says the doctor may refer your family to a speech-language pathologist, the professional trained to evaluate and treat speech and language disorders. ASHA also keeps a directory, ProFind, for finding a certified speech-language pathologist.

For a child under three, you can contact your state’s early intervention program directly. The CDC is clear that no doctor’s referral or diagnosis is needed to make that call, and every state provides the evaluation at public expense. Therapy that follows is a separate matter, and in some states it carries a sliding-scale fee.

From age three, the CDC suggests calling any local public elementary school, even one your child does not attend, to ask for an evaluation for preschool special education. Under federal special education rules a parent can request that first evaluation, and it must be completed within 60 days of the parent’s consent unless the state sets a different timeline.

The full process of getting a speech evaluation is explained step by step, and if you are told to wait and see, you are still entitled to make either call yourself.

Common Questions From Parents

What Is the Difference Between a Speech Delay and a Language Delay?

Speech is producing sounds clearly and smoothly. Language is understanding words and using them to share ideas. A child can struggle with one or both, and since the everyday terms overlap, it is fair to ask which one a professional means.

Is a Speech Delay the Same as Being a Late Talker?

Not quite. Late talker describes a toddler who talks late while understanding and play come along well, and it is not a diagnosis. Speech delay is a looser, wider term that can also cover trouble with sounds.

What Causes a Speech Delay?

For most toddlers who talk late, no cause turns up. When one does, it is usually hearing, trouble planning the movements of speech, a wider developmental difference such as autism, or late talking that runs in the family, and a large study found no link with parenting practices.

How Is a Speech Delay Diagnosed?

Through an evaluation with a speech-language pathologist, who looks at what your child says, how much your child understands, how your child uses gestures and how development is going overall. A hearing check is often included, since hearing problems can affect both speech and language.

Can a Speech Delay Go Away on Its Own?

Sometimes. About half of late talkers catch up by their third birthday without any help, and nobody can say beforehand whether a given child will be one of them, so a professional look is worth having even when catching up is possible.

Is a Speech Delay a Sign of Autism?

Sometimes, and a speech delay alone is not enough to tell. According to the AAP, a language delay can be the first sign of something broader, autism included, so clinicians watch how a child shares attention, answers to their name and uses gestures.

Who Should I Talk to First About a Speech Delay?

Your child’s doctor is a sensible first call and may refer you to a speech-language pathologist. Under three, you can also contact your state’s early intervention program yourself, and from three, you can ask any local public elementary school for an evaluation.

Reviewed by Monica d’Errico-Franklin, M.S., CCC-SLP

More about Monica