Developmental language disorder causes speech delay

Donya Betancourt, Pediatrician, drdonya@hotmail.com

This is the second part of a series on speech delay in children.

Let's start with the maturation delay. Most children with speech delays have a developmental language disorder (DLD), which means they are normal in all areas such as recognizing parents, recognizing objects, responding to facial expressions, following commands that are accompanied with a gesture indicating what they are expected to do, pointing to desired objects, etc.

They will seem to have normal comprehension or understanding of other's speech, meeting normal age appropriate hearing skills, such as recognizing and turning toward sounds, following 1 or 2 step commands without a gesture, pointing to named body parts and objects, but are unable to speak.

For the parents of a child that suffers from DLD it is good to know that with early intervention of speech therapy, most of these children will have improved speech by the time they begin school and their speech will ultimately become normal.

Some children with an expressive delay are just "late talkers" and have a constitutional delay in their speech development. These children will develop normal speech and language skills as they get older without any treatment. Unfortunately, there is no way to differentiate children with a constitutional delay, who will have improvement of their speech without intervention from those children who will require treatment. You can only tell in hindsight and it is not advisable to just "wait and see" if your child's speech will improve.

Another important cause of speech delay is hearing problems, so all children suspected of having a speech or language delay should have their hearing formally tested. It is important to note that it is not enough to assume that the child hears because he responds to a loud clap or bell in the doctor's office or because he comes when you call him from another room.

Other causes of speech delay include mental deficiency or mental retardation and pervasive developmental disorders, including autism. In addition to expressive (speech) and receptive (understanding) delays, children with these conditions will also commonly have a delay in their visual (seeing) language skills such as recognizing objects, responding to facial expressions, following commands that are accompanied with a gesture indicating what you want done, pointing to desired objects, etc.

Autism is a neurologically based developmental disorder; onset occurs before the child reaches the age of 36 months. Autism is characterized by delayed and deviant language development, failure to develop the ability to relate to others and ritualistic and compulsive behaviors, including stereotyped repetitive motor activity.

A variety of speech abnormalities have been described, such as echolalia which is when the child will repeat what they are told. The speech of some autistic children has an atonic (flat), wooden or sing-song quality. Autistic children, in general, fail to make eye contact, smile socially, respond to being hugged or use gestures to communicate.

Autism is three to four times more common in boys than in girls. Psychosocial Deprivation (e.g., poverty, poor housing, malnutrition) and social deprivation (e.g., inadequate linguistic stimulation, parental absenteeism, emotional stress, and child neglect) have an adverse effect on speech development.

Abused children who live with their families do not seem to have speech delay unless they are also subjected to neglect. Because abusive parents are more likely than other parents to ignore their children and less likely to use verbal means to communicate with them, abused children have an increased incidence of speech delay.

Things that do not cause speech delays are a child being "tongue-tied," being "lazy," having a lot of siblings that "talk for him," or living in a bilingual family.

What you should do if you suspect that your child has speech delay will be the topic next week.