Wed, 13 Aug 2003

Speech development, when to start worrying

Donya Betancourt, Pediatrician,

By their first birthday, many children are able to pronounce their first words. During their second year, toddlers begin to talk intelligibly and by their second birthday they can happily chatter away.

Girls tend to speak a bit earlier than boys, however, socio- cultural factors, genetics, and the child's birth order in the family, also play a role in speech development.

Speech is the motor action of communicating by articulating expression, whereas language is the knowledge of a symbol system used for interpersonal communication. The two develop in tandem, but understanding, or receptive language, leads the way at each stage.

Receptive language (understanding) begins to develop even before birth, as babies begin to respond to and remember words, voices and music as well as the steady sound of their mothers' heart beating.

In general, a child is considered to have speech delay if speech development is significantly below the norm of other children of the same age.

Parents should be concerned if the child is not talking rapidly by 12 to 15 months, not comprehending simple commands by the age of 18 months, not talking by the age of two, not forming sentences by the age of three, or is having difficulty telling a simple story by four to five years of age.

Parents should also be concerned if the child's speech is largely unintelligible, even after three years of age, or if the child's speech is more than a year late, in accordance with normal patterns of speech development.

Delay in reaching developmental milestones could indicate mental retardation or other problems.

Physicians should begin investigating children by the age of two years if any of the following warning signs are present: * The child is making no effort to speak. * The child's speech is very hard to understand. * The child only responds to the parents voice when their face is visible. * The child is not using connecting words. * The child does not follow simple verbal commands. * The child avoids communication by playing in his or her own world, or seems to have lost skills he or she once had.

There may be no problem at all. But a child should definitely have a hearing and speech evaluation if any of the following ensue: * No babbling or jargon (12 months). * No single words (18 months). * Vocabulary of 10 words or less (24 months). * Vocabulary of less than 100 words or no 2 word phrases (30 months). * Vocabulary of less than 200 words, no sentences, clarity less than 50 percent (36 months). * Vocabulary of less than 600 words, no complete sentences, clarity less than 80 percent (48 months).

About 5-10 percent of children have a developmental disability that causes a delay in their speech and language development. It is important to keep in mind that language development is more than just speech -- other forms of communication, like sign language, writing, and visual skills (such as pointing, recognizing parents, recognizing objects and responding to facial expressions), are also involved.

Speech delay has long been the concern of physicians who care for children. The concern is well founded, because a number of developmental problems accompany the delayed onset of speech. In addition, speech delay may have a significant impact on personal, social, academic life and (later on) vocation.

Early identification and appropriate intervention may mitigate the emotional, social and cognitive deficits of this disability.

A speech delay can be caused from problems with: * The output of speech (anatomical problems with the vocal cords, etc.) * The input of speech (hearing loss). * The processing of speech (mental retardation and developmental language disorders).

The two main types of speech delay are expressive delays -- meaning the inability to generate speech, or receptive delays, the inability to decode or understand the speech of others.

Children can also have a delay caused by a combination of both types (mixed expressive/receptive delay). Three common causes of speech delay are mental retardation, hearing loss and maturation delay which we will talk about them next week.