Delay In Talking

A delay in speech development may be a symptom of many disorders, including mental retardation, global developmental delay, hearing loss, an expressive language disorder, psychosocial deprivation, autism, elective mutism, receptive aphasia and cerebral palsy. Speech delay may also be sometimes caused by bilingualism. There is a very wide range of normal development. There is also a very wide range in the understanding of normal development and comparisons with other children may lead to unfounded parental concerns.

• Speech delay is a common childhood problem that affects 3 to 10 percent of children.¹
• The disorder is three to four times more common in boys than in girls.¹

Possible causes include:

• Mental retardation
• Deafness
• Cerebral palsy
• Social deprivation
• Elective mutism (child selectively refuses to speak according to particular circumstances)
• Infantile autism
• Degenerative central nervous system disease.

The following is only a rough guide but there is a wide variation of normal speech development:¹

• 1 to 6 months: coos in response to voice
• 6 to 9 months: babbling
• 10 to 11 months: imitation of sounds
• 12 months: says mama or dada with meaning
• 13 to 15 months: vocabulary of four to seven words in addition to jargon
• 16 to 18 months: vocabulary of 10 words
• 19 to 21 months: vocabulary of 20 words
• 22 to 24 months: vocabulary more than 50 words; two-word phrases; most of speech is now understood by strangers
• 2 to 2 1/2 years: vocabulary of 400 words, including names; two- to three-word phrases; use of pronouns
• 2 1/2 to 3 years: use of plurals and past tense; knows age and sex; counts three objects correctly; three to five words per sentence
• 3 to 4 years: three to six words per sentence; asks questions, relates experiences, tells stories; almost all speech understood by strangers
• 4 to 5 years: six to eight words per sentence; names four colors; counts 10 pennies correctly

• Assessment will depend on the context and associated concerns.
• Assessment of hearing function and a detailed developmental assessment.
• A thorough investigation of possible causes of development delay, including disorders of metabolism, may be required.

• Required management may be just explanation, simple advice and reassurance with the involvement of the Health Visitor.
• However early detection and intervention of speech delay may prevent or at least reduce the educational, emotional and social problems that may be caused.
• A referral for speech therapy may be required. However although there is some evidence for the effectiveness of interventions for expressive speech difficulties, the evidence for interventions for expressive syntax is mixed and there is no evidence for interventions for receptive language difficulties.²
• Multidisciplinary involvement may be required and the involvement of the parents is vital.
• Management is dependent on cause and associated problems such as hearing impairment.

• This is dependent on the cause of the speech delay.
• The prognosis is improved with early detection and intervention.