Speech and Language Delays in Children
Language Delays are a Common Concern
Every child develops at a different rate. Some children walk at 10 months, while others walk at 15 months. Some children speak in sentences at the age of 2 years, while others are just beginning to put two words together. While there is a range in the ages when children achieve certain milestones, there is a point where a child will be considered “delayed” – when milestones are not achieved at an age where the vast majority of children have mastered the skill.
Language delays are a common concern for parents: indeed, 1 in 20 children has some sort of language disorder. Many parents are concerned when a child does not begin speaking at an expected age, or cannot pronounce words clearly. These are concerns about speech, a form of verbal expressive language. There are other forms of language delays; language is complex and is composed of receptive and expressive language. A delay may be encountered in language comprehension, production, and/or in speech articulation.
Children With Communication Disorders
Types of Language
While speech is often the most common concern with language development in toddlers, it is only one form of language. Language can be broken down into two main categories: receptive language and expressive language.
Receptive language is the amount of language a child is able to understand. The ability to comprehend language is a separate skill from the ability to produce spoken language.
Expressive language is the amount of language a child is able to communicate. For most children, this is spoken language. Some children may also express themselves through sign language, picture charts, or a speech producing device.
Speech is the verbal production of expressive language; the ability to verbally communicate with others.
Articulation is the clarity of the sounds of speech – how well a child is able to produce specific phonemes in their native language.
Receptive Language Milestones
Receptive language develops long before expressive language. A 3 month old baby will recognize voices, and babies will understand several words (including the word “no”) by the age of 9 months. By the age of 2 years, most children understand over 300 words and are able to follow directions that contain two distinct steps. Refer to the table below for typical receptive language milestones.
Receptive Language by Age
|Age||Milestones||Signs of Delay|
Will turn head to voice
Does not make eye contact or does not smile.
Is able to differentiate between voices and environmental sounds – will look at the door when a doorbell is rung, for example.
Does not turn to look at a parent talking or seek the source of a sound.
Understands that objects do not disappear when hidden from sight (object permanence); understands a few simple labels in everyday life (dog, kitty, daddy, phone, the word “no”).
Does not search for hidden objects, does not appear to understand "no" or any other word.
Will carry out directions that have only one step if gestures are provided; understands a variety of labels, action words, and names of familiar people.
Does not respond to simple requests ("come here") or does not engage in games like peek-a-boo.
Will carry out one-step directions without gestures or visual cues.
Does not follow basic directions (push the button, roll the ball).
Will point to named objects in a book and point to body parts
Cannot point to any named body parts.
Understands questions like "where" and "what," comprehends over 300 words, and will follow two-step directions.
Cannot identify action words like "run" or "jump" in pictures, cannot follow two-step directions (put your cup down and come here).
Understands 500-1,000 words, turn-taking, color identification, prepositions (in/under/on), and gender identification.
Cannot identify parts of objects, is unable to sort objects.
Is able to categorize and infer meaning.
Does not engage in pretend play, match and categorize objects.
Is able to listen to and answer questions about a short story, comprehends time concepts, begins to identify numbers and letters.
Cannot answer questions about a simple story: "What did Goldilocks eat in the Three Bears' house?" e.g.
Pretend Play at 3-4 Years of Age
Causes of Toddler Receptive Language Disorders
A child may not be able to process or comprehend language for a myriad of reasons. Any parent who suspects a receptive language problem should contact Early Intervention in their home state - these programs serve toddlers and will provide screening at no (or very low) cost.
Children struggling with language comprehension may not be able to order their thoughts, follow directions, or understand spoken language.
Possible causes include:
- Traumatic brain injury
- Global developmental delay
- Auditory processing disorder
- Chronic ear infections
Expressive Language Milestones
Expressive language appears later than receptive language, as the infant and toddler learns how to convey meaning. Beginning with vocalizations at the back of the throat in early infancy, a baby will progress to repetitive babble by the age of 9 months. A 12 month old child will be able to wave "bye bye" and will have a variety of babble sounds, in addition to a word or two. By the age of two, most children have approximately 50 words in their vocabulary and are stringing 2 word phrases together.
Expressive Language by Age
|Age||Milestones||Signs of Delay|
Smiles, vocalizes, and makes "raspberry" sounds.
Does not vocalize.
Laughs, Imitates sticking a tongue out, may begin to babble.
Does not laugh or imitate facial expressions.
Babbles with an increasing number of sounds, squeals to get attention.
Does not produce any babble containing consonants.
Waves hello, says 1-2 true words (like dada or ball).
Does not produce complex babble (known as "jargon") or wave.
Will roll a ball back and forth with an adult (emerging turn-taking), can label ~5 objects.
Does not interact with an adult caregiver, does not produce a variety of complicated jargon.
Imitates words, names some pictures of objects.
Has no true words, cannot imitate words.
Has approximately 50 words and begins putting 2-word phrases together.
Has less than 20 words or does not string together 2 word phrases.
2 1/2 years
Uses the word "I" or "me" to refer to self, asks simple questions ("where cookie?"), and uses 2 word phrases.
Has less than 50 words and no 2 word-phrases.
Asks what/where/who questions, speaks in 3-5 word sentences.
Does not ask questions, count to three, or produce short sentences.
Hearing Loss Must Be Ruled Out
Causes of Expressive Language Disorders
Some children have no difficulty understanding language, but cannot express themselves in a typical manner. A child with an expressive disorder may have poor syntax (word phrases appear in an unusual order), stutter, have difficulty recalling words, repeat a single word over and over again, or have fewer number of words than a typically developing child. The inability to express ideas may cause behavioral problems in children, as they are unable to communicate their wants and needs. Possible causes for expressive language disorders include:
- Traumatic brain injury
- Developmental delay
- Childhood Apraxia of Speech (a motor-planning disorder)
- Maturational delay
A Child With Childhood Apraxia of Speech
The ability to produce clear speech takes a rather long time. A young child may call a ball a "bah," as the L sound is difficult for a young toddler to produce. Indeed, many articulation errors are common in toddlers - some sounds take as long as 6-8 years to master!
Speech sounds may be broken into categories: bilabial sounds are produced when the lips are pressed together to make the sound, labiodental sounds are made when the lower lip contacts the upper teeth. Some types of speech sounds are:
- Bilabial - sounds are made by pressing two lips together (like the letter M).
- Labiodental - sounds are made by pressing the bottom lip to the upper teeth (like the letter F).
- Dental - sounds are made by pressing the tongue to the back of the teeth (like the TH sound).
- Alveolar - sounds are made by moving the tongue against the palate ridge just behind the upper teeth (known as the alveolar ridge). The letter T is produced in this manner.
- Postalveolar - the tongue must move along the back of the alveolar ridge - the sound CH is made this way.
- Velar - the back of the tongue rises up to meet the soft palate. The letter K is produced this way.
- Palatal - the tongue must move against the arch of the palate, as in the J sound.
Speech Sounds by Age
|Speech Sound||Age When 50% of Children Master the Sound||Age when 90% of Children Master the Sound|
3.5 years for girls, 4 years for boys
3.5 years for boys, 4 years for girls
4 years for girls, 5 years for boys
5 years for girls, 6 years for boys
Blends (bl, sp, pr, etc.)
5.5 years for girls, 7 years for boys
5.5 years for girls, 7 years for boys
6 years for girls, 7 years for boys
TH (soft as in thin)
6 years for girls, 8 years for boys
TH (voiced as in this)
6.5 years for girls, 7 years for boys
ZH (as in treasure)
While it is normal for the mastery of some speech sounds to take years, a child should be intelligible. By the age of 2 years, a child should be intelligible 50% of the time to his or her family. By the age of 3 years, a child should be intelligible 75%-100% of the time to strangers. Articulation delays are often referred to as "speech delays" by parents, and are the most common form of language delay in toddlers. Articulation disorders may be caused by:
- Phonological disorders
- Childhood apraxia of speech
- Motor planning disorders
- Low oral-motor muscle tone
Identify Speech and Language Delays Early
First Steps When a Language Delay is Suspected
Parents who suspect a language delay should contact their child's pediatrician and their state's early intervention team. Sometimes, a pediatrician will pass off a language delay concern with a statement like, "don't worry, he'll talk when he's ready." While some language delays may be slight and maturational in nature, all delays should be assessed via screening by a speech-language pathologist. At minimum, a child with a language delay should receive:
- A hearing test (audiogram) by a licensed audiologist
- Testing for receptive and expressive language and articulation
- Physical exam by a pediatrician
Children with a confirmed language disorder will be referred to various specialties, depending on the cause of the delay. Children with hearing loss will be seen by an Ear, Nose, and Throat specialist, for example, and will receive hearing aids or a cochlear implant to allow language to develop properly (along with the appropriate therapy). Children with childhood apraxia of speech may be seen by a neurologist and will receive intensive speech-language therapy.
Two Success Stories
The author of this article has two children who require speech-language therapy. One child had a severe expressive language delay (phonological delay) and severe articulation disorder. This child was enrolled in early intervention and obtained speech-language services for two years. At the age of four, he was declassified from special education and is now an articulate, communicative six year old in a mainstream classroom.
The author's second child has a congenital, progressive hearing loss and wears hearing aids. This child has age-appropriate language as a result of intensive auditory-verbal therapy and early detection/intervention.
Successful Treatment of Language Disorders
Treatment of any receptive, expressive, or speech delay will depend on the underlying cause. The earlier a language disorder is identified, the more readily it can be treated. Successful outcomes often rely on early detection, early intervention, and are dependent on the underlying reason for the disorder.
Some children may have severe difficulty with speech and may require sign language or adaptive communication devices to produce speech. The advent of tablet computers has generated an entirely new and affordable world of speech devices in the form of apps.
If detected at an early age, the future is bright for many children with speech or language delays. With prompt attention, a language disorder may be managed and appropriate accommodations made for children who require therapy or assistive communication devices.
This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.
Questions & Answers
Question: What is the success rate for early intervention and treatment for language disorders?
Answer: This is a question with an extremely complicated answer. The success rate will vary based on the etiology or cause of the language disorder. As language disorders may be caused by many different conditions including deafness, childhood apraxia of speech, auditory processing disorder, oral motor difficulties, and more, the treatment and efficacy will vary. Also, the definition of "success" must be defined. One person may define success as a child reaching the level of their peers without a language disorder. Another person might define success as a child making greater progress with therapy than they would make without therapy, and by making substantial gains in the ability to communicate via alternate methods if verbal communication is not possible.
Early intervention is nearly always critical for young children with a language disorder, no matter the etiology, to make progress. The earlier intervention can take place, the greater the potential gains due to the neuroplasticity of young children.
Question: What is the prevalence of tongue clicking associated with stuttering in toddlers?
Answer: I cannot find specific statistics on the percentage of children who click their tongues in conjunction with stuttering, though it is definitely reported among some young children who struggle with this language disorder. Stuttering is five times more common in young boys than in young girls, and may prevent a minority of children from producing sound at all. Since stuttering affects fewer than one percent of adults, many children do outgrow this disorder as they develop. Early intervention is, of course, always advised with a speech-language-pathologist. Additional evaluation for hearing loss and other disorders (such as Tourette syndrome) by a qualified physician may also be recommended if any additional disorders are suspected.
Leah Lefler (author) from Western New York on December 17, 2012:
Thanks, haikutwinkle. We had a significant period of worry with my older son, as he had only a few true words at the age of two (he could say "go" and "uh-oh"). Fortunately, he received early intervention and is a typical developing 1st grader today!
haikutwinkle on December 17, 2012:
an excellent hub!
Leah Lefler (author) from Western New York on October 23, 2012:
Some speech and language problems are developmental, Pinkchic, and the kids manage to outgrow them. My children needed some extra help, and the speech therapy they received was tremendously helpful. If you are ever worried about your son, there are free screening services via Early Intervention or the school district (depending on age). My older son no longer requires intervention, but my younger son has a severe hearing loss and has a teacher of the deaf and speech therapist who work with him on a daily basis.
Sarah Carlsley from Minnesota on October 23, 2012:
Very interesting hub here. My son sometimes has problems with stuttering, which hopefully is something that passes with age.
Leah Lefler (author) from Western New York on August 23, 2012:
Thanks, Hyphenbird. My sons have been through a lot of speech therapy (and auditory therapy). With two children who have required intensive intervention, it is essential that the parent become knowledgeable about the conditions and therapies. A therapist is only with the child an hour or two per week, while the parent is with the child for most waking hours. Knowledge truly is power, and intervention is extremely effective if the parents are involved in the therapy!
Brenda Barnes from America-Broken But Still Beautiful on August 23, 2012:
You did an amazing job with this article. It is so interesting, well laid out and researched and entirely professional. I am impressed and thank you very much.
Leah Lefler (author) from Western New York on August 22, 2012:
anastasiaphillis, children who speak more than one language will take longer to speak the same number of words in each language, as they are trying to integrate the sounds of multiple phoneme sets. As long as her receptive language is fine (i.e. she understands things well), I wouldn't be concerned. I think it is absolutely fantastic she is learning three languages at an early age!
Leah Lefler (author) from Western New York on August 22, 2012:
Any parent with a worry about their child's development should always have it screened - it never hurts to have a speech or language screening done, and may help a struggling child significantly. We watch our Nolan's language closely, teaches12345, to make sure he is keeping up with his age-matched peers.
Anastasia Phillis from Chicago on August 22, 2012:
My daughter is 2 yrs and 8 months, and she is trilingual (I am Greek, her father is Italian and she is growing up in the States) so its hard for me to tell what "normal" would be. She talks all the time and understands pretty much everything but her talking might be a bit delayed by normal standards. I don't think I should be considering normal standards in her case though! Any words of wisdom? Thanks!
Dianna Mendez on August 21, 2012:
Excellent topic, well researched and written. You are so right, parents much keep watch on the language development of toddlers, if they do not display proper communication by certain ages, you must have it checked out. Love your charts with the speech sounds by age. Voted up.
Leah Lefler (author) from Western New York on August 21, 2012:
Thanks, Om. We were really stressed when our older son couldn't even imitate words at the age of 2. We would say a word like "cat" and he would say, "fah-vah." We are not certain if he had apraxia or if he had a phonological disorder - but with therapy he has done extremely well and now is quite articulate (unless he is trying to produce an unfamiliar word for the first time). My younger son will always require some intervention in school, as he has a progressive hearing loss and accommodations must be made - but he is doing very well with the necessary supports and early intervention!
Om Paramapoonya on August 21, 2012:
Truly awesome hub! I like how you discuss this fascinating topic in such great details. Also, excellent job on using tables to summarize different types of language development. Rated awesome and tweeted!