Page header image

Speech and Language Problems

What are speech and language problems?

All children seem slow in the early stages of learning language, but some children continue to have problems. A problem with speech can be either a disorder or a delay.

Speech and language disorders describe children whose speech and language is not developing normally. This is the most common developmental problem in preschool children.

A speech or language delay describes a child whose skills are developing, but at a slower rate than normal.

A speech problem can be mild, moderate, or severe. It can affect your child's emotional and social interaction with your family, friends, and in school. You and your health care provider should carefully watch your child's progress into the school-aged years.

Speech is the actual sound of spoken language. Speech is divided into three parts: articulation, voice, and fluency.

  • Articulation is making sounds. Children who have articulation problems will probably substitute, leave out sounds, use other sounds in place of the correct sound, or change normal speech sounds. For example, it is not unusual for 3 year olds to substitute the "f" sound for "th" in their speech; "I am firsty (thirsty)." These errors should not, however, be present in the speech of a child over 5.
  • Voice disorders are when there is an abnormal voice quality, pitch, or loudness when speaking. It may result from an abnormal larynx (voice box) or breathing pathway. It may be caused by misuse or abuse of the voice box, like always screaming.
  • Fluency disorders are problems with keeping a normal rate and rhythm of the flow. Examples are stuttering and stammering.

What is the cause?

There are many possible causes of speech and language problems including:

  • developmental disorders or delays
  • hearing loss
  • mental retardation
  • autism or pervasive development disorder (PDD)
  • learning disabilities
  • lack of people using language around the child so the child will learn
  • nerve or muscle problems such as cerebral palsy, muscular dystrophy, or a brain injury
  • face or mouth deformity such as, cleft lip or cleft palate
  • problems with decoding speech

What are the symptoms?

You may notice that your child may be learning to speak later than you expected. Or, your child's speech may be unclear. You may also notice that your child needs you to repeat directions before completing a task correctly. The earlier your child is diagnosed the better.

The following are problems to be concerned about. Call your child's provider during office hours if your child:

  • Does not understand his name, the meaning of "no," and a few words or simple commands by age 1 year.
  • Is not saying words by 14 to 16 months of age.
  • Cannot answer basic "what," "where," "who" questions by age 3 years.
  • Has trouble being understood by people outside the family after age 3.
  • Has any unusual facial, vocal, or breathing behaviors when speaking.
  • Has noticeable hesitations or repetitions in speech past age 5 years.
  • Is chronically hoarse without having a cold.
  • Cannot tell a simple story in the right order by age 5.
  • Cannot tell a more detailed story by age 7.
  • Shows limited increase in new words.
  • Shows poor school performance.
  • Shows a good ability to do physical things, but has trouble talking.

You should not "wait and see" if a problem goes away or continues. You may miss many months of valuable therapy.

How is it diagnosed?

Your health care provider will check to see if your child has mastered the important language milestones. These milestones are a guide to help you and your provider decide if your child needs speech and language testing.

                 Milestones for Normal Speech 
      Age              Speech 
    --------------    -------------------------------------
    Birth             Single cry for everything
    2 to 3 months     Different cry for different needs; 
                      cooing in response to attention
    3 to 4 months     Random babbling 
    5 to 6 months     Rhythmic babbling 
    6 to 11 months    Imitative babbling 
    12 months         1 to 2 words 
    18 months         5 to 20 words 
    24 months         2-word sentences, knows more words

During the first 12 to 18 months, a baby learns social skills, how to make sounds, and how to understand what you are saying. Your baby learns that his own behavior (smiling, making sounds) has a powerful effect upon the behavior of others.

As a child gains more control of his muscles, he can make more and better sounds. A baby learns by watching adults and learning the subtleties of speech and language.

At 18 to 24 months, children frequently have a vocabulary spurt from 5 to 10 words to more than 50 words. Children begin to use single words to communicate and eventually combine words. Children start understanding language a lot more when they are about 2 or 3 years old. Children understand more language than they can express during their early years.

All children suspected of having a speech/language problem should have hearing tests. An audiologist experienced in testing babies and young children will test your child.

What are language disorders?

Language is a system of verbal, written, or gestured symbols that are used to communicate. Language has several parts that develop at the same time. Language is divided into content, form, and use.

  • Content, or semantics, refers to the meaning of the message.
  • Form includes grammar and syntax. Grammar and syntax refer to rules that define the structure and organization of words to form sentences.
  • Use refers to the use of language both verbal and nonverbal.

Receptive and expressive language disorders:

  • A receptive language disorder means that you don't understand what's being told to you.
  • An expressive language disorder means you don't know how to tell someone else something.

What kind of testing and therapy will my child have?

Speech therapy is available even for infants. Only a specialist in the evaluation of speech/language disorders can accurately tell which children will need treatment and what treatment is best for each child.

Successful treatment depends upon identifying the problem early. When your doctor suspects your child has a speech or language disorder, he or she will refer your child to a qualified speech/language pathologist. Your child will also need to have a hearing test.

Speech/language pathologists are certified by the American Speech, Language and Hearing Association. In many states a state license is also required. A speech and language evaluation will identify the nature and severity of the disorder or delay, identify possible causes, and outline a treatment program.

Your doctor may find that assessment or treatment may also involve referral to other professionals such as a developmental pediatrician, learning specialist, neurologist, otolaryngologist, psychiatrist, or psychologist.

Language therapy is done to:

  • improve your child's ability to understand language
  • increase your child's vocabulary
  • expand your child's use of expressive words and sounds
  • help your child develop language to an appropriate level.

If your child cannot speak, language therapy will focus on providing another system of communication. This can include the use of a gestural or sign language, picture boards, or an electronic device.

How can I help my child at home?

  1. Talk to your child.

    Children learn words and the rules for using them by listening to others talk. They model their language behavior after you. Therefore, what you say and how you say it is important. Talking is a natural part of many daily routines such as mealtime, bath time, and dressing. Your child can expect certain language to be used over and over again within his familiar routines.

  2. Encourage your child to ask for items, make choices, and answer questions at his language level.

    Teach your child to use words instead of crying or pointing to satisfy his basic wants or needs.

  3. Listen to your child.

    Encourage storytelling and sharing of information.

  4. Encourage play.

    Provide objects and toys appropriate to your child's level of play. Use the toys yourself and call your child's attention to how you use them. Set aside a special time each day to play with your child. Give him opportunities to play with other children.

  5. Sing or provide music for your child.

    Help your child learn new songs. While singing, a child learns new words and sentence patterns, memory skills, listening skills, imitation, and expression of thoughts and feelings through words.

  6. Plan family trips and outings.

    Language is based on ideas and experiences. Talk about the new experiences.

  7. Read to your child.

    Ask a librarian for books appropriate for your child's age. Reading provides an opportunity to teach and review words and ideas.

For more information, write or call:

American Speech-Language-Hearing Association
10801 Rockville Pike
Rockville, MD 20852
(301) 897-5700

Written by the Section of Developmental-Behavioral Pediatrics, Hackensack Medical Center's Institute for Child Development in Hackensack, New Jersey.
Published by McKesson Provider Technologies.
Last modified: 2006-09-12
Last reviewed: 2006-08-22
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright 2006 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.
Page footer image