Introduction

Speech is undoubtedly one of the most powerful tools we use to communicate and connect with others. From a baby’s first words to a toddler’s growing vocabulary, the way speech develops is indeed a remarkable journey. For some children, however, this journey takes longer. This is what is known as speech delay.¹ In this article, we will go through what speech delay is, how it differs from typical development, and how families and professionals can help children with speech delay thrive.

Understanding speech delay

Speech is developed during preschool years, and when this development is impacted in children within the developmental period (2 years, 0 months to 8 years, 11 months), it is known as speech delay. This occurs when the development of the ability to understand and speak is correct, but it is slower than what is considered normal. It’s essentially when a child’s conversational speech is either not where it is expected to be at their age, or is characterised by speech sound error patterns which are not appropriate for the child’s age.^1,2

Speech development milestones: what is expected

To understand speech delay, it is helpful to know what typical speech development looks like. Speech in itself involves the production of speech sounds. From the moment they’re born, babies can recognise their parents' voice. Though crying is their first vocal act, it's just the beginning. 

In the first few months of life (one to four months), babies begin to produce vowel-like sounds, known as cooing. Between three and eight months, they start producing clearer vowel sounds and playful noises like raspberries. At five to ten months, babbling or the sequential production of a consonant and a vowel, like “babababa”, occurs. The speech sounds “m,” “b,” and “p” tend to be produced early because they are easy to imitate. By the age of one year, most babies will be able to say the words “mama” and “dada.” Between ages one and two, most toddlers will be able to name a few common objects when asked, and by two years of age, most toddlers will be able to say two-word phrases, such as “all gone.” Between ages two and three, caregivers will be able to understand their toddler’s speech most of the time, and toddlers should be able to use two to three-word phrases to ask questions or describe events, as well as use speech to get someone’s attention or make a request. While they may, at this age group, repeat starting phrases or words such as “I, I, I, I want”, they shouldn’t get stuck or frustrated. Between ages three and four, unfamiliar listeners should be able to understand a child’s speech, and they should be able to speak in longer sentences of four or more words, as well as describe events and talk fluently, without repeating syllables or words. Between ages four and five, children should be able to communicate clearly and easily with other children and adults, as well as say sentences in lots of detail, such as “I like to read my books.” Most sounds should be said correctly, with exceptions in “th,” “ch,” “r,” “l,” “s,” and “z,” which may not yet be accurate.^3,4,5 

These are some speech milestones that most children will reach at certain ages; however, it is important to note that every child develops in their own unique way and at different rates. These milestones, however, are helpful guides in tracking speech development, and they are what is expected of children within the developmental period. If you notice any delays in speech in your child, this may be a sign of speech delay, and it is worth speaking to a medical professional.⁵

Causes of speech delay

Speech delay is quite common and can result from a wide range of medical and non-medical factors. Some of these factors include: ⁶

Medical factors 

• Hearing loss
• Low birth rate 
• Birth asphyxia 
• Seizure disorder 
• Autism Spectrum Disorder - studies show that up to half of children with confirmed speech and language delay have autism too⁷

Non-medical factors 

Family-based risk factors 

• Consanguinity - this means being related to someone by birth, not marriage. It is a significant risk factor, and studies show it can also be a risk factor for hearing loss, leading to speech delay
• Someone in the family has a speech-language disorder - such as stuttering, unclear speech, late speaking, poor vocabulary or dyslexia 

There are also environmental risk factors, such as trauma and watching television for more than two hours.⁶

Signs of speech delay

In order to know if your child may have a speech delay, it is important to keep a check on whether they are reaching the expected milestones required at their age range, which we have discussed above. If your child is delayed in several of these milestones, this may be a sign of speech or language delay. In addition, sometimes a related sign may be that children show behaviour problems, such as temper tantrums, because they are frustrated when they cannot express what they need or want.⁵ If you are concerned about your child experiencing a speech delay, you should speak to a medical professional for advice.

Diagnosis and management of speech delay 

If speech delay is suspected, the first step is to find out what the reason for this may be. Diagnosis of the underlying cause of speech delay - some of which have been listed above is what guides effective management. To begin with, a child suspected of having a speech delay should first be sent for an audiometry (hearing test) to rule out if their speech delay is due to a cause of hearing loss.  

Other causes that a medical professional might look out for include global developmental delay and autism spectrum disorder. Speech delay may be an early presenting feature in children with global developmental delay, therefore providing an important early opportunity to intervene. Both global developmental delay and autism spectrum disorder require a broad approach, which a child development centre can look into. Children with craniofacial abnormalities, such as, Down’s syndrome, may suffer from both conductive deafness and developmental delay, which should be treated.⁷

Families should be quick to ask for help if they are worried their child may have a speech delay. Diagnosis is an effective tool for understanding and can be extremely beneficial in knowing how best to manage speech delay.

Interventions for speech delay

Speech delay is common, with around twenty per cent of children learning to talk or use words later than other children their age. Though sometimes a sign of a more serious problem, such as autism spectrum disorder or hearing loss, speech delay can also, at times, be temporary and may go away on its own, or with some extra help. Families can encourage their child to talk by using gestures or sounds and playing, reading, and talking with their child. Sometimes, your child may need more help from someone beyond family, such as speech and language therapists, who are trained professionals who can help work with children to develop or improve their speech patterns.⁵ 

Interventions may take place in many different settings, such as at home, school or in the clinic. They vary in duration and intensity depending on the child’s needs, the resources available, and the policies of individual speech and language therapy services. 

Interventions can be delivered both directly via the clinician or indirectly via a third person. Direct intervention is when a child is treated either one-on-one or within a group of children, depending on the age and needs of the children requiring therapy, as well as the facilities available. On the other hand, indirect intervention focuses on a more natural approach, where adults in the child's environment, such as their caregivers, help the child communicate. This approach helps create a more supportive environment for the child by promoting positive parent-child interaction. Indirect approaches are being used more now in many settings, where speech and language therapists train professionals and carers who work with the children, as well as provide programmes or advice on how to enhance a child’s communication.⁸

In general, it is never too early to communicate with your baby. The best way for babies to learn to communicate is by face-to-face communication with others, and you can help with that by talking and reading to your baby. This can help develop a baby’s speech from the early days.⁵

Conclusion 

Speech is a valuable form of communication, and while speech delay can be a source of worry for many families, it is important to remember that your child is not alone. Speech delay is common and can, at times, go away on its own or with professional help. With early recognition, professional support, and loving engagement from families, children with speech delay can thrive.