It is common for parents to worry about the pace of maturity and development in their children. But some parents may be perplexed when their otherwise healthy and normal child does not begin talking – even after his or her second birthday passes. While it is true that every child progresses at his or her own rate, delayed speech skills may be a good reason for a visit to a physician or a child specialist.

Speech and Language Development

Generally speaking, there are certain milestones for development of speech and language in kids. For instance, children should be able to say simple words clearly at 12 to 15 months of age. By 18 months, the child should possess the ability to understand basic commands like “stop” and “no.” Before their third birthday, most children can talk in short sentences; and they can tell a simple story by age 5. Children who do not reach these benchmarks are said to suffer from a delay in speech and language development.

There are many causes of speech and language delay.

Mental Retardation

Nearly 50 percent of speech and language delay cases are due to mental retardation. Many mentally retarded children exhibit impairments in hearing and understanding words as well as the use of gestures; and the more severe the retardation, the greater the delay in speech. Mental retardation can be caused by conditions such as intrauterine infections in the mother during pregnancy, genetic defects, meningitis (inflammation of the membranes covering the brain), trauma to the central nervous system, and hypoxia (a lack of oxygen in the blood).

Loss of Hearing

Loss of hearing is another common cause of delay in speech. Children must be able to hear properly in order to understand sounds and develop a vocabulary. Hearing loss can occur as a result of otitis media with effusion (inflammation of the middle ear), the presence of fluid in the middle ear during the first years of life, atresia of the external auditory canal (the absence of an opening in the ear), middle ear structure malformations, chromosomal abnormalities, intracranial hemorrhaging (bleeding inside the cranium), hypoxia, and meningitis. Whenever hearing loss is present, there will usually be a delay in speech and language development.

Delay in Maturation

Sometimes, there is a delay in the maturation of the central neurologic process that is responsible for speech development. In other words, speech delay can result when the procedure where the brain sends signals to the muscles in the tongue, lips, and mouth is slow to develop. This condition is seen more in boys than in girls and is often rooted in genetic problems. But in most cases, these children improve their language skills to the point where they catch up with their peers by the time they enter school.

Expressive Language Disorder

Even children who have normal intelligence, articulation, and hearing may still be unable to put their thoughts into words. In these cases, the cause may be a dysfunction in the area of the brain responsible for translating ideas into speech. Children with expressive language disorder tend to communicate by means other than the spoken word, such as gestures or facial expressions.

Bilingualism

Bilingualism often exists when a child’s parents are fluent in two different languages. Since children of these couples are exposed to a larger number of sounds and words, additional time may be required for them to formulate their language skills. Usually, such children become proficient in both languages before they reach 5 years of age.

Autism

This is a neurological developmental disorder which impedes speech and language skill development. Autism is characterized by abnormalities in the function or structure of the brain, though what causes these abnormalities is not known, autistic children display deviant speech habits such as speaking in a singsong voice, discussing a limited range of topics, referring to themselves in the third person, or failing to relate to the person they are speaking to. Autism is found three to four times more often in boys than in girls.

Psychosocial Deprivation

Children who live in poverty and malnourishment often demonstrate delays in speech. This phenomenon is attributed to inadequate stimulation of their linguistic skills due to conditions such as parental absenteeism, emotional stress, and social deprivation. For the same reasons, psychosocial deprivation is also seen in children who are neglected or abused by their parents. If the child can be removed from the problematic domestic situation, their speech and language skills will often improve dramatically.

Elective Mutism

Unlike autism or a delay in maturation, elective mutism is seen more frequently in girls than in boys. These children may be unusually shy and timid and will not enjoy talking to anyone other than their parents or a few friends. As a result, kids with elective mutism may develop poor language skills and peer relationships. Though the cause is often psychopathological in nature, elective mutism may also occur after a traumatic event or a severe injury to the mouth or throat.

Receptive Aphasia

Children who suffer from this condition appear as if they are not listening to a person speaking to them. Like autism or expressive language disorder, a brain abnormality is the root cause of receptive aphasia; and the condition may be mild, moderate, or severe. Not only may a speech delay be present, but these kids may also have difficulty developing reading and writing skills.

Other Causes

There are several other possible causes of speech and language delay, though they tend to occur less frequently. These include:

 

• Cerebral palsy, a form of paralysis that affects motor functions

 

• Ear infections

 

• A short frenulum, which is the fold beneath the tongue

 

• Problems with the tongue and palate

 

• Oral motor problems, these are inefficient communications in the areas of the brain responsible for speech

 

To effectively manage a child with speech and language delay problems, a collective effort by a diverse health care team is necessary. A primary care physician attempts to diagnose the type of speech delay and relays his findings to other members of the health care team. He or she will also repair any defect that can be corrected. A speech language pathologist formulates a treatment plan for the child and employs comprehension and communication strategies that are designed to improve the child’s linguistic abilities. The speech pathologist also advises parents on how they can encourage their child to develop these skills. If the speech and language delay is due to hearing loss, an audiologist is consulted. This specialist may recommend hearing aids, auditory training, sign language instruction, lip reading, or even surgery to correct or combat hearing loss. A psychologist may be incorporated into the health care team to help children who have elective mutism or autism by giving them psychotherapy or behavioral therapy.

Communicating with Children

As soon as children are born, it is essential that parents begin talking to them on a regular basis. As early as six months of age, infants can benefit from parental activities like reading to them from picture books and helping them identify pictures. Other strategies like pointing out objects in a room, imitating sounds, and identifying foods at a grocery store will also help children develop their speech and language skills. But if parents suspect that their child is not making adequate progress in this area, they should contact their pediatrician for advice on how to proceed.