A language delay is
that is significantly below the norm for a child of a specified age.
Language delay is a communication disorder, a category that includes a
wide variety of speech, language, and hearing impairments. The milestones
of language development, including the onset of babbling and a
child's first words and sentences, normally occur within
approximate age ranges. However, individual children vary enormously
regarding the exact age at which each milestone is reached. There also are
different styles of language development. Most children have acquired good
verbal communication by the age of three. But one child may be wordless
until the age of two and a half and then immediately start talking in
three-word sentences. Another child might have several words at ten months
but add very few additional words over the following year. Other children
start talking at about 12 months and progress steadily.
Language delay usually becomes apparent during infancy or early childhood.
Any delay in general development usually causes language delay. Children
with language delay may acquire language skills in the usual progression
but at a much slower rate, so that their language development may be
equivalent to a normally developing child of a much younger chronological
age. Maturation delay, also called developmental language delay, is one of
the most common types of language delay. Children with a maturation delay
may be referred to as "late talkers" or "late
bloomers." Maturation delays frequently run in families.
Speech/language delay is the most common developmental disorder in
children aged three to 16 years, affecting approximately 3 to 10 percent
of children. It is three to four times more common in boys than in girls.
Causes and symptoms
Common nonphysical causes of language delay include circumstances in which
the following are the case:
Language delay may result from a variety of underlying disorders,
including the following:
Mental retardation accounts for more than 50 percent of language delays.
Language delay is usually more severe than other developmental delays in
retarded children, and it is often the first noticeable symptom of mental
retardation. Mental retardation causes global language delay, including
delayed auditory comprehension and use of gestures.
Impaired hearing is one of the most common causes of language delay. Any
child who does not hear speech in a clear and consistent manner will have
language delay. Even a minor hearing impairment can significantly affect
language development. In general the more severe the impairment, the more
serious the language delay. Children with congenital (present at birth)
hearing impairment or hearing loss that occurs within the first two years
of life (known as prelingual hearing loss) experience serious language
delay, even when the impairment is diagnosed and treated at an early age.
However, deaf children born to parents who use sign language develop
infant babble and a fully expressive sign language at the same rate as
Symptoms of language delay include the following:
Language delays resulting from underlying conditions may have symptoms
specific to the condition. Nonetheless, specific symptoms of language
delay may include the following:
Mentally impaired children usually babble during their first year and may
speak their first words within the normal age range. However, they often
cannot do the following:
Mentally impaired children in conversation may be repetitive and routine,
. Nevertheless vocabulary and grammatical development appear to proceed by
very similar processes in mentally retarded and developmentally normal
In general the severity of language delay depends on the severity of the
mental retardation. Levels of retardation and language skill are ranked as
Language delays among mentally retarded children vary greatly. Some
severely mentally impaired children who also have
may acquire exceptional conversational language skills, sometimes called
the "chatterbox syndrome." Some children (called savants)
test as mentally retarded but learn their native language, as well as
foreign languages, very easily. With
and some other disorders, language delay is more severe than other mental
impairments. This factor may be due to the characteristic facial
abnormalities and relatively large tongues of Down-syndrome children.
Children with Down syndrome also are at higher risk for hearing impairment
and ear infections that cause hearing loss.
Symptoms of language delay in a hearing-impaired child include the
Dyslexic children have difficulty separating parts of words and single
words within a group of words. Symptoms of dyslexia may include:
A learning-disabled child usually exhibits an uneven pattern of language
development. In addition, about 50 percent of autistic children never
learn to speak. Those who do speak often have severe language delay and
may use words in unusual ways. They rarely participate in interactive
dialogue and often speak with an unusual rhythm or pitch. The speech of
some autistic children has an atonic or sing-song quality.
Children with congenital blindness average about an eight-month delay in
speaking words. Although blind children develop language in much the same
way as sighted children, they may rely more on conversational formulas.
The speech of children with receptive aphasia is both delayed and sparse,
ungrammatical, and poorly articulated. Children with expressive aphasia
fail to speak at the usual age although they have normal speech
comprehension and articulation. Children with defined lesions in language
areas on either side of the brain have initial but quite variable language
delays. Usually their language catches up by the age of two or three
without noticeable deficits.
Apraxia affects the ability to sequence and vocalize sounds, syllables,
and words. Children with apraxia know what they want to say, but their
brains do not send the correct signals to the lips, jaw, and tongue to
form the words. In addition to language delay, apraxia often causes other
Children who are not talking at all by the age of two should have a
. Children who are not progressing in word-learning skills by the end of
the first grade should be tested for dyslexia.
Diagnosis of language delay requires a complete physical examination and a
thorough developmental history, with special attention to language
milestones. In young children it may be very difficult to distinguish
between a late talker and a developmental expressive disorder. The
diagnosis often is made by a speech/language pathologist. Language
performance of bilingual children must be compared to that of other
bilingual children of a similar cultural and linguistic background.
Generalized delay in all developmental milestones suggests mental
Numerous tests are used to screen for language delay and assess language
development. Some of these are described below:
Other tests for language delay include:
About 60 percent of language delays in children under age three resolve
spontaneously. Early detection and intervention for language delay can
help prevent social, cognitive, and emotional problems. Treatment of
language delay is individualized for each child with the primary goal of
teaching the child strategies for comprehending spoken language and
producing appropriate linguistic or communicative behavior. Depending on
the type and cause of the delay, the healthcare team may include a
physician, a speech/language pathologist, an audiologist, a psychologist,
an occupational therapist, and a social worker. Psychotherapy may be
recommended if the language delay is accompanied by
or depression. Speech therapy is used to help mentally impaired children
develop intelligible language. Behavior therapy may help autistic children
progress in speech acquisition.
Hearing-impaired children who are identified and receive early
intervention before six months of age develop significantly better
language skills than children identified after six months of age. Early,
consistent, and conscious use of visual communication modes such as sign
language, finger spelling, and cued speech, and/or hearing amplification
and oral training can reduce the language delay. Since only about 10
percent of deaf children are born to deaf parents, hearing parents can
promote their deaf child's language development by learning and
using sign language. Many types of hearing aids are available for children
as young as three months.
may be used for profoundly deaf children aged two to six. These children
usually develop better language skills than those with hearing aids or
With appropriate intervention language-delayed children usually catch up
with their peers. Children with maturation delay usually have normal
language development by the time they enter school. Although a bilingual
home environment can cause a temporary language delay, most children
become proficient in both languages before the age of five. Nevertheless,
early language delays may cause problems with behavior and social
interactions. A language delay can lead to elective
, a condition in which children choose not to speak.
Such children typically speak when they are on their own, with their
friends, and sometimes with their parents; however, they will not speak in
school, in public situations, or with strangers.
Most mentally retarded children eventually develop at least some degree of
language. But frustration and anger at their inability to communicate
effectively can lead to numerous social and behavioral problems. An
adolescent with Down syndrome and an IQ of about 50 may speak at the
grammatical level of an unaffected three-year-old, with short, repetitive,
simple sentences. Nevertheless, Down-syndrome children often are very
sociable and interested in conversational language.
Children who receive early intervention for hearing impairments can
develop at nearly the same rate as other children. However, depending on
the severity of their hearing loss, they may continue to have difficulties
with articulation and speech quality as well as with written language.
Children who lose their hearing after the first few years of life have far
fewer language delays than children who are deaf from birth or who lose
their hearing within the first year.
Most children with receptive aphasia gradually acquire a language of their
own, understood only by those close to them. Children with expressive
aphasia will not develop normal language skills without intervention and
are at risk for language-based learning disabilities.
There are no known preventions for most language delays. Prenatal care and
during pregnancy and early childhood may help prevent some expressive
language delays. Hearing-impaired children who use sign language within
their families usually have no signed-language delay.
—Impairment of the ability to make purposeful movements, but not
paralysis or loss of sensation.
—A developmental disorder in which a child has lower-than-normal
proficiency in vocabulary, production of complex sentences, and word
recall, although language comprehension is normal.
—Developmental language delay; a language delay caused by the
slow maturation of speech centers in the brain; often causes late
—A developmental disorder in which a child has difficulty
comprehending spoken and written language.
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631 6th Ave. South, Second Floor, St. Petersburg, FL 33701. Web site:
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