Speech Delay

1. See Also
   1. Language Milestone
   2. Language Milestone Red Flags
   3. Developmental Red Flags
2. Epidemiology
   1. Prevalence: 219% of children ages 2-7 years old in the U.S.
3. Diagnosis
   1. Language Milestone
   2. Language Milestone Red Flags
4. Causes: Primary Language Disorders
   1. Developmental Speech and Language Delay
      1. Delayed speech despite normal comprehension, intelligence, hearing, socialization, articulation
      2. Most common of the primary language disorders
      3. Expect normal speech by school age with parent and therapist intervention
   2. Expressive Language Disorder
      1. Presents in similar fashion to Developmental Speech and Language Delay
      2. Active intervention is critical as this does not correct spontaneously
   3. Receptive Language Disorder
      1. Delayed speech characterized as sparse, agrammatic, and with poor articulation
      2. Example: Does not respond to "point to the picture of the girl?" or "where is the dog?"
      3. Response to intervention is less than for other primary language disorders and longterm speech development is abnormal
5. Causes: Secondary Language Disorders
   1. Autism
      1. Associated with Echolalia, pronoun reversal, language regression and impaired communication
   2. Cerebral Palsy
      1. Associated with Incoordination of Tongue, Hearing Loss, cognitive delay
   3. Childhood Apraxia of Speech
      1. Difficulty creating sound in the correct order (speech is difficult to understand)
   4. Dysarthria
      1. Severity ranges from slurred articulation to completely incomprehensible speech
   5. Hearing Loss
      1. Before spoken language established: Distorted speech sounds
      2. Aftrer spoken language established: Gradual decline in articulation, and lack of progress in expanding vocabulary
   6. Cognitive Disorder
      1. See Developmental Milestones
      2. Overall Developmental Delay
   7. Selective Mutism
      1. Refusal to speak in certain social situations
6. Resources
   1. Books for parents
      1. Schwartz (2003) New Language of Toys
         1. Paid link to Amazon.com (ISBN 1890627488)
      2. Hamaguchi (2010) Childhood Speech, Language, and Listening Problems
         1. Paid link to Amazon.com (ISBN 0470532165)
   2. Web
      1. American Speech-Language hearing Association
         1. http://www.asha.org
7. Management: Referral
   1. Indications
      1. Language Milestone Red Flags
   2. Consultants
      1. Speech and language pathologist
      2. Early intervention program
      3. Audiologist
      4. Public school (as of age 3 years old)
8. Prognosis
   1. Early diagnosis and treatment prior to school age results in best outcomes
9. References
   1. McLaughlin (2011) Am Fam Physician 83(10): 1183-8 [PubMed]
   2. Schum (2007) Pediatr Clin North Am 54(3): 425-36 [PubMed]