Understanding Speech Delays

Although we often think of speech and language as one and the same, they are actually different entities. "Speech is the formation of the sounds of a language, the way in which words are formed and is a vehicle for language or thought," explains Penny Glass, Ph.D., a developmental psychologist and director of the Child Development Program in the Division of Behavioral Medicine, Department of Psychiatry and Behavioral Sciences at Children's National Medical Center in Washington, D.C. Language also includes important nonverbal ways of communicating, such as eye contact and pointing to get an adult's attention.

Kids may not always have speech delays along with language delays. A child with a language problem may have crystal-clear speech, and one with a speech impediment may have great comprehension. "The primary question should be, Is the child making an effort to communicate?" Dr. Glass says. If the answer is yes, this is much less likely to be a developmental disability.

What Is Speech Therapy?

Speech development begins with a new assortment of coos and babbles when a baby is about 9 months old. Infants begin to string together sounds and practice intonation by putting sounds such as "ma-ma," "ba-ba," and "da-da" together. But they usually don't quite know what they're saying. "If a child can just say 'ma-ma', you don't know what she means," Dr. Glass explains. "But if someone says 'Where's ma-ma?' and points to you and actually looks at you, then she's learning to understand the meaning of the word."

At 12 to 15 months, the variety of speech sounds increases and children may begin to practice their sounds, which begin to take the shape of words or word approximations. They are also able to understand routine requests such as putting something in the trash and they love to carry out such "errands." Between 18 and 24 months, they may combine a word and gesture to request something, begin to imitate a two-word phrase, and, after lots of practice, point to pictures in a book when the picture is named. By age 2, a child should have a 50-word vocabulary and should use these words to form two-word sentences. By this age children can also follow a two-step direction ("Please pick up the cup and give it to your sister").

Speech Problems in Children

The biggest boost in vocabulary takes place between the ages of 2 and 3. The child can comprehend descriptive concepts, especially words like big, and use more complex sentences. Toddler sentence structures correspond to ages. A 2-year-old should begin to combine two words in a sentence; a 3-year-old, three words; and so on. Parents should be able to understand about half of their child's speech when the child is 2 years old and about three-quarters by 3 years.

There may be a specific reason why a child doesn't understand language or can't produce speech. All newborns have their hearing screened before hospital discharge, but screening is not perfect and some hearing loss is progressive. In an otherwise quiet environment and without visual distractions, even a young infant should show a behavioral response to her parent's voice or another pleasant sound. If you're in doubt, ask your pediatrician to check your child's middle ear function for unwanted fluid and to retest your child's hearing. The same goes for children who can't imitate sounds, Dr. Glass says. As they get older, these children will have trouble with speech. Early and proper treatment is essential.

If you suspect a language or speech delay, focus first on receptive language, Dr. Glass says. You can enforce this with repetition. For example, before you show your infant his bottle, you should say the word. You can then present the bottle and say the word, and you should repeat the word as your child takes the bottle. It's a conditioning procedure. This technique is most effective when you're using specific words with common daily events while your baby experiences them, such as mealtimes, bath, bedtime, and being picked up. If your child comprehends appropriately, he'll show signs that he understands by looking at an object, smiling, or interacting. "I find that kids who understand language but are not producing it can learn expressive language," says William Levinson, M.D., a developmental pediatrician at Children's and Women's Physicians of Westchester in Valhalla, New York. If a child understands words, with speech therapy he will eventually be able to express himself with words.

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