Speech Delay Concerns (for Physicians)
If you or a parent have concerns about a young child’s speech development, we recommend the following steps:
- Validate the concern. There are many lists of language milestones, but your best bet is to use a standardized developmental screening tool, such as the Ages and Stages Questionnaire®. This will not only help confirm that there is a problem, but help you with the differential diagnosis. If the child is 18 months of age or older, an MCHAT would also be appropriate (available for free on the First Signs website).
- Arrange for hearing evaluation if not recently done. As one-third of childhood hearing loss is progressive, we cannot rely on only the newborn hearing screen. Also, be aware that the commonly done otoacoustic emission can be falsely reassuring in the rare cases of an auditory neuropathy.
- Refer for Early Intervention Services if less than 3 years of age, and to the ISD if older than three. You may consider an additional referral for private speech services rather than waiting to see what services are provided by Early On or the schools and the child’s progress with these services (insurance and transportation are other considerations, of course).
- Consider your differential diagnosis, which will help you decide if the above is sufficient or if referral for further evaluation is warranted.
Differential Diagnosis of Speech Delay
Oral malformation, such as cleft lip and palate: If child is under the care of a craniofacial program, the speech issues will be addressed in their program.
Speech Delay: Immature pronunciation and delayed intelligibility for age.
Childhood Apraxia of Speech: Speech affected by difficulty in controlling the oral musculature, in the absence of a broader motor disorder, such as cerebral palsy. Features include inconsistency of speech production, as well as other signs of difficulty with oromotor control, such as trouble chewing or excessive drooling for age.
Specific Language Impairment: Delay in acquisition of language, often receptive and well as expressive, with age-appropriate non-verbal skills.
Autism: Impaired communication accompanied by impaired social interactions and atypical, often repetitive behaviors. There is absence of pretend play and joint attention, and very few activities that engage the child.
Cognitive Impairment: The speech delay is “the tip of the iceberg”, with receptive language and non-verbal skills delayed as well.
A speech and language pathologist (SLP) will be able to diagnose childhood apraxia of speech and speech delay, while neuropsychological testing is needed to diagnose cognitive impairment and specific language impairment (although the input of the SLP is very helpful in that process and well). The diagnosis of autism is ideally made by a multidisciplinary team, but depending on local resources, may be made by a psychologist, psychiatrist or developmental pediatrician.
Resources at Helen DeVos Children’s Hospital:
Speech Delay Community Resources:
There are many excellent SLPs and psychologists in our communities, some practicing in schools or with Early On, some in private practice, and some associated with facilities such a Mary Free Bed and Hope Network.
Speech Delay Web Resources:
Speech Apraxia: apraxia-kids.org
Speech Delay: speechdelay.com
Speech Delay Articles
Speech and language Development and Disorders in Children, H Sharp & K Hillenbrand, Pediatr Clin N Am 55 (2008), p 1159-1173
Autism: Definition, Neurobiology, Screening, Diagnosis, I Rapin & R Tuchman, Pediatr Clin N Am 55(2008), p 1129-46.
“How Should You Evaluate a Toddler for Speech Delay?” J Jackson et al, J Fam Practice 60(4) 2011, p 230-1.