Speech Delay

Speech Delay is a topic covered in the Select 5-Minute Pediatrics Topics.

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Basics

Description

  • Speech delay is delay in the acquisition of spoken language.
  • Language is a system of symbols through which humans communicate thoughts, feelings, and ideas. It has 3 components—receptive, expressive, and visual language.
    • Receptive language is the ability to process and understand language.
    • Expressive language is the ability to communicate through speech, written, or formal sign language.
    • Visual elements include eye contact, pointing, and gestures.
  • Speech delay can be primary as in specific language impairment (SLI) or developmental language disorder (DLD), or secondary to another condition such as a syndrome or neurologic disorder. SLI is impaired speech/language in an otherwise normally developing child who lacks signs or stigmata of other conditions.
  • Constitutional language delay, a retrospective diagnosis, is language delay associated with eventual achievement of normal speech and language milestones by school age. There are no subsequent difficulties with learning to read or write.
  • Expressive language disorders include the following:
    • Verbal dyspraxia: little speech produced with great effort, very dysfluent, single words most commonly
    • Speech programming deficit disorder: poorly organized, difficult-to-understand speech
  • Mixed receptive and expressive disorders
    • Verbal auditory agnosia: impaired ability to decode speech, resulting in a severe expressive impairment. Can often learn language visually
    • Phonologic/syntactic deficit disorder: most common type of DLD. Comprehension exceeds spoken ability. Speech is dysfluent, grammatically incorrect with short utterances.
    • Most frequent causes of speech delay:
      • Hearing loss
      • SLI
      • Autism spectrum disorder
      • Intellectual disability (formerly mental retardation)

Epidemiology

  • Up to 15% of 2-year-old have speech and language delays.
  • 5% of school-aged children have speech and language delays.
  • 3:1 male-to-female ratio in DLD

Risk Factors

  • Family history of speech/language delay or disorder
  • Male gender
  • Low maternal education
  • Maternal depression
  • Prematurity
  • Birth weight <1,000 g

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