Developmental Delay: 
Speech and Language

Page Contributors:  Tiffany Lambright, MPH, RN, Anita Allouche, RN, BSN, BA, Kameron A. Sperduto, BSN, RN, and Heather Jenkins-Rosales, BSN, RN

Overview

• Speech Disorders caused by difficulties with the production of sounds, with articulation or pronunciation, stuttering, or vocal problems.
  
• Language disorders caused by problems understanding language (receptive language disorder) or difficulty communicating thoughts, ideas and/or feelings in words (expressive language disorder).
  
• Language delay is when a child’s develops language in the expected order but at a slower rate than average.
• Different types and causes of Childhood Speech & Language Disorders (American Speech-Language-Hearing Association, 2015)
• Speech and Language Delay and Disorder - University of Michigan Health System website
• Speech development by age (table)

Consider a referral for speech/language development evaluation for any child who (ASHA, 2013):

• doesn’t smile or interact with others (birth–3 months),
• doesn’t babble (4–7 months),
• makes only a few sounds or gestures (eg, pointing; 7–12 months),
• says few words (12–18 months),
• doesn’t understand what others say (7 months–2 years),
• doesn’t put words together (18 months–2 years),
• has speech that is unintelligible to unfamiliar listeners (2–3 years),
• struggles to say sounds or words (2½–3 years).

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Assessment & Screening

• Ages and Stages Questionnaire for development screening ($)
• Parents’ Evaluation of Developmental Status (PEDS) ($)
• The Survey of the Wellbeing of Young Children
  

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Position Papers

• Screening for Speech and Language Delay and Disorders in Children Aged 5 Years or Younger: US Preventive Services Task Force Recommendation Statement (2015) 
• Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening (AAP, 2006) -- Open Access AAP Policy Statement *Includes table of screening tools: AAP Council on Children with Disabilities.

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Articles

• Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood (Prelock, et al, 2008)
• Ten questions about terminology for children with unexplained language problems (Bishop, 2014) 
• Management of Developmental Speech and Language Disorders (O'Hare & Bremner, 2016)
• Validity of the ages and stages questionnaires in term and preterm infants (Schonhaut, et al, 2013)

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Resources

Treatment 

• In California, if under the age of 3, refer to local regional center. If over 33 month of age, refer to local school district.

Interventions

• Find your local Regional Center (California)
  
• Reach out and Read
• Hanen Centre
• Activities to promote speech

Other resources: 

• Information about Early Intervention Law
• Healthy Children.org -- Speech and Language
• CDC page on Developmental Monitoring and Screening in Children
• Ability Path (Parents) -- includes video on speech and language development
• Kids Health - Delayed Speech or Language Development (Parents)
• Tips for Helping Toddlers Develop Language at Home - video

Organizations

• American Speech Language Hearing Association
  
• Parent to Parent USA
• Apraxia Kids (Providers and Parents) *Includes Webinars ($) 
  
• Healthy Child.Org (From the American Academy of Pediatrics): www.healthychildren.org
• Developmental Delay Resources (DDR): www.devdelay.org/
• Help Me Grow National Center: www.helpmegrownational.org
• First Signs: www.firstsigns.org
• Act Early! National Center on Birth Defects and Developmental Disabilities: www.cdc.gov/ncbddd/autism/ActEarly/default.htm
• National Center of Medical Home Initiatives for Children with Special Needs: www.medicalhomeinfo.org/
• Zero to Three: www.zerotothree.org
• National Institute of Health (providers)
• Center for Parent information and Resources (ParentHub)

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