Speech Delay

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 three 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-olds 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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