Special Advice: Get serious about baby talk

A look at speech and language development problems in children


Five to 10 per cent of all children have a developmental disability that causes a delay in their speech and language development. Language development involves more than just speech and includes other forms of communication such as sign language, writing and visual skills (pointing and gesturing).

A speech delay can be caused from problems with the output of speech (problems with the vocal chords), the input of speech (hearing loss) or the processing of speech (mental retardation and developmental language disorders). The two main types of speech delays are expressive delays and receptive delays. Some children may have a mix of both expressive and receptive.

Most children with speech delays have a developmental language disorder (DLD) with an expressive delay and will meet normal age appropriate visual language skills. They seem to have normal comprehension or understanding of other's speech. These children will also meet normal age appropriate auditory receptive skills. With early intervention most of these children will have improved speech by the time they begin school and their speech will ultimately become normal.

Some children with an expressive delay are just 'late talkers' and have a constitutional delay in their speech development. These children will develop normal speech and language skills without treatment as they get older. Unfortunately, there is no way to differentiate between children who need treatment and those who don't. A parent can tell only in hindsight and it is not advisable to just 'wait and see'.

Another important cause of speech delay is hearing problems. Therefore all children suspected of having a speech or language delay should have their hearing formally tested.

It is not enough that parents think he hears because he responds to a loud clap or bell in the doctor's clinic or because he comes when you call him from another room. They should be screened for a hearing loss with a simple audiometry test. Children aged below four usually need to see an audiologist for a more detailed testing.

In addition to a formal hearing test and assessment by a paediatrician, children with speech and language delays should be referred to an early childhood intervention programme so that a speech therapist can initiate evaluation and treatments.

Another important cause of speech delays includes mental deficiency and pervasive developmental disorders including autism. In addition to expressive and receptive delays, children with these conditions will also commonly have a delay in their visual language skills like recognising objects, responding to facial expressions and following commands that are accompanied with a gesture.

Examples that don't cause speech delays are a child being tongue-tied, lazy, having a lot of siblings talk for him or living in a bilingual family.

Discuss with your paediatrician if your infant is not meeting these milestones on time or he has a regression or loss of language skills that he has already learned.

Newborns can localise sounds to their right or left side shortly after being born and will turn head to look in the direction of a sound.

This works best with loud noises and when your baby is awake and alert but they should also be able hear soft sounds.

Infants learn to recognise their parents by one to two-and-a-half months.

Infants can imitate speech sounds by three to six months.

Help your child speak

In case your child has a speech problem, besides referring him for an evaluation and treatment this what you can do among other things:

- Read to your child – especially picture books where you can point and name.

- Use simple language when you talk to your child and ask a lot of questions. You can also keep narrating out loud the things you are doing.

- Respond to your child's speech and give positive reinforcement when he does talk.

- Repeat and expand on what he says, turning his single words into simple phrases or sentences.

- Be patient and give him time to say what he wants. Don't rush him

- Don't force him to talk by withholding something he wants. This could lead to stress and frustration.


Lookout for these milestones

Listed below are early speech and language milestones, and include the upper limit of when 75 per cent of infants meet this milestone, so your child may still be developing normally if he has not mastered a milestone by the age indicated. These milestones should be used as a general guideline to help identify infants that are at a risk of having speech and language problems.

- Monosyllabic babbling or making isolated sound with vowels and consonants (ba, da, ga, goo) usually begins by four to eight months.

- Polysyllabic babbling or repeating vowels and consonants (bababa, lalala) usually begins by 5-9 months.

- Comprehending individual words (mommy, daddy, no) usually occurs by six to 10 months.

- By six to nine months many infants can follow a one step command with a gesture. By 7-11 months he should be able to follow a command without a gesture.

- The first word (other than mama/dada) is usually spoken by nine to 14 months.

- By 10-15 months, the child should be able to point to an object that he wants.

- By 11-20 months, your child should be able to say four to six words.

- He should be able to follow a two-step command without a gesture by 14 to 21 months.

- By 16 to 20 months, your child should be able to tell what he wants using words.

- He should be able to point to one or more body parts by 14-18 months, increasing to six body parts by 22 months.

- Two word combinations or sentences are used by 18 to 22 months.

- A vocabulary spurt leading to a 50+ words occurs by 16 to 24 months.

- Pronouns are used between the ages of 19 to 26 months, although they may still be used incorrectly and reversed. This tends to correct itself out by 30 months.

- By 24 months a child's speech should be half understandable by strangers or by someone who is not routinely around the child.

- By 24-32 months, he should be able to name four pictures.

- Conversations with two to three simple sentences put together can usually occur by this time.

- By 29-34 months your child should be able to give the name and use of at least two objects.

- The child should be able to name one colour by 2-½ to 3-¼ years and this will increase to four colours by three to 4-¼ years.

- By three years his speech should be 75 per cent understandable by strangers, or someone who is not routinely around the child. By this time he normally has a vocabulary of about 250 words.

- His speech should be fully understandable by four years with a vocabulary of well over 600 words.


- The information in the articles has been provided by Ayesha Saeed Hussaini. An educational pyschologist and practising at the Comprehensive Medical Centre, Dubai, Ayesha is currently