when to be concerned about a speech delay

• what is a speech delay?
• what are the signs of speech delay?
• what is the treatment for a speech delay?

As parents, it's natural to compare your child to their peers as they grow. From their first words to their first steps, parents and caregivers anxiously await signs that their child is hitting the appropriate childhood milestones. There are many factors to consider when looking at your child’s development and that is especially true when talking about your child’s speech and/or language skills.

We sat down with Nicole Cyphert M.S. CCC-SLP and Marley Yarian, M.A. CCC-SLP, speech-language pathologists at Dayton Children’s Hospital, to learn more about childhood speech development, signs of a speech delay and treatment for a speech delay.

what is a speech delay?

A “speech delay” is a broad term used to describe when a child’s speech and/or language skills are below the level where they should be given the child’s age. Sometimes this label is given to a child whose skills are only behind in one communication area and other times their skills may be behind in multiple communication areas.

Communication areas are commonly lumped into the category of “speech delay

• Articulation (what we often refer to as “speech”): The ability to produce sounds and combine those sounds to create words.
• Expressive language: The ability to communicate a message to share ideas. This can be through words, sign language, pictures, gestures and actions.
• Receptive language: The ability to understand and comprehend a message that was communicated.

Some children may be described as a “late talker” by their health care provider. A “late talker” is a toddler (between 18-30 months) who has good understanding of language, typically developing play skills, motor skills, thinking skills and social skills, but has a limited spoken vocabulary for his or her age.

what are the signs of a speech delay?

Signs of speech delay vary by the age of the child. Below is a breakdown by month of what your child should typically be doing at each milestone. If they aren’t doing most of these activities, it’s possible they have a speech delay:

• By 12 months your child should be: Reaching/raising arms, open hand pointing, waving, showing/giving an object, imitating gestures (e.g. blowing a kiss), engaging in social interactions/playing games (e.g. playing peek-a-boo), copying simple sounds, saying 1-2 words, and responding to simple phrases (e.g. go bye-bye).
• By 18 months your child should be: Using a combination of long strings of sounds, syllables and real words with speech-like inflection, following simple directions such as “give the ball to daddy,” identifying 1 or more body parts, and using an increasing amount of gestures (e.g. clapping, high fives, index finger point, head nodding for yes/no).
• By 24 months your child should be: Using and understanding at least 50 different words, putting two words together (e.g. mommy outside), following two step directions (e.g. get the napkin and put it in the trash), and using words to request help.

For a comprehensive list of speech and language milestones by age, visit the Centers for Disease Control (CDC) website or the American Speech-Language Hearing Association (ASHA) website.

what causes a speech delay?

We don’t always know! In some cases, the cause may be environmental, such as a traumatic brain injury or fetal alcohol syndrome. In other cases, the cause may be due to affected genes, such as in Down syndrome or Fragile X syndrome. Frequent ear infections can also cause speech delays. And sometimes, there is no identifiable environmental or genetic factor at play. 

when should a parent be concerned about a speech delay?

If your child is not meeting developmental milestones, talk to your child’s pediatrician about a referral for a speech/language evaluation by a speech-language pathologist.

how are speech delays diagnosed?

During a speech/language evaluation, the speech-language pathologist will ask you questions about your child’s development and interact with your child to assess a variety of communication skills. The information collected will be analyzed and compared to same-aged peers to determine if a delay is present. 

what is the treatment for a speech delay?

The treatment for a speech delay is speech therapy services! There are various service delivery models including outpatient, in-home, virtual and school-based. Here at Dayton Children’s , we offer in-person and virtual outpatient speech therapy services that focus on direct, hands-on instruction, while also educating and empowering the caregivers to embed language stimulation into everyday routines at home. Our goal is to help you create a language rich environment in your day-to-day life to set your child up for success.

If your child is under the age of 3, they may be eligible for Ohio Early Intervention (Help Me Grow). This is a free, in-home service to all eligible children in Ohio. Call 1-800-755-4769 for more information.

If your child is age 3 and older, contact your local school district’s special education coordinator to request testing for public preschool.