This document summarizes information about speech and language delay in children. It defines speech as the verbal production of language, while language refers to the conceptual processing of communication, including both receptive and expressive abilities. The prevalence of speech and language delay is reported to range from 2.3-19% in children under 5 years old. Causes can include hearing loss, mental retardation, maturation delay, bilingualism, psychosocial deprivation, autism, and various physical factors. The document outlines typical developmental milestones and provides screening tests to evaluate potential delays.

1. Speech and language delay in children
JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND
PREVENTIVE DENTISTRY
| Apr - Jun 2012 | Issue 2 | Vol 30 |

2. Communication delay
Speech
Delay
Language
Delay

3. INTRODUCTION
 Speech and language development in children is a
dynamic process.
 Speech and language development is one of the most
useful pointers of a child’s overall development and
intellectual functioning

4. Definition
 SPEECH- refers to the mechanics of oral communication or the
motor act of communication by articulating verbal expressions.
 Speech is the verbal production of language.
 Speech delay, also known as alalia, refers to a delay in the
development or use of the mechanisms that produce speech.
.

5. Definition
 language is the conceptual processing of
communication.
 Language includes receptive language (understanding)
and expressive language (the ability to convey
information, feelings, thoughts, and ideas).
 Language delay refers to a delay in the development or
use of the knowledge of language.

6. PREVALENCE
 Prevalence rates for language delay have been reported across
wide age ranges and samples.
 Disorder is three to four times more common in boys than
in girls.
 For children aged less than 5 years, studies have reported
prevalence rates ranging from 2.3% to 19%
 Prevalence of speech and language delay with a mean age of
6.1 years was found to be 16.27% and the male to female ratio
was 2.76:1.

7. The Difference Between Speech
and Language
 Speech and language are often confused, but there is a
distinction between the two:
 Speech is the verbal expression of language and includes
articulation, which is the way sounds and words are
formed.
 Language is much broader and refers to the entire system
of expressing and receiving information in a way that's
meaningful. It's understanding and being understood
through communication — verbal, nonverbal, and
written.

8. Normal Speech Development
 The mechanism of speech production is composed of
four processes
1. Language processing: in which the content of an utterance is
converted into phonemic symbols in the brain language
centre.
2. Generation of motor commands to the vocal organs in the
brain motor centre.
3. Articulatory movement for production of speech by the vocal
organs based on these motor commands.
4. Emission of air sent from the lungs in the form of speech

9. NORMAL PATTERN OF SPEECH AND
LANGUAGE DEVELOPMENT
 1 to 6 months
 6 to 9 months
 10 to 11 months
 12 months
 13 to 15 months
 Coos in response to voice
 Babbling
 Imitation of sounds; says
“mama/dada without meaning
 Says ‘mama/dada ‘with meaning ,
often imitates two and three words
 Vocabulary of four to seven words in
addition to jargon,<20% of speech is
understood by strangers

10. NORMAL PATTERN OF SPEECH
DEVELOPMENT
 16 to 18 months
 19–21 months
 22 to 24 months
 Vocabulary of ten words, 20% to 25%
speech understood by strangers.
 Vocabulary of 20 words, 50% speech
understood by Strangers
 Vocabulary >50 words, two word
phrases, dropping out of jargon, 60-
70% of speech is understood by the
strangers

11. NORMAL PATTERN OF SPEECH
DEVELOPMENT
 2-2.5 years
 2.5-3 years
 Vocabulary of 400 words, including
names, two-three word phrases, use of
pronouns, diminishing echolalia,75% of
speech understood by strangers
 Use of plurals and past tense, knows age
and sex; counting objects correctly, use
three to five words per sentence, 80-90%
of speech understood by strangers

12. NORMAL PATTERN OF SPEECH
DEVELOPMENT
 3 to 4 years
 4 to 5 years
Three to six words per sentence; asks
questions, relates experiences, tells stories,
almost all speech understood by strangers
Six to eight words per sentence, colors
identification , counts ten pennies correctly

13. What causes speech and language
problems?
 1) Hearing loss
 2) Mental Retardation
 3) Maturation delay
 4) Expressive language delay
 5) Bilingualism
 6) Psychosocial deprivation
 7) Autism
 8) Elective mutism
 9) Receptive aphasia
 10) Cerebral palsy

14. Hearing loss
 Intact hearing in the first few years of life is vital to
language and speech development.
 Hearing loss at an early stage of development may
lead to profound speech delay.
• caused by otits media with effusion,
• malformations of the middle ear
structures
• atresia of the external auditory
canal.
conductive
• result from intrauterine infection,
Kernicterus,
• ototoxic drugs, bacterial
meningitis,hypoxia
sensorineural

15. Mental retardation
 Mental retardation is the most common cause of speech
delay.
 Accounting for more than 50% of cases a mentally
retarded child demonstrates global language delay and
also has delayed auditory comprehension and delayed use
of gestures.

16. Maturation delay
 Maturation delay (developmental language delay)accounts
for a considerable percentage of late talkers
 In this condition, a delay occurs in the maturation of the
central neurologic process required to produce speech.

17. Expressive language disorder
 Children with an expressive language disorder fail to
develop the use of speech at the usual age.
 These children have normal intelligence, normal
hearing, good emotional relationships, and normal
articulation skills.

18. Bilingualism
 A bilingual home environment may cause a temporary
delay in the onset of both languages.
 The bilingual child’s comprehension of the two
languages is normal for a child of the same age;

19. Psychosocial deprivation
 Physical deprivation (e.g., poverty, poor housing,
and malnutrition) and social deprivation (e.g.,
inadequate linguistic stimulation, parental absent,
emotional stress, and child neglect) have an adverse
effect on speech development.
 Abused children who live with their
families do not seem to have a speech
delay unless they are subjected to
neglect.

20. Autism
 Autism is a neurologically based developmental disorder,
onset before the age of 36 months.
 Autism is characterized by delayed and deviant language
development, failure to develop the ability to relate to
others and ritualistic and compulsive behaviours, including
the stereotyped repetitive motor activity.

21. Elective mutism
 Elective mutism is a condition in
which children do not speak because they do not want to.
 It is seen more commonly in girls than in boys.
 The basis of mutism is usually family psychopathology
 The children are shy, timid, and withdrawn

22. Receptive aphasia
 A deficit in the comprehension of spoken language
is the primary problem of receptive aphasia.
 The speech of these children is not only delayed
but also sparse, agrammatic, and indistinct in
articulation.
.

23. Cerebral palsy
 Delay in speech is common in
children with cerebral palsy.
 The speech delay may be due to hearing loss,
spasticity of the muscles of the tongue, coexisting
mental retardation or a defect in the cerebral
cortex

24. DENTAL- ASSOCIATED CAUSES
1) Ankyloglossia:-
 It is an etiologic factor in speech problem or delay
 A tongue tie or short lingual frenum may preclude
the normal production of the interdental”th”
sounds as well as sounds involving tongue tip
evation (e.i./t/,/d/,/l/)

25. 2) Palatal vault:
Occasionally patient with speech
delay is observed to have high
narrow palatal vault.
 These patients do not have contact site for/t/,/d/,/n/and
/l/.the adaptive patient will produce tongue tip contacts
against the lingual surface of the maxillary incisors.
3)Malocclusion
 Class III malocclusion causes around 50% of severe
articulation deviation as compared to 20%in class II and
2.7% in class I and causes speech delay.

26. 4) Tonsil and Adenoids
 The tonsils are though to play a role in speech production
 If large can encourage fronting of the tongue in speaking
and swallowing and causes speech delay and disorders.
5)Tongue
 Tongue is major organ of speech articulation and is the
culprit most of the time when articulation error are
involved.
 The reason is that it is the most adaptable of the speech
organs, and is expected to provide the major adjustments
necessary for normal speech pattern.
 macroglossia has been attributed to a delay of speech
,dental and developmental problems.

27.  6) Baby bottle mouth :
 Even infants can experience tooth decay, and it is often
caused by babies being fed liquids that contain sugars,
whether natural or synthetic, through a bottle,
especially when the baby is allowed to fall asleep with
the bottle.
 Bacteria cause dental problems commonly referred to
as “baby bottle mouth
 Without those first teeth, your child can face struggles
in learning how to speak and causes speech delay

28.  7) Cleft palate :
 It is common for children who are born
with a cleft palate to have speech problems
or delay.
 Before the palate is repaired, there is no
separation between the nasal cavity and the
mouth.
 8)Cross bite &open bite :it causes interdental production
of alveolar sounds S, sh, z, zh, th, t,d are affected and causes
speech disorder and delay

29. Clinical Evaluation of a Child with
Speech Delay
 A history and physical examination are important in the
evaluation of a child with speech delay.
 The physician should be concerned if the child is not
1)- babbling by the age of 12 to 15 months,
2)- not comprehending simple commands by the age of
18 months,
3)- not talking by 2 years of age,
4)- not making sentences by 3 years of age,
5)- or is having difficulty in telling a simple story by the
age of 4-5 years.

30. Screening Tests
 1) The early Language milestone scale
 2) Peabody picture vocabulary test revised
 3) Denver developmental screening test

31. 1) .The early Language milestone
scale
 It is a simple tool that can be used to assess language
delay in children who are younger than 3 years of age.
 The test focuses on the expressive, receptive, and
visual language.
 The early Language milestone scale helps clinicians
implement the mandate to serve the developmental
needs of children from birth to the age of 3.

32. 2) Peabody picture vocabulary test revised
 For children 2.5 years to 18 years of age
 It is an untimed, individual intelligence test.
 The test measures an individual’s receptive (hearing)
vocabulary and provides a quick estimate of their
verbal ability or aptitude.
 The test is given verbally and
takes about 20-30 min.

33. 3)Denver developmental screening
test
 It is the most popular screening
test in clinical use for infants and
young children.
 It is a test for screening cognitive
and behavioural problems in
preschool children.
 The scale reflects what percentage of a certain age
group is able to perform a certain task and the
subject’s performance against the regular age
distribution is noted.

34. Diagnostic Evaluation
 1) Audiometry-All children with speech delay should be
referred to it.
 2) Tympanometry -is also a useful diagnostic tool.
 3) An auditory brain-stem response- provides a
definitive and quantitative physiologic means of ruling
out peripheral hearing loss. It is useful in infants and
uncooperative children.
 4) Functional magnetic resonance imaging- can also
be used to study the brain lobe activity in speech delayed
children.

35. Speech disorder
Any deviation in the condition of breathing and
voice producing mechanisms including the
integrity of mouth and oral cavity can cause
speech disorders. There are speech related
problems that cause ineffective communication
like problems in voice, articulation and
fluency.

36. PROCESS OF
SPEECH
HEARING
UNDERSTANDING
THOUGHT &
WORD PROCESSING
VOICE PRODUCTION
ARTICULATION

37. 1. Voice Disorder

38. 2. Articulation Disorder
 Errors in the formation of speech sounds.
 Four basic errors in articulation
 Omission (see for seen)
 Substitution (wip for lip, train for crane, doze for
those)
 Distortion (talt for salt, zleep for sleep)
 Addition of extra sounds (Buhrown for brown)

39. 3. Fluency Disorders
 Interrupt the natural, smooth flow of speech
with inappropriate pauses, hesitations, or
repetitions. It is characterized by unnatural
variations in speed, stress and pauses.
 Examples are Cluttering and Stuttering.

40. Language disorders
Abnormal comprehension or expression of
spoken or written language. Individuals with
language disorders frequently have problems in
sentence processing and retrieving information
from short to long term memory. It is present
when there is a disruption in the usual rate and
sequence of the milestones in language
development.

41. Language delay
 Implies that a child is slow to develop linguistic skills
but may acquire them in the same sequence as
normal children.

42. Examples of language disorders
 Central auditory processing disorder – problem in
processing sounds attributed to hearing loss or
intellectual capacity.
 Aphasia – language disorder that results from damage to
parts of brain responsible for language.
 Apraxia- also known as verbal apraxia or dyspraxia is a
condition where the child has trouble saying what he or
she wants to say correctly and consistently.
 Dysarthria – the weakening of the muscles of the mouth,
face and respiratory system affects the production of oral
language.

43. Speech and Language Disorders that
result from Hearing Impairment
 Deafness restricts the perception of the sound elements
of a language and other sounds in the environment with
or without hearing aid.
 Persons who are deaf or hard of hearing manifests
speech and language disorders.

44. Management
 The management of a child with speech delay should
be individualized.
 The health care team might include the physician, a
speech - language pathologist, an audiologist,
psychologist, an occupational therapist, and a social
worker.
 The primary goal of language remediation is to teach
the child strategies for comprehending spoken
language and producing appropriate linguistic or
communicative behaviour.

45. Management
 Psychotherapy is indicated for the child with elective
mutism.
 In autistic children gains in speech have been
reported with behaviour therapy that includes
operant conditioning.
 In children with hearing loss, measures such as
hearing aids auditory training, lip reading instruction
can be indicated.

46. Management
 Direct therapy or group therapy provided by a
clinician, caretaker, or teacher to the child and/or
include peer and family components.
 Therapies include naming objects, modelling and
prompting, individual or group play, discrimination
tasks, reading and conversations.

47. Role of the Pediatric Dentist in
Screening a Child for Speech or
Language Delay
 Pediatric dentists are primarily involved in
treating young children
 communication with the child is essential
for co-operation and effective treatment.
 During the process of communicating with
the child, any evidence of abnormal speech
or deviant or delayed language skills can be
identified by the pediatric dentist.

48.  The pedodontist can play an important role in counseling
the family and suggesting appropriate resources when
significant nonfluencies are noted in a child’s speech
 The following guidelines are suggested:
 1)Do not discuss the speech symptoms directly with the
child at first.
 2)Ask the parent general question about the child’s speech
as to the ease of talking, etc.
 3) Contact a speech clinician and report the symptoms
observed
 4) In dialogue with the child attempt to maintain eye
contact during the nonfluencies and avoid completing
words that the child block on.

49. COMMUNICATION MANAGEMENT
 It include one or more of the following types of
essential therapy
1) speech therapy
2) behavior therapy
3)environmental modification
4)be a good speech model
5)consult speech –language expert concerning
each child with a communication

50. DENTAL MANAGEMENT
 Evaluation should be made regarding their speech
disorder and assessment the level of impairment
 Differentiation should be made if the impairment really
exists or it is delayed milestone
 Make use of non-verbal communication
 Pen, pencil and notebook should be handy for the child to
convey his doubts and queries
 The dentist must ensure that communication is
established at all times during the treatment
 Make sure that child’s vision is not hampered and non-
obstructive at all times

51. DENTAL MANAGEMENT
 Well-lit clinic so that the child’s visibility is maintained
 Any spoken instructions should always be supplied
with written instructions so that it is handy for the
child
 Assess if the speech pathology is due to underlying
dental problem such as spacing, cross bite, open bite,
caries
 Give child more opportunity and express rather that
listening from parents
 Do not interrupt while they are talking or try to fill
gaps
 Be patient and good listener

52. Some parenting tips for helping their
child’s speech and language:
 Start talking to child at birth. Even newborns benefit
from hearing speech.
 Respond to baby’s coos and babbling.
 Play simple games with baby like peek-a-boo and
patty-cake.
 Listen to child. Look at them when they talk .
 Give them time to respond. (It feels like an eternity,
but count to 5—or even 10—before filling the silence).
 Describe child what they are doing, feeling and
hearing in the course of the day.
 Encourage storytelling and sharing information.
 Don’t try to force child to speak.

53. Summary
 Speech and language development is a useful indicator
of a child’s overall development and cognitive ability.
 Many children with these disorders and delay show
dramatic improvement by adolescence. However,
people with severe communication disorders may
experience ongoing challenges to their ability to
function as independent adults
 Identification of children at a risk for developmental
delay or related problems may lead to intervention and
assistance at a young age.

54. REFERENCE
 Dr. Priya Shetty Speech and language delay in children:A review and the role of a
pediatric dentist JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND
PREVENTIVE DENTISTRY | Apr - Jun 2012 | Issue 2 | Vol 30 | 103
 MAURA R. McLAUGHLIN, MD, University of Virginia School of Medicine,
Charlottesville, Virginia Speech and Language Delay in Children
 Manjit Sidhu, Prahbhjot Malhi1, Jagat Jerath2 Early language development
in Indian children:A population-based pilot study Annalsof Indian
Academy of Neurology, July-September 2013, Vol 16, Issue 3
 Dr.R.Ganavi Assessment of Speech and LanguageDelay using Language
EvaluationScale Trivandrum(LEST 0-3) Chettinad Health City Medical
Journal 2015; 4(2): 70 - 74

55. THANK YOU!!!!