The document outlines the normal stages of speech development in children, from cooing to more complex speech and language abilities by age four to five. It discusses common speech and language disorders, their assessment, potential causes, and the importance of early intervention, noting that around 6% to 19% of children may be affected. Management of speech delays includes referrals for therapy, with effectiveness varying based on underlying causes, and emphasizes the need for a multidisciplinary approach.

1. SPEECH
DEVELOPMENT
Babu Appat

2. Language is the process whereby
we communicate with others. It
involves an element of
understanding and expression
(speech).

3. It is one of the most highly
developed of all human skills,
giving us a framework for thought
and allowing us to communicate

4. Disorders of speech and language
are common, ranging from unclear
speech or a slight delay in
development to more significant
difficulties associated with
serious disorders

5. This presentation will give you an
outline of the normal
development, assessment of the
child presenting with these
difficulties and some of the more
common causes

6. This presentation will give you an
outline of the normal
development, assessment of the
child presenting with these
difficulties and some of the more
common causes

7. Normal speech development
The following is only a rough guide
but there is a wide variation of
normal speech development

8. 1 to 6 months:
Turns to sound, startled by loud sounds,
cooing and babbling sounds. Copies
smiles and laughs. Different sounds for
different needs.

9. 6 to 12 months:
Babbling initially 'da', 'ba' then
combining syllables towards 7/8
months - da-da', 'ba-ba'

10. 12 months:
says 'mama', 'dada' or another
simple word with meaning

11. 12 - 18 months:
vocabulary of 6-20 words, not
necessarily understood by unfamiliar
adults. Pretend play - for example,
pretending to talk on the phone

12. 3-4 Years
Three to six words per sentence; asks
and answers questions, relates
experiences, tells stories; almost all
speech understood by strangers. Errors
with tense are normal - eg, 'runned'
instead of 'ran'

13. 4-5 Years
Six to eight words per sentence; names
four colours; counts to ten

14. Variations in
development versus
delay

15. It is important to clarify
what the concern is, as
there can be a lot of
variation in speech and
language development

16. Consider whether
either of the parents
was a late speaker

17. There tends to be a gender
difference with girls developing
slightly faster than boys and it is
traditionally said that
bilingualism may delay speech
(although there is emerging
evidence to the contrary

18. Parents are usually the
first to express concern -
are they comparing to
other children and simply
observing normal
variation?

19. Examples of the need
for referral include

20. There is no double syllable babble at a
year.
There are fewer than six words, or there is
persistent drooling, at 18 months
There are no two- to three- word
sentences by 2½ years
Speech remains unintelligible by 4 years.

21. Epidemiology
Speech delay is a common childhood
problem. It is estimated to affect around
6% of children.
However, this figure has been reported to
be as high as 19%
The disorder is more common in boys than
in girls.

22. • Aetiology
Primary
• Primary speech and language delay. Delay
is not caused by other conditions. Children have
normal understanding, intellect, hearing,
emotional relationships and articulation skills.
• Expressive language disorder. Needs active
intervention to improve.
• Receptive language disorder.
Secondary
Problems can arise from:
• Speech or articulation difficulties:
• Cleft lip
• Tongue tie

23. Stammer
Cerebral palsy (can cause delay for several reasons)
Deafness.
Developmental problems:
Maturational delay (often familial)
Environmental deprivation and neglect
Learning disability
Communication difficulties:
Autism
Other
Selective mutism (the child selectively refuses to speak according to particular
circumstances)
Childhood apraxia of speech. Difficulty in making the right sounds in the correct
order.
Dysarthria. Motor difficulty in creating speech.

24. Assessment
The questions to ask yourself are:
Is the child's hearing normal?
Is this an articulation (speech) or
language problem?
Is this an isolated problem or part of a
more global delay?
Is there a communication disorder?

25. Assessment of the child to
answer these questions can be
complex - particularly beyond
toddlerhood - and a speech and
language therapist assessment
may also be required

26. History
These children may be
particularly shy about talking so
obtain a good history from the
parents

27. Establish whether the child appears to have difficulty in
hearing.
Note whether the child seems to understand what the
parent is saying. If they seem to understand, but respond
with unintelligible speech, there is a speech problem. If
there are comprehension difficulties too, there may be a
language or other problem.
Note whether there are delays in other physical or social
skills which could suggest a more global delay.
Establish whether there are abnormalities in nonverbal
communication skills that might suggest autism.
Obtain a complete developmental history.
Check the past medical and perinatal history.
Ask about a family history of deafness or language delay.

28. Examination
Observe the child play and interact with the parent.
Listen to any talking and note any imaginative play:
A stammer is associated with normal comprehension;
however, speech is immature, stuttered or
unintelligible.
Note that the ability to form interpersonal relationships
is often normal in children with learning difficulties, as
it is in all other causes except for autism.
Autism and language disorders may both be associated
with delays in other developmental areas.
Ask the child simple questions about pictures or their
play: note whether they seem to understand you.
Assess motor and social skills.
Note any anatomical abnormalities, and examine
mouth and ears. Exclude tongue tie as a cause.

29. Investigations
Organise a formal hearing test by an
audiologist. If you think that there is
some sort of language difficulty
following your assessment, get a
speech and language evaluation too

30. Management
Management may sometimes be just explanation, simple advice and
reassurance with the involvement of the health visitor.
However, early detection and intervention for speech delay may prevent, or
at least reduce, the educational, emotional and social problems that may be
caused.
A referral for speech therapy may be required. The effectiveness of therapy
depends upon the cause for speech delay. There is some evidence for the
effectiveness of interventions for expressive speech difficulties; the evidence
for interventions for expressive syntax is mixed and there is no evidence for
interventions for receptive language difficulties.[5]
There is currently no evidence for the best treatment of childhood apraxia of
speech.[7] Also, there is no convincing evidence that speech and language
therapy is effective for early acquired dysarthria.[8]
Multidisciplinary involvement may be required and the involvement of the
parents is vital.
Management is dependent on cause and associated problems such as hearing
impairment.
If the underlying problem is related to the auditory apparatus and surgery is
required, children still need targeted language therapy to complete their
rehabilitation.

31. Management
Management may sometimes be just
explanation, simple advice and reassurance
with the involvement of the health visitor.
However, early detection and intervention
for speech delay may prevent, or at least
reduce, the educational, emotional and
social problems that may be caused.

32. Management
A referral for speech therapy may be required.
The effectiveness of therapy depends upon the
cause for speech delay. There is some evidence
for the effectiveness of interventions for
expressive speech difficulties; the evidence for
interventions for expressive syntax is mixed and
there is no evidence for interventions for
receptive language difficulties.
.

33. Management
There is currently no evidence for the best
treatment of childhood apraxia of
speech. Also, there is no convincing evidence
that speech and language therapy is effective
for early acquired dysarthria.
Multidisciplinary involvement may be required
and the involvement of the parents is vital.

34. Management
Management is dependent on cause and
associated problems such as hearing
impairment.
If the underlying problem is related to the
auditory apparatus and surgery is required,
children still need targeted language
therapy to complete their rehabilitation

35. There is no systematic child
development and behaviour
screening policy in place as this
was not recommended at the
last UK National Screening
Committee (NSC) review. This is
currently under review

36. Prognosis
This is dependent on the cause
of the speech delay.
The prognosis is improved with
early detection and
intervention.

37. THANK
YOU
• babuappat@gmail.com