Language delay in toddlers

Are you worried that your toddler might be going through a language delay? It can be difficult to tell whether your child is just a late talker, or whether they have an underlying condition that causes speech impairment. In most cases, there’s no reason to be concerned. However, it is every parent’s responsibility to monitor the development of their child and look out for signs that may suggest they’re having difficulties. Let’s take a look at some of the potential causes of delayed speech development and the signs to be aware of. We’ll also give you a rundown on diagnosis and treatment options, as well as ways that you can support your child’s language development at home.

What is language delay?

Language delay occurs when a child fails to achieve the appropriate language milestones during the first years of life. This can happen for a variety of reasons, which we will discuss below. 

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Speech and language delay problems are common among toddlers who are just learning to communicate with the world around them. It’s estimated that between 5% and 12% of children aged 2 to 5 years are affected by speech and language delay. (1)

Some children who reach typical language milestones later than their peers eventually catch up to them, but others continue to have difficulties. 

Early language development is the foundation for language development and literacy skills later in life. Youngsters with speech and language impairment in preschool years are more likely to have learning disabilities when they go to school. For example, they’re at 4-5 greater risk for poor reading performance than children who develop their language skills at a normal pace. 

What’s more, evidence suggests that if speech delay issues remain untreated, in 40-60% of cases they can persist in adulthood and put children at a higher risk of social relationships, emotional, behavioral, and cognitive problems. (2)

That’s why it’s extremely important to identify these problems early on and address them before a child is admitted into the education system. 

There are two kinds of language delay. There are children who only experience one of them, others are affected by both. Let’s take a look at what they are. 

What is expressive language delay?

Expressive language delay (ELD) refers to a condition where a child is struggling to express themselves verbally. The development of their speech is not in line with the standards of normal development. Some children can have difficulties putting words together to form sentences, others have trouble choosing the right vocabulary in a certain context. ELD can manifest in many different ways and is treated differently in each case. 

What is receptive language delay?

Receptive language delay is when a child is having difficulty understanding language. For example, they may not be able to follow directions or answer questions. Just like ELD, receptive language delay can also manifest in different ways. Therapies depend on the specific type of language skill (or skills) that the child is having trouble with.

What are the signs of language delay in toddlers?

It takes the expert opinion of a trained professional to determine whether your child has a language impairment. But there are signs to be aware of which can tell you if you should be paying closer attention to your toddler’s language development. 

You can identify the symptoms of language delay in toddlers by determining whether your child is hitting the typical language milestones for each age. 

According to the CDC, these are the most important milestones your child should reach by age:

2 months:

• Cooing, making gurgling sounds 
• Turning their head toward sounds

4 months:

• Babbling
• Copying sounds they hear 
• Crying in different ways to show hunger, pain, or tiredness

6 months:

• Responding to sounds by making sounds 
• Stringing vowels together when babbling 
• Taking turns with parents when making sounds
• Responding to their own name 
• Making sounds to show content and discontent 
• Starting to say consonants (jabbering that includes “m” and “b” sounds)

9 months:

• Understanding “no” 
• Making lots of different sounds
• Copying sounds and gestures
• Using their fingers to point at things

1 year:

• Responding to simple verbal requests 
• Using simple gestures, like shaking their head or waving 
• Making sounds with changes in tone in a way that resembles speech
• Calling parents “mama” and “dada”
• Trying to imitate the words parents say 

18 months:

• Saying several single words
• Saying “no” and shaking their head
• Pointing at objects to indicate something they want

2 years:

• Pointing to things or pictures when they are named 
• Knowing the names of familiar people and body parts 
• Saying sentences with 2 to 4 words 
• Following simple instructions 
• Repeating words they overheard
• Pointing to pictures in a book

3 years:

• Following instructions with 2-3 steps 
• Being able to name familiar things 
• Understanding prepositions of place like “in,” “on,” and “under” 
• Knowing and saying their own first name, age, and sex
• Naming friends
• Starting to use pronouns
• Starting to use nouns in the plural form
• Talking clearly enough for strangers to understand most of the time 
• Carrying on a conversation using 2-3 sentences

If your child has not yet reached the milestones that correspond to their age, don’t panic. It could be that they’re just a late talker and will eventually catch up to their peers. However, if you’re really concerned, seek the help of a trained professional.

What causes language delay?

Language delay in toddlers can be caused by a variety of underlying conditions or a combination of conditions. Here are some of the most common culprits:

• Hearing impairment: Loss of hearing is an often overlooked but very common cause of language delay. If your toddler cannot hear well, it’s likely that they will struggle to understand language and learn to express themselves. The problem may also be related to auditory processing disorder so it is important to consider whether this is the core issue.
• Learning disabilities: Language impairments are often the earliest signs of learning disabilities like dyslexia or dysgraphia, which can have their roots in genetics, chromosome abnormalities, birth complications, illnesses or injuries affecting the brain, and a range of other causes.
• Autism spectrum disorder (ASD): Language delay can be an early indicator of autism spectrum disorder. One study has found that children who are diagnosed with ASD have more difficulties with receptive language, while children who are diagnosed with developmental language delay (DLD) have more trouble with expressive language skills. (3)
• Psychological factors: In some cases, speech delay is caused by psychosocial deprivation such as inadequate linguistic stimulation, parental absenteeism, emotional stress, child neglect or abuse. (4)
• Bilingualism: Growing up in a bilingual (or multilingual) home environment may also lead to language delays, but by the age of 5 years, children usually master both languages. 

Language delay in toddlers: diagnosis and treatment

Parents who are concerned about their toddler’s language development should have the child evaluated by a pediatrician. 

The doctor may prescribe a hearing test or refer the child to a developmental specialist or a speech and language therapist.
Depending on the results of the evaluation, your child may need speech therapy or further tests to rule out serious underlying conditions that may be causing their language delay.

How to support your child’s language development

Language difficulties are associated with the type and quality of interactions between children and parents. (5)

For example, when parents engage in a conversation with a child by commenting on what the child is doing or talking about the thing that the child’s attention is focused on, they are promoting language development. 

On the other hand, an overuse of directive and corrective statements, like commands and criticisms, has been shown to cause language delays.

When therapy is needed, the involvement of parents can be beneficial to the outcomes of the treatment process. 

So what can you do as a parent to make sure that your toddler gets all the support they need to develop at a normal pace?

• Start talking to your baby as soon as they are born
• Respond to your baby’s coos and babbling
• Narrate what you’re doing as you do chores around the house
• Sing to your child and read books to them out loud
• Use a child-directed speech style: acknowledge what your child is doing or pointing to and comment on it
• Ask your toddler questions and answer their inquiries
• When your child says something, expand on it with other words
• Play games with your child and talk about what you’re doing

Conclusion: language delay in toddlers

Language delays are common in children between 2 and 5 years, and most of the time, they are nothing to worry about. If you notice that your toddler is not achieving typical language development milestones, talk to your physician about it. A doctor’s assessment can determine whether you need to look into it further. If there are no serious underlying conditions such as autism spectrum syndrome, language delay can be treated with therapy with the help of a speech-language pathologist. To prevent language delays in healthy children, parents need to make sure they’re doing everything to interact with their children and stimulate them to enhance their language development. 

References

(1) Evidence Summary: Speech and Language Delay and Disorders in Children Age 5 and Younger: Screening. U.S. Preventive Services Task Force. May 2019. https://www.uspreventiveservicestaskforce.org/Page/Document/evidence-summary30/speech-and-language-delay-and-disorders-in-children-age-5-and-younger-screening

(2) Sunderajan, T., & Kanhere, S. V. (2019). Speech and language delay in children: Prevalence and risk factors. Journal of family medicine and primary care, 8(5), 1642–1646. https://doi.org/10.4103/jfmpc.jfmpc_162_19

(3) Özyurt, G., & Eliküçük, Ç. D. (2018). Comparison of Language Features, Autism Spectrum Symptoms in Children Diagnosed with Autism Spectrum Disorder, Developmental Language Delay, and Healthy Controls. Noro psikiyatri arsivi, 55(3), 205–210. https://doi.org/10.5152/npa.2017.19407

(4) Alexander K.C. Leung & C. Pion Kao (1999). Evaluation and Management of the Child with Speech Delay. Am Fam Physician. 1;59(11), 3121-3128. https://www.aafp.org/afp/1999/0601/p3121.html

(5) Garcia, D., Bagner, D. M., Pruden, S. M., & Nichols-Lopez, K. (2015). Language Production in Children With and At Risk for Delay: Mediating Role of Parenting Skills. Journal of clinical child and adolescent psychology: the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 44(5), 814–825. https://doi.org/10.1080/15374416.2014.900718