Language delays in children: What are they and how to recognize them?

Language delays are difficulties or delays in the development of speech and language skills in a child, compared to the usual norms for his age. These delays can manifest in various ways, such as the child may start speaking later than his peers, use a more limited vocabulary, have difficulty constructing sentences, or not understand the language he hears well

Zyla Musliu,
Speech therapist in Psychiatry for children and adolescents
Tel. +045 663

Language delays may be temporary and resolve over time and with appropriate help, but in some cases they may be a sign of a deeper developmental disorder, such as autism spectrum disorders, speech disorders, hearing impairments, or other neurological or mental difficulties.

This means that the child may have difficulty in:

• Beginning to speak at the expected age
• Using words and sentences to express themselves
• Understanding what is said
• Constructing complete and clear sentences

A child with language delay may have normal development in other aspects such as motor or social skills, but lag behind in language. The causes can be different – ​​from genetic factors, hearing problems, an environment poor in language stimulation, to other disorders such as autism spectrum disorder or developmental delay.

If such a delay is suspected, it is best to consult a speech therapist or child development specialist for evaluation and early intervention.

What are the causes of language delays?

The causes of language delays can be numerous and often affect one child differently. Below are some of the main causes:

1. Hearing problems

• Hearing loss (congenital or acquired)
• Recurrent ear infections (otitis)

A child who does not hear well is unable to learn and imitate words properly.

2. General developmental delay

• When a child's overall development is slower (motor, cognitive, social), it often affects language as well.

3. Neurological or genetic disorders

• Autism (often associated with delays in communication and social interaction)
• Syndromes such as Down, Rett, etc.
• Cerebral palsy (if it also affects the speech muscles)

4. Problems in the structure of the speech apparatus

• Problems with the mouth, tongue, palate (e.g. cleft palate)
• Motor difficulty in coordinating speech (verbal dyspraxia)

5. Poor linguistic environment

• The child is not sufficiently exposed to conversations, books, songs, and games that stimulate language.
• Parents who don't talk much to their child or use technology as a substitute for communication.

6. Psychological or emotional factors

• Emotional trauma, stress, lack of security or attachment to the caregiver can affect communication.
• Children who are very withdrawn or passive may be late in starting to speak.

7. Bilingualism (in some cases)

• Children who grow up bilingual may sometimes speak a little later, but this is usually not a pathological delay.

Some children have an isolated language delay. This is often called “late-onset language delay,” and many of them catch up later, especially with professional help.

Signs and symptoms of language delays

The signs and symptoms of language delays vary depending on the child's age and the type of delay (whether there is difficulty speaking, understanding, or both). Below I present them according to the stages of development:

At the age of 12–18 months:

• Doesn't use first words like "mom", "dad", "water"
• Does not make gestures such as nodding, waving
• Does not understand common words or simple commands (“give me the ball”, “Mommy is here”)
• Does not imitate sounds or words

At the age of 18 months – 2 years:

• Has very few words (less than 20 words at 18 months, less than 50 at 2 years)
• Does not use two-word phrases (such as “I want water,” “Mommy, come on”) by around age 2
• Has difficulty understanding simple commands (“put the toy in the box”)
• Uses more shouting, pulling, or gestures to communicate than words

At the age of 2–3 years:

• Does not form short sentences
• Does not understand most of what is said to him/her
• Does not name common objects
• Adults have difficulty understanding when they speak

At the age of 3–4 years:

• Has a very limited vocabulary
• Sentences are poor, without logical connections
• Grammar is very wrong for the age
• Has difficulty telling an event or answering simple questions

At the age of 4+:

• Speaks in a way that foreigners have difficulty understanding
• Has problems pronouncing many sounds
• Does not use the correct tenses in sentences (such as past, present)
• Has difficulty understanding stories or following instructions with more than one step

General indicators that may be alarm signal at any age:

• Does not respond when spoken to (listening should be excluded)
• Shows no interest in communicating or interacting with others
• Seems emotionally isolated or unexpressive.

If a child has some of these symptoms, it is important to get an early assessment. Timely intervention has a great impact on improving language and communication.

How are they diagnosed?

Language delays are diagnosed through an evaluation process that is usually done by a speech and language therapist (SLT), but sometimes other specialists such as psychologists, neurologists, or child development doctors are involved. Here's how the process usually goes:

1. Information collection (anamnesis):

• Questions about pregnancy and birth history
• General development (walking, eating, behavior)
• Family history of language delays or other problems
• Information about the environment where the child is raised (if more than one language is spoken, language stimulation, etc.)

2. Hearing assessment:

• Often the child is referred to an otolaryngologist (ENT) to rule out hearing problems, which are a common cause of speech delays.

3. Observation of the child:

• How does he react when spoken to?
• How many words do you use, how do you construct sentences?
• Does he understand simple commands or questions?
• How you communicate non-verbally (gestures, facial expressions)

4. Standard language tests:

• The speech therapist uses age-appropriate assessment tools to measure:
• Expressive language (what and how the child speaks)
• Receptive language (what you understand when spoken to)
• Vocabulary, sentence construction, pronunciation, etc.

5. Assessment of overall development:

• Sometimes a broader assessment is done to see if the language delay is part of a larger problem (such as global developmental delay, autism spectrum disorders, etc.)

At the end of this process, the specialist provides a diagnosis and proposes an intervention plan that may include regular speech therapy, home exercises, or additional assistance as appropriate.

How are language delays treated?

Treatment for language delays depends on the cause, the degree of delay, and the child's age, but is generally based on early and personalized intervention. Here's how treatment is typically structured:

1. Speech and language therapy (speech therapy)

This is the main treatment for most children with language delays.

• Therapy is led by a speech therapist (speech and language specialist)
• Sessions take place individually or in groups, usually 2-3 times a week (or more often in more severe cases)

The speech therapist works with:

• Vocabulary development
• Sentence construction
• Understanding language (instructions, questions)
• Pronunciation of sounds
• Using language to communicate in different situations

2. Parental involvement

• Parents are trained to stimulate language at home through games, reading, songs, and daily communication
• Models are set such as: speaking more slowly, repeating words, giving the child choices (“do you want water or milk?”)

3. Help for other comorbid disorders (if any)

If the delay is part of another condition such as:

• Autism
• Developmental lag
• Hearing problems

... then multidisciplinary treatment is needed, involving doctors, psychologists, developmental therapists, and sometimes even the use of assistive devices (such as alternative communication - PECS, symbol tablets, etc.)

4. Stimulating language environment

• The child should be in an environment that encourages them to speak, with educational toys, people who talk to them patiently, without too much exposure to TV or tablets (passivity harms language development)
• Daycare centers or preschools with a development focus can be very helpful.

5. In some cases, other supportive therapies:

• Occupational therapy – if the child also has coordination problems or sensory difficulties
• Physiotherapy – if there is motor impact (as in cerebral palsy)

How long does the treatment take?

• It depends on the child – some improve significantly in a few months, others need help for several years
• The earlier it is started, the greater the chances of improvement.

Prevention and care

Preventing language delays is not always possible (especially when they are related to genetic or neurological factors), but in many cases, good language development can be encouraged and supported with appropriate care and intervention from an early age.

Preventing language delays

1. Early and continuous communication

• Talk to your baby from the first months of life, even if he or she doesn't speak yet.
• Describe what you are doing (“I am putting on your shirt”, “Look at the red ball!”)
• Use simple and repetitive language

2. Reading books from infancy

• Reading helps children become familiar with words, sounds, and language structures.
• Even books with pictures and simple stories have a huge impact

3. Avoid passive exposure to technology

• TV, tablets, and videos do not help with language development (especially under the age of 2)
• Direct communication with adults and interactive games are more effective

4. Games that encourage language

• Toys that require construction, naming, description (e.g., animal toys, colors, shapes)
• Role-playing games (“house play”, “puppet story”, etc.)

5. Hearing monitoring

• Frequent ear infections should be checked by a doctor.
• Language delays are often related to hearing loss.

Be careful if there is suspicion of delay

1. Don't expect "it will talk later"

• Although some children catch up later, early assessment is essential
• It is better to rule out the problem than to wait for it to worsen.

2. Consultation with specialists

• Speech therapist for language assessment
• ENT doctor for hearing
• Developmental psychologist or pediatrician for general development

3. Continuous help at home

• Use the speech therapist's advice to exercise naturally during the day
• Talk a lot, listen patiently, give time to express yourself

4. Encouragement and positive reinforcement

• Pressure or punishment for not speaking should be avoided.
• Every attempt to communicate should be praised and encouraged.

/Telegraph/