Don’t Dismiss Speech Delays


Apr 8, 2018


As parents, we all have a gut instinct, a sixth sense. It’s a sense that we sometimes listen to and sometimes ignore. We ignore it the most when we know that something is wrong, but we want to convince ourselves that we are overreacting.

I’m a speech and language pathologist, but I’m also a parent to a 3-year-old girl. Through my own experiences over the last three years, I’ve learned more about speech and language development, as well as about parenting, than I learned through my textbooks and workshops.

While listening to our instincts and learning from our experiences are necessary parts of being a parent, it’s important to know where perceptions and facts diverge. Because we fear the worst for our children, we sometimes listen to explanations from our family or peers that are reassuring — but not necessarily accurate.

Here are some common examples of seemingly innocuous ways to describe speech and language issues that I’ve come across in the course of my practice.

  • “Boys will be boys”
  • “My daughter spoke very early, but boys don’t talk early or talk that much”
  • “But won’t he/she outgrow this by themselves?”
  • “I spoke late too and I’m doing okay now”

Professional impression: Speech-language delay

While it is true that girls and boys have different rates of speech and language development, speech and language problems are three to four times more common in boys than in girls. Therefore, it’s best to visit an expert at even the slightest sign of a delay or deviance.

Delays can be noticed as early as 6 months to 1 year. When a child demonstrates motor delays, such as a delay in sitting, crawling, and walking they are at a higher risk for a speech delay. Therefore in these cases, speech language therapy should be initiated when the child is at six months as a preventive measure.

Some children may demonstrate just a speech delay. Early signs of this include absence of pointing, making specific actions, or inability to engage with an adult. A delay does not get outgrown. If left untreated, these children are at a higher risk for a learning disability. If intervention is done early, it reduces the risk for it to turn into a lifelong disability.

  • “He doesn’t like to play with toys, he just breaks them – but that’s like most boys, I guess”
  • “He/she doesn’t sit to listen to a story, do a puzzle, or color”
  • “He/she plays with a toy for a few seconds before moving on to the next toy, I guess he/she gets bored easily”

Professional impression: Attention difficulties.

A child should be able to play with a toy or listen to a story by age 2, for a few minutes at least. Play starts becoming more constructive by age 2 also. Children are able to engage themselves or engage with adults without getting bored. However, if a child has difficulty sustaining attention, it will seem like they get bored easily or are destructive. Attention difficulties could be indicative of autism or ADHD (attention deficit hyperactivity disorder), or sometimes it may just be subtle attention deficits not indicative of anything more serious. In any case, if attention difficulties are not targeted early, they could lead to academic difficulties such as not finishing exams, drifting off in class, social difficulties, trouble selecting an occupation, and more.

  • “She’s really smart: she can recite all her nursery rhymes and talk in the same accent as Peppa Pig. But she doesn’t like to answer questions”
  • “He’s lost in his own world most of the time and doesn’t hear us call his name”
  • “He likes to play by himself for hours…”
  • “Hmm I’ve never given her Play-Doh before, that’s probably why she doesn’t know what to do with it”
  • “She can open and close apps by herself, she just doesn’t like coloring”

Professional impression: Communication difficulties due to autism spectrum disorder

Most young children first develop what we call “need-based” communication. They learn the words that meet their needs and wants like “water,” “ball,” and “milk.” Language development then starts including comment words such as “mamma, look.” For children on the autism spectrum, their language may continue to be need-based beyond the age of 2 and not include comments, directions or questions. Or they may develop sentences that are not for communicative purposes, like imitating a character or reciting a rhyme. Most often their utterances are not directed at a specific person – instead, they’ll speak spontaneously, not in response to a question or request.

Most children identify themselves and start responding to their name as early as a few months by smiling, cooing, or looking at the adult. Children on the autism spectrum, however, may seem like they are lost in their own thoughts and do not always respond to their name.

In play skills, typically, developing children try and figure out toys by themselves, and if they can’t, they will take them to an adult for help. They show interest in different toys. Children with autism may not show much interest in toys or may play with one particular toy repetitively in the same manner.

Not all children with autism demonstrate all of the above symptoms. Every child is different. But if any of these symptoms are observed, it’s best to have your child evaluated by an expert.

  • “She’s fussy like most children, she takes two hours per meal, and doesn’t like ‘wet’ food – but she’ll outgrow it when she goes to big school”
  • “He doesn’t eat fruits or vegetables, he only eats three things – but that’s exactly how my husband used to be”

Professional impression: Pediatric feeding issues

Some children demonstrate an increased time for eating meals, they may hold their food in their mouths and not chew. Some children prefer foods of only a certain texture, such as crunchy. Some children cannot bear being near the sight or smell of certain foods, like fruits. Some children may not like mixing textures when foods are eaten together, like roti and sabzi or daal and rice.

Feeding difficulties are very often seen in children with autism, but they are also seen in children with no known diagnosis. Feeding disorders are due to oral sensory issues or motor incoordination. These difficulties are managed in therapy through sensory and behavioral approaches. If left untreated, these difficulties lead to social disturbances as the child grows, since food is a very important part of socialization. A child then may have trouble eating with other children during recess in school, finishing food on time in recess, eating at a birthday party, or eating during travel.

  • “It sounds so cute when she talks like a baby, I’m sure she’ll outgrow it”

Professional impression: Articulation disorder

Each sound develops at a different age. By age 3, a child should be saying P, B, M, N, H, T, D, K , and G clearly. S, Z, Sh, Ch, J, R, and L are later developing sounds and should be achieved by 4 and a half years.

Examples of sound errors are: A child may substitute one sound for another, e.g., “tat” instead of “cat.” Speech therapy, when done early for articulation, produces results much more quickly than when done later. If a sound is not said correctly beyond the age at which it should occur, it will not get outgrown. It will continue to be mispronounced and become more difficult to change at an older age.

  • “He stammers because his teacher is strict and yells at him”
  • “He only stammers sometimes, I think it’s because he’s imitating his friend”

Professional impression: Fluency disorder, i.e., stuttering/stammering

This is not caused by imitation or environmental factors. The exact cause of stuttering is not yet known. It’s said to be a genetic predisposition in some kids. Some children demonstrate speech disfluencies at age two and a half years. These are called normal non-fluencies and are to be expected between children aged two and a half to three and a half. These are not indicative of stuttering. This occurs because the child is learning a lot of new speech and motor skills. If these persist beyond three and a half years and there is a family history of stuttering the child should be evaluated by a speech therapist.

None of the above mentioned signs/symptoms on their own are definitively indicative of a disability or disorder. It may mean some delay or difficulty in a particular area that can be supported by consulting a professional. There is no losing by identifying these problems early and addressing them, only winning.


Written By Merzia Maskati

Merzia Maskati is a practicing speech, language and dysphagia therapist with 10 years of experience. She is the founder of the Speech Dysphagia Language Clinic, a private clinic in Mumbai that provides data-driven and empirical speech and occupational therapy in a fun, collaborative and interactive environment. Merzia also consults at the American School of Bombay. She can be reached at merzia@sdlc.co.in or sdlc.co.in.


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