Delayed Speech and Language in Toddlers

How frustrating is it when you have a point to share but can't find the words because of fear, anxiety, anger or pain? Have you ever gone a day without speaking about how you feel or what you want from a loved one, stranger or God?

Communication is very important at all stages of human life. This article seeks to help parents and caregivers understand what speech delay is, the risk factors, key speech-language milestones for toddlers, how and when to intervene when speech-language delays have been identified.

It is important to note that development is a complex process that does not only involve speech but also gross motor development (walking), fine motor skills (hand-eye coordination development), personal and social development (recognising mother) and cognitive development.

Risk Factors

Speech is sound produced, while language is a measure of comprehension. When speech is unclear and speech errors made are inappropriate for a child's age, it is considered speech delay.

The pace of mastering language and speech varies from one child to the next. Here are some risk factors associated with speech-language delay.

Medical risk factors

• Hearing impairment

• Visual Impairment, including blindness

• Orthopaedic (muscles and bones) impairment

• Traumatic Brain Injury

• Asphyxia (deficient supply of oxygen to the brain)

Family-based risk factors

• Family history of language and reading problems

• Multilingual (speaking multiple languages) family environment

• Low paternal and maternal education

• Dysfunctional families/ emotional disturbance

Environmental risk factors

• Screen time (TV, Tablets or smartphones)

• Chronic noise exposure

Screen time

" Let's avoid screens all together for children under the age of 3, just as we avoid putting steak in baby bottles. Clearly a baby's stomach cannot digest solids. Its brain cannot digest screens."

Dr Serge Tisseron

According to DataReportal, the average person spends a total of 6 hours and 55 minutes looking at a screen each day. Screens occupy a huge chunk of our lives and therefore it is an important risk factor to discuss.

For something we spend a lot of time on, it would be great to have information on how it affects us or our offspring. Unfortunately, literature on the effects of screens on the brain is very young.

It takes about 20 years to establish an effect in science but screens especially phones and tablets have been a major part of children's lives only in the past 7-9 years. In these 7-9 years, there have been key experiments and studies, and three will be mentioned in this article.

Let's begin with a study by Linköping University and Georgetown University. A vest fitted with microphones was worn by 9-months-old infants to collect precise data on children's living environment. With the data, they counted the number of words pronounced by adults and infants, the number of interactions per day and the sound emitted by digital devices.

Results partially supported that:

• A higher amount of words spoken by an adult has a positive effect on a child's language development.

• A high conversation rate between parent and infant is associated with better language development.

• Less interaction with digital devices is associated with better language development.

From the first study, we see that parent-child interaction is very important and our digital habits have consequences, especially if they distract us from human interaction.

The second and third experiments will help us understand more about how children interact with digital devices.

Prof Georgene Troseth hides a toy in a room as a toddler watches her do this on a monitor. The child is then told to go find the toy. Will the child locate the toy as easily as he had seen it been hidden on the monitor? The answer is no, the child fails to find the toy.

Prof Georgene Troseth and the toy experiment

In the final experiment, child psychologist, Rachel Barr went an extra step by doing the same experiment but this time brain activity was measured during the exam. From both experiments we can learn that:

• Before age two it's hard to transfer information and understand the things on a screen are the same in the real world.

• Exchange via screen does not stimulate the brain's learning centre the same way that face-to-face interaction does.

Rideout reported that, on average, children from birth to 23 months old spend 42 min with screens per day, and 2- to 4-year-olds spend 2 h and 39 min per day. Most of this screen time (72%) is spent viewing video content.

Since this is the reality parents can purpose to reduce their child's screentime or accompany a child as they watch a video to help them understand what they are watching.

Key speech milestone for toddlers

Paediatric Milestones- Speech/Language

This simplified table has been sourced from EZmed and a video on the same can be found here.

The tables have information on speech and language milestones from birth to four years of age. They can be used as a guide even if the language you use is not English. This information has been sourced from the American Speech-Language-Hearing Association.

From birth to one year

​Hearing and Understanding	​Talking
Birth–3 Months Startles at loud sounds. Quiets or smiles when you talk. Seems to recognize your voice. Quiets if crying.	​Birth–3 Months Makes cooing sounds. Cries change for different needs. Smiles at people.
4–6 Months Moves her eyes in the direction of sounds. Responds to changes in your tone of voice. Notices toys that make sounds. Pays attention to music.	4–6 Months Coos and babbles when playing alone or with you. Makes speech-like babbling sounds, like pa, ba, and mi. Giggles and laughs. Makes sounds when happy or upset.
​7 Months–1 Year Turns and looks in the direction of sounds. Looks when you point. Turns when you call her name. Understands words for common items and people, like cup and daddy. Starts to respond to simple words and phrases, like “No,” “Come here,” Plays games with you, like peek-a-boo Listens to songs and stories for a short time.	​7 Months–1 Year Babbles long strings of sounds, like babababa. Uses sounds and gestures to get and keep attention. Points to objects and shows them to others. Uses gestures like waving bye Imitates different speech sounds. Says 1 or 2 words, like hi, dog, dada, mama, or uh-oh.

One to two years

Hearing and Understanding​	​Talking
​Points to a few body parts when you ask. Follows 1-part directions, like "Roll the ball" Responds to simple questions, like “Who’s that?” Listens to simple stories, songs, and rhymes. Points to pictures in a book when you name them.	Uses a lot of new words. Uses p, b, m, h, and w in words. Starts to name pictures in books. Asks questions, like “What's that?”, “Who’s that?” Puts 2 words together, like "more apple," "no bed," and "mommy book."

Two years to three years

​Hearing and Understanding	​Talking
​Understands opposites, like go–stop, big–little, and up–down. Follows 2-part directions, like "Get the spoon and put it on the table." Understands new words quickly.	​Has a word for almost everything. Talks about things that are not in the room. Uses k, g, f, t, d, and n in words. Uses words like in, on, and under. Uses two- or three- words to talk about and ask for things. People who know your child can understand him. Asks “Why?” Puts 3 words together to talk about things. May repeat some words and sounds.

Three to four years

​Hearing and Understanding	​Talking
​Responds when you call from another room. Understands words for some colours, like red, blue, and green. Understands words for some shapes, like circle and square. Understands words for family, like brother and grandmother.	​Answers simple who, what, and where questions. Says rhyming words, like hat–cat. Uses pronouns, like I, you, me, we, and they. Uses some plural words, like toys, birds, and buses. Most people understand what your child says. Asks when and how questions.

Speech Treatment and Intervention

Now that you are armed with information on speech-language milestones, you can assess your child. If you have any concerns, it is advisable to visit a paediatrician. Early intervention can be recommended based on an accumulation of risk factors.

How can you help your child learn a language?

• Responding to the first sounds, gurgles, and gestures a baby makes.

• Repeating what the child says and adding to it.

• Talking about the things that a child sees.

• Asking questions and listening to the answers.

• Looking at or reading books.

• Telling stories.

• Singing songs and sharing rhymes.

Conclusion

Children develop at different rates. Speech and language may develop early with some and late with others. These skills are developed within a range, and this article equips you with that knowledge. Now you know what to expect.

Additional resource

Here you will find additional information on children and digital media and for more information on speech-language delay American Speech-Language-Hearing Association.

Special thanks to Dr Sammy Karis MBChB, M.H.Sc and Psychologist Eunice Nyambura.