Any child with a delay in speech onset or delay in language development (see Quick Guide to Developmental Milestones) warrants further assessment by a paediatrician experienced with children with speech and language delay. A very simple guideline to follow for absolute delay would be speech by 18 months, phrases by 24 months and sentences by 36 months.

Presence of Speech generally means being able to use at least 3 words (besides ‘Papa’ and ‘Mama’) meaningfully. Accompanying this should be concomitant language and communication development. Language (use of words to express our needs, interest and feelings) involves both receptive (receiving and understanding) and expressive (output and response) components. Communication involves both verbal and non-verbal modes, including gestures, facial expressions, tone and pitch of voice and language interpretation and construction.

There can be many reasons why a child can be slow in acquiring speech or language such as:

• Hearing impairment
• Speech & Language Disorder
• Specific Language Impairment
• Cognitive Impairment/Slow Learner
• Specific Learning Disability
• Dyslexia
• Autism Spectrum Disorder/Other communication disorders

Several of these disorders may not present themselves as the full pattern at a young age. It is only through serial assessments and long-term tracking that the eventual diagnosis can be made.

Some disorders, such as hearing impairment, will have very good outcomes with early treatment. All children with any speech and language delay therefore would benefit from a hearing screen. Mild hearing impairment can be missed if not tested appropriately and will result in adverse outcomes for language and learning skills. Other disorders have long-term impact on academic outcomes even in a child with normal to superior intelligence, but will benefit from early intervention.

Attention and social skills are closely interlinked with speech and language development. Delays in either area will lead to significant impact on the other. It is therefore important to follow up closely with the doctor once delay is detected and intervention put in place.