# Speech and language delay in children - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Developmental Delay - StatPearls (NCBI Bookshelf NBK562231) - https://www.ncbi.nlm.nih.gov/books/NBK562231/ · Speech and language delay - disease-level clinical article (speech-language-delay-full.txt) · Speech and language delay - disease-level clinical article (speech-language-delay-clinical.txt) - Verified date: 2026-08 ## Verified against - Developmental Delay - StatPearls (NCBI Bookshelf NBK562231) - https://www.ncbi.nlm.nih.gov/books/NBK562231/ - Speech and language delay - disease-level clinical article (speech-language-delay-full.txt) - Speech and language delay - disease-level clinical article (speech-language-delay-clinical.txt) ## Treatment metadata - Hearing test first, then structured developmental assessment (no drug therapy) - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text SPEECH AND LANGUAGE DELAY IN CHILDREN Sources: Developmental Delay - StatPearls (NCBI Bookshelf NBK562231) - https://www.ncbi.nlm.nih.gov/books/NBK562231/ · Speech and language delay - disease-level clinical article (speech-language-delay-full.txt) · Speech and language delay - disease- level clinical article (speech-language-delay-clinical.txt) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SIGNS - what you find (2) - Exam should include a detailed neurologic assessment with hearing and vision testing - Looking for dysmorphic features is part of the standard exam [dysmorphic features] TESTS (8) - Screening commonly uses parent-report tools such as the ASQ-3 and PEDS at well-child visits - PEDS runs about 75 percent sensitivity and 74 percent specificity across all ages - ASQ-3 sensitivity is roughly 85 percent and specificity roughly 86 percent - Developmental screening is scheduled at 9, 18, and 30 months, with autism-specific screening added at 18 and 24 months - Routine labs rarely find a cause since most developmental delay is idiopathic, so testing is reserved for a specific indication - Chromosomal microarray is the first genetic test when a specific indication or syndrome such as Fragile X is suspected - Brain MRI is rarely needed without a specific family history, injury, or focal neurologic finding - EEG is reserved for a clear history of regression or a directly observed seizure IF NOT THIS - what else fits (6) - A delay confined to speech sounds and expression, apart from other domains, is one differential - Developmental language disorder is a separate differential from an isolated speech delay - Intellectual disability is on the differential when speech and language lag - Autism spectrum disorder is a differential for delayed speech and language - Social communication disorder belongs on the differential for delayed speech and language - Social deprivation belongs on the differential for delayed speech and language Source StatPearls "Developmental Delay" - disease-level clinical article Status traced to the source above 1. HEARING TEST FIRST, THEN STRUCTURED DEVELOPMENTAL ASSESSMENT (NO DRUG THERAPY)[1st line] Adult Source Speech and language delay - disease-level clinical article (speech-language-delay- full.txt) Why Speech and language is one of the domains the article grades, not a diagnosis on its own. It describes delay as impairment in any one of several distinct domains - gross and fine motor, speech and language, cognition and performance, social, sexual and psychological function, and activities of daily living - and classes it as isolated where a single domain is involved, multiple where two or more are, and global where most developmental areas are affected. The article's physical examination puts the sense organs in the same breath, asking for a detailed neurological examination that takes in hearing and vision. A child who cannot hear cannot learn to talk, so the ear is examined before anything is called a delay. Caution HOW COMMON - the article puts speech and language at 2% to 19%, the widest band of any domain it lists. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) A worried mother is usually describing something real. WHEN TO SCREEN - screen development whenever a parent raises a concern or something looks wrong in the room, and routinely at the 9-month, 18-month and 30-month well-child checks. An autism-specific screen is advised at 18 and 24 months. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) ASK, DO NOT WAIT TO BE TOLD - at every well-child encounter the primary-care doctor should invite the parents to say what worries them about the child's behaviour or milestones. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) WHICH TOOL - the article names two parent-report questionnaires for the clinic and gives their performance: PEDS runs at 75% sensitivity and 74% specificity across all ages (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231), and the Ages and Stages Questionnaire, Third Edition at 85% and 86%. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) TAKE THE HISTORY THE ARTICLE ASKS FOR - go through the neonatal period for anything adverse: hypoxic-ischaemic encephalopathy, jaundice, low or high tone, hypothyroidism, congenital abnormality. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) Then chart each developmental line, milestone by milestone - sitting, crawling, walking, talking, language, social interaction and learning. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) WATCH THE CHILD PLAY - more comes out of playing with the child using toys suited to the age (cars, blocks, crayons and paper), and watching them move about the room, than from any question. Home videos can help too. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) A silent child in a clinic room is not evidence of anything. NO MEDICINE IS PRINTED HERE BECAUSE THE ARTICLE NAMES NONE. Its treatment section is a list of people, not prescriptions - the strategies it describes are multi-modal. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) No drug, strength or frequency appears anywhere in it, so none is invented. WHAT ACTUALLY CHANGES THE OUTCOME - training the parents helps them grasp what the child's needs actually mean day to day, and what a developmental delay puts at risk. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) Guidance for parents belongs in every antenatal and well-child visit. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) A PROGRAMME THAT EXISTS FOR EXACTLY THIS - the WHO's caregiver skills training programme (CST) was built for families of children with developmental delays or disorders. Its modules are engagement, communication, management of behaviour, play and home routine, adaptive behaviour, and caregiver self-care. SET THE HOME UP TO TEACH LANGUAGE - the delays themselves can be prevented, and shortened once they are there, by surroundings that stimulate the child cognitively, motorically, sensorily, psychologically, socially and emotionally - at home, at school and at daycare alike. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Speech and language delay - disease-level clinical article (speech-language-delay- clinical.txt) Why Most of these children are simply late, and a few are not. Below are the article's referral destinations, the features that mean the delay is not isolated, and the reason a delay is followed rather than filed: it carries a substantial risk of going on to become a neurodevelopmental disorder or syndrome. Caution REFER FOR THE SPEECH ITSELF - the article's own line for this domain is to consider a referral to a speech and language therapist. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) REFER THE EAR SEPARATELY - where hearing is impaired, the article says to consider a referral to audiology. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) Hearing loss and speech delay travel together, and the audiology appointment does not wait for the speech therapy one. RED FLAG - THE ALARMING FEATURES the article lists are loss of hearing or of vision at any age; tone that stays too low or too high; movements that are not symmetrical; no communicative speech by 16 months; a head circumference out of proportion; and the loss of skills the child had already gained. A child who spoke words and has stopped is a different and more urgent problem from one who never started. NO WORDS AT ALL BY 16 MONTHS is on that list by name and is not a wait-and-see finding. WHAT ELSE PRODUCES A SILENT CHILD - the article's own differential for delayed speech and language runs: general speech delay, developmental language disorder, intellectual disability, autism spectrum disorder, social communication disorder, and social deprivation. Deafness sits beside them under sensory impairment. SEARCH FOR THE BACKGROUND CAUSES - between 18 and 30 months the article ties poor behavioural outcomes and serious delay to: parents with little education; anaemia in pregnancy; malnutrition; prematurity; male sex; low birth weight; depression before or after the birth; intimate partner violence; the use of drugs, tobacco or alcohol while pregnant; and poverty. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) WHO TO SEND TO WHEN IT IS NOT ONLY SPEECH - assessment starts with primary care and goes on, as the case needs, to paediatric subspecialists: child and adolescent psychiatrists, neurologists, developmental and behavioural paediatricians, and others. REASSURE, THEN BOOK THE FOLLOW-UP - most developmental delay has no identified cause and passes with time (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231), and because most of it resolves on its own the outlook is generally good. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) The follow-up is the safety net, not the reassurance. DO NOT LET DENIAL END THE EPISODE - where there is real clinical concern that the delay is an evolving syndrome, and the parents do not understand it or will not accept it, follow-up appointments with the primary-care doctor during the developmental assessment are what keep the child in the system. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) KEEP FOLLOWING IT - every developmental delay is followed carefully until it either resolves or turns into a developmental disorder. (Developmental Delay - StatPearls - NCBI Bookshelf, NBK562231) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)