Causes Speech and Language Problems
A delay in speech development may be a symptom of many disorders, including mental retardation, hearing loss, an expressive language disorder, psychosocial deprivation, autism, elective mutism, receptive aphasia and cerebral palsy. Speech delay may be secondary to maturation delay or bilingualism. Being familiar with the factors to look for when taking the history and performing the physical examination allows physicians to make a prompt diagnosis. Timely detection and early intervention may mitigate the emotional, social and cognitive deficits of this disability and improve the outcome.
Speech is the motor act of communicating by articulating verbal expression, whereas language is the knowledge of a symbol system used for interpersonal communication. In general, a child is considered to have speech delay if the child’s speech development is significantly below the norm for children of the same age. A child with speech delay has speech development that is typical of a normally developing child of a younger chronologic age; the speech-delayed child’s skills are acquired in a normal sequence, but at a slower-than-normal rate.
Speech delay has long been a concern of physicians who care for children. The concern is well founded, because a number of developmental problems accompany delayed onset of speech. In addition, speech delay may have a significant impact on personal, social, academic and, later on, vocational life. Early identification and appropriate intervention may mitigate the emotional, social and cognitive deficits of this disability and may improve the outcome.
Causes speech and language problems
- Developmental speech and language disorder is a common reason for speech/language problems in kids. This is a learning disability that is caused by the brain working differently. These kids may have trouble producing speech sounds, using spoken language to communicate, or understanding what other people say. Speech and language problems are often the earliest sign of a learning disability. Find out more about language-based learning disabilities.
- Hearing loss is often overlooked, and easily identified. If your child is speech/language delayed, their hearing should be tested.
- Intellectual disabililtyis a common cause of speech and language delay.
- Extreme environmental deprivation can cause speech delay. If a child is neglected or abused and does not hear others speaking, they will not learn to speak.
- Prematurity can lead to many kinds of developmental delays, including speech/language problems. Find out more about prematurity and speech and language delays.
- Auditory Processing Disorder describes a problem with decoding speech sounds. These kids can improve with speech and language therapy.
- Neurological problems like cerebral palsy, muscular dystrophy, and traumatic brain injury can affect the muscles needed for speaking.
- Autism affects communication. Speech/language/communication problems are often an early sign of autism. Find out more: Autism and Communication.
- Structural problems like cleft lip or cleft palate can interfere with normal speech. More on speech development and cleft palate.
- Apraxia of speech is a specific speech disorder in which the child has difficulty in sequencing and executing speech movements.
- Selective mutism is when a child will not talk at all in certain situations, often school.
Causes of Speech Delay
- MENTAL RETARDATION Mental retardation is the most common cause of speech delay, accounting for more than 50 percent of cases. A mentally retarded child demonstrates global language delay and also has delayed auditory comprehension and delayed use of gestures. In general, the more severe the mental retardation, the slower the acquisition of communicative speech. Speech development is relatively more delayed in mentally retarded children than are other fields of development. In approximately 30 to 40 percent of children with mental retardation, the cause of the retardation cannot be determined, even after extensive investigation. Known causes of mental retardation include genetic defects, intrauterine infection, placental insufficiency, maternal medication, trauma to the central nervous system, hypoxia, kernicterus, hypothyroidism, poisoning, meningitis or encephalitis, and metabolic disorders.
- HEARING LOSS Intact hearing in the first few years of life is vital to language and speech development. Hearing loss at an early stage of development may lead to profound speech delay. Hearing loss may be conductive or sensorineural. Conductive loss is commonly caused by otitis media with effusion. Such hearing loss is intermittent and averages from 15 to 20 dB. Some studies have shown that children with conductive hearing loss associated with middle ear fluid during the first few years of life are at risk for speech delay. However, not all studies find this association. Conductive hearing loss may also be caused by malformations of the middle ear structures and atresia of the external auditory canal. Sensorineural hearing loss may result from intrauterine infection, kernicterus, ototoxic drugs, bacterial meningitis, hypoxia, intracranial hemorrhage, certain syndromes (e.g., Pendred syndrome, Waardenburg syndrome, Usher syndrome) and chromosomal abnormalities (e.g., trisomy syndromes). Sensorineural hearing loss is typically most severe in the higher frequencies.
- MATURATION DELAY Maturation delay (developmental language delay) accounts for a considerable percentage of late talkers. In this condition, a delay occurs in the maturation of the central neurologic process required to produce speech. The condition is more common in boys, and a family history of “late bloomers” is often present.13 The prognosis for these children is excellent, however; they usually have normal speech development by the age of school entry.
- EXPRESSIVE LANGUAGE DISORDER Children with an expressive language disorder (developmental expressive aphasia) fail to develop the use of speech at the usual age. These children have normal intelligence, normal hearing, good emotional relationships and normal articulation skills. The primary deficit appears to be a brain dysfunction that results in an inability to translate ideas into speech. Comprehension of speech is appropriate to the age of the child. These children may use gestures to supplement their limited verbal expression. While a late bloomer will eventually develop normal speech, the child with an expressive language disorder will not do so without intervention. It is sometimes difficult, if not impossible, to distinguish at an early age a late bloomer from a child with an expressive language disorder. Maturation delay, however, is a much more common cause of speech delay than is expressive language disorder, which accounts for only a small percentage of cases. A child with expressive language disorder is at risk for language-based learning disabilities (dyslexia). Because this disorder is not self-correcting, active intervention is necessary.
- BILINGUALISM A bilingual home environment may cause a temporary delay in the onset of both languages. The bilingual child’s comprehension of the two languages is normal for a child of the same age, however, and the child usually becomes proficient in both languages before the age of five years.
- PSYCHOSOCIAL DEPRIVATION Physical deprivation (e.g., poverty, poor housing, malnutrition) and social deprivation (e.g., inadequate linguistic stimulation, parental absenteeism, emotional stress, child neglect) have an adverse effect on speech development. Abused children who live with their families do not seem to have speech delay unless they are also subjected to neglect. Because abusive parents are more likely than other parents to ignore their children and less likely to use verbal means to communicate with them, abused children have an increased incidence of speech delay.
- AUTISM Autism is a neurologically based developmental disorder; onset occurs before the child reaches the age of 36 months. Autism is characterized by delayed and deviant language development, failure to develop the ability to relate to others and ritualistic and compulsive behaviors, including stereotyped repetitive motor activity. A variety of speech abnormalities have been described, such as echolalia and pronoun reversal. The speech of some autistic children has an atonic, wooden or sing-song quality. Autistic children, in general, fail to make eye contact, smile socially, respond to being hugged or use gestures to communicate. Autism is three to four times more common in boys than in girls.
- ELECTIVE MUTISM Elective mutism is a condition in which children do not speak because they do not want to. Typically, children with elective mutism will speak when they are on their own, with their friends and sometimes with their parents, but they do not speak in school, in public situations or with strangers. The condition occurs somewhat more frequently in girls than in boys. A significant proportion of children with elective mutism also have articulatory or language deficits. The basis of mutism is usually family psychopathology. Electively mute children usually manifest other symptoms of poor adjustment, such as poor peer relationships or overdependence on their parents. Generally, these children are negativistic, shy, timid and withdrawn. The disorder can persist for months or years.
- RECEPTIVE APHASIA A deficit in the comprehension of spoken language is the primary problem in receptive aphasia; production difficulties and speech delay stem from this disability. Children with receptive aphasia show normal responses to nonverbal auditory stimuli. Their parents often describe such children as “not listening” rather than “not hearing.” The speech of these children is not only delayed but also sparse, agrammatic and indistinct in articulation. Most children with receptive aphasia gradually acquire a language of their own, understood only by those who are familiar with them.
- CEREBRAL PALSY Delay in speech is common in children with cerebral palsy. Speech delay occurs most often in those with an athetoid type of cerebral palsy. The following factors, alone or in combination, may account for the speech delay: hearing loss, incoordination or spasticity of the muscles of the tongue, coexisting mental retardation or a defect in the cerebral cortex.
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