SPEECH DELAY

By
Norrifhan Akmal Ismail
Nur Atiqah Ab Rahman

OUTLINES

Definition
Normal speech development
Signs of speech delay
History taking
Causes of speech delay

DEFINITION

Childs speech development is

significantly below the standard for
children of the same age.

Age

Achievement

1-6 months

Coos in response to voice

Laughs

6-9 months

Babbling

10-11 months

Imitate sounds
Says mama, dada without meaning

12 months

Says mama dada with meaning

Imitate 2-3 syllables words

16-18 months

10 words
Shows 2 parts of body

2 years

>50 words
Two words phrases

3 years

Talk constantly in 3-4 word

sentences

4 years

Ask questions
Tell stories

5 years

Fluent speech
Good articulation
Knows ABC
Names 4 colours
Tells time

2.5 years

Speaking in single syllables

Didnt have vocabulary of 50 words

3 years

Speaks only simple two word phrase

Strangers cant understand his
pronunciation

Say only few words

Communicate mostly through grunting
and pointing

He hasnt said one word

Isnt babbling or speaking in mock

sentences at all.

2 years
1.5 years
1year

SIGN OF SPEECH DELAY

HISTORY TAKING

Developmental history
Maternal illness in pregnancy
Maternal use of alcohol
Perinatal history
Past medical history
Use of medication
Psychosocial history
More than one language spoken to the
child
Family history

EXAMINATION

Check ears
Check for any dysmorphic features
Distraction test
Developmental assessment

AETIOLOGY

Hearing loss
Global developmental delay
Anatomical disorder
Oromotor dysfunction
Autism
Bilingualism
Receptive aphasia
Expressive language disorder

HEARING LOSS

Impairment in either one or both ears of

any severity

Can be due to
Sensorineural : caused by a lesion in the

cochlea or auditory nerve.

Conductive : abnormalities of the ear canal or

middle ear.

SENSORINEURAL

CONDUCTIVE

Genetic

Otitis media with effusion

Antenatal and perinatal

-Congenital infection
-Preterm
-Hypoxic-ischaemic
encephalopathy
-Hyperbilirubinemia
(bilirubin can damage the
vestibulocochlear nerve)

Eustachian tube dysfunction

-Down syndrome
-Cleft palate

Postnatal
-Meningitis/encephalitis
-Head injury
-Drugs ; aminoglycosides,
frusemide

Impacted wax

Symptom
s

No response when
called
Talk loudly
Watching TV at high
volumes
Mispronouncing
words

SENSORINEURAL

CONDUCTIVE

Usually present at birth,

irreversible

Usually due to middle ear disease

such as otitis media
More common

Management
- If severe, need amplification
with hearing aids/ cochlear
implants

Management
-Conservative
-Surgical repair
-Amplification

HEARING TEST
AGE

TYPE OF TEST

COMMENTS

Newborn screening

Automated Otoacoustic
Emission (AOE) test

Determines cochlear function by

creating echo response. Sound wave
given via probe

Any age

Brainstem Auditory
Evoked Response (BAER)

Measures brainstem responses to

sound and recorded as wave activity

7-9 months

Infant Distraction Test

(IDT)

Assess the ability to hear a sound

and turn to locate it.

Infants

Behavioural observation
assessment (BOA) test

Identifies body reactions to sound

>2.5years

Conditioned play
audiometry

Earphones placed on child They need

to perform the action each time they
hear the sound

Older children

Pure tone audiometry

(PTA)

Patient presses a response

button/raises hand when the test
tone is heard

GLOBAL DEVELOPMENTAL
DELAY

Delay in all skill fields (gross motor,

vision and fine motor, hearing and
speech, language and cognition, social
and behaviour)

i.e Down syndrome

DOWNS SYNDROME

Trisomy 21

Can be due to
Meiotic non-disjunction
Translocation
Mosaicism

Hearing impairment from secretory otitis media

Narrow Eustachian tube infection block glue ear

hearing loss speech delay

Thyroid dysfunction hypothyroidism abnormal growth

of brain mental retardation speech delay