University of Iowa Health Science Relations and
Debora Downey, MA
Adjunct Instructor of Speech Pathology & Audiology
First Published: November 2000
Last Revised: April 2004
Peer Review Status: Internally Peer Reviewed

In addition to photos or a lock of hair, a baby book typically includes milestones such as first words and sentences. But sometimes these milestones are delayed, and children don’t talk "when they should," causing concern for parents and caregivers.

Delayed talking or problems with fluency have many different causes, so it is important for parents to seek out appropriate resources for diagnosis and treatment, said Debora Downey, a speech pathologist with the Center for Disabilities and Development at University of Iowa Hospitals and Clinics. Early intervention is vital, as an undiagnosed language disorder can later be difficult to remediate and contribute to other learning problems.

"If parents become concerned about their child’s speech and language development, the first thing they should do is discuss it with their pediatrician," Downey said. "Pediatricians are an excellent starting point for guiding parents to the most appropriate resources. The key is to look at each child’s individual needs."

Downey said a general rule is that by age 2 a child should be able to put two words together. By age 3, a child normally should be able to communicate independently.

"That means being able to make himself or herself understood without a parent repeating or interpreting the comment for listeners," Downey said. "The range of normal varies in terms of sound development. However, if your child is not able to communicate by the age of 3, then you should seek assistance."

Downey and UI colleagues recently published an overview article in the journal Infants and Young Children on the diagnosis and treatment of children who are not talking. The article emphasized the usefulness of a multidisciplinary approach to help children and their families get the services they need.

Health care professionals can help determine if language problems are related to hearing problems, brain development or another condition such as autism. Some parents may already be aware of an existing motor or cognitive disorder that, as the child ages, impacts speech and language development.

Downey said that in other cases a family may need assistance identifying a possible speech or language problem with a child, especially if the child can be understood by the family but is unintelligible to everyone else at age 3 or older. Then, it is a good idea for parents to consider having the child evaluated at an early age.

"Children with underlying language disorders who go undiagnosed can end up later in life with obvious learning disabilities. By then, the language foundation cannot be remediated," Downey said. "Reading, writing and math are other forms of language, so children need a solid language foundation. Otherwise, no matter how much support you provide later on, the children cannot reach their full potential. It would be like building a house and there’s no framework to support the walls."

Downey said it is important to recognize that language delay and speech delay are different. "Language delay has to do with how a child responds to and reacts to his or her environment, whereas speech delay has more to do with the actual sound development and sequencing of sounds to make words," she said.

Sounds such as "r," "l" and "s" can be difficult for children to say even up until age 7. Time and maturation often are all that is needed for a child to learn to correctly pronounce certain sounds or words, Downey said. However, there are instances where intervention is preferred.

"If a child named 'Sam' or 'Rita,' for example, cannot properly say his or her own name and begins to withdraw socially, then it is important to seek services because the problem, although normal for the child’s age, impacts the child’s emotional status," Downey said.

For children and adults who cannot produce language because of motor problems caused by conditions such as multiple sclerosis, head injury or stroke, several electronic devices can help with communication at home, work and school.

"Our augmentative communication services at the Center for Disabilities and Development allows us to evaluate individuals and match a low-tech, mid-tech or high-tech device to the child’s or adult’s needs," Downey said.

Downey added that the American Speech and Hearing Association is also a useful resource for people who want to find speech and language experts in their area.