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 dont 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 childs 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 childs individual
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
"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 theres 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
"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 childs age, impacts the childs emotional status,"
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 childs or adults 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.