Speech Problems

What are speech problems?

A childhood speech problem is regarded as present when a child's level of speech understanding or speech production is below the normal range for its age, regardless of the cause. Such a problem may be part of a wider learning difficulty; or specific to speech articulation, or to the normal understanding or use of language. Speech problems tend to run in families, and they afflict males up to 10 times more often than females.

What causes speech problems?

Speech is normally learnt by hearing and imitating, so that any failure of hearing at an early age, may have an important effect on speech. Many speech problems relate to hearing difficulties which may be due to otitis media (middle ear infection), or glue ear (accumulation of fluid in the middle-ear cavity), for example. Congenital (from birth) hearing loss is particularly serious, as severely affected children will not acquire intelligible speech unless they receive remedial training.

Other causes of speech problems include cleft lip and/or cleft palate (fissured lip and/or palate from birth); delay in mastering the fine muscular movements needed to articulate sounds; difficulty in remembering the sequence of sounds to make words; problems with producing speech fluently, such as early stuttering; and hoarse voice, often due to constant shouting.

Delay in speaking is usually due to slow development rather than to disease or damage to the brain. Sometimes, such delay is wrongly put down to laziness,  emotional disturbance or learning difficulty. Even so, many children with speech problems do show some degree of learning difficulty; but this may be the effect of the problem rather than its cause.

What can I do to avoid speech problems?

  • Make sure your child is not suffering a hearing impairment.
  • Ensure that your child receives adequate verbal stimulation from the earliest stage.
  • Avoid baby talk. Use normal, simple, one-syllable words at first, whether or not the child seems to understand them.
  • Gradually increase the complexity of vocabulary spoken to the child.
  • Start reading your child stories at a young age.

How are speech problems diagnosed and treated?

Speech difficulties are assessed by comparison with the average child; and it should be remem­bered that the normal range at any age is wide. Typical stages are as follows:

  • 3 months: Pleasurable babbling begins.
  • 9 months: Real speech is echoed without using recognizable words.
  • 22-28 months: First simple words produced.
  • 18-24 months: First short telegraphic phrases, such as, 'Go now'
  • 2-3 years: Longer sentences with adjectives, such as, 'I like hot pie'.
  • Over 3 years: Progressive but uneven advance to fluency, usually reached by age 6-7

Hearing problems are assessed by simple tests of response to sounds and, in older children, by an audiogram test (tone test using headphones which allows the severity of hearing loss at different pitches to be charted).

The treatment of speech problems depends on the cause. Remediable hearing loss should be corrected at the earliest opportunity. Hearing aids, often used on both sides, can be helpful. Cleft lip and/or palate should be repaired as soon as it is thought medically advisable. Referral to a speech therapist may be made to help treat developmental speech problems.

When should I see my doctor?

At the slightest suspicion that your child may not be hearing normally, or that progress in speech development or fluency is delayed, see your doctor, speech and language therapist or health visitor. Babies with normal hearing will always respond in a startled way to unexpected loud noises, but be sure the child has no visual clue as to the source of the noise. Mothers are seldom in any doubt about the normality of the hearing

of toddlers. However, older children may be taken as inattentive or lazy when, in fact, the problem is hearing loss

What will the doctor do?

The doctor will perform simple tests of hearing and try to assess speaking ability by prompting conversation. If satisfied that there is a problem, a paediatric (concerning childhood disorders) appointment will be arranged to carry out a full investigation.

Are speech problems in children serious?

It is interesting to note that some highly gifted adults were late in learning to speak as children. Even so, persistent speech prob­lems may deeply affect social and personal devel­opment, making early recognition and treatment essential to bring about all possible improvement.


  • Baby babbling may not progress to word utterance.
  • Failure to reach normal speech milestones.
  • Unnatural silence.
  • Failure to understand what is said.
  • Defective pronunciation of words.
  • Defective articulation.
  • Noise production not resembling language.

    The following organization can provide the names of your local NHS and private therapists, and information for parents of affected children:

    College of Speech and Language Therapy.



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