Speech-Language Delays or Disorders

Speech-Language Delays or Disorders pdf


Speech-Language delays or disorders can cause significant problems for children if left untreated. Kids with speech intelligibility issues and poor language skills will have poor communication in a variety of settings. These challenges may be evident at home or school. If a child is not understood due to difficulty with speaking clearly, his ability to engage with others can be affected. He may lack confidence and may withdraw from social events. If a child cannot understand things well due to language difficulties, she may also lack confidence to participate in games or projects at school.


The most common speech and language delays and disorders are outlined below.

In children, Speech-Language Delay is characterized by a delay in speech skills when compared to a child’s age, more specifically when a child is unable to articulate sounds at an age-appropriate level. Typically, an age has been identified by which children should clearly pronounce each sound. When a child is not able to articulate clearly, such as saying “wabbit” for “rabbit” or “dat” for “that,” he or she might be identified as having a delay. With intervention and time, this speech articulation issue can be remediated.

See the following chart for language milestones by age http://www.asha.org/slp/schools/prof-consult/norms/ Children with a language delay speak later than what is expected for their age and may have difficulty understanding. This type of difficulty is called a language disorder. Children with a language disorder will demonstrate a reduced vocabulary, compared to their same-aged peers. With intervention, children can show progress and can “catch up” with peers who are not delayed. It is important to understand language milestones and to seek language therapy for a child who is falling behind.

A Speech-Language Disorder, like a speech sound disorder or a language disorder, may be evident throughout a child’s academic years, and he or she may struggle to speak clearly without therapy. Early intervention is very important to help a child avoid frustration with his or her speech or language deficits. A child will continue to have challenges in school due to the difficulty understanding or expressing herself verbally or in writing, so intervention and progress monitoring are crucial for a child’s success.

Language Disorders

Expressive Language Disorder: A disorder in which it is difficult to express oneself due to reduced vocabulary or the knowledge of how to use correct word order or syntax.  A child may use the wrong tense, have poor use of pronouns, or have a limited bank of words. These symptoms may be apparent during speaking and in written language when creating sentences and telling a story. A child might use short sentences and demonstrate frustration. He will have a hard time expressing his thought or ideas. It might be evident that he has a hard time elaborating with details. His story might not make sense when you listen or when you read it; the ideas might be inconsistent or jump around.

Receptive Language Disorder: A disorder in which it is difficult to understand or comprehend language. A child will have a hard time understanding words and what they mean. She will have a hard time following directions. She might look confused when asked questions about what she has read or heard or about what happened. She might answer with a response that doesn’t make sense to the topic that is being discussed, which shows she didn’t understand the question. In school, reading tasks may be hard for the child, and she will have a hard time answering who/what/when/where/why questions, inferencing, and understanding the main idea or recall details of a story.

Mixed Language disorder: This disorder is a combination of an expressive and a receptive language disorder. Children may have a hard time expressing themselves verbally or with written language and may also have a hard time with understanding or comprehending ideas and words when they are being spoken to or when they are reading. These challenges can affect their communication with others during conversations due to a decreased vocabulary or poor use of tense and syntax and due to a difficulty with correctly forming sentences when speaking or writing. A mixed language disorder can affect how conversations are understood due to a poor comprehension of semantics, which is what words mean, and due to a difficulty comprehending what is read.

Childhood Onset Fluency Disorder (Stuttering): Stuttering is a disorder that affects the ability to speak without repeating sounds, words, or phrases. Stuttering can cause a child a lot of embarrassment and social issues. Stuttering is usually a disorder that lasts a lifetime, and strategies need to be utilized to improve communication. During times of stress, worry, or heightened emotions, stuttering may be more apparent. Therapy is crucial to help build confidence, focus on individualized and effective strategies, and address psychological factors like anxiety.

Speech Sounds Disorder: Speech-Language disorders, including articulation disorder, language disorder and stuttering, can be treated effectively when diagnosed and caught early.


Speech Therapy for articulation delay and disorder should focus on teaching the correct pronunciation of error sounds to increase intelligibility so the child is more easily understood. Intervention should include visual, auditory, and tactile feedback so the child can use all modalities to learn how to coordinate his or her oral neuromuscular movements to produce sounds clearly. It is important to create a good rapport and trust with the child so he or she is motivated to improve speech. A good model should be provided by the speech pathologist. A child should understand how he is heard in order to hear the difference between the modeled correct pronunciation of sounds and his distorted pronunciation of sounds, which affects the clarity of his overall speech. Speech therapy should be delivered on a consistent basis to increase the chance of decreasing poor behaviors and patterns and to encourage proper tongue placement and awareness of how to correctly create sounds for speaking. The goal is to allow the child to learn correct speech production and to correct her errors independently so she will eventually be able to speak clearly without any assistance. A variety of methods are used in articulation therapy. They may vary depending on the needs of the child being treated.

Contextual approach: focuses on speech sounds that are in syllable-based contexts

Contrast approach: focuses on using word pairs instead of sounds

Core vocabulary approach: focuses on whole word production

Cycles approach: focuses on phonological pattern errors

Distinctive feature approach: focuses on missing phonemes

Metaphon approach: focuses on the metaphonological awareness of language or the ability to think about speech sounds or to manipulate them auditorily, such as rhyming or blending

Naturalist approach: focuses on natural and frequent activities

Non-speech oral motor approach: focuses on oral motor training to teach sounds

Speech sound perception approach: focuses on helping a child get a stable representation of a phoneme

Speech therapy for language disorders: should focus on expressive language (speaking) language and receptive language (listening & comprehension) skills. Areas targeted would include therapy for increasing vocabulary, phonology, morphology, syntax, and semantics. The therapist could focus on writing skills and pragmatic language skills for social communication.

Expressive Language

Therapy will focus on improving the use of verbal and written language skills. Focus areas include vocabulary, syntax or word order, pronoun usage, correct tense, and the length of sentences.

Receptive Language

Therapy will focus on improving understanding verbal and written language skills. The areas to focus on will include understanding vocabulary and increasing comprehension of what is heard and read by answering the who/what/when/where/why questions, learning to infer, understanding main idea, using negation, following directions, and sequencing skills.

Mixed Language

Therapy will focus on improving both expressive and receptive language skills. Vocabulary development and comprehension along with using good syntax and demonstrating comprehension by answering the who/what/when/where/why questions and improving the ability to infer, discussing the main idea, and demonstrating the completion of tasks when given either verbal or written directions.


A speech-language therapist who specializes in fluency therapy will assess a child who demonstrates signs of stuttering to determine if the child is exhibiting true stuttering and to classify the stuttering as mild, moderate or severe. The child will be observed and tested to determine if he is repeating sounds, partial words, or whole words or if he is blocking and using facial grimaces, sputtering, and/or using avoidance behaviors. This treatment is specialized, and for best results it should be initiated as early as possible to avoid social and psychological issues as the child grows.


Formal tests, such as the Goldman Fristoe-3 Test of Articulation, are used to determine if an articulation delay or disorder exists. Observation of the child both during testing and in a natural environment or when speaking with others will also help to determine whether any challenges are present. A parent report can help determine the child’s social and educational history and any other relevant medical history. An oral examination can show if any physical constraints are present that might affect speech articulation.

Formal language tests for assessing expressive and receptive language skills include the Clinical Evaluation of Language Fundamentals (CELF-5), the Peabody Picture Vocabulary Test (PPVT), and the Test of Language Development (TOLD). These tests are used to determine if a language delay is present, which means that the child’s speech and language development is following the usual pattern or sequence but is slower in nature when compared to other same aged peers, or if a true disorder is present, which means the development is not following the usual pattern or sequence. Observation during testing, teacher report, parent report about language milestones and communication skills in the home can help a therapist understand how the child is functioning.

If a child is stuttering or a teacher or parent has reported that the child is stuttering, the therapist needs to understand the child’s complete history of when the symptoms started and what the symptoms are. A Stuttering Severity Instrument (SSI) can be used for formal data. It is important to observe the child during different situations that involve communication with peers and adults. Observing behaviors in both a quiet one-on-one setting and a group situation can help the therapist see how the child is affected and reacts with his or her speech.


A referral for a comprehensive speech and language evaluation may be warranted to confirm a delay or disorder and to better understand your child’s strengths and weaknesses. This type of assessment includes an evaluation of your child’s speech skills, language skills, and social communication skills. Other areas may be evaluated as concerns arise. Referrals may include speech therapy to focus on improving articulation, language therapy to improve expressive and or receptive language skills to help with communication and academic performance, parent consultations, and an Individualized Educational Program (IEP).

Parent Consult. A speech pathologist might provide guidance to parents on strategies to use to help speech intelligibility at home, such as the use of a home program that is consistent with the program a speech therapist would provide to the child. Strategies to improve language skills will also be discussed with parents and caregivers to help the child improve his or her expressive skills and to improve understanding.

School Services. School-based supports, such as an IEP, can help your child receive accommodations and modifications that he or she may require to access learning in the classroom setting. This plan will help your child’s teachers and educators understand how they can help him or her feel confident and be successful in the classroom setting. An IEP is a detailed document that does require clear educational impact of symptoms.


Speech Language delays and disorders are common and highly treatable. It is important to diagnose them early and start intervention early to increase the chances of a successful academic career and to establish confidence in children for their communication skills with others.


  • Articulation
  • Expressive language
  • Receptive language
  • Pragmatic language
  • Conversations
  • Interacting
  • Verbal comprehension
  • Following Directions
  • Achievement
  • Learning problems


American Speech-Language Hearing Association. http://www.asha.org/

Bernstein, Deena K. &   Tiegermann-Farber, Ellenmorris (2017). Language and Communication Disorders in Children, Third-Sixth Editions.


Bell, Nanci (2005). Talkies visualizing and verbalizing for language comprehension and expression.


Echevarria, Jana J., & Richards-Tutor, Cara, & Vogt, MaryEllen J. (2014). Response to Intervention (RTI) and English learners: Using the SIOP model (SIOP Series), 2nd Edition.


Law, James; Garrett, Zoe & Nye, Chad. (2003). Speech and language therapy interventions for children with primary speech and language delay or disorder.


Lederer, Susan Hendler & Loehr, Jenny (2006). I Can Say That.  


Linder, Toni (2008). Administration guide for TPBA2 & TPBI2 (Play-based Tpba, Tpbi, Tpbc).


Pfiffikus (2016). Following directions activity book | toddler–grade K – ages 1-6.


Back to: Home → Disabilities