Delayed speech can be defined as a child’s inability to provide similar speaking skills to their peers. If a child is unable to provide the expected speech that is compatible with his / her age, this may be a “speech disorder” or “developmental language delay”. Speech impairment due to any organ is called “organic speech disorder”, and the condition that occurs without any organ disorder is called “functional speech disorder”.
In order to have a speech in a child, language skills must be developed, sound production must be possible and there must be no defects in the organs that will perform the speech function. In this case, intelligence, hearing, vision, oral cavity, upper airways, lungs and the nervous system and muscular system that feed them must be natural. Therefore, the problems of eye, ear, nose, throat, brain, nervous system and musculoskeletal system should be investigated in order to determine the presence of speech disorder in a child with delayed speech.
One of the most important reasons for the delay in speech is hearing loss. Hearing loss may be congenital or acquired later. There may be a beginning hearing impairment when the child hears beforehand. Hearing the child’s loud sounds, hearing some sounds (only low voices, high-pitched voices) does not indicate that the child has no hearing loss, but can cause the speech not to start. For this reason, it is essential to conduct a detailed hearing assessment in the child whose speech is suspected of delay. The most common cause of acquired (postprandial) hearing loss is conditions that occur with impaired middle ear ventilation in children who frequently have upper respiratory tract. In addition, an inconspicuous (submucosal) cleft palate, and the presence of tongue ligament problems can cause late speech or speech disorders.
Otolaryngology, child neurology and child psychiatry work together to reveal the pathology in these children. The problem is functional in a child who has no organic disorders. The problem may be functional speech impairment or developmental language delay. There is no organic cause in functional speech disorder. In this case, psychiatric disorders should be investigated the most.
For speech, all individuals use the language that belongs to the community they are in. In order for children to complete language development, they must first understand the language and then use the language. We call these “receiving language” and “expressive language”. We expect an advanced understanding of the language in a child who cannot speak yet. If the recipient language skill is developed, it can be thought that it is not a problem for the brain and nervous system. Such a child does not speak yet, but he can perform commands such as “bring me the car”, “put your teddy bear in the toy-box”. Developmental language delay may occur in 18-20 months old children whose recipient language has developed but the expressive language has not yet been formed. In this case, the child can be monitored using the “wait-see” method, but in the meantime, other pathologies should be excluded by researching. These children generally have a family history of the late talking mother, father or siblings.