How to investigate and manage the child who is slow to speak.(Clinical review)

Summary points

Delay in speech and language development in children can be defined as a "delay in speech and/or language development compared with controls matched for age, sex, cultural background, and intelligence"

To evaluate such children, carefully analyse the child's cognitive strengths and weaknesses

The analysis should take account of the history and context in which the child is developing, the observed performance of the child, and the results of a validated test of cognitive function

In all cases of suspected speech and language delay, audiometry and a good clinical evaluation of the central nervous system and ear, nose, and throat are mandatory

The management of children with speech and language delay should be multidisciplinary, involving the child's parents and school teacher, as well as various health professionals

Children who are slow to speak often present clinicians with a dilemma--should they conduct further investigations or just wait and see if the problem resolves (as it does in most children aged under 3 years)? Two paediatricians propose a guideline that can be used to investigate and manage children with speech or language delays

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Delay in speech and language development is the most common developmental disorder in children aged 3 to 16 years. The prevalence of this disorder ranges from 1% to 32% in the normal population and is influenced by factors such as the age of the child at presentation and the test method used in diagnosis). (1 2) A high rate of comorbidity (up to 50%) is known to exist between psychiatric disorders such as autism and disorders of speech and language development. (3) Despite the prevalence and reported risks of comorbidity, however, about 60% of cases of speech and language delay tend to resolve spontaneously ha children aged under 3 years. (1) Children who are slow to speak form a particular category of patients with speech and language developmental disorders and often present clinicians with a dilemma--whether to conduct further investigations or just wait and see. This is because a delay in speaking could be either a normal (and temporary) stage in the child's development or the initial symptom of a psychiatric, neurological, or behavioural problem. As a result, the timely diagnosis, choice of therapy, and an individualised approach to the child with a speech and language delay become imperative as these interventions may prevent subsequent psychological or psychiatric problems later in life.

We provide here an update of the current literature on speech and language development in children. Using a real patient encounter, we illustrate how a child with a delay in language development is presented to the clinician. We also propose a guideline that can be used to investigate and manage children with speech or language delays.

Sources and selection criteria

We did a database search on Medline (National Library of Medicine) using the following key words: "speech and language disorders", "children (0-18 years)", "screening methods", "diagnostics", and "interventions". We chose relevant review and research articles that had been published on the subject after 1990 because we were …