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Language Delay

Language refers to the understanding (comprehension) and use (verbal expression) of words and sentences to access and express ideas.  Language is expressed verbally and in writing. Language development involves developing vocabulary, acquiring grammatical skills, ability to understand and use conceptual terms (words denoting position, time, quality, quantity), ability to choose words to precisely express ideas/thoughts as well as the ability to use language for a variety of social purposes (gaining attention, requesting, commenting, rejecting, making social greetings) in a variety of settings. As a child grows, the ability to process and produce more complex language (make inferences, understand jokes and double word meanings) increases. 

A language disorder is suspected when a child demonstrates weaknesses in any of these areas as their skills are not in line with the expectations for their chronological age. Language disorders are seen in an individual difficulty understanding or using spoken or written language to communicate thoughts, feelings and experiences. A language disorder can negatively impact a child's ability to function effectively and to be successful in school, in social situations and in daily life. 


Articulation refers to the way phonemes/sounds are formed.  Vocal tract movements for speech sound production: involves accuracy in placement of the articulators, timing, direction of movements, force extended, speed of response, and neural integration of all events.

Children may say some sounds the wrong way as they learn to talk. They learn some sounds earlier, like p, m, or w. Other sounds take longer to learn, like z, v, or th. Most children can say almost all speech sounds correctly by 4 years old. A child who does not say sounds by the expected ages may have a speech sound or articulation disorder. 

Childhood apraxia of speech is a type of speech disorder. Childhood Apraxia of Speech (CAS) is a motor speech disorder that first becomes apparent as a young child is learning speech. For reasons not yet fully understood, children with apraxia of speech have great difficulty planning and producing the precise, highly refined and specific series of movements of the tongue, lips, jaw and palate that are necessary for intelligible speech. In order for speech to occur, messages need to go from your brain to your mouth. These messages tell the muscles how and when to move to make sounds. When a child has apraxia of speech, the messages do not get through correctly. The child might not be able to move their lips or tongue in the right ways, even though their muscles are not weak. Sometimes, the child might not be able to say much at all. A child with CAS knows what they want to say. The problem is not how the child thinks but how the brain tells the mouth muscles to move. 

Apraxia of speech is sometimes called verbal apraxia, developmental apraxia of speech, or verbal dyspraxia. Following the 2007 ASHA Ad Hoc Committee’s position statement the term childhood apraxia of speech is now most commonly used.  The most important concept is the root word “praxis.” Praxis means planned movement. To some degree or another, a child with the diagnosis of apraxia of speech has difficulty programming and planning speech movements. Apraxia of speech is a specific speech disorder. This difficulty in planning speech movements is the hallmark or “signature” of childhood apraxia of speech. 



We all have times when we do not speak smoothly. We may add "uh" or "you know" to what we say. Or, we may say a sound or word more than once. These are called disfluencies.   

Stuttering is a speech and language impairment characterized by disruptions in the forward flow of speech (or “speech dysfluencies”) People who stutter may have more disfluencies and different types of disfluencies than as noted above. They may repeat parts of words (repetitions), stretch a sound out for a long time (prolongations), or have a hard time getting a word out (blocks). Stuttering is more than just disfluencies. Stuttering also may include tension and negative feelings about talking. It may get in the way of how you talk to others, and lead to avoidance of certain words or situations. You may also notice other behaviors like head nodding or eye blinking. Sometimes people who stutter use these behaviors to stop or keep from stuttering. The problem often starts in childhood and may become a life-long challenge. Stuttering may also begin later in life as a result of a stroke or injury. 


Cluttering involves excessive breaks in the normal flow of speech that seems to result from disorganized speech planning, talking too fast or in spurts, or simply being unsure of what one wants to say.  By contrast, the person who stutters typically knows exactly what he or she wants to say but is temporarily unable to say it.  

Cluttering is a fluency disorder characterized by a rapid and/or irregular speaking rate, excessive dysfluencies, and often other symptoms such as language or phonological errors and attention deficits. It is often noted with children who have difficulty with language formulation. 


Voice Disorder can be seen as a hoarse, breathy, harsh or nasal voice quality as a result of mistreatment or overuse of the voice (screaming or yelling) or due to structural abnormalities (e.g., cleft palate, enlarged adenoids, etc.). 


Selective mutism (SM), formerly called elective mutism, is best understood as a childhood anxiety disorder characterized by a child or adolescent’s inability to speak and communicate effectively in one or more social settings (e.g., at school, in public places, with adults) despite being able to speak comfortably in other settings (e.g., at home with family) where they are comfortable, secure, and relaxed. . 

Affected individuals understand language use and, although they have the physical and cognitive ability to speak, they demonstrate a persistent inability to speak in particular settings over a particular period of time due to anxiety.