We cry, we talk, we listen to the world of sound and words. These acts are not as simple as they sound. A child listens a lot before he can speak well. Our ability to speak helps us to know more about the wonderful world we live in. It helps us to understand other Individuals ideas and emotions and tell them what we want to say. This difficult act cannot be mastered by many. Let us know more about speech and language problems.

Do you/your child have any of the following problems mentioned here?

Child is 18 months old and yet does not speak or though he speaks you feel he is not talking according to children of his age
Does not speak clearly/ cannot produce certain sounds due to which others find it difficult to understand his speech.
Any problem with voice 
a) male using feminine voice after puberty   b) hoarse voice
Dysfluencies while speaking i.e. repeating speech sounds again and again; getting stuck on a word/fear of speaking etc.
Difficulty in speaking/loss of speech after stroke or after major head injury.

Behaviour problems i.e. does not attend to your commands, cannot concentrate on a task for long, talks irrelevantly and behaves differently from children of his age.

If yes,

Consult a Speech Language Pathologist


I. Delay in speech and language development :

When speech and language is inappropriate for his age, use this checklist to note if there is any delay.

Checklist :-

By 3 months:

1. Makes crying and non-crying sounds.
2. “Coos”, laughs

By 6 months :

1. Vocalises to toys.
2. Repeats some vowel and consonant sounds (babbles) when alone or when spoken to.

By 9 months:

1. Attempts to imitate sounds.
2. Interacts with others by vocalizing after adults.

By 1 year to 1 ½ years:

1. Imitates actions and words of adults.
2. Responds to words or commands with appropriate actions. For example, ‘Stop that’, ‘ Get down’, ‘What is that’?
3. Uses few single words and gestures to ask for objects.

By 1 ½ to 2 years:

1. Uses two word sentences meaningfully.
2. Recognises pictures.
3. Looks at pictures with adults.

By 2 to 3 years :

1. Talks in sentences consisting of 3 to 5 words.
2. Answers simple questions.

The delay can be as a result of :

1.  Hearing loss: Moderate/severe/profound hearing loss.

Mental retardation: Mentally retarded children are slow in learning and have difficulty in learning and memory. This affects their speech and language development.

3.  Hyperactivity/Autism/Attention deficit: These may pose difficulty in acquiring age appropriate speech and language.

Poor speech and Language stimulation: When parents speak to the child they facilitate speech and language development. However, lack of adequate exposure to different aspects of speech and language would interfere with speech development.


Brain damage : Certain special centers in the brain are responsible for enabling us to speak and understand speech of others. Damage to these centers delays speech and language development.

6.  Difficulty in reading writing and mathematics.

Some children experience difficulties when they start schooling like :

1.  Difficulty in oral expression.
2.  Difficulty in written expression.
3.  Difficulty in listening comprehension.
4.  Difficulty in loud reading.
5.  Difficulty in mathematics.
6.  Makes unusually large number of grammatical errors.
7.  Difficulty in becoming oriented to new surroundings.
8.  Difficulty in right left orientation.
9.  General clumsiness, poor coordination, poor balance, or a tendency to fall down a lot.

II. Incorrect pronounciation of speech sounds :

1. Incorrect adult model and incorrect learning :
For example a child produces ‘tat’ for ‘cat’ or ‘tun’ for ‘sun’

Cleft lip and/or palate:
This can be corrected by surgery and/or prosthesis (appliance). However, certain difficulty in maintaining air pressure in the mouth may result in nasal and incorrectly pronounced speech.


Weakness, incoordination and paralysis of the speech musculature:
In addition to incorrect pronounciation, the child may also have difficulty in swallowing and chewing.

4.  Moderate/severe/profound hearing loss.

III. Voice Disorders :

Hoarse Voice : Children are very active and enthusiastic. They may talk, shout and scream a lot. This can make their voice hoarse.

IV. Stammering (stuttering) :

Speech like walking has rhythm and flow. Disruption of this flow reduces the effectiveness of speech. Stammering may range from mild hesitation to severe disruption in the flow of speech. Young children of 2 to 4 years of age may exhibit repetition of words and phrases while speaking. Such non-fluency in early speech and language development, is often referred to as normal non-fluency. The child may come out of this phase on his own with the help of parent’s support. 


I. Language Disorders: 

Of the various faculties of the brain, the ability to express ideas, thoughts and feelings through speech is a precious gift to mankind. This wonderful faculty is possible because of speech centers of the brain and the speech organs we possess.

Paralysis or head injury may damage these speech centers causing language disorders known as aphasia. Such people have difficulty in expressing and understanding speech. In addition they may have difficulty in reading, writing and calculating. Such people need emotional support and help from the family. Speech and language therapy helps to recover their speech communication skills.

II. Unclear Speech: 

There are centers in the brain responsible for movement and coordination of the speech musculature. Lesions of these centers cause weakness, incoordination and paralysis resulting in unclear speech. Apart from this difficulty they may have difficulty in swallowing and chewing.

III. Voice Disorders :


Hoarse Voice:
This may result from excessive use or misuse of voice, cancer of larynx, hearing loss, growth on vocal cords and paralysis of the vocal cords. For this, consultation of ear, nose, throat specialists is also required.


Voice inappropriate to gender:
During and/or after puberty, there is a change in the male voice. Some men are unable to learn to use the new low pitched voice and are often mocked as effeminate. Voice therapy helps them in restoring their correct voice.

IV. Stammering

Disruption of flow of speech reduces effectiveness of speech. Stammering may range from mild hesitation to severe disruption in the flow of speech. This problem starts in childhood and may continue in adulthood. This may affect their personal and social growth. They may experience difficulty in getting employment.

The management of speech-language disorders is done by a Speech Language Pathologist. The other team professionals are Audiologist, Psychologists, ENT, Pediatrician, Neurologist, Special educators. Person having speech and language difficulties can be helped with speech –language therapy. Speech and language therapy is a long term process. It is not an instant formula. It requires consistent practice and coordinated work between you and your therapist. The family members also have an important role to play throughout the management process.

For any speech language and/or hearing problem consult the Audiologist/Speech Language Pathologist at the nearest general/private hospital.


It is helpful to note the risk factors of communication disorders:

Postnatal infections
Rubella, herpes.
Birth weight. 
Birth weight less than 1500 grams.
Ototoxic Drugs (streptomycin etc.)
If taken for a period of 10 days or longer.
Deviations in sucking or feeding.
In case of premature babies having other complications, cleft lip and palate may have difficulty in sucking, swallowing and chewing along with delay in speech and language development.
Birth defects :
Cleft lip/palate; submucous cleft; bifid or missing uvula, abnormalities of the pinna, hydrocephalus, proven chromosomal syndrome.
Blood transfusion/exchange
May result in severe jaundice.
Family History of Hearing loss
Hearing loss in family attributed to hereditary etiology.
Family History of speech problems or learning disabilities.
If child’s immediate family or first degree relative.


  Early Identification, Prompt Management & Supportive help from family and  
  community form heart of the rehabilitation process