Speech Delay: Why Isn't My Child Talking and When Should I Worry?

What is speech delay and at what age should you worry? Learn the stages of language development, possible causes and ways to support talking at home.

"Children his age are making sentences, ours is still saying just a few words." "She understands everything but doesn't talk." "The older generation say, 'Boys talk late, just wait.'" Parents of children around the age of two often say things like this. Speech delay is one of the developmental topics families wonder about and worry about most. Every child develops at their own pace, and some children really do start a little late and then catch up with their peers. In some cases, however, a delay can be a sign of a problem that needs to be assessed and supported. In this article we cover the general stages of language development, the possible causes of speech delay, the signs that call for an assessment, and how you can support your child's language development at home.

What Is Speech Delay?

Speech delay is when a child's speech and language skills fall noticeably behind the level expected for their age. It helps to distinguish two concepts here:

• Speech: Producing sounds and words with the mouth, that is, articulation and fluency. Being unable to say words clearly is a speech problem.
• Language: Understanding words and using them meaningfully; vocabulary, sentence building and communication skills. Having difficulty understanding words or making sentences is a language problem.

Some children understand what is said to them very well but speak little (expressive language delay). Others have difficulty both understanding and speaking (receptive and expressive language delay). This distinction matters in planning the assessment and support process.

Another important point is that communication is not made up of words alone. A child pointing, waving, making eye contact and pulling you over to show you something are all part of communication. A child whose speech is delayed but whose gestures and social interest are strong is assessed differently from a child whose speech and social communication are both limited.

Stages of Language Development: What to Expect at What Age

The stages below offer an approximate framework. There are natural differences between children; a delay of a few weeks in a single stage is generally not a cause for concern. What really matters is the overall trajectory and whether there is a delay in more than one area.

0–12 months

• Responds to sounds, turns towards where a sound comes from
• Cooing, followed by repeated syllables such as "ba-ba" and "da-da" (babbling)
• Begins to respond to their name
• Towards the first birthday uses gestures such as waving and pointing
• Around one year, the first meaningful words may appear

12–24 months

• Vocabulary gradually increases
• Understands simple instructions ("Bring the ball")
• Can point to familiar objects and body parts
• Around the age of two begins to combine two words ("Mummy come", "Give water")

2–3 years

• Vocabulary expands rapidly
• Makes simple sentences of three or four words
• Asks questions such as "What?" and "Where?"
• Adults in the child's close circle can understand most of what the child says

3–5 years

• Makes longer and more complex sentences
• Can tell about an event in sequence
• Explores the world with "Why?" questions
• Strangers can also understand most of their speech; they may still have difficulty with some hard sounds (such as r and ş)

What Causes Speech Delay?

There is no single cause of delay. Sometimes no clear cause is found and the child is simply a "late talker". Sometimes there is an underlying condition:

• Hearing problems: Frequently recurring middle ear infections or congenital hearing loss can directly affect language development. For this reason, a hearing assessment is important in every case of language delay.
• Developmental language disorder: Marked and persistent difficulty in the language area alone, without another developmental problem.
• Autism spectrum disorder: When speech delay occurs together with social communication difficulties, an assessment for autism may be needed. You can find details on this in our article on signs of autism.
• General developmental delay: Along with language, there may be delays in motor, cognitive and social areas too.
• Conditions related to the mouth and speech organs: Motor speech problems such as difficulty planning the muscle movements needed for speech.
• Environmental factors: Not being talked to enough, limited opportunities for one-to-one interaction and prolonged screen exposure at an early age can negatively affect language development.

Explanations such as "Boys talk late", "His father talked late too" or "He's late because he hears two languages" are commonly heard. Family history and gender can create some differences; the language development of children growing up in a bilingual environment can also follow its own course. However, these explanations are not sufficient reason to put off an assessment. In assessing bilingual children in particular, the child's total communication skill across both languages is looked at.

Screens and Speech Delay: A Common Picture in Turkey

In many families today, children are introduced to phones, tablets and television at quite an early age. Putting on a cartoon during mealtimes, handing over a phone to calm the child while shopping, and the screen becoming a "helper" amid working parents' exhaustion are all very understandable situations. But language develops through two-way interaction. Although a screen presents words to the child, it does not respond to the child's voice, take turns with them or follow their interest.

Reducing screen time and adding one-to-one play and conversation time in its place is an important step that supports language development in many children. However, reducing screen time is not a substitute for a specialist assessment where one is needed. For practical suggestions on screens, you can read our article on screen addiction.

Practical Tips for Supporting Speech at Home

There is a great deal you can do at home while the assessment process is under way or while your child is receiving support. These suggestions are steps that contribute to your child's development but do not replace specialist support on their own.

1. Get down to eye level and face your child

When you talk to your child, get down to their level. That way they can see your face, your mouth movements and your expressions.

2. Follow your child's interest

If your child is playing with a car, instead of showing them another toy, talk about the car: "The car's going. Fast car. Stop!" Talking about what the child is already interested in makes learning easier.

3. Describe what you are doing and what they are doing

Think aloud through the day: "Now I'm washing the apple. The apple is red. I'm cutting it." Describe the child's actions too: "You put the block down. One more!"

4. Use short, simple sentences

Speak one step beyond your child's current level. With a child who uses single words, make two-word sentences: when the child says "Water", expand it to "Drink water" or "Cold water".

5. Wait and create opportunities

Meeting the child's needs immediately, before they ask, can reduce their need to speak. Put a toy they love somewhere they can see but not reach, and wait a few seconds. When the child points or makes a sound, say the word yourself and hand over the toy.

6. Offer choices

Questions such as "Apple or banana?" give the child a chance to repeat the word they hear.

7. Read books and sing songs

Looking at picture books together, naming the pictures and singing repetitive songs or nursery rhymes are very valuable for language development. Reading the same book over and over is fine; repetition strengthens learning.

8. Offer the correct model instead of correcting

When the child says "I gonna throw the ball", instead of saying "No, you don't say it like that", naturally repeat the correct form by saying, "Yes, you're going to throw the ball."

9. Do not pressure them to speak

Insisting with "Say it, come on, say it!" can create anxiety in the child and cause them to avoid speaking. It is important to keep communication enjoyable and pressure-free.

10. Replace screen time with one-to-one interaction

Limit screens as much as possible, especially under the age of two. With older children, watching together and talking about what is being watched is more beneficial than passive viewing.

A day-to-day example: language support at the breakfast table

Suppose your twenty-two-month-old points at the cheese at breakfast and makes an "uh-uh" sound. Instead of handing over the cheese straight away, you can proceed like this:

1. Look in the direction the child is looking and smile: "Do you want cheese?"
2. Say the word clearly and slowly: "Chee-se."
3. Wait a few seconds; if the child responds with a sound, a syllable or a word, greet it immediately with delight.
4. Expand the word: "Cheese! White cheese. Here you go."
5. Even if the child does not respond, give them the cheese. The aim is not to punish but to create repeated and enjoyable opportunities for communication.

Repeating this small cycle many times a day in routines such as meals, bath time, getting dressed and play can be far more effective than separate "lesson" times.

Involve all the adults who care for the child

If the child also spends time with a grandparent, a childminder or a nursery teacher during the day, share the approach you use at home with them. When everyone uses similar language, it reinforces what the child is learning.

The strongest tool for your child's speech is an adult who talks with them in play, with enjoyment and patience.

When Should You Seek Professional Support?

If one or more of the following applies, we recommend seeking an assessment for your child:

• Around one year, is not babbling, pointing or waving
• Around eighteen months, uses no meaningful words
• Around two years, is not making two-word sentences
• Has difficulty understanding simple instructions
• Does not respond consistently to their name
• At three years, even close family can understand very little of their speech
• At any age, loses words or skills they had previously gained
• The delay is accompanied by little eye contact, limited social interest or repetitive behaviours

The assessment usually involves several specialists. A hearing test (paediatric ear, nose and throat and audiology) is one of the first steps. A speech and language therapist assesses the child's language and speech skills in detail. If other developmental difficulties accompany the delay or there is a suspicion of autism, an assessment by child psychiatry and developmental paediatrics is needed. Diagnosis and treatment planning are carried out by these specialists. Where needed, special education support can also be planned through the Guidance and Research Centre (RAM, Turkey's state educational guidance and assessment centres).

How Is Speech Delay Addressed in Therapy?

The basic intervention for speech delay is speech and language therapy, carried out by speech and language therapists. In this therapy, play-based activities, parent training and home programmes are used according to the child's age and needs. If there is an underlying hearing problem, autism or general developmental delay, a multidisciplinary plan is drawn up with the relevant specialists.

The psychologist's role in this process is complementary. In some late-talking children, there may be tantrums caused by being unable to express themselves, withdrawal, separation anxiety or difficulty in peer relationships. Child and play therapy can be supportive for these emotional and behavioural difficulties, because play offers the child a space for expression where words are not enough. In addition, sessions with parents can help the family manage their anxiety, set up a pressure-free communication environment at home and keep the balance between siblings in mind.

However, psychological support is not a substitute for speech and language therapy or for necessary medical assessment. For a general framework on whom to turn to in which situation, our article on when to take your child to a child psychologist can be a guide.

Frequently Asked Questions

Do boys really talk later?

Some small differences can be observed in boys' language development on average; but this difference does not explain a marked delay. If your child is clearly behind the stages expected for their age, it is important to have an assessment regardless of gender.

Is speech delay a sign of autism?

Speech delay can occur in autism, but not every child with speech delay has autism. In autism, language delay is usually accompanied by social communication difficulties, a lack of joint attention and repetitive behaviours. A child psychiatry assessment is needed to make the distinction.

Does growing up in a bilingual environment delay speech?

The number of words a bilingual child has in each language taken separately may initially look lower; but their total communication skills are usually appropriate for their age. Bilingualism alone is not considered the cause of a delay. If there is a marked delay, an assessment should be carried out.

Does speech delay go away by itself?

Some children start late but catch up with their peers. However, it is hard to predict in advance which child will catch up on their own. For this reason, having an assessment instead of "let's wait" makes it possible to get early support if it is needed.

• #language development
• #speech delay
• #child development
• #early intervention

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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