Causes of Speech Delay

Good session with the speech therapist today. We spent a little time on the “Why” of it all. The bad news is that she can’t tell me instantly and comprehensively what the problem is, and then fix it five minutes later. Your tax dollars NOT at work, people.

The good news is that she didn’t tell me after the first few session that she was pretty sure he was autistic. She told me that today, and that as she’s gotten to know him her feeling has changed. Autism isn’t the end of the world, and of course we would deal. But that’s a loaded word, and I’m grateful she didn’t make me deal with it at the same time I was digesting the fact that my baby needs intervention on the scale of 3x a week.

He’s getting great help. I love his speech therapist, in particular. Whatever the problem is, he’s making progress. But eventually we’re going to have to decide what the cause of the delay is, as his ongoing treatment will need to be more customized as he gets older.

While Elliot’s therapist is only available to me a few hours a week, Dr. Google is on call 24/7. I’ve been doing a lot of research. I’ve also gotten lots of great comments and notes from wise mothers and therapists (thank you so, so much!) with valuable information.

The most common causes of speech delays (combined info from multiple sources) and my take on whether that’s what we’re living with.

    Mental Retardation/Intellectual Disability

Marked by delays in language, auditory comprehension and gestures. He definitely has language delays. He tested poorly on comprehension, but I think there was a lot of “won’t” in that “can’t.” It’s my feeling that he understands us most of the time, inclusive of times when I’m talking about something conceptual or referring to something not visible. He’s a gesturing fool. If this is the reason, it’s a mild case. I think it’s unlikely.

    Hearing Loss

He passed his hearing tests as well as a baby his age can. They won’t be able to test him in more detail for about a year. We’ve already got our apointment set with the pediatric ENT for that time. If he has hearing loss, it’s mild. He can clearly hear. Theoretically possible there’s a distortion issue, but I doubt it.

    Maturation Delay

This is when the central neurologic process required to produce speech matures late. Most common in boys, and often runs in families. We’ve got no family history of this, but last time I checked he IS a boy. Certainly possible. This is my favorite option.

    Expressive Language Disorder/Apraxia

I think these are two different things, but I haven’t been able to tease them apart. ELD seems so widely defined that I feel like apraxia can fit in there. Someone smarter than I am will have to explain it to me. The hallmark here is that children have normal intelligence and hearing, but a brain disfunction makes it difficult to translate ideas into speech. When I asked about it today, his therapist said apraxia is definitely a possibility. He does not, however, show a physical groping for words with his mouth that is apparently common with apraxia. That’s one strike against, but not enough to put this in the unlikely camp. These kids are more likely to deal with things like dyslexia when they’re older. Entirely possible.

    Receptive Aphasia/Auditory Processing Disorder

This a receptive (no kidding) language issue. The desriptions I’ve read of aphasia sound too severe to fit. In general, he understands us. I don’t think this is it.


The many variants and severities of autism would require me to write a book. I know autism can have a late onset, and it’s possible that we’ll see more as he grows that takes us back to this path. But if he’s autistic, it’s not profound. (I have heard about severe, profound late-onset autism, but I’m going to call that a unicorn for now and leave it alone.) He doesn’t display unusually repetitive behaviors or express extreme focus on things or actions. He’s very attached, demonstrates eye contact, responds to his name, etc. He is slow to warm up with strangers, which is why he set off alarm bells by refusing to demonstrate those things in his initial evaluations. So, he’s still in the common diagnosis window (up to 36 months) but I don’t think this is it.

I’ve left off my list other common causes of speech delays that I know are not possible. Those include cerebral palsy, selective mutism, psychosocial deprivation, bilingualism, structural problems and prematurity.

I also read about something called Einstein Syndrome. Aside from the fact that it seems to have been made up by some dude with a book to sell, I think this is an excellent option for us to consider. Or at least for me to contemplate along with my fantasies about finding out that I am Oprah Winfrey’s lost half sister.


14 responses to this post.

  1. You need a margarita, dear. I’ll be happy to buy.


  2. We can get virgin Margaritas for the kids.


  3. Posted by Tara on April 30, 2011 at 11:47 am

    I have a friend who has a daughter,7, who has apraxia and it can mimic in a way, autism. She has a plethera of information on the subject. I could ask her for some reading material on the subject. I just read up on it this morning,ironically and he does seem he could meet the criteria. How old is he?<3


  4. Posted by Tara on April 30, 2011 at 11:51 am

    plethora ;p…and for what it’s worth, the Einstein Syndrome isn’t so unusual. I know a few myself,so don’t count it out.


    • Good to hear I can put Einstein back in the mix!

      I would love to hear a recommended reading list from your friend, thank you. I’m definitely still on the learning curve.

      Elliot just turned 19 months. We’re definitely on it early, which is a relief.


  5. Posted by Ingrid on April 30, 2011 at 3:10 pm

    The words Elliot does make– what are the quality of the sounds? Clear or nasal or muddled, etc…. The reason I ask is that a little girl I know who is most likely (although not certainly) dealing with apraxia has sounds that are pretty garbled in the words she can say, and I think that’s one sign of the disorder. Then again, my daughter (not a delay but has articulation issues due to low tone) speaks in a very nasal voice which I guess is an indicator of the low-tone thing (Elliot doesn’t have gross motor delays so low-tone is off the table for him, but I only mention it because I think the quality of the sounds can give a clue to the cause). This list reminds me of one I made when I was trying to figure out what was going on with my daughter– doesn’t it make you want to go back and get a MA in speech therapy?


    • I feel like I’m getting my MA in speech therapy right now!

      Elliot has some funny emphasis stuff, like saying maMA and BayBEE, but I think his diction is pretty clear. He does switch up consonants (“How” for cow) but I don’t think that’s quite the same thing as being garbled. Or maybe it is?

      I have heard the nasal thing in relation to cleft lip/palate. I think you make an excellent point about considering not only the speech but the various qualities of the speech.


  6. […] more: Causes of Speech Delay | jaysaint Posted in Expressive language disorder Tags: been-able, different-things, eld, language, […]


  7. Posted by Sarah on May 2, 2011 at 8:15 am

    Thanks so much for the update. I’m always glad to learn more.

    I have absolutely nothing to contribute but support and interest. And maybe a margarita, too. Or I’ll just crash when Leanne shows up with them.


  8. I’m a little behind because I’ve had a tiny little vacation, but I’m always happy to see an update.

    As always, I’m pulling for Elliot.


  9. Posted by julia on May 3, 2011 at 5:28 pm

    hi there – just wondered if anyone had pointed you in the direction of Dr Natasha Campbell McBride’s book and website – – absolutely well worth a look into for anything remotely looking like autism etc.


  10. Posted by julia on May 3, 2011 at 5:47 pm

    ps – i just read she does mention speech delay directly in the’ what is GAPS?’ essay on her website (


  11. Thank you for sharing your experiences. I found this blog through Electric Rocket (old friend from high school). My oldest daughter has Expression Language Disorder and a few other things. So it was refreshing to read your blog. It can be a tough road to walk so, it is nice to know we are all in the fight together.


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