She doesn't talk much: is it a language disorder or a language delay?

Language delay or language disorder: What's the difference?

When a child doesn't talk much or at all by around age two, many parents begin to worry (if they haven't already started, that is). Parents and teachers at this point may start to talk about a "speech delay" or "language delay". This makes sense, since the first thing you notice as a parent is that your cousin's child, who was born two weeks after yours, began saying words two or three months ago and now has a vocabulary of several dozen words, while your child is barely using three words. Terms like "delayed" or "late talker" seem perfectly appropriate at this point.

Then along comes a speech-language pathologist throwing around the term "language disorder." That sounds a lot scarier! The word "disorder" conjures up images of mental wards, medications, and psychiatrists—loony bins, capsules, and shrinks, oh my! (Actually, speech and language disorders are almost never treated with medication. Exceptions to this are so rare that I have trouble even thinking of an example—maybe botox for spasmodic dysphonia, but I've only ever heard of that being used on adults).

So what's the difference between a delay and a disorder?

Let's try an analogy: say you're flying from Los Angeles to New York, and your flight is delayed for two hours. You take off two hours late and land in New York two hours late. Maybe you even have a nice tailwind and make up some time in flight so that you're only an hour late. This is what a speech or language delay is like. Maybe a child doesn't talk as early as her peers, but, once she starts, she quickly makes up ground, and by the time she enters kindergarten, you can't tell there was ever a problem.

Now imagine that your flight is delayed two hours, and then you have to sit on the runway for a couple more hours because you've missed your turn to take off. Once you've taken off four hours late, you run into severe turbulence over the Rocky Mountains and the pilot has to slow the plane down and climb several thousand feet; then you have to make a wide detour around a large thunderstorm in the Midwest; then the engine trouble that delayed your flight in the first place resurfaces because it wasn't fixed properly, and you have to make an emergency landing in Memphis. This is what a speech or language disorder is like. The child often doesn't talk until several months after her peers, and once she begins, speech and language development do not follow the normal course of development. In some cases, the child never catches up with her peers and experiences language difficulties into adulthood.

This is an important distinction in that, by this definition, children with simple delays do not need treatment since they are not disordered. However, children with true disorders are almost always delayed, and what’s more, the delay is often the first sign of the disorder. Therefore, a speech or language delay is considered a risk factor and speech-language therapy is often recommended, even if it's too early to tell whether a true disorder exists. If the child turns out not to have a true disorder, the therapy will have been unnecessary. But, since early intervention for speech and language generally consists of play-based interaction with an interested adult, there are no ill effects for the child. There are no drugs, no surgeries, and no invasive or aversive procedures to leave the child traumatized. On the other hand, if the child does have a true disorder, early intervention can be tremendously beneficial. In fact, the earlier intervention begins the better. For this reason, it is always a good idea to consult a speech-language pathologist if you suspect your child's language development is lagging behind.

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