The warning signs of early speech delay are categorized into age related milestones, beginning at the age of 12 months and continuing through early adolescence.

At the age of 12 months, there is cause for concern if the child is not able to do the following:

- Using gestures such as waving good-bye and pointing at objects

- Practicing the use of several different consonant sounds

- Vocalizing or communicating needs

Between the ages of 15 and 18 months children are at a higher risk for speech delay if they are displaying the following:

- Not saying "momma" and "dada"

- Not reciprocating when told "no", "hello", and "bye"

- Does not have a one to three word vocabulary at 12 months and up to 15 words by 18 months

- Is unable to identify body parts

- Displaying difficulties imitating sounds and actions

- Shows preference to gestures over verbalization

Additional signs of speech delay after the age of 2 years and up to the age of 4 include the following:

- Inability to spontaneously produce words and phrases

- Inability to follow simple directions and commands

- Cannot make two word connections

- Lacks consonant sounds at the beginning or end of words

- Is difficult to understand by close family members

- Is not able to display the tasks of common household objects

- Is unable to form simple 2 to 3 word sentences

Speech delay, also known as alalia, refers to a delay in the development or use of the mechanisms that produce speech. Speech, as distinct from language, refers to the actual process of making sounds, using such organs and structures as the lungs, vocal cords, mouth, tongue, teeth, etc. Language delay refers to a delay in the development or use of the knowledge of language.

Because language and speech are two independent stages, they may be individually delayed. For example, a child may be delayed in speech (i.e., unable to produce intelligible speech sounds), but not delayed in language. In this case, the child would be attempting to produce an age appropriate amount of language, but that language would be difficult or impossible to understand. Conversely, since a child with a language delay typically has not yet had the opportunity to produce speech sounds, it is likely to have a delay in speech as well.

Speech and language impairment are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency.

A speech impairment is characterized by difficulty in articulation of words. Examples include stuttering or problems producing particular sounds. Articulation refers to the sounds, syllables, and phonology produced by the individual. Voice, however, may refer to the characteristics of the sounds produced—specifically, the pitch, quality, and intensity of the sound. Often, fluency will also be considered a category under speech, encompassing the characteristics of rhythm, rate, and emphasis of the sound produced

A language impairment is a specific impairment in understanding and sharing thoughts and ideas, i.e. a disorder that involves the processing of linguistic information. Problems that may be experienced can involve the form of language, including grammar, morphology, syntax; and the functional aspects of language, including semantics and pragmatics

An individual can have one or both types of impairment. These impairments/disorders are identified by a speech and language pathologist.

Selective mutism previously known as "elective mutism" is an anxiety disorder very common among young children, characterized by the inability to speak in certain situations. It should not to be confused with someone who is mute and cannot communicate due to physical disabilities. Selectively mute children are able to communicate in situations in which they feel comfortable. About 90% of children with this disorder have also been diagnosed with social anxiety. It is very common for symptoms to occur before the age of five and do not have a set time period. Not all children express the same symptoms. Some may stand motionless and freeze in specific social settings and have no communication.

Alalia is a disorder that refers to a delay in the development of speaking abilities in children. In severe cases, some children never learn how to speak. It is caused by illness of the child or the parents, the general disorders of the muscles, the shyness of the child or that the parents are close relatives.

Anarthria is a severe form of dysarthria. The coordination of movements of the mouth and tongue or the conscious coordination of the lungs are damaged.

Aphasia can rob all aspects of the speech and language. It is a damage of the cerebral centres of the language.

Aphonia is the inability to produce any voice. In severe cases the patient loses phonation. It is caused by the injury, paralysis, and illness of the larynx.

Conversion disorder can cause loss of speaking ability.

Feral children grow up outside of human society, and so usually struggle in learning any language.

Some people with autism never learn to speak.

Most intellectually disabled children learn to speak, but in the severe cases they can't learn speech (IQ 20-25). Children with Williams syndrome have good language skills with mean IQ 50. Children with Down syndrome often have impaired language and speech.

Even though most speech sound disorders can be successfully treated in childhood, and a few may even outgrow them on their own, errors may sometimes persist into adulthood rather than only being not age appropriate. Such persisting errors are referred to as "residual errors" and may remain for life.

A speech sound disorder is a speech disorder in which some speech sounds (called phonemes) in a child's (or, sometimes, an adult's) language are either not produced, not produced correctly, or are not used correctly. The term protracted phonological development is sometimes preferred when describing children's speech to emphasize the continuing development while acknowledging the delay.

Muteness or mutism () is an inability to speak, often caused by a speech disorder, hearing loss, or surgery. Someone who is mute may be so due to the unwillingness to speak in certain social situations.

The following are brief definitions of several of the more prominent speech disorders:

Expressive language disorder is a communication disorder in which there are difficulties with verbal and written expression. It is a specific language impairment characterized by an ability to use expressive spoken language that is markedly below the appropriate level for the mental age, but with a language comprehension that is within normal limits. There can be problems with vocabulary, producing complex sentences, and remembering words, and there may or may not be abnormalities in articulation.

As well as present speech production, very often, someone will have difficulty remembering things. This memory problem is only disturbing for speech; non-verbal or non-linguistically based memory will be unimpaired. An example of a child with expressive language disorder can be seen here.

Expressive language disorder affects work and schooling in many ways. It is usually treated by specific speech therapy, and usually cannot be expected to go away on its own.

Expressive language disorder can be further classified into two groups: developmental expressive language disorder and acquired expressive language disorder. Developmental expressive language disorder currently has no known cause, is first observed when a child is learning to talk, is more common in boys than girls, and is much more common than the acquired form of the disorder. Acquired expressive language disorder is caused by specific damage to the brain by a stroke, traumatic brain injury, or seizures.

Care must be taken to distinguish expressive language disorder from other communication disorders, sensory-motor disturbances, intellectual disability and/or environmental deprivation (see DSM-IV-TR criterion D). These factors affect a person's speech and writing to certain predictable extents, and with certain differences.

Careful diagnosis is also important because "atypical language development can be a secondary characteristic of other physical and developmental problems that may first manifest as language problems".

Language delay is a failure in children to develop language abilities on the usual age appropriate for their developmental timetable. Language delay is distinct from speech delay, in which the development of the mechanical and motor aspects of speech production is delayed.

Oral communication is a two-stage process. The first stage is to encode the message into a set of words and sentence structures that convey the required meaning, i.e. into language. In the second stage, language is translated into motor commands that control the articulators (organs and structures such as the lungs, vocal cords, mouth, tongue, teeth, etc.), thereby creating speech, i.e. orally-expressed language.

Because language and speech are independent, they may be individually delayed. For example, a child may be delayed in speech

(i.e., unable to produce intelligible speech sounds), but not delayed in language. However a child with a language delay typically has not yet been able to use language to formulate material to speak; he or she is therefore likely to have a delay in speech as well.

Language delay is commonly divided into "receptive" and "expressive" categories. Receptive language refers to the process of understanding what is said to the subject. Expressive language refers to the use of words and sentences to communicate messages to others. Both categories are essential to effective communication.

Individuals with PLI have particular trouble understanding the meaning of what others are saying, and they are challenged in using language appropriately to get their needs met and interact with others. Children with the disorder often exhibit:

- delayed language development

- aphasic speech (such as word search pauses, jargoning, word order errors, word category errors, verb tense errors)

- Stuttering or cluttering speech

- Repeating words or phrases

- difficulty with pronouns or pronoun reversal

- difficulty understanding questions

- difficulty understanding choices and making decisions.

- difficulty following conversations or stories. Conversations are "off-topic" or "one-sided".

- difficulty extracting the key points from a conversation or story; they tend to get lost in the details

- difficulty with verb tenses

- difficulty explaining or describing an event

- tendency to be concrete or prefer facts to stories

- difficulty understanding satire or jokes

- difficulty understanding contextual cues

- difficulty in reading comprehension

- difficulty with reading body language

- difficulty in making and maintaining friendships and relationships because of delayed language development.

- difficulty in distinguishing offensive remarks

- difficulty with organizational skills

Language delay is a risk factor for other types of developmental delay, including social, emotional, and cognitive delay. Some children may grow out of these deficits, even coming to excel where they once lagged, while others do not. One particularly common result of language delay is delayed or inadequate acquisition of reading skills. Reading depends upon an ability to code and decode script (i.e., match speech sounds with symbols, and vice versa). If a child is still struggling to master language and speech, it is very difficult to learn another level of complexity (writing). Thus, it is crucial that children have facility with language to be successful readers.

Neuroscientist Steven Pinker postulates that a certain form of language delay may be associated with exceptional and innate analytical prowess in some individuals, such as Albert Einstein, Richard Feynman and Edward Teller.

The word hyperlexia is derived from the Greek terms "hyper" ("over") and "léxis" ("diction", "word").

If assessed on the Wechsler Adult Intelligence Scale, for instance, symptoms of mixed receptive-expressive language disorder may show as relatively low scores for Information, Vocabulary and Comprehension (perhaps below the 25th percentile). If a person has difficulty with specific types of concepts, for example spatial terms, such as 'over', 'under', 'here' and 'there', they may also have difficulties with arithmetic, understanding word problems and instructions, or difficulties using words at all.

They may also have a more general problem with words or sentences, both comprehension and orally. Some children will have issues with pragmatics - the use of language in social contexts as well; and therefore, will have difficulty with inferring meaning. Furthermore, they have severe impairment of spontaneous language production and for this reason, they have difficulty in formulating questions. Generally, children will have trouble with morphosyntax, which is word inflections. These children have difficulty understanding and applying grammatical rules, such as endings that mark verb tenses (e.g. -"ed"), third-person singular verbs (e.g. I "think", he "thinks"), plurals (e.g. -"s"), auxiliary verbs that denote tenses (e.g. "was" running, "is" running), and with determiners ("the, a"). Moreover, children with mixed receptive-expressive language disorders have deficits in completing two cognitive operations at the same time and learning new words or morphemes under time pressure or when processing demands are high. These children also have auditory processing deficits in which they process auditory information at a slower rate and as a result, require more time for processing.

In psychiatry, stilted speech or pedantic speech is communication characterized by situationally inappropriate formality. This formality can be expressed both through abnormal prosody as well as speech content that is "inappropriately pompous, legalistic, philosophical, or quaint". Often, such speech can act as evidence for autism spectrum disorder (ASD) or a thought disorder, a common symptom in schizophrenia or schizotypal personality disorder.

To diagnose stilted speech, researchers have previously looked for the following characteristics:

- speech conveying more information than necessary

- vocabulary and grammar expected from formal writing rather than conversational speech

- unneeded repetition or corrections

While literal and long-winded word content is often the most identifiable feature of stilted speech, such speech often displays irregular prosody, especially in resonance. Often, the loudness, pitch, rate, and nasality of pedantic speech vary from normal speech, resulting in the perception of pedantic or stilted speaking. For example, overly loud or high-pitched speech can come across to listeners as overly forceful while slow or nasal speech creates an impression of condescension.

These attributions, which are commonly found in patients with ASD, partially account for why stilted speech has been considered a diagnostic criteria for the disorder. Stilted speech, along with atypical intonation, semantic drift, terseness, and perseveration, are all qualities known to be commonly impaired during conversation with adolescents on the autistic spectrum. Often, stilted speech found in children with ASD will also be especially stereotypic or rehearsed.

Patients with schizophrenia are also known to experience stilted speech. This symptom is attributed to both an inability to access more commonly used words and a difficulty understanding pragmatics, or the relationship between language and context. However, stilted speech appears as less common symptom compared to a certain number of other symptoms of the psychosis (Adler "et al" 1999). This element of cognitive disorder is also exhibited as a symptom in the narcissistic personality disorder (Akhtar & Thomson 1982).

In its more common usage, "stilted speech" is a term used to describe overly-formal, unnatural-sounding speech.

Hyperlexia is a syndrome characterized by a child's precocious ability to read. It was initially identified by Norman E. Silberberg and Margaret C. Silberberg (1967), who defined it as the precocious ability to read words without prior training in learning to read, typically before the age of 5. They indicated that children with hyperlexia have a significantly higher word-decoding ability than their reading comprehension levels. Children with hyperlexia also present with an intense fascination for written material at a very early age.

Hyperlexic children are characterized by having average or above-average IQs, and word-reading ability well above what would be expected given their age. First named and scientifically described in 1967 (Silverberg and Silverberg), it can be viewed as a superability in which word recognition ability goes far above expected levels of skill. Some hyperlexics, however, have trouble understanding speech. Some experts believe that most, or perhaps all children with hyperlexia, lie on the autism spectrum. However, one expert, Darold Treffert, proposes that hyperlexia has subtypes, only some of which overlap with autism. Between 5 and 20 percent of autistic children have been estimated to be hyperlexic.

Hyperlexic children are often fascinated by letters or numbers. They are extremely good at decoding language and thus often become very early readers. Some hyperlexic children learn to spell long words (such as "elephant") before they are two years old and learn to read whole sentences before they turn three.

An fMRI study of a single child showed that hyperlexia may be the neurological opposite of dyslexia.

Studies show that low receptive and expressive language at young ages was correlated to increased autism symptom severity in children in their early school years. Below is a chart depicting language deficits of children on the Autistic Spectrum. This table indicates the lower levels of language processing, receptive/expressive disorders, which is more severe in children with autism. When autistic children speak, they are often difficult to understand, their language is sparse and dysfluent, they speak in single, uninflected words or short phrases, and their supply of words is severely depleted. This leads to limited vocabulary while also having deficits in verbal short term memory.

Specific language impairment (SLI) is diagnosed when a child's language does not develop normally and the difficulties cannot be accounted for by generally slow development, physical abnormality of the speech apparatus, autism spectrum disorder, apraxia, acquired brain damage or hearing loss. Twin studies have shown that it is under genetic

influence. Although language impairment can result from a single-gene mutation, this is unusual. More commonly SLI results from the combined influence of multiple genetic variants, each of which is found in the general population, as well as environmental influences.

Although textbooks draw clear boundaries between different neurodevelopmental disorders, there is much debate about overlaps between them. Many children with SLI meet diagnostic criteria for developmental dyslexia, and others have features of autism.

Echolalia can be categorized as immediate (occurring immediately after the stimulus) vs. delayed (some time after the occurrence of a stimulus). Immediate echolalia results from quick recall of information from the short-term memory and "superficial linguistic processing". A typical pediatric presentation of immediate echolalia might be as follows: a child is asked "Do you want dinner?"; the child echoes back "Do you want dinner?", followed by a pause, and then a response, "Yes. What's for dinner?"

In delayed echolalia the patient repeats words, phrases, or multiple sentences after a delay that can be anywhere from hours to years later. Immediate echolalia can be indicative that a developmental disorder exists, but this is not necessarily the case. Sometimes echolalia can be observed when an individual echoes back a statement to indicate they are contemplating a response and fully heard the original statement.

Researchers observed the daily repetitions of an autistic six-year-old in order to examine the differences between triggers for delayed versus immediate echolalia. Researchers further distinguished immediate echos by the sequential context in which they occur: after corrections, after directives, or in indiscernible sequential positions. Delayed echos are distinguished on the basis of ownership: self-echos, other-echos, and impersonal echos. The results showed that nearly all immediate echos produced by the six-year-old were found in sequential contexts, while the delayed echoes also occurred in the basis of ownership.

Although echolalia can be an impairment, the symptoms can involve a large selection of underlying meanings and behaviors across and within subjects. "Mitigated echolalia" refers to a repetition in which the original stimulus is somewhat altered, and "ambient echolalia" refers to the repetition (typically occurring in individuals with dementia) of environmental stimuli such as a television program running in the background.

Examples of mitigated echolalia are pronoun changes or syntax corrections. The first can be seen in the example of asking the patient “Where are you going?” and with patient responding “Where am I going?” The latter would be seen in the clinician asking “Where are I going?” and the patient repeating “Where am I going?” In mitigated echolalia some language processing is occurring. Mitigated echolalia can be seen in dyspraxia and aphasia of speech.

A Japanese case report describes a 20-year-old college student who was admitted to the hospital complaining about headaches and meningitis; however, he also exhibited signs of ambient echolalia. The researchers stated that the young patient's repetition was occurring at approximately the same tempo as his normal speech rate. The patient did not simply repeat words he had heard one after another. The patient reported that his ambient echolalia appeared to be random but appeared when he was distracted. He was also aware of his echolalia, but said he is unable to stop the repetitions.

Examples of disorders that may include or create challenges in language and communication and/or may co-occur with the above disorders:

- autism spectrum disorder - autistic disorder (also called "classic" autism), pervasive developmental disorder, and Asperger syndrome – developmental disorders that affect the brain's normal development of social and communication skills.

- expressive language disorder – affects speaking and understanding where there is no delay in non-verbal intelligence.

- mixed receptive-expressive language disorder – affects speaking, understanding, reading and writing where there is no delay in non-verbal intelligence.

- specific language impairment – a language disorder that delays the mastery of language skills in children who have no hearing loss or other developmental delays. SLI is also called developmental language disorder, language delay, or developmental dysphasia.

Aphasia is loss of the ability to produce or comprehend language. There are acute aphasias which result from stroke or brain injury, and primary progressive aphasias caused by progressive illnesses such as dementia.

- Acute aphasias

- Expressive aphasia also known as Broca's aphasia, expressive aphasia is a non-fluent aphasia that is characterized by damage to the frontal lobe region of the brain. A person with expressive aphasia usually speaks in short sentences that make sense but take great effort to produce. Also, a person with expressive aphasia understands another person's speech but has trouble responding quickly.

- Receptive aphasia also known as Wernicke's aphasia, receptive aphasia is a fluent aphasia that is categorized by damage to the temporal lobe region of the brain. A person with receptive aphasia usually speaks in long sentences that have no meaning or content. People with this type of aphasia often have trouble understanding other's speech and generally do not realize that they are not making any sense.

- Conduction aphasia

- Anomic aphasia

- Global aphasia

- Primary progressive aphasias

- Progressive nonfluent aphasia

- Semantic dementia

- Logopenic progressive aphasia

Cluttering is a speech and communication disorder that has also been described as a fluency disorder.

It is defined as:"Cluttering is a fluency disorder characterized by a rate that is perceived to be abnormally rapid, irregular, or both for the speaker (although measured syllable rates may not exceed normal limits). These rate abnormalities further are manifest in one or more of the following symptoms: (a) an excessive number of disfluencies, the majority of which are not typical of people with stuttering; (b) the frequent placement of pauses and use of prosodic patterns that do not conform to syntactic and semantic constraints; and (c) inappropriate (usually excessive) degrees of coarticulation among sounds, especially in multisyllabic words".

Stuttering is often misapplied as a common term referring to any dysfluency. It is also often incorrectly applied to normal dysfluency rather than dysfluency from a disorder. Cluttered speech is exhibited by normal speakers, and is often referred to as stuttering. This is especially true when the speaker is nervous, where nervous speech more closely resembles cluttering than stuttering.

Cluttering is sometimes confused with stuttering. Both communication disorders break the normal flow of speech, but they are distinct. A stutterer has a coherent pattern of thoughts, but may have a difficult time vocally expressing those thoughts; in contrast, a clutterer has no problem putting thoughts into words, but those thoughts become disorganized during speaking. Cluttering affects not only speech, but also thought patterns, writing, typing, and conversation.

Stutterers are usually dysfluent on initial sounds, when beginning to speak, and become more fluent towards the ends of utterances. In contrast, clutterers are most clear at the start of utterances, but their speaking rate increases and intelligibility decreases towards the end of utterances.

Stuttering is characterized by struggle behavior, such as overtense speech production muscles. Cluttering, in contrast, is effortless. Cluttering is also characterized by slurred speech, especially dropped or distorted /r/ and /l/ sounds; and monotone speech that starts loud and trails off into a murmur.

A clutterer described the feeling associated with a clutter as:

Echolalia can be an indicator of communication disorders in autism, but is neither unique to, nor synonymous with syndromes.

Echophenomena (particularly echolalia and echopraxia) were defining characteristics in the early descriptions of Tourette syndrome (TS). Echolalia also occurs in aphasia, schizophrenia, dementia, catatonia, epilepsy, after cerebral infarction (stroke), closed head injury, in blind children, children with language impairments, as well as certain developing neurotypical children. Other disorders associated with echolalia are Pick's disease, frontotemporal dementia, corticobasal degeneration, progressive supranuclear palsy, as well as pervasive developmental disorder.

In transcortical sensory aphasia, echolalia is common, with the patient incorporating another person's words or sentences into his or her own response. While these patients lack language comprehension, they are still able to read.