Is it a speech delay or a hearing problem? How to tell the difference
Today, we are going to tackle a chicken/egg, cart/horse type of situation. Maybe not exactly, but they are topics that are often confused, even debated in the world of speech, language and hearing, especially when the two are co-morbid: speech delay vs. hearing problem. To get a little technical here for a moment, there is something that is referred to as the auditory-feedback loop. What it boils down to is that our speech and hearing mechanisms are interdependent. If there is a breakdown in the chain, the result is compromised communication; any combination of speech, hearing, understanding, and expressive communication.
When a child isn’t meeting communication milestones, it can be hard to know exactly why. Two common concerns are speech delays and hearing problems; and while they may look similar on the surface, they require different types of support and treatment. They even, for the most part, have different underlying problems. Understanding the difference between speech delay vs hearing problem is crucial for early intervention and long-term success.
What Is Speech Delay?
A speech delay means a child is not developing speech and language skills at the expected rate, even though other areas of development may be typical. This can involve:
- Difficulty forming words or sentences
- Limited vocabulary for their age
- Trouble with speech sounds or clarity
Causes of speech delay include motor issues (like apraxia of speech), developmental disorders, or lack of language exposure, but not necessarily hearing loss.
What Is Considered a Hearing Problem?
A hearing problem, on the other hand, affects how well a child hears sounds, including speech. This may result from:
- Chronic ear infections
- Sensorineural hearing loss (damage to the inner ear or auditory nerve)
- Temporary or permanent hearing issues
When a child can’t hear clearly, it becomes difficult for them to learn how speech sounds, which can mimic or even cause speech delays.
Signs That May Indicate a Hearing Problem
According to the American Speech-Language-Hearing Association (ASHA), possible signs of hearing loss in young children include:
- Not responding to their name or familiar voices
- Inconsistent response to sounds or instructions
- Watching others to imitate speech rather than using their own words
- Speaking in a very loud or very soft voice
- Delays in both speech and language development
“Children with hearing loss often appear to have a speech or language delay when in fact, their difficulty understanding or producing language is related to not being able to hear it clearly.”
— *ASHA, Hearing Loss in Children
When It’s “Just” a Speech Delay
Using the word just in this header gives false diminished importance. Speech delay can lead to many effects on a young child’s development, notwithstanding the effects of social emotional development and dysregulation due to frustration with communication. For all intents and purposes here, we are referring to speech delay in the absence of hearing issues.
If a child consistently follows directions, responds to sounds, and uses gestures or facial expressions to communicate, but struggles to form words or combine them into sentences, they may have a speech delay without hearing issues.
Some signs specific to speech-only concerns include:
- Understanding language well but struggling to speak
- Frustration when trying to communicate
- Normal hearing screening results
- Good nonverbal communication
Speech Delay vs Hearing Problem | How to Tell the Difference:
A few key distinctions can help you determine whether hearing loss might be a factor:
| Speech Delay | Hearing Problem |
| Understands language but can’t express well | Trouble understanding and expressing |
| Responds consistently to sounds | Inconsistent or no response to sound |
| Clear nonverbal communication | May rely heavily on visual cues |
| Normal hearing screening | Fails hearing test or shows signs of hearing loss |
Get a Professional Evaluation
The most reliable way to differentiate between a speech delay and a hearing issue is through a comprehensive evaluation:
- Hearing Test (Audiological Evaluation)
A licensed audiologist will check how well your child hears different frequencies and volumes. This should be the first step if a communication delay is suspected. Hearing screenings are often conducted during preschool years and when children are in elementary school. However, if you suspect a hearing or speech issue, do not wait! Your pediatrician might also do a hearing screening, or they could refer you to an ear, nose, and throat doctor (ENT or otolaryngologist), who might even partner with an audiologist in their office. Knowledge is the power we need to be proactive!
- Speech-Language Evaluation
A certified speech-language pathologist (SLP) assesses how your child understands and uses language. They’ll also look at articulation, voice, fluency, and social communication. Much like hearing screenings, speech and language screenings are often conducted if your child attends preschool/daycare. Most school districts also conduct pre-K screenings which are heavy in speech/language skills. SLP’s are not only trained in assessment but are also trained in how to provide counseling and referrals for optimal outcomes.
“Early identification of hearing loss and intervention can significantly improve outcomes in language, social, and cognitive development.”
— Centers for Disease Control and Prevention (CDC), Hearing Loss in Children
Final Thoughts
If you’re concerned about your child’s communication development, trust your instincts and act early. A child with a speech delay may simply need speech therapy, while a child with a hearing issue may benefit from hearing aids, cochlear implants, or other interventions. The earlier you identify the cause, the better the outcome.
* ASHA is the American Speech Language Hearing Association, a national organization dedicated to making effective communication a human right, accessible and achievable for all.
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