Speech and Language Disorders in Kids with a CHD

Children with Expressive Language Disorder have trouble saying what they want to say.

Kids with Expressive Language Disorder often:

• Learn to speak late

• Make more grammar mistakes than other children

• Mix up verb tenses (past, present, future)

• Leave out word endings (suffixes)

• Use words in the wrong way more than other children

• Leave out words

• Know fewer words than other children

• Have trouble “finding” or thinking of the words they want

• Speak in shorter sentences than other children

• Use general words (“thing” “stuff”) more than other children

• Have trouble telling a story

Children with Receptive Language Disorder have trouble understanding what others say. 

Children with Receptive Language Disorder often: 

• Have trouble answering questions 

• Cannot understand directions 

• Are challenged by hearing complex sentences 

• Do not understand stories 

• Get lost in conversations 

• Get confused when people are talking to them 

• Do not understand spoken lessons

• Learn words slowly 

• Have poor reading comprehension

Kids with Developmental Language Disorder have significant and ongoing challenges using and processing language.

Children or teens with Receptive Language Disorder often: 

• are late to learn how to speak in sentences

• have trouble learning new words

• have trouble making conversation

• have a hard time understanding directions

• make an unusual number of grammar mistakes, including leaving out word endings (suffixes), articles (a, an, the), and other words that serve a grammatical purpose

• put words in the wrong order within a sentence

• use fewer complex sentences than peers

• have trouble finding the right word when they speak

• struggle with reading comprehension

• do not understand when people use nonliteral language

• have trouble with writing

• struggle to tell a story or explain an idea in a way that makes sense

• make many spelling mistakes

When children or teens stutter, their speech is often interrupted.  They repeat sounds and words, and may have long pauses between words.  

Sometimes children make unusual facial expressions or body movements when they stutter. 

It is normal for young children to stutter from time to time. During typical development, young children may stutter for days or weeks, and then the stutter goes away on its own. This cycle may happen multiple times over the course of development. 

Families should ask their doctor or speech-language pathologist if a stutter: 

• Does not go away for months 

• Gets worse 

• Goes along with unusual body movements or facial expressions 

In some cases, stuttering can be a sign of a brain difference or brain injury.  When a child has a stutter, families should ask their doctor if their child should see a neurologist.  Families and medical providers should bear in mind that children with heart defects have a higher than typical risk of brain injury.

Childhood Apraxia of Speech (CAS) affects how a child’s muscles move and work together.  

Children with CAS sometimes have trouble saying sounds and words quickly and clearly. 

Children with CAS may: 

• Be late to babble and speak 

• Make many speech errors 

• Make inconsistent or unusual speech errors 

• Have more monotone speech 

• Be hard to understand 

• Move their mouth silently as they try to make sounds 

Many children with CAS also have problems with grammar and literacy.

In some cases, CAS can be a sign of a brain difference or brain injury.  Children with heart defects are more likely than other children to have a brain injury or brain difference. When a child has CAS, families should ask their doctor if their child should see a neurologist.  

Speech sound disorders make it hard for a child to hear or make certain speech sounds. They can include: 

• Articulation Disorders: the child has trouble making or combining speech sounds 

• Phonological Disorders: the child has trouble hearing and remembering speech sounds 

All young children are learning to pronounce words correctly, and all young children make errors in pronouncing words.  Children are only diagnosed with a disorder if they have much more trouble than their peers. 

When children have dysarthria, the muscles they need for speech are unusually weak. They have trouble speaking quickly and clearly. Dysarthria can be very different from one child to another.

Children with dysarthria might :  

• Have shallow, uneven breathing 

• Have breathy or rough voices and reduced volume 

• Have imprecision in speech 

• Have speech that sounds nasal 

• Have trouble saying many sounds 

• Have trouble speaking loudly, clearly, and quickly 

 Dysarthria is usually a sign of a brain difference or brain injury.  If a parent worries that their child has dysarthria, they should tell their doctor. Most children with dysarthria need to see a neurologist. Children with heart defects are more likely than other children to have brain differences or injuries.

Children who have speech and/or language problems are more likely than other children to have trouble with reading and writing.  

When a child has a speech and/or language disorder, families should talk with their doctor and teacher about the risk of a reading or writing disability.  If a child seems to be struggling with literacy, families may request an educational evaluation. Cardiac neurodevelopmental programs are often able to provide an educational evaluation.

Any time a child has a delay or disability related to language, they require speech and language therapy from a Speech and Language Pathologist (SLP). Families can receive speech and language therapy through a school IEP or an outpatient clinic.

Families should always notify their pediatrician, developmental care team, school team, and speech and language pathologist if they have concerns about their child's language development.

Sometimes, adults believe that since a child has a heart defect, they should wait to allow a child's speech or language to "catch up." This "wait and see" response usually is not helpful. Instead, children with heart defects and language problems should receive early and appropriate intervention.

This content was reviewed by a Speech and Language Pathologist at Boston Children's Hospital.

Developmental care is best when it is local. Families local to Boston can receive care from the Speech-Language Pathology Program and/or the Cardiac Neurodevelopmental Program (CNP). Families from other regions can use the link below to find their local care team.