Delay in speech and language can be the first signs of specific verbal issues (such as dysphasia), dyslexia, hearing impairment, intellectual disability, autism, or other conditions associated with difficulty establishing contact, motor disorders (dyspraxia), deprivation, communication problems within the family, or complex psychosocial issues in children with multicultural backgrounds. First year of life: Weak vocalization and cooing. Limited contact with adults. Suspected hearing impairment. Underdeveloped reflexes for orientation, sucking, and swallowing; feeding problems. Short frenulum of the tongue. Children aged 1-2 years: No words or attempts to speak or express themselves (gestures). Suspected limited understanding of speech and disobedience to commands (note that recurrent otitis media is a cause of hearing impairment). Insufficient alertness. Difficulty establishing contact with the child. Speech is weak and unclear by the second birthday. Children aged 3-4 years: Faulty or unclear speech (phonemes or syllables pronounced with altered placement, and long words shortened). Significant grammatical errors. Limited vocabulary and difficulties in finding words. Weak or absent speech, or only a few sentences. Inadequate responses, "private language." Stuttering begins or continues beyond the age at which it physiologically occurs (around 3 years). Weak contact, the child does not stop to listen. Difficulties in following short instructions. Children aged 5-6 years: Pronunciation errors (r, s, l, k, etc.), should be corrected before school age (Speech Sound Disorders - SSD). Non-fluent speech (stuttering, unclear speech) (SSD). Language and speech development poorly correlate with age. Overall speech is unclear, which may be due to motor or phonological fluency issues or difficulties in speech comprehension. Children aged 7-15 years: All the aforementioned problems if they have not been previously evaluated.