Differentiation of Comorbid Neurodevelopmental Conditions in Pediatric Speech Delay: A Cross-Sectional Study Publisher



Ashrafi MR ; Heidari M ; Hosseinpour S ; Kargar A ; Abadi MZM ; Jabbari H ; Pourbakhtyaran E ; Yousefimanesh H ; Mohammadi M
Source: Advances in Neurodevelopmental Disorders Published:2026

Abstract

Objectives: Pediatric speech delay, occurring in 3–20% of children worldwide, can significantly impact developmental outcomes and quality of life. However, clinical differentiation between isolated delays and those associated with neurodevelopmental comorbidities remains challenging. This cross-sectional observational study (2023–2024), conducted at the Pediatric Neurology Clinic in Tehran, Iran, aimed at differentiating neurodevelopmental comorbidities such as Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), epilepsy, and anxiety disorders in speech-delayed children, further stratified by cognitive functioning (low IQ versus normal IQ). Methods: A total of 123 children aged 3–7 years with speech delays underwent comprehensive neurodevelopmental assessments, including audiometry (ABR), Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Gilliam Autism Rating Scale (GARS-3), SNAP-IV questionnaire, and Persian Language Developmental Battery (PLDB).Children were categorized based on IQ: low (<90, n=111) and standard (≥90, n=12). Notably, isolated speech delays occurred exclusively in normal-IQ children (25%). Results: The study identified ADHD (42.3%), ASD (22.5%), epilepsy (10.8%), and anxiety disorders (8.1%) in the low-IQ group, while ADHD (50%) was the most common comorbidity in normal-IQ children. The PLDB identified specific linguistic deficits in normal-IQ children, mainly in verb conjugation and grammatical judgment. Logistic regression analysis (Fisher’s exact test, p< 0.001) revealed significant differences in comorbidities between IQ groups, with ADHD and anxiety prevalent in normal-IQ children, while ASD and epilepsy were more common in the low-IQ group. Conclusions: The findings underscore the importance of cognitive stratification and culturally adapted neurodevelopmental assessments for precise etiological differentiation, leading to targeted early interventions, improved diagnostic pathways, and individualized management strategies. © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2026.