The absence of speech or the development of only minimal speech has been well documented, even in the more mildly affected. There is often a characteristic vocal quality in the crying of babies, which has been described as feeble or low-pitched. The low- pitched cry frequently present at birth and early infancy often disappears by 12 months.

Most people with CdLS exhibit errors in articulation. Consonants are typically distorted or missing. In addition, there have been some reported observations of severe oral-motor and verbal apraxia, which is the loss of the voluntary aspect of speech and motor movement.

There have also been unconfirmed reports that individuals have a tendency to unexpectedly utter a meaningful word or phrase only once, using completely clear articulation and often performing at a level higher than previously observed. But then this performance is rarely if ever repeated.

In almost all individuals the ability to produce language was remarkably inferior to the ability to comprehend language. There was also considerable discrepancy between vocabulary measures and syntactic skills in that people who had highly developed vocabulary usually did not exhibit the expected syntactic skills. Similarly, children who were using an average utterance length of 4-5 words per utterance typically were not using question transformations.

The majority of individuals are very quiet. They often make eye contact and there is often a sense they understand what is being said, but they are not usually vocal. Even among individuals who have good language skills, there are few who can be described as talkative.

The decision to begin speech therapy should not be delayed. Some parents have reported they have been told speech therapy could not begin until their children were talking! Additional parents reported they were told their children could not receive speech therapy or learn to talk until the gastric tube was removed and their children were eating normally. This of course is not true.

Some children who are talking have never received nourishment except through their gastric tube. However, when appropriate it would be beneficial to work with a speech-language pathologist on feeding therapy so the oral mechanism functions as normally as possible.