The following two cases illustrate different types of speech and language disorders that can arise from neurodevelopmental versus acquired conditions. Early deficits in these domains can have variable sequelae on later reading, learning, and social-emotional outcomes. Attending to signs and symptoms of potential speech and language involvement in complex neuropsychiatric cases allows for timely intervention to improve long-term academic and social functioning. As illustrated in Fig. 15.1, speech and language disorders are seen across a wide array of genetic and acquired medical conditions. They have their own genetically and environmentally mediated mechanisms, which interact with the broader set of etiologies affecting children with complex neurodevelopmental and neurological conditions. Highlighted here are two children, each seen twice, approximately 3–4 years between consultations; one with developmental speech-language concerns and comorbid ADHD, and one whose challenges evolved over time following a childhood stroke.