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Speech Delay


 

Speech Delay

by Kenneth Lyen

Definition

Speech delay refers to children who do not start talking at the expected age.

Historical

In the 18th century, a Scottish mathematician, Thomas Braidwood taught hearing-impaired students how to talk by starting with simple sounds and then progressing to syllables. In 1817, Jean-Marc Itard, a French physician, proposed that stuttering was due to a weakness of the nerves to the tongue and voice box, and recommended exercises to strengthen these organs. Speech therapy became a profession in the early 1900s, and schools for training speech therapists were started in Europe in the 1920s.

Epidemiology

The prevalence of speech delay depends on the definition. In the late 1980s, the American Speech-Language Association estimated that about 5 per cent of the USA population had some form of speech or language disorder. Of that group, the following is a more detailed breakdown:
Articulation problems 60%
Delayed speech, aphasia 20%
Fluency disorder 12%
Voice disorders 8%

Speech and Communication

Speech is a learned method of verbal communication requiring the combined deployment of thoughts, sound production and language skills. The ability to communicate ideas, commands and emotions by audible spoken words is one of the features that distinguishes man from other animals. In its broadest sense, speech and language are indistinguishable.

Theories of Language Development

There are four major theories of language acquisition in children.

1. Imitation
In 1957 BF Skinner (1904-1990), an American psychologist, argued that children learnt language by imitating their parents. According to his theory, as the child gains more words and phrases, the language would become progressively more like that of an adult.

2. Innate
Noam Chomsky (1928 - ), an American professor of linguistics, observed in 1959 how children from various ethnic groups and cultures learnt language. They acquired the basic rules of syntax and semantics far more quickly than could be accounted for by imitation alone. He proposed that children must have an inborn predisposition to learning language.

3. Understanding
Jean Piaget (1896-1980), a Swiss psychologist, argued that language acquisition was dependent upon thought and understanding. A word or phrase could only appear in the child’s vocabulary after he had understood its meaning. Hence, younger children can only understand solid concepts like "ma", "ball", and "dog". Only when the child begins to grasp abstract concepts will these words enter his vocabulary.

4. Social Interaction
According to this theory, a child develops language through social interaction. The adult modulates to some extent the child’s language by providing feedback. Verbal exchanges with adults play a critical role in shaping language skills. This theory maintains that both an innate tendency and an encouraging environment fosters language development.

No single theory wholly explains language development in children, and it is probable that all four theories are correct to some extent, each addressing one aspect of this complex process.

Normal Speech and Language Development

The one-month-old baby starts exploring with his tongue and lips to produce soft cooing sounds through the mouth. By about three months, the infant will start to babble, experimenting with different sounds like "ooh" and "aah", and may learn to blow bubbles. Between three to six months, baby begins to add consonants to the vowel sounds, such as "goo" and "pa". However, these sounds do not necessarily refer to any specific persons or objects. Around 9 to 12 months of age, the child should be able to say "ma" or "ba", and an occasional word.

Each child is unique, and some develop speech faster than others. Boys are often slightly slower than girls in talking. Children who have a special interest in a particular topic, e.g. boys who like dinosaurs and fantasy figures, can learn that special vocabulary faster. There is no need to coach your child. He is picking up vocabulary just by listening to words spoken all around him.

Normal Language Development

Age             Ability
3 months  Babbles
4 months  Squeals, laughs
8 months  "Ma", "Ba" (nonspecific), "mumum"
12 months "Mama", "baba" (specific, referring to father), jabbers
24 months 2-word phrases
30 months 3-word phrases
36 months Complete simple sentence structure
42 months 4-word sentences
48 months 5-word sentences

My 2-year-old is not saying any words. I am worried.

A child who is saying absolutely no words by 18 months needs to be investigated. You should consult your doctor. A formal hearing test is important, as is an assessment of your child’s development. Causes of speech delay include hearing impairment, delayed development, isolated speech delay, and autism spectrum disorder.

Hearing

The ability to hear is essential, especially in the early months. If a child is born deaf, there seems to be a critical age at which he must start to hear because should hearing only occur after this age, subsequent speech will never sound quite normal. On the other hand, if a child loses his hearing after he has already learnt how to speak, there will be a gradual but smaller drift away from correct pronunciation. Usually the sounds produced by the late-onset hearing-impaired child can still be understood by listeners.

Mispronunciation of Words

If a child has a partial hearing loss and does not hear sounds accurately, his speech will be affected. Therefore, it is important to exclude a hearing impairment. Certain medical conditions can cause mechanical difficulties in sound production, and these should also be investigated.

Normal young children often mix up sounds, especially consonants like "g" and "d" ("duck" becomes "guck"); "c" and "t" ("car becomes "tar"). They have difficulties with the "f", "s" and "r" sounds. They may combine two or three words into one single word. For example, "out" may mean "I want to go out for a walk". Some children are apparently lazy. They know how to say the word properly, but by habit, they do not pronounce it correctly, e.g. "ter" refers to "water". In general, do not be over-concerned. If your child can speak, but pronounces the words inaccurately, give him a couple more years to refine his speech. If the problem continues, consider speech therapy.

Tongue Tie

My child cannot pronounce his words accurately. Is this due to tongue tie, and should I have his tongue tie cut?

It is normal for children up to the age of seven years to have some difficulty pronouncing certain consonants. Tongue tie has often been blamed not only for poor pronunciation, but also for speech delay. I do not think that tongue tie causes either. Therefore, I do not recommend surgery. Speech training is a better solution.

Bilingualism

In Asia, as in many countries, it has become quite customary for parents to talk to their children in two languages, such as an Asian dialect and English. Alternatively, caregivers such as grandparents and baby-sitters may use one dialect, and the parents another. Potentially, this can lead to some confusion, as the child may learn that the English word "ball" is referred to as qiu in Mandarin.

Research suggests that while children who are spoken to in two languages may not acquire as wide a vocabulary in any one language compared to those spoken to in one language, there are no permanent problems. Indeed, bilingual children have an advantage in that they can be fluent in two languages. Bilingual children often mix the two languages and slot in words of the second language when talking in the first language. Quite soon, one language becomes dominant. Many speech-delayed children can still be bilingual, but there may be situations in which a child with delayed speech may make better progress when confined to one language only. It is best to consult the speech therapist about this issue.

Speech Delay

Early signs of speech delay include:
- Not responding to nearby voices or sounds by eight weeks.
- Not showing interest in people or toys by three to four months.
- Not vocalizing or babbling by ten months (average six to eight months).
- Not saying single words at 21 months (average ten to 15 months).
- Not saying two-word phrases at 27 months (average 18 to 22 months).
- Not using intelligible speech by four years (average three to three-and-a-half years).
- Not using grammar correctly by five years (average four to four-and-a-half years).

Causes

Since speech is in part a learned function, any interference with learning ability may be expected to cause a speech disorder. The most common interfering condition is brain damage which in turn may cause intellectual disability or cerebral palsy. This is irrespective of whether the condition is congenital or acquired. The ability to pronounce or articulate words may also be affected by such physical disabilities as cleft palate, cerebral palsy, or loss of hearing. It may likewise deteriorate because of paralysis of any part of the articulating mechanism, such as the tongue. Impairment may also be due to having poor role models for the child to imitate speech.

Voice disorders, known as dysphonias, may be the result of disease or an accident that affected the voice box or larynx. They may also be caused by damage to the nerves supplying the vocal cords. Disorders of the rate of talking and its rhythm are generally due to a neurological disturbance, such as cerebral palsy.

Classification of Language Disorders

The classification of language disorders is problematic. The are currently at least four ways in which language disorders are classified:

1. Neurophysiological
Receptive aphasia
Central auditory dysfunction
Expressive aphasia (Broca)

2. Behavioral
Limited expressive language
Semantic disability
Word-finding difficulty
Syntactic limitation
Phonologic-prosodic disability

3. Process-Based
Auditory imperception
Failure to access semantic memory
Phonology-syntactic disorder
Some comprehension problems
Impaired connection between higher-order schemata of linguistic and peripheral motor planning

4. Medical
Asperger syndrome
Autism spectrum disorder
Cerebral palsy
Cleft palate
Cocktail party syndrome
Developmental language delay
Down syndrome
Encephalitis
Epilepsy
Fragile-X syndrome
Hearing impairment
Hydrocephalus
Incontinentia pigmenti
Intellectual disability
Klinefelter syndrome
Landau-Kleffner syndrome
Meningitis
Moebius syndrome
Muscular dystrophy
Neurofibromatosis
Noonan syndrome
Otitis media
Pierre Robin syndrome
Rett syndrome
Treacher-Collins syndrome
Williams’ syndrome
Worster-Drought syndrome

Diagnosis

These are the steps that you should take to help you arrive at a diagnosis. If you suspect speech delay:
- Exclude hearing loss by having a formal hearing test with an audiologist.
- Check his developmental level by consulting a developmental pediatrician.
- Rule out medical conditions, like cerebral palsy or autism spectrum disorder by consulting a pediatrician.

The diagnosis and treatment of speech delay may require the aid of several health professionals, including the family physician, developmental pediatrician, pediatric neurologist, otorhinolaryngologist (ENT specialist), audiologist, psychologist, social worker, speech therapist. These professionals, working as a team, can help children with speech problems through special education, speech training, behavioral modification, medication or surgery, if applicable.

Speech Therapy

A speech therapist is a specialist who has been trained to diagnose and treat the various disorders of speech, language, and voice. Because physical, neurological, or psychological conditions are frequently either responsible for or are related to the speech disorder, the therapist often works as a member of the team listed above. Speech disorders caused by disease, injury, or malformation, all fall in the territory of the physician and surgeon. Once these problems are resolved, the speech therapist is responsible for teaching the speech-impaired child to hear and monitor speech accurately, think appropriately in verbal terms and exercise control over speech disordered by incoordination or emotional influences. In the hearing impaired, the speech therapist can help the child become more aware of errors of enunciation, and thus help improve speech. In addition to speech therapy, music therapy also provides valuable additional techniques to enhance speech.

Advice for Parents

If your child is speech delayed, talk to him as much as possible, "bathing" him in words. Use everyday situations to stimulate speech. For example, when feeding, dressing, or bathing, talk about that activity. Use short sentences. There is some argument as to whether or not you should use "baby talk" or "motherese". Such speech would be characterized by repeating words, employing a higher speech tone and a rising inflexion at the end of a sentence, e.g. "Baby want water water". Personally, I would not worry too much about "baby talk": it is far more important that you talk and interact with your child. Whenever possible, try to use visual clues like pointing to an object. Catch your child at his most receptive period, such as when performing an activity, such as dressing, eating, bathing, or going out. Do not just sit your child in front of the television set for hours on end. Limit watching TV to no more than say one hour each day. Instead, interact, play, sing, and talk to your child. Get everyone involved in this endeavor. And have fun!

This article first appeared in Rainbow Dreams (2002).