Is your child a late talker? Or does your child have other challenges with communication? Do you wonder whether your child might have a communication disorder? If so, you can contact your Pediatrician to discuss your concerns and in California you can also contact your local Regional Center or Family Resource Center. These agencies will help guide you to the right referrals for assessment and services.
If your concerns are mainly about speech and language development (“late talkers”), a speech-language pathologist (SLP) can help. A complete speech and language evaluation is usually the first step. It can spot communication disorders and help with design of an intervention plan.
A Speech and Language Evaluation
Can your child benefit from early intervention by a speech-language pathologist? The best way to tell is to have a complete developmental assessment, preferably in your family’s home language.
The assessment should consist of:
- Determining your concerns and priorities
- Identifying your child’s existing communication strengths and weaknesses
- Evaluating the effectiveness of your child’s attempts at communication
- Evaluating your child’s environments to find out what supports or interferes with effective communication
Reasons to Intervene Early
Speech-language pathologists recommend early intervention if there is atypical or delayed development of communication skills, or the potential for it. There are five reasons for implementing interventions. They include:
- Prevention of a disorder
- Elimination of a disorder
- Modification or remediation of a disorder
- Teaching strategies that help a child compensate for a disorder
- Modification of the environment to aid the child
Here are ways to better understand each of these types of intervention.
Prevention of a disorder. If prevention is stressed, there may be a means for delaying or avoiding the onset of a disorder. Federal legislation encourages prevention by stressing early identification and treatment of communication disorders. An example is the Early Hearing Detection and Intervention (EHDI) program. This is a national initiative to screen the hearing of all newborns by one month of age. The program has greatly enhanced early detection of hearing loss, allowing for earlier intervention and better outcomes.
Elimination of a disorder. A child may be able to develop normal speech or language, although this is difficult to predict for most young children. We often don’t know the cause of “late talking” and can’t predict the course of development. Many articulation disorders are the result of an error pattern that then becomes the habitually used incorrect sound. With intervention, these speech sound disorders are often quickly eliminated, especially for school-age children.
Modification or remediation of a disorder. This involves improving communication skills and functioning. It is the most common outcome expected from speech and language intervention for young children with communication delays. Becoming a more effective communicator helps a child to advance developmentally. It also can prevent other problems, such as behavior problems.
Teaching Strategies to help a child compensate for a disorder. These are strategies used to develop a functional means of communication for a child. Compensatory strategies can reduce a child’s frustration with communication difficulties. For example, a young child with Down Syndrome can learn and effectively use many signs (Baby Sign or American Sign Language signs) or gestures (pointing to a desired item) to express their needs while they are also working on developing their speech. A non-verbal child with autism may use Picture Exchange Communication System (PECS) as a strategy to help develop a functional means of communication. These strategies may also be used to give the child an immediate way to communicate while also working on more long-term strategies to develop other speech and language skills. For younger children, teaching simple attention-getting or cause-and-effect work best. For example, “When I hit the switch, the toy lights up and makes music.” Older children with greater cognitive maturity can benefit more often from these strategies. They are able to explore alternative communication strategies.
Modification of the environment to aid the child. This can mean many things and is usually combined with one of the other more direct strategies. These are all the factors outside of the child, including communication partners. If changed in some way, these may facilitate the child’s ability to communicate. For example, by reducing background noise and visual distractions, such as by turning off the television or music, a child with sensitivity to distraction might be better able to concentrate on communication. Or a speech-language pathologist and occupational therapist might work together to treat a child to deal with issues like sensory integration or body stability issues. By changing position, support, seating, or room lighting, for example, a child can become more comfortable and more able to take turns with communicating.
References:
McClean, L.K. & Cripe, J.W. (1997) The effectiveness of early intervention for children with communicative disorders. In Guralnik, M.J. (Ed.) The effectiveness of early intervention. Baltimore, MD: Paul Brooks Publishing.
California Speech-Language-Hearing Association. (2002) Preferred practice patterns for speech-language pathologists in service delivery to infants and toddlers and their families. Sacramento, CA: California Speech-Language-Hearing Association.
Late-talking children are those at age two with a vocabulary of fewer than 50 words and who use limited or no two- or three-word combinations, such as “more juice.” Most late-talking toddlers gradually catch up with their peers during the first years of school. However, a substantial number will continue to have trouble with acquiring expressive language. For this reason, it’s important to know how to spot atypical communication in your child and to know what to do.
Signs of Speech Delays
Certain risk factors or signs of speech delays at age two suggest a child should receive early language intervention services. These signs include:
- Small vocabulary for age (fewer than 20 words)
- Use of few action words (verbs)
- Trouble understanding simple language
- Limited vocalizations with few consonants
- Reduced or absent imitation
- Few communicative gestures (for example, shaking head for “no”)
- Chronic otitis media (middle ear infections)
- Family history of delayed speech, language, or reading
When parents express concerns about late talkers, some pediatricians adopt a “wait-and-see” attitude. But intervention may be of benefit for all concerned in situations like these: You are feeling concerned, communication seems more of a struggle than a pleasure for your child, or your child is frustrated by attempts at making connections with you and others.
A good place to start is with the Family Resource Centers or your pediatrician. They can help you find a speech-language pathologist (SLP) who has expertise in early intervention. SLPs can determine how much delay exists by doing an assessment of your child’s speech and language skills.
Assessment consists of meeting the child, playing with developmentally appropriate toys, and listening to the child’s sound system. Vowels are usually the first sounds acquired. Consonant sounds may not all be produced until around age eight.
Standardized tests can also be used. There are many standardized tests for children from age birth to three and the ones chosen are at the discretion of the agency that is testing. To assess every aspect of development, tests look at at least five domains:
- Cognitive
- Expressive communication
- Receptive communication
- Gross motor
- Fine motor
Other more specialized testing is available for social-emotional and behavioral aspects of a child’s development. Tests are also available for more in-depth assessment of a child’s communication skills.
Types of Speech Sound Disorders
Is your child starting to speak a few words and attempting to combine words? But, are you (and all other listeners) unable to understand what your child is saying? If so, this might signal early signs of a speech sound disorder. The term “speech sound disorder” might conjure a mispronounced “s” sound or a “lisp,” or problems making a clear “r” sound (the “wed wabbit” syndrome). But other types of speech sound disorders also exist. The underlying cause of the disorder is the first concern of a SLP. Understanding what’s causing the problem can help with planning an effective intervention.
An articulation disorder is one possible cause. This is thought to result from not learning the movements needed to produce the correct consonant sound. The articulators are the structures that move to make speech sounds, like the lips, tongue, and jaw. If no structural or motor problems exist, and the problem is just due to incorrect learning, an articulation disorder is the most easily corrected speech sound disorder. Many children easily learn the new or better way of producing the sound through direct teaching using placement cues, auditory feedback, and clinician guidance. Other speech sound disorders are referred to as phonological processing disorders. These children continue to speak like younger children. They may use mostly vowel sounds with only a few consonants, or they leave off final speech sounds in simple words.
Another speech sound disorder is called childhood apraxia of speech (CAS). Over the years, it has been called a number of other things, such as developmental verbal dyspraxia (DVD). Children with CAS can start out by looking like late talkers. Their speech development can seem quite delayed. Children can become very frustrated by not being understood. They may look as if they are struggling to get their mouth to move in the correct way. If a child is frustrated and CAS is suspected, intensive therapy may be recommended.
If your child is showing any signs of these speech sound disorders, be sure to see a qualified speech-language pathologist. In many cases, early intervention is the best way to turn things around.
References
Rescorla, L. & Ratner, N.B. (1996) “Phonetic profiles of toddlers with specific expressive language impairment (SLI-E)”. Journal of Speech and Hearing Research, 39, 153-165.
Lof, G.L. (2004) “Confusion about speech norms and their use.” Thinking Publications Online Conference. www.thinkingpublications.com/LangConf04/OLCIntro.html
If your child is a late talker or has other challenges with communication, early intervention will likely be recommended. A speech-language pathologist (SLP) can work with you to develop communication goals and objectives. These goals are usually updated at least every six months. That’s because young children can change very quickly during their developmental growth spurts.
A recent research review about treatment of communication disorders in young children came to two clear conclusions:
- Early intervention for all types of communication disorders can be effective and more efficient than that provided at later ages.
- Sound clinical judgment is needed to determine the treatment goals, settings and procedures that are best for any given child’s needs
Styles of Intervention
Three basic styles of therapeutic interventions are commonly used to facilitate communication, language and speech development. These styles include:
- Therapist-directed approaches
- Child-centered approaches
- Combinations of the two approaches
Therapist-directed approaches are what most people think of when they imagine what “speech therapy” might look like. These approaches include traditional drill play. This is when the child practices the speech sounds for a certain number of times and then gets to take a turn at a game or other preferred activity. These approaches also include modeling correct speech production by the SLP. The approach is generally structured with clear targets and corrective guidance offered by the SLP.
Child-centered approaches may also be called indirect language stimulation, facilitative play or naturalistic. This approach focuses on teaching communication skills the way most typically developing children naturally develop their skills, by playing and interacting with others. Parents who watch this type of therapy often remark that it seems as if the SLP is “only playing” with the child. It is well-known among early interventionists that “play is the work of childhood.” In this approach, the SLP follows the child’s lead and adds language to each activity. Children pay attention when adults act like good playmates.
Combinations of these two methods can expand the types of activities and environments to meet the needs of each individual child. Following the child’s lead is still an important component of this approach.
References:
McClean, L.K. & Cripe, J.W. (1997) The effectiveness of early intervention for children with communicative disorders. In Guralnik, M.J. (Ed.) The effectiveness of early intervention. Baltimore, MD: Paul Brooks Publishing.
California Speech-Language-Hearing Association. (2002) Preferred practice patterns for speech-language pathologists in service delivery to infants and toddlers and their families. Sacramento, CA: California Speech-Language-Hearing Association.
