A speech and language disorder is often first diagnosed at developmental check-ups. Children may not reach each expected developmental milestones (see below). These disorders impair a child’s functioning, and can if severe enough disrupt a child’s ability to communicate, they have especially serious consequences. In their most severe forms, it can be expected to persist over a lifetime. But in saying this I would like to stress that it is not uncommon for children who present with speech and/or language difficulties in the early stages go on to develop adequate language skills with no long-term adverse effects on their learning. It should also be noted that children with Specific Speech and Language Disorder (SSLD) score in the average or above average range on an intelligence test, this I think is any parent biggest fear after diagnoses as they wish as any parent would for their child to eventually live an independent and happy life.
Specific Speech and Language Disorder (SSLD)
A speech delay is defined as pronunciation errors that a child uses, these delays occur after the child should have mastered them in terms of development, e.eg. substituting ‘t’ for ‘ k/c’ whereby a child would say ‘tar’ for ‘car’. This is normally resolved by around 40 months, but if a child of 4 years uses this then they would be said to have a speech delay and would need to be assessed. Unusual errors, which persist are deemed ‘Speech Disorder’.
A language delay is when a child does not learn enough grammar or vocabulary for their age. Language delays/disorders can involve both understanding and speaking. A language disorder presents when a child makes unusual substitutions for words or forms sentences in a way that would not be expected e.g a child may say ‘I falled down’ but it would be very unusual to say ‘fall mine’. Children with a Language Disorder will also have difficulty learning language easily, answering questions and following instructions.
Speech and Language delays and disorders can be independent of each other but can also co-occur. The causes of speech or language delay can be unknown, although there can be contributing factors such as ‘glue ear’, premature births, family history of delay and lack of exposure to a language.
Some of these delays will be picked up at the child’s developmental checks or at pre-school/school, but always remember as a parent you can refer or ask for a referral to a speech and language therapist who can assess your child. Speech and Language intervention has been shown to be extremely beneficial to children with SSLD. The therapist will devise a programme, which targets specific areas of weakness within the language system. Therapists usually work closely with resource teachers to help children with SSLD improve their language skills by working on areas such as:
- Pronounce words correctly and increase vocabulary
- Use more vocabulary and use it appropriately
- Understand language, listening to information and understanding complex information
- How to follow an instruction
- Learn grammar, accessing vocabulary to form sentences
- Check their understanding of explanations and story-telling.
- Show them how to take part in a conversation
- Improving literacy skills
An assessment (see below for details about an assessment of needs in Ireland) for SSLD will usual not only include a speech and language therapist but also an educational psychologist. Your child will have to be assessed to rule out other conditions that may also explain their speech and language delay. An educational psychologist will put together a planned intervention to help your child and will work closely with the speech and language therapist and school resources teacher – if your child is of school going age. The educational psychologist will use the following definition from the DSM-IV to determine if your child has SSLD.
The DSM-1V list diagnostic criteria for expressive language disorders, mixed receptive and expressive disorder and phonological disorder separately. They do not offer diagnostic criteria for receptive language disorder as a separate entity. A diagnosis of a language disorder is made when:
There is a substantial difference between the child’s language abilities and their non-verbal performance as registered on standardised measures of language.
The language difficulties interfere with academic, occupational achievement or with social communication.
The language difficulties do not meet the diagnostic criteria for other disorders.
How can parents help their child?
As parents, the first place we can help our child is to understand the normal milestones for speech and language. Getting this type of knowledge empowers us and help us help our child. We can then become aware of any problems and look for interventions more quickly.
Milestones for Normal Speech and Language
Birth Undifferentiated cry
2 to 3 months Differentiated cry; responsive cooing
3 to 4 months Random babbling
5 to 6 months Rhythmic babbling
6 to 11 months Imitative babbling
12 months 1 to 2 words
18 months 5 to 20 words
24 months 2-word sentences, increasing vocabulary size
During the first 12 to 18 months: a baby learns social skills, how to make sounds, how to understand what you are saying and that their own behaviour has a powerful effect on others.
At 18 to 24 months: toddlers will have a vocabulary spurt from 5 to 10 words to more than 50 words, will start understanding the language a lot more when they are about 2 or 3 years old. Children understand more language than they can express during their early years.
So what problems should a parent be concerned about and discuss them with their GP or the doctor at their child’s developmental check-ups:
- Does not understand his name, “no,” and a few words or simple commands by age 1 year.
- Is not saying words by 14 to 16 months of age.
- Cannot answer basic “wh” questions (what, where, who) by age 3 years.
- Has difficulty being understood by people outside the family after age 3.
- Has any unusual facial, vocal, or breathing behaviours associated with speech?
- Has noticeable hesitations or repetitions in speech past age 5 years.
- Is chronically hoarse without having a cold.
- Cannot tell a simple sequential story by age 5.
- Cannot tell a more involved story by age 7.
- Shows limited development of vocabulary.
- Shows poor school performance.
- Demonstrates a significant gap between nonverbal and verbal abilities.
Your GP or the doctor at the developmental check-up will refer you on for an assessment, this can be with a speech and language therapist and/or psychologist. These specialists will determine what actions can be put in place to help your child. Remeber a lot of children referred to a speech and language therapist will go on to no further problem s after treatment.
So what are some ways in which parents can help their child develop their language skills
- Making eye contact with your child is so important, they need to see all your expressions and know they have your attention too.
- Use the correct terms and words for objects and when speaking to your child from birth, we are all guilty of using simplified words such as tata instead of thank you.
- Make sure you have their attention before you initiate a conversation, getting their attention to what is being said is important, it helps them to focus and not get distracted by other people or the noises.
- Use gestures and repetition while you help them build their vocabulary, make sure to point things out on regular basis and us the same words to describe someone or something.
- Read to them at night from birth. Helps them to develop their listening skills, plus use other games to develop their listening skills also such as ready, steady, go, where they have to wait and hear go before reacting. Listen walks are also useful in your locality, just a simple walk in the park while they listen out for the dog barking, birds chirping or car noises etc.
- Show them the images in the books as you read to them and when old enough get them to point out different people or object in each image.
- Name their toys and use toys to develop language, ie.e teddy could go on an adventure and ask them to help you tell the story of Teddy’s adventures.
- Listen to audiobooks for them and for you, again they need to hear language to develop it.
- Above all Watch tv shows for kids – age appropriate to them – watch these with them and sing along to all the songs
- Include them in conversations with other children and adults from birth, again age-appropriate conversations.
- Get them socializing with other children, play dates or trips to the park etc.
- Take them to story time at the local library.
- Place names on objects, be as colourful as you can and help your child to learn words by giving them choices, for example, ask them questions where they have to pick something from two choices such as “Do you want cereal or toast?”
- have patience and allow your child time to express themselves and speak and follow their lead when communicating. Never interrupt or speak for your child.
Assessment of Need in Ireland
In Ireland, parents of any child born after 1st June 2002 may apply to the HSE for an Assessment of Need under the Disability
Act, if they think that their child may have a disability.Your first point of contact is your local Assessment Officer who is responsible for your child’s assessment. Each Local Health Office has an Assessment Officer. They can assist you with your child’s application and help support you through the process. The Assessment Officer is responsible for issuing your child’s assessment report. Applications must be made in writing on a standard form which is available from your Local Health Office. Call the HSE information line 1850 24 1850 or check out www.hse.ie for a list of Local Health Officers in Ireland. Your child’s assessment must start within 3 months from when the completed application form is accepted by the HSE. It must be completed within a further 3 months from the date on which the assessment commenced.
Children with disabilities are also covered under the Education Act 1998 and the EPSEN Act 2004