Listen to how they say what they say

By Ayesha Inoon

Children, from the moment of birth, are constantly learning and developing their abilities and skills - including that of speech and language. The way parents and caregivers interact with them will determine the path that language development takes in the crucial first five years.

While difficulties with speaking fluently affect about one child in 20, especially between the ages of three and five, evidence shows that most children tend to outgrow this phase. Shalini Wickremesooriya, who specialises in working with children with, Speech, Language and Learning disorders, discusses the development of speech and language and various related disorders, with MediScene.

Development of speech and language

It is a misconception that children learn language passively. Language acquisition is a product of active, repetitive, and complex learning. The child's brain is learning and changing more during language acquisition in the first six years of life than during any other cognitive ability he is working to acquire.
Children learn to speak at different rates. The important thing to watch is that language development proceeds steadily, not whether it is fast or slow. However, parents should observe whether their child is progressing more or less in accordance with the general yardstick of speech and language development.

Significant stages involve babbling, which occurs between 6 - 12 months, and the single word stage, between 12 - 18 months. The combining word stage is between 18 months to two years, and the telegraphic stage when a child speaks in 3-4 word sentences leaving out the functional words occurs between 2 -3 years. Between 3- 4 years a child is able to speak 4-5 word sentences but distorts sounds such as l, r, s, sh, ch, y, v, z, and th. By 4 -5 years sentences become longer and more complex and r and z sounds are developing while all other sounds are established by the age of 5 years.

Speech and language disorders

Speech and language, while often used as interchangeable terms, are distinguishable. A speech disorder refers to difficulties in producing speech sounds, or problems with voice quality. A language disorder, on the other hand is the inability to understand and/or use words in context, both verbally and nonverbally. Children may hear or see a word but not be able to understand its meaning. They may also have trouble getting others to understand what they are trying to communicate.

Speech disorders may be categorised as:

Articulation disorders:

This refers to the misarticulating of sounds. The child's speech may be understandable or virtually unintelligible depending on the frequency of error sounds when the child is talking.

Making the sounds of speech involves precise coordination of many muscles, including those of breathing, the vocal cords, tongue, and soft palate. The structures themselves, such as size and shape of teeth, tongue, and hard and soft palates are equally important. If any one of these elements is impaired, an articulation disorder may result. Common causes include anatomical differences such as cleft lip and palate, or tongue tie or other craniofacial anomalies, abnormality in the function of the muscles or nerves involved and developmental delays.

When identifying articulation disorders four types of errors are usually noticed.

  • Substitution- a sound is substituted for one they cannot make yet. E.g. "wed for red", "fumb for thumb", "wabbit for rabbit", or "thun for sun".
  • Omission- a sound is left out that is too hard. E.g. "ed for red", "han for hand"
  • Distortion - There is an attempt to make the sound but it is misarticulated. E.g. "wewe de gog?" for, "where's the dog?"
  • Addition- an extra sound is added. E.g. "galue" for "glue"

Phonological disorders

Children develop sounds in stages called "phonological processes”. The processes involve groups of sounds that are mispronounced in a pattern and are eventually corrected as the child outgrows the process. The disorder occurs when the child does not go through the natural maturing process
The impairment may result in the child being perceived as unintelligible even at the single word level. Children with phonological disorders are at a high risk for reading and learning disabilities later and should be treated with intensive speech therapy as soon as they are diagnosed.

Consistent error patterns are:

  • Stopping or "cluster reduction": Children will take a sound blend (like [bl] [sp] or [tr]) and omit one of the sounds: "blue" becomes "boo", "spoon" becomes "poon"
  • Backing: dog becomes /gog/
  • Final consonant deletion: coat becomes /ko/
  • "Velar fronting": Children substitute sounds produced in the front of the mouth (t, d, n) for sounds produced in the back of the throat (k, g). E.g., "duck" becomes "guk", "car" becomes "tar"

Dysfluency or Stammering

It is a disorder of speech flow that most often appears between 3 - 5 years. It is more common in boys that girls and may spontaneously disappear in a few weeks or months, but speech and language therapy should be considered.

Stammering usually starts around the time that language skills are developing, and onset is generally gradual in nature. Late-onset developmental stuttering is also possible. It is generally not a problem with the physical production of speech sounds or cognitive skills. It also does not affect and has no bearing on intelligence.

Some causes include genetics and neurophysiology, learning and environmental factors and emotional or anxiety disorders.

The following list is often known as the "Eight Danger Signs of Stammering" and is a clear indicator of the different characteristics of this disorder that aid in identification:

  • Part-word (syllable) repetitions: usually the first syllable (eg"da-da-da-daddy")
  • Substitution of the "schwa" or weak vowel in a repetition: instead of "bay-bay-baby", the child may say "buh-buh-baby”.
  • Prolongation of a sound or holding onto one sound for a longer time, e.g. “mmmmommy”.
  • Tremors: uncontrollable movements of the jaw, lips or tongue when speaking dysfluently.
  • Pitch and loudness rise when repeating or prolonging a sound.
  • Struggle and tension: visible difficulty getting the word out; e.g. eye blinking/ movements, facial grimaces, lip, limb, or torso movements.
  • Moment of fear: a brief, fleeting expression of fear when approaching certain words or sounds or during a moment of stuttering.
  • Avoidance: unusually long or an unusual number of pauses, avoidance of certain words or of speaking altogether

There are also Voice Disorders which can arise due to vocal overuse and misuse such as by shouting at a sporting event, talking over noise, or talking for long periods of time, but these are uncommon in children.

The fast-paced, stressful lifestyle that many of us have today seems to be increasingly bringing on speech disorders in young children. Adults can play an important role in aiding their speech development, and helping them overcome any apparent difficulties.

  • Provide age-appropriate stimulation for the child. While television and CD's may be good mediums, without two-way communication, the benefits are lost - instead, an adult who can respond, for example by singing or dancing along with the child, should always be present.
  • Allocate a few minutes each day to do something fun and interesting with the child - it could be anything from an outing in the park, to washing the dishes together. Initiate conversation by talking about your own day, rather than putting them in the spotlight with questions such as, "What did you do in school today?"
  • Maintain natural eye contact when the child is having difficulties. Don't interrupt or finish his sentences, or display any anxiety in the child's presence.
  • If you speak quickly, slow down your own rate of speech when you talk to your child. Don't tell him to slow down, start again or to take a deep breath. Pausing for a second before you answer or ask a question can also help him to feel less rushed.
  • Do not bribe or reward the child for correct speech.
  • If, after the right stimulation and environment has been provided, the child still appears to have speech delays or difficulties, a speech therapist can help diagnose and treat the issue. No age is too early to begin therapy, and problems that are identified early can often be sorted out faster. As research indicates, it also helps avoid learning problems that may arise later.
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