Pediatric Advisor 10.0: Speech and Language Disorders

Children & Adolescents Clinic

Clinical Reference Systems: Pediatric Advisor 10.0

Speech and Language Disorders

What are speech and language disorders?

All children seem slow in the early stages of learning language, but some children continue to have problems.

As a parent, you may have become concerned about your child's speech and language development. Your child may be learning to speak later than you expected. Or, your child's speech may be unclear. You may notice that your child needs you to repeat directions before completing a task correctly.

The earlier your child is diagnosed the better. Speech therapy is available even for infants. Only a specialist in the evaluation of speech/language disorders can accurately tell which children will require specific therapies.

You should not "wait and see" if a problem goes away or continues. You may miss many months of valuable therapy. All children suspected of having a speech/language problem must have hearing tests. An audiologist experienced in examining infants and young children will test your child.

What is the difference between a disorder and a delay?

Speech and language disorders describe children whose speech and language is developing abnormally. This is the most common developmental problem in preschool children.

A speech or language delay describes a child whose skills are developing, but at a slower rate than normal. A speech problem can be mild, moderate, or severe.

A speech or language problem affects your child's emotional and social interaction with your family, among friends, and in school. Delays and disorders may precede future problems in intellectual development and success in school. You and your doctor should carefully watch your child's progress into the school-aged years.

What are language disorders?

Language is a system of verbal, written, or gestured symbols that are used to communicate. Language has several parts that develop at the same time. Language is divided into content, form, and use.

Content, or semantics, refers to the meaning of the message.
Form includes grammar and syntax. Grammar and syntax refer to rules that define the structure and organization of words to form sentences.
Use refers to the use of language both verbal and nonverbal.

Receptive and expressive language disorders:

A receptive language disorder means that you cannot understand the content, form, or use of language.
An expressive language disorder means you have trouble using content, form, or use of language when trying to convey a message.

What are speech disorders?

Speech is the actual sound of spoken language. Speech is divided into three parts: articulation and phonology, voice, and fluency.

Articulation is making sounds. Children who have articulation problems will probably substitute, leave out, or distort normal speech sounds at inappropriate ages. For example, it is not unusual for 3 year olds to substitute the "f" sound for "th" in their speech; "I am firsty (thirsty)." These errors should not, however, be present in the speech of a child over 5.
Phonology is the sound system of a language and the rules of sound sequences that make up words. A phonology disorder is failing to grow out of patterns such as babbling or developing inappropriate sound patterns.
Voice disorders are when there is an abnormal voice quality, pitch, or loudness that may result from an abnormal larynx (voice box) or breathing pathway. It may be caused by misuse or abuse of the voice box (for example, habitual screaming).
Fluency disorders are problems with rate and rhythm of the flow of speech, such as stuttering and stammering.

What is considered normal speech development?

Your doctor will check to see if your child has mastered the important language milestones. These milestones are a guide to help you and your doctor decide if your child needs speech and language testing.

 
                 Milestones for Normal Speech 
    -------------------------------------------------------
      Age              Speech 
    --------------    -------------------------------------
    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, and how to understand what you are saying. Your baby learns that his own behavior (smiling, making sounds) has a powerful effect upon the behavior of others.

As a child gains more control of his muscles, he can make more and better sounds. A baby learns by watching adults and learning the subtleties of speech and language.

At 18 to 24 months, children frequently have a vocabulary spurt from 5 to 10 words to more than 50 words. Children begin to use single words to communicate and eventually combine words. Children start understanding 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.

The following are problems to be concerned about. Call your child's physician during office hours if your child:

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 behaviors 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.

What causes speech and language problems?

Developmental language disorder
This is the most common reason for speech/language problems in children. The cause of this disorder has something to do with the nervous system. But its exact cause is unknown.
Hearing loss
Hearing impairment is the most frequently overlooked but the most easily found cause of language problems. Your child's hearing should be tested. Normal speech/language development depends on good hearing and listening skills. If there is a hearing problem, speech and language may not develop at a normal rate. Chronic middle ear infections almost always interfere with hearing.
Mental retardation
Children with any level of mental retardation will also have language problems. A child who is intellectually impaired is likely to have problems in all aspects of language.
Autism or pervasive development disorder (PDD)
A child with autism or PDD will usually have problems with communication.
Learning disabilities
Children who have learning disabilities have neurologically-based learning problems that may be observed as a short attention span, poor memory, and delayed or disordered language development. These learning difficulties can interfere with a child's success in school and social interactions with peers.
Not having a good example
Learning language strongly depends on hearing others speak. There must be enough language models available for the child to develop normal language skills.
Developmental delays related to prematurity
Many premature babies are considered at high risk for delays in their intellectual, motor, and language skills. All areas of their development must be carefully watched.
Neurological impairment
Some motor disorders such as cerebral palsy, muscular dystrophy, and traumatic brain injury affect a child's muscles, including those involved in speech production.
Structural abnormalities
There are many structural abnormalities that affect speech. These can include cleft lip or cleft palate, tracheal stenosis, or craniosynostosis (deformity of the skull).
Impaired decoding of speech
A child who cannot decode speech sounds has a disorder known as "word deafness." Using visual communication such as sign language or gestures works for these children.

What kind of testing and therapy will my child have?

Successful treatment depends upon identifying the problem early. When your doctor suspects your child has a speech or language disorder, he or she will refer your child to a qualified speech/language pathologist. Your child will also need to have a hearing test.

Speech/language pathologists are certified by the American Speech, Language and Hearing Association. In many states a state license is also required. A speech and language evaluation will identify the nature and severity of the disorder or delay, identify possible causes, and outline a treatment program.

Your doctor may find that assessment or treatment may also involve referral to other professionals such as a developmental pediatrician, learning specialist, neurologist, otolaryngologist, psychiatrist, or psychologist.

Language therapy aims to:

improve your child's ability to understand language
increase your child's vocabulary
expand your child's use of expressive words and sounds
help your child develop language to an appropriate level.

The goals of speech therapy are to correct deviant speech sound production, teach phonological rules, and correct inappropriate vocal pitch, intensity, or intonation.

If your child cannot speak, language therapy will focus on providing an another system of communication. This can include the use of a gestural or sign language, picture boards, or an electronic device.

How can I help my child at home?

Talk to your child.
Children learn words and the rules for using them by listening to others talk. They model their language behavior after you. Therefore, what you say and how you say it is important. Dialogue is a natural part of many daily routines such as mealtime, bath time, and dressing. Your child can expect certain language to be used over and over again within his familiar routines.
Encourage your child to ask for items, make choices, and answer questions at his language level.
Teach your child to use words instead of crying or pointing to satisfy his basic wants or needs.
Listen to your child.
Encourage storytelling and sharing of information.
Encourage play.
Provide objects and toys appropriate to your child's level of play. Use the toys yourself and call your child's attention to how you use them. Set aside a special time each day to play with your child. Give him opportunities to play with other children.
Sing to or provide music for your child.
Help your child learn new songs. While singing, a child learns new words and sentence patterns, memory skills, listening skills, imitation, and expression of thoughts and feelings through words.
Plan family trips and outings.
Language is based on ideas and experiences. Talk about the new experiences.
Read to your child.
Ask a librarian for books appropriate for your child's age. Reading provides an opportunity to teach and review words and ideas.

For more information, write or call:

American Speech-Language-Hearing Association
10801 Rockville Pike
Rockville, MD 20852
(301) 897-5700
www.asha.org