Ding-dong! A cheeky face peeped through the glass door, four-year-old Andy was just in time for his 1pm appointment.
“Open door!” he called out.
As we reached my therapy room, Andy said: “I want ball.” “Which one?” I asked. “Yellow ball,” he replied. Andy’s mum smiled and said: “Guess what? Andy was trying to say new three-word sentences last week. They’re not clear yet, but I know he’s trying.”
When Andy’s class was over, I had another visitor. Five-year-old Michelle and her parents were here for a first consultation. Michelle’s parents had told me over the phone that she could form sentences so I said: “Hi, what’s your name?” Michelle replied: “Hi, what’s your name?”
I tried again, pointing to her this time and emphasising “your.” Still, Michelle repeated my question. Michelle’s parents told me that the girl can indicate her basic needs and wants but tends to repeat questions instead of answering them. She began talking in two-word sentences only at around three-and-a-half years old but her development has plateaued since then.
Michelle reportedly can manipulate an object just by watching an adult do it once or twice. Once, she saw her mother entering the password to unlock her iPad. After dinner, Michelle ran to the iPad and unlocked it successfully!
At 4pm, three-year-old Hafiz arrived. He pressed his face against the glass door and I could see him mouth “open” with his mother’s prompting. He immediately ran into the therapy room, used his hands to sign “book” and waited for me to show him his favourite car book. “Car book!” I said, while signing
“book.” Hafiz grabbed the book, said something that sounded like “boo” and became engrossed with flipping through the pictures. I asked his mother: “Did he just say ‘book?’ ” “I think so. He’s beginning to say things as he signs now,” said his mum.
These are just some examples of the cases that I see as a speech language pathologist, or speech therapist as we are more commonly called in Malaysia. Most people would assume that the cases above are speech difficulties but speech actually relates to the pronunciation of words. For example, saying “cat” instead of “tat.” The cases above, in fact, relate to children with language difficulties, where children have difficulties understanding and using words to communicate.
Talking is as easy as 1-2-3?
Language is a complicated process. The two main components of language are understanding and production (which may or may not be verbal communication). These two levels then further branch out to more complex aspects.
Children learn to understand simple words at first, then begin to follow longer instructions and understand more abstract concepts. As they grow older, they begin to comprehend complex questions. For example, a child of two will struggle to answer “why” questions but a four-year-old can easily answer simple “why” questions on his/her own.
Similarly, children learn to first communicate using single words when they are a year old. They begin to move on to saying two-word phrases at two years old, incorporating more words into their existing vocabulary. By the time a child is four, they are able to retell stories and are taking an active role in conversations by asking questions themselves.
A child with language difficulties can face breakdowns at any of these areas. Hafiz understands single words and is able to sign them to get his message across. Andy and Michelle can form short, basic sentences but Michelle faces more difficulties in answering questions than Andy. So what strategies were used to help Andy and Hafiz? And what did we do to help Michelle?
Visual cues and hands-on learning
Many children with language difficulties tend to be visual and hands-on learners to compensate for their weaker listening skills. When listening skills are weak, this affects a child’s understanding and ability to communicate in an age-appropriate manner. Children who are visual and hands-on learners usually struggle with listening activities but they love manipulative activities like assembling toys, songs with gestures and playing puzzles.
Using visual cues and hands-on activities can aid the child to learn new words, concepts and questions. Each of us have a mental dictionary in which we store our knowledge of words but children with language difficulties have difficulties accessing this storage.
Visual cues can help to organise the words in a child’s mental dictionary to form single words, sentences and narratives.
For example, Hafiz was having difficulties focusing on purely listening to us name an object multiple times, so he was taught sign language to understand single words and eventually use them to communicate. We didn’t expect him to try to say the words as he signed, so that was a bonus!
Andy initially struggled with forming sentences, even though he had a large vocabulary of single words. His parents would ask him to imitate each word as they tried to help him to form a sentence but he would quickly forget how to create the sentence the next time.
When he came to see me, we practised getting him to form sentences on his own using gestures and pictures as visual cues so that he relied less on us providing him the words which he needed.
How about Michelle? Since she is unable to process what she hears and instead repeats the question, this indicates that her main learning style is not by listening. It may be better to use written sentences to cue her and let her watch adults answer each other before letting her try on her own. These methods
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