AT age three, Aisha has yet to use any meaningful words. She is well cared for and appears generally contented. She browses through books, plays only with her favourite blocks and is happy to gaze at Barney for a good length of time.
Her parents notice that she appears intelligent, taking in all that happens around her. She follows some instructions well, especially when she is called upon to eat or hop into the car for a ride.
She frequently points to the TV and says “V” when she wants the TV to be switched on. She could say “juh” for juice, point and say “bird”, “wo wo” for the neighbour’s dog and “no” to things she objected to.
Her family felt nothing was amiss until relatives remarked on her lack of speech and how she does not play and interact like other children.
Is there a disparity her family can’t see that others can?
Speech and language delay
Speech and language delay is the failure to develop speech and language abilities according to the typical developmental time-table.
Speech delay is distinct from language delay in that speech refers to the verbal motor output whereas language refers to the internal programming system of ideas.
In simple terms, when we want to communicate something, we need two systems to work well together.
For example, if Aisha wanted her father to have some juice with her, her language system would need to coin ‘“papa-drink-juice too” and then her speech system would have to organise all the sounds needed in a systematic fashion so that her father hears just that clearly.
However, with speech and language delay, Aisha may have trouble formulating the idea of “papa-drink-juice-too” and would have resorted to just “juice”. Her speech system, which is also a little atypical, would then attempt putting together “juh” to indicate this.
The outcome: Aisha says “juh” (to get her father to drink some with her) and her father gives her more and more juice. She then coins the word “no” to mean it isn’t what she meant and the trouble begins as daddy only hears her retort “no, no, no” and a lecture on wastage begins.
Language can be broken into two categories: receptive language (language understanding) and expressive language (referring to the use of words, sentences and ideas to communicate what we think, need and want, for instance).
Language and speech are two independent areas, hence they may be individually delayed. An example of speech delay: You may find a child who understands everything but when she puts together a sentence, she is hardly understood.
Conversely, you may have a highly articulate child who speaks so precisely but cannot communicate what she means. For example, she may be saying “chocolate-cake-fall, chocolate-cake-fall” and get more frustrated when the teacher cleans it up for her, unaware that she enjoys seeing the cake on the floor and ants on it in class. This is an example of language delay.
As every child is different and has a personality of their own, parents have to be able to discern what their littles ones are good at, and see if it is simply a lack of nurturing or a problem that requires professional attention.
Universal milestones suggest that:
> Before age one, children should be actively using their voices to communicate and relate to those in their environment – cooing, babbling and charming adults into “teaching” them many words as they soak in this information with all their innate skills.
> By the age of one, children should be able to understand a variety of words and be able to use a few single words appropriately.
> By age two, words should be combined into two- or three-word phrases that communicate their ever-growing ideas.
> Between ages three and five, they learn to engage in conversations, ask and answer questions, follow and give directions, and can speak alone in the presence of a group (without their parents).
As a general rule, children should have intelligible (understandable but not necessarily perfect) speech by age four and complete, correct use of all speech sounds between ages five and seven.
As more and more parents are well read and informed these days, warning signs of a possible problem are frequently heeded early.
An infant who does not vocalise or does not respond to sound is cause for concern.
Parents should be concerned if a child between 12 and 24 months:
> Isn’t using gestures, such as pointing or waving bye-bye, by 12 months.
> Prefers gestures over vocalisations to communicate, by 18 months.
> Has trouble imitating sounds, by 18 months.
> Has difficulty understanding simple verbal instructions and requests from his parents.
What parents can do
The first thing a parent can do is to discuss their observations together and seek each other’s support to have their child examined by his regular paediatrician. An assessment by relevant team members can be sought if needed, including an audiologist who tests hearing and a speech language pathologist to assess his skills.
The second thing is to make a commitment to each other that you will both seek to understand your child so that you can nurture and respond to him in a way that best suits him, to facilitate his speech and language development.
Getting back to little Aisha, her parents can help her with some of these ideas:
> They can watch Barney with her, pointing out new words and commenting with short phrases rather than leave her to process it all on her own.
> Not leaving her alone but, rather, coaxing her often to interact by joining in her play, making comments and getting her to think, to develop her language and thinking. For example, they can say: “Can tiger have a block, please?” or “Let’s make this block baby’s stool,” etc, to force her to break her linear play with blocks.
> Learn skills to expand her current use of speech. For instance, the next time she says “V,” they can expand it by consistently adding another word and saying “on TV” before switching it on. When she says “bird,” expand it by saying “hi, bird”.
With good facilitation skills, Aisha will quickly expand both her speech and language repertoire simply through the fact that her parents, teachers and carers have skills to take her a level up in her speech and language development.
Whatever your child’s age and problem, recognising and treating problems early on is the best approach to help him cope with speech and language delays.
With suitable techniques, over time you can be assured that your child will be able to communicate with you and the rest of the world more confidently.
Pamela Thomas Joseph, a speech language pathologist, will be conducting a parent and teacher workshop on Facilitating Speech And Language Skills in Ipoh on March 13. For details please contact Coreen (013-3301728 / e-mail jpltraining email@example.com)
One Voice is a monthly column which serves as a platform for professionals, parents and careproviders of children with learning difficulties. Feedback on the column can be sent to firstname.lastname@example.org. For enquiries of services and support groups, please call Malaysian Care ( 03 90582102) or Dignity & Services ( 03-77255569). E-mail: email@example.com