For many children, the acquisition of speech is anything but a smooth, natural process. Words simply do not come easily to these children, and their social functioning and school success may suffer as a result.
A child who is able to speak but has trouble making himself understood (or understanding the speech of others) is said to have a specific communication disorder.
These disorders are divided into three main subtypes depending on whether the main problem is with pronouncing words, formulating meaningful phrases or understanding spoken language.
These three subtypes have many features in common. Although all become apparent early in life most children who have trouble forming words learn to speak by school age but a portion will be dyslexic or show more subtle inadequacies. They also affect males more often than females and tend to run in families. Finally, and not surprisingly, they all have a negative effect on school performance.
Delayed development in language and speech is the most common developmental disability in children, affecting approximately 10 percent of all children.
WHEN SHOULD I SUSPECT THAT MY CHILD HAS A COMMUNICATION DISORDER?
AGE 1
• Says two or three words; makes animal sounds. Not easily understood by strangers
AGE 2
• Uses phrases of two or three words
• Uses "I," "me," and "you"
• About 50 percent intelligible
AGE 3
• Says 4-5 word sentences
• Knows about 900 words
• About 75 percent intelligible
AGE 4-5
• Can use past tense correctly; uses "yesterday"; uses complete sentences with adjectives, adverbs
• Knows about 1,500-2,100 words
• 100 percent intelligible
AGE 5-6
• Understands "if," "because," and "why"
• Knows about 3,000 words
• Makes most sounds correctly; may distort s, z, sh, ch, and j
WHAT CAUSES COMMUNICATION DISORDERS?
In the vast majority of cases, the cause is unknown. Most likely, however, subtle brain abnormalities, some of them genetic, interact with environmental influences (such as the amount of talking that goes on in the home) to produce communication disorders.
IS MEDICAL ATTENTION NECESSARY?
Yes. If you suspect that your child is not developing normally, consult your pediatrician without delay. The doctor will examine your child and perform a series of tests designed to rule out such causes as hearing loss, mental retardation, autism and disorders associated with structural brain lesions, such as cerebral palsy. Once these have been eliminated, the doctor will probably refer you to a speech and language pathologist or a psychologist trained to work with language disorders.
HOW CAN THE DOCTOR TELL IF MY CHILD HAS A COMMUNICATION DISORDER?
There are three methods available for assessing speech and language development. The first is direct observation of the child's language skills. The doctor or speech pathologist will interact directly with the child, talking, asking questions or playing, depending on the child's age. Second, the doctor will question the parents. This involves taking a history of the child's use of language from about age one to the time of the consultation. Finally, speech pathologists use several different standardized tests for assessing language development in children. The choice of a specific test or tests is based on the age of the child and the type of impairment.
WHAT TREATMENTS ARE AVAILABLE?
The treatment for any of the specific communication disorders is speech and language therapy by a certified speech pathologist. Sometimes educational and psychological problems accompany these disorders, so additional counseling may be needed as well.
CARING FOR A CHILD WITH A COMMUNICATION DISORDER
Parents play a key role in encouraging their children to expand their verbal capabilities. The following are some guidelines for helping:
• Provide listening opportunities. Speak to the child about on-going activities. Say "open" each time a door is opened. Repeat the word several times. Give the child the opportunity to speak or repeat what was just said.
• Choose a vocabulary that is useful, easy to pronounce and understandable to the child.
• Encourage vocabulary building by promptly the child to say the word before fulfilling a request, for example, to say "drink" before getting a beverage.
• If the child says two words, answer with three or four word phrases.
• Always reinforce the child's attempt to communicate with verbal praise and affection. Give support, not criticism.
• Don't correct mistakes. Instead, repeat and expand. If the child says "pisketti," respond, "Yes, we're having spaghetti for dinner."
• Don't anticipate all the child's wants. Wait for the child to express them.
LONG TERM OUTLOOK
Most children with developmental language disorders can express themselves verbally by school age, but residual problems often persist. Children with articulation problems commonly catch up by the fourth grade, usually with no residual problems.
Children who have more severe problems often have learning disabilities, especially with reading, reading comprehension and spelling. Rarely, such expression and receptive language defects may persist into adulthood.
GETTING HELP
Call your doctor if your child:
• Consistently has incomprehensible speech after age four
• Does not use many words and short sentences by age two and a half
• Has difficulty following simple directions or doesn't respond to his name
