An Integrative Approach to Children's Wellness: Speech Therapy

Late Bloomer or Developmental Delay

When my son was eighteen months he did not speak in real words.  We were living in France at the time and he sounded like the old Frenchmen who we saw sitting outside the corner Cafe.  His pitch went up and down like their speech and he would add some gestures and a very French belly laugh. When my father-in-law came to visit he said that he thought Tommy was speaking a foreign language.  Tommy would call from our garden to the trash men and police men as they walked by, they would wave to him and speak in French and he would wave back and speak in his jargon.  They thought he was speaking American English.

   

Being a certified and licensed speech language pathologist I was worried.  He had met his motor developmental milestones with no problem.  He walked at nine months and was running by ten months.  He was physically fine but he did have a history of chronic ear infections and there was also a family history of late talking; both of my brothers were in speech therapy through third grade.  I began discussing my concerns with my speech therapy colleagues back in the U.S.  When I asked if they thought he needed speech therapy I really didn’t get any definitive answers.  That’s when I approached my pediatrician in the U.S. with my concerns.

My pediatrician sent us to a pediatric ENT who worked with a pediatric audiologist for a hearing assessment and a tympanogram to assess the possibility of fluid in his ears.  Somehow he passed the hearing assessment, but the tympanogram show that there was indeed fluid in both ears.  The ENT said that when children have fluid in their ears, it sounds like it does when you are talking under water at the pool.  I knew that a child first needs to hear speech before they can produce it, so I was no longer surprised that Tommy’s speech was delayed.  He also said that when children’s ears are full of fluid they do one of two things – they either act out or they withdraw.  This was another eye opener.  Tommy was never one to withdraw, but his constant activity seemed to have increased and he didn’t respond to our requests.  Now everything made sense, he wasn’t talking because he was hearing distorted speech sounds and he wasn’t following our directions because he couldn’t hear them.

We worked with our ENT to come up with a treatment plan.  We decided on the placement of tubes in both ears and I began providing Tommy with speech therapy and I taught my husband and daughter how they could help stimulate his speech development.  I also talked with Tommy’s preschool teachers and I explained how important it was for Tommy to see their faces when they were talking to him.  I also asked that he sit close to the teacher when she was reading stories or leading other group activities.

Waiting for Tommy’s speech to catch up was hard and I know that waiting is very difficult for all parents, especially when you are concerned about your child’s development.  It’s hard to know the exact age a child will meet speech and language milestones; but there are milestones that children consistently pass through.  At twelve months, a child can say one or two words, like dog, hi, dada, mama.  By eighteen months, the child should be able to understand simple questions, like Who’s that? Where are your shoes?  By two to three years, the child is able to put three words together and familiar people understand their speech.  By five years old, they can tell a short story, understand most of what is said at home and school, and say most speech sounds in words. 

If the child is not able to do these things in the time frame listed above, they may be exhibiting a delay in speech and language development.  If parents are concerned about their child’s speech and language development, they should consult with a speech language pathologist.  A speech delay is when a child has difficulty producing sounds in words.  A language delay is when a child has difficulty with the code that we use to communicate thoughts and to understand others.

When parents bring their child into my office, I analyze the child’s utterances for both what they understand and the speech and language that they are using.  I determine factors that may be slowing down the child’s speech and language development and I council parents on the next steps to take to help their child.  The treatment services that I provide as a speech language pathologist varies depending on the child’s specific areas of difficulty.  Some children may only need help with language.  They may have problems with understanding what others are saying, their vocabulary may be small, they may have trouble thinking of words, and they may have problems saying words and sentences; while other children may need help with the mechanics of producing speech.  They may substitute one sound for another, they may leave out sounds, and they may change how sounds are made.

As parents, there are things that you can do at home to help your child understand and talk.

·        Talk, talk, talk.  Talk naturally to your child and use a lot of different words.  Talk about what your child sees and talk about what he – and you – are doing.  Ask questions that require more than a “yes” or “no” answer.

·        Listen.  Take time to listen to your child and respond to what he says.  Don’t interrupt or correct speech sounds.  If your child makes some mistakes with sounds, it’s okay.  You can say the sounds correctly when you talk so that your child can hear the correct pronunciation of the error sounds.  A child must first be able to hear the sound before he can be expected to produce the sound.

·        Read.  Ask questions and talk about the story.  Help your child retell the story using the pictures in the book.

·        Play.  Talk about the toys as you and your child play with them.  Set aside a special time each day to play with your child.  Provide your child with blocks, dishes, dolls, boxes, cars, trucks, dress-up clothes, paper and crayons.  Reward your child’s play with attention and praise.

·        Have your child’s hearing tested if you have to repeat a lot or use a loud voice.

·        Set limits for TV and computer time.  Use the time for talking, reading, and playing together.

·        Good resource books are “Beyond Baby Talk” by Apel and Masterson and “Talking on the Go” by Dougherty and Paul.  These books are available at www.asha.org/shop.

While every child grows at their own pace, it is always better to consult with a specialist when you feel that your child is lagging behind.  Speech language pathologists are certified by the American Speech-Language-Hearing Association and they have completed their master’s degree and earned ASHA’s Certificate of Clinical Competence (CCC).  If you are concerned that your child may have a speech or language delay, please contact me.

Laura A. Michie, M.Ed. M.A., CCC-SLP, Speech Language Pathologist

301-471-3169, LauraMichieSLP@comcast.net, www-frederick-slp.com