Speech and Language Problems in Children

What are speech and language problems?

All children learn language slowly in the early stages, but some children continue to have problems. A problem with speech can be either a disorder or a delay.

Speech and language disorders describe children whose speech and language is not developing normally. 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. It can affect your child's emotional and social interaction with your family, friends, and in school. You and your healthcare provider should carefully watch your child's progress into the school-aged years.

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

• Articulation is making sounds. Children who have articulation problems will probably substitute, leave out sounds, use other sounds in place of the correct sound, or change normal speech sounds. 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.
• Voice disorders are when there is an abnormal voice quality, pitch, or loudness when speaking. It may result from an abnormal larynx (voice box) or breathing pathway. It may be caused by misuse or abuse of the voice box, like always screaming.
• Fluency disorders are problems with keeping a normal rate and rhythm of the flow. Examples are stuttering and stammering.

What is the cause?

There are many possible causes of speech and language problems including:

• developmental disorders or delays
• hearing loss
• mental retardation
• autism or pervasive development disorder (PDD)
• learning disabilities
• lack of people using language around the child so the child will learn
• nerve or muscle problems such as cerebral palsy, muscular dystrophy, or a brain injury
• face or mouth deformity such as, cleft lip or cleft palate
• problems with decoding speech

What are the symptoms?

You may notice that your child may be learning to speak later than you expected. Or, your child's speech may be unclear. You may also notice that your child needs you to repeat directions before completing a task correctly. The earlier your child is diagnosed the better.

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

• Does not know his name, the meaning of "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 "what," "where," "who" questions by age 3 years.
• Has trouble being understood by people outside the family after age 3.
• Has any unusual facial, vocal, or breathing behaviors when speaking.
• Has noticeable hesitations or repetitions in speech past age 5 years.
• Is always hoarse without having a cold.
• Cannot tell a simple story in the right order by age 5.
• Cannot tell a more detailed story by age 7.
• Has a hard time learning new words.
• Shows poor school performance.
• Is able to do physical things, but has trouble talking.

You should not "wait and see" if a problem goes away or continues. You may miss many months of valuable therapy.

How are speech and language problems diagnosed?

Children go through expected language stages in the first year of life and a wide range of development in the second year. During the first 12 to 18 months of life, a baby learns social skills, how to make sounds, and how to understand what you are saying. Your baby learns that his own behavior, such as smiling or making sounds, has a powerful effect on other people.

At birth your baby will cry, but the cry will not have specific meaning. By 2 to 3 months, babies start to develop cries that have more meaning, such as hunger or pain. They also start to coo. A 3 to 4-month old baby will start to babble randomly and by 5 to 6 months will be able to babble rhythmically. As a child gains more control of his muscles, he can make more sounds.

A baby learns to speak by listening to adults. Between 6 and 11 months your baby will be able to imitate sounds that you make. At 12 months, your baby may be able to speak 1 or 2 words.

At 18 to 24 months, children often have a vocabulary spurt. They may quickly go from saying 5 to 10 words to more than 50 words. Children start to use single words to communicate and eventually they combine words. Usually, children understand more language than they can speak during their early years.

By age 2, children begin combining words to make short sentences. They are able to pronounce most vowels and say simple phrases. A child at this age will repeat words that they hear, start to use pronouns, and ask for common foods by name. By 3 years of age, a child will speak longer sentences and use more pronouns. They have fun with language and are able to express ideas and feelings. Strangers can understand most of their words.

At 4 years of age, children can tell stories and speak in sentences of 5 to 6 words. They ask "Why?" and "Who?" questions. The child at this age is able to describe how to do things and even define some words. Children may still have trouble saying some words, especially big words.

Remember, children vary in their speech and language development. Your healthcare provider will help determine if your child needs extra help to learn to speak or use language.

All children suspected of having a speech/language problem should have hearing tests. An audiologist experienced in testing babies and young children will test your child.

What are language disorders?

Language is a system of verbal, written, or gestured symbols that are used to communicate. Language disorders include problems with:

• the meaning of the message
• the structure and organization of words to form sentences
• verbal and nonverbal ways to communicate
• understanding what's being told to you.
• telling someone else something

What kind of testing and therapy will my child have?

Speech therapy is available even for infants. A specialist can advise which children need treatment and which treatment is best for each child.

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 speech/language pathologist. Your child will also need to have a hearing test.

Language therapy is done to:

• improve your child's ability to understand language
• increase your child's vocabulary
• expand your child's use of expressive words and sounds

If your child cannot speak, language therapy will focus on learning to use gestures, 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. Therefore, what you say and how you say it is important. Talking is a natural part of many daily routines such as mealtime, bath time, and dressing. Encourage your child to ask for items, make choices, and answer questions. Teach your child to use words instead of crying or pointing to get what he wants.
• Listen to your child. Encourage him to tell stories and share 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 or provide music for your child. Singing songs can help your child learn new words, sentence patterns, memory skills, listening skills, imitation, and how to express 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. Reading to your child to help 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
http://www.asha.org