6  Speech and Language Impairments

Jose is worried about his son, Michael. His second birthday was almost two months ago, and he still isn’t talking much. His older sisters talked early, and once they started talking, they never seemed to stop. Michael is quieter and a bit shy. He communicates mainly by pointing, and his sisters often speak for him.

Jose takes Michael to the park to make sure he plays with other children his own age. Jose notices that the other 2-year-olds often use two words together when they talk, and he can understand most of what they say. The other parents at the park tell him not to worry, that Michael will start talking any day now, but Jose is still concerned.

At Michael’s next checkup, Jose shares his concerns about Michael’s speech with the pediatrician, Dr. Rose. He tells her that Michael really only uses the words no and cookie, and that sometimes he uses cookie to mean other things—if he is thirsty, sees something else he wants to eat (like french fries), or wants a toy. He does say other words, but he doesn’t use them spontaneously; he only repeats them after someone else says them to him.

Jose also explains that Michael does not seem to understand when he asks him to do something that has two steps, like “Put the truck away, and go get your coat.” After listening to Jose, Dr. Rose smiles at Michael and gives him a few directions. Although he readily follows her one-step requests (“Bring me the book, please”), he shows confusion when the doctor gives him a more complex direction (“Bring me the kitty, and then sit down by Daddy”). At the end of the visit, she gives Jose the contact number for the local early intervention program so he can have Michael evaluated.

Jose calls right away for an evaluation. A speech-language therapist from the program finds that Michael does have a delay in speech and language, and she begins speech therapy with him twice a week at home. She also offers suggestions for Jose to use during his daily interactions with his son, such as reading with Michael every day and narrating what he and Michael are doing throughout the day. The therapist explains to Jose that it is important to give his son plenty of time to respond to questions and to encourage him to speak, even if it’s only part of a word or phrase.

At the therapist’s recommendation, Jose enrolls Michael for a few days a week in a community program for 2-year-olds to give him more social interaction and exposure to language from other children. He shares what he has learned from the therapist with the program teacher, who begins to incorporate some of the same strategies in her daily routines with Michael.

Within a few months, Jose notices that Michael is talking more and that it’s a lot easier to understand what he is trying to say. Michael understands more complex language and even holds short conversations with others. Now when everyone tells Jose that his son will be fine, he believes they are right.

Language, whether spoken, written, or signed, refers to words, their meanings, and how we put words together. It consists of receptive language, which refers to understanding the words other people use, as well as expressive language, the ways in which we use words or other means to communicate, like talking, gesturing, or signing. Children with a language disorder may have difficulty understanding what other people say and/or using language to get their meaning across.

Speech is about producing the sounds of language—how a child sounds when he pronounces words and how fluent he is when he talks. Children may have problems with language development, with speech development, or with both. Speech and language disorders may also be present in children with other disabilities, such as intellectual disabilities or autism spectrum disorder.

What Are Speech and Language Impairments?

When a child’s speech and language skills are developing in the expected sequence but at a slower rate, the child is considered to have a speech and language delay. Although a delay may resolve as the child grows, support from a speech-language professional may be useful to help get the child back on the same timeline as other children.

In contrast, an impairment in speech and language involves significant problems in acquiring and using verbal or other communication modes, and comprehension may also be affected. Common disorders include the following (ASHA 2017b):

»  Articulation disorders are problems where certain sounds are changed, left off, or added, such as a w in place of an r so the word rabbit sounds like wabbit.

»  Stuttering is a fluency disorder in which the child produces an involuntary repetition of sounds, especially initial consonants: “C-c-can I play, too?”

»  Childhood apraxia of speech (CAS) is a motor disorder that impacts speech. Children with CAS have a hard time getting their jaw, tongue, and lips to move the correct way to make the sounds and words they want to express. Their speech may sound choppy.

These and other disorders require specific intervention from a speech-language pathologist (speech-language therapist) or other health care professional. Speech and language difficulties account for approximately 20 percent of all children and adults ages 3 through 21 receiving special education services (Kena et al. 2016).

It can be difficult, especially with a very young child, to distinguish between a delay and a disorder, so a therapist may err on the side of caution and choose to use specific interventions rather than wait to see if the delay resolves itself (KidsHealth 2013; NIDCD 2017c).

Possible Reasons for Speech and Language Impairments

A child may be born with a speech or language impairment, or she might develop it later. An impairment is often part of another disability or medical condition, such as Down syndrome, cerebral palsy, cleft lip or palate, or autism spectrum disorder (NIDCD 2017c). A permanent or temporary hearing loss may impact a child’s speech and language skills; if the loss is not addressed or is severe enough, the child will have a difficult time understanding, imitating, and using language.

Other possible causes of speech or language disorders are illness, brain injuries, infections, and environmental factors (Prelock, Hutchins, & Glascoe 2008). Genetic factors may also play a role. In many cases, the cause of a delay or problem in speech or language is unknown.

Impact of Speech and Language Impairments on Development and Learning

In addition to difficulty with spoken language, children with speech and language delays or impairments may have trouble with reading, writing, and learning. The development of sound awareness and the ability to produce and reproduce sounds are the foundational skills a child needs to learn to decode the written word and learn to read (Zembar & Blume 2009).

Speech and language delays and disorders sometimes impact a child’s social and emotional development by inhibiting his understanding of the rules (use and context) of social language, known as pragmatics (McLeod, Daniel, & Barr 2013). This makes it harder for a child to express his ideas, feelings, and personal experiences in a way that is appropriate for his age and to form or maintain close friendships (Wadman, Durkin, & Conti-Ramsden 2011). Behavioral difficulties, such as hyperactivity or attentional difficulties, may also result (Dockrell et al. 2007).

Since communication affects so many areas of a child’s development, it is vital to seek support as early as possible for a suspected problem.

Identifying Speech and Language Impairments

Language is a key area many teachers and parents express concern about. Since all children develop differently, understanding the wide range of speech and language development is important in identifying signs of a delay or disability. According to the American Speech-Language-Hearing Association (ASHA), most children exhibit both receptive and expressive language skills by the age of 1 (2017c).

Language explodes in early childhood!

By the age of

2: Children have single-word vocabularies of several hundred words

3: Children have a word for almost everything they see

4: Most children’s speech can be understood by any adult

5: Most children use past tense correctly

6: Most children ask questions to get information (ASHA 2017c)

The Centers for Disease Control and Prevention (CDC 2017b) has developed a list of important milestones in all areas of development, including speech and language, which can help parents and teachers identify when a child may have a delay or disability. The CDC’s “Learn the Signs: Act Early” campaign stresses that parents should let their doctor know if they are concerned about their child’s speech and language development. Not reaching these milestones by the ages listed, or any loss of milestones already achieved, is something that families need to talk about with a medical professional.

Strategies for the Classroom

Choosing appropriate speech and language interventions for a child is primarily the responsibility of licensed therapists, in consultation with the child’s family and medical providers. In addition to working with the child individually, in the classroom, or in small groups, therapists provide teachers and families with ideas and strategies to support children during everyday activities and routines and to give them multiple ways to express themselves and communicate with others.

Promoting Communication Skills

Look at your everyday classroom routines to become more aware of how your actions and interactions affect children with speech and language disorders. Here are some ways to support children’s communication efforts:

»  Give simple, straightforward directions so children can follow them successfully.

»  Provide plenty of time for a child to say something. Avoid attempting to help by saying what you think the child is trying to say.

»  Ask open-ended questions when reading a story to a child with a speech or language impairment, such as “What do you think about what the bear did?” Avoid a bombardment of questions, however; this is often stressful for a child who has difficulty communicating. You might comment on something from the story and wait to see if the child responds. If he doesn’t, move on.

»  Prompt children to participate in social conversations: “Sami, Meredith asked if you want to use the rolling pin for the playdough now that she’s done with it. What do you want to tell her?” Practice conversation skills; for example, explain and model how to add to a topic of conversation or ask for clarification (ASHA 2017e).

»  Teach older children how to use language for different purposes. Use pictures of situations in which children might need to address someone—asking an adult for help, starting a social conversation with another child—and prompt them about what they would say.

Talk!

Probably the most effective intervention you can provide for children with speech and language impairments is to talk to them more. Talking to children and responding to their efforts at conversation, as well as using rich vocabulary, is positively associated with children’s language skills (Hart & Risley 1995; Hoff 2006). Some strategies include these:

»  Talk to children while you are feeding them, changing them, dressing them, or playing with them. Talk about what is happening around them and what they see in their environment.

»  Make eye contact with a child while you are talking to her and respond to her nonverbal communication: “Min, you’re looking at your juice. Do you want juice?” “Elena, you touched Jem on the shoulder. Do you want her to chase you up the hill?”

»  Expand on what a child says, modeling correct syntax and pronunciation: “‘Dog sleep?’ Yes, you see the doggie sleeping on the chair.”

»  Spend time talking with children, not just to them. Remember, conversations need to go back and forth. Let children talk about the things that interest them—ants, camping, patterns, and so on.

»  With older children, talk about books you have read, what you liked about them, and strategies you use to help you read better. Provide a wide variety of books and encourage children to read often. To introduce a more extensive vocabulary, read aloud books that are more sophisticated than those children can read themselves.

Speech and Language Development in Dual Language Learners

When learning a language at any age, comprehension develops more rapidly than the ability to speak that language. Many dual language learners (DLLs)—young children who are actively learning more than one language at the same time (Nemeth 2009; Severns 2012)—go through a natural silent period where they listen more than they talk. This is sometimes mistakenly identified as a language delay or disability (Haynes 2007). If a DLL truly has a language delay or disorder, it will be seen in both the child’s home language and in English (Spear-Swerling 2006).

Research indicates that being exposed to or learning more than one language simultaneously does not cause speech or language delays; it is not even considered a risk factor (Bardige 2016; Castro, Ayankoya, & Kasprzak 2011; Espinosa 2013; Paradis, Genesee, & Crago 2011; Tabors 2008). Parents of a young child who has a speech or language delay or disorder may wonder whether they should refrain from speaking the family’s home language with the child to avoid confusion; however, this is not necessary (Gutierrez-Clellen, Simon-Cereijido, & Wagner 2008). In fact, there are many reasons to continue using a child’s home language, even when she has a speech or language impairment. Doing so allows the child to communicate and share a common culture with family members (Espinosa 2013; Paradis, Genesee, & Crago 2011) and use her home language to build a strong foundation in the second language (Paradis 2010). Bilingualism is an asset in today’s global society, and research supports continuing to encourage young children’s home languages while also helping them learn English (Espinosa 2013).

Augmentative and Alternative Communication

Use a variety of strategies to help a child communicate (Eisenberg 2015). Taking a broad view on what communication looks and sounds like helps you think outside of the box and makes you open to using any and all means possible to increase a child’s ability to understand and communicate. As discussed in Chapter 3, both universal design and augmentative and alternative communication (AAC) support unaided communication (using gestures, facial expressions, and/or sign language) and aided communication (using objects or something other than your body to help you communicate, like picture symbols, words, or a computerized communication board) to help children get their meaning across.

The philosophy behind AAC is that the best way to help a child learn to communicate is to give him every option there is to find the way that best works for him. Some parents and teachers worry that introducing picture symbols or sign language to communicate will inhibit a child’s development and use of spoken language, but research has found that the use of aided communication does not hinder spoken language (Crais, Watson, & Baranek 2009; Eisenberg 2015; Romski et al. 2010). Having an alternative means of communication diminishes a child’s frustration at not being able to make himself understood.

Summary

A delay in talking is usually one of the first signs of development that concerns parents. Often, doctors and well-meaning family members will tell parents that some children are just late talkers or more interested in moving and being active, and that there is nothing to worry about. Speech and language development can be delayed for many different reasons, and there are times when no interventions are needed and the problem resolves on its own, but this is not always the case.

While the range of speech and language development is wide, there are some specific signs that may indicate that intervention is necessary. It is important to help a young child communicate in any way possible, and working with a speech-language therapist is essential to helping the child develop strong speech and language skills. As the child gets older, the risk of the language delay or disability impacting academic skills and social interactions is strong, so early intervention is essential to prevent academic and social failure.