Understanding speech delay

July 08, 2013

Vanessa D'Auria a licensed Speech Therapist with over a decade of experience working with children from toddler to preschool. Motherburg is lucky to have Vanessa as a monthly contributor who will be touching on speech delay and the tools and tips to helping your child in building a stronger speech.

MB: At what age should one start seeking help in speech delay

From that very first cry, your son or daughter is communicating with you. Each day from birth on, your child is taking in information about communicating in the world. This information includes recognizing a familiar voice, learning where to look in order to figure out where a sound is coming from and developing social routines such as playing peek a boo. When talking about a speech delay, it is important to first define a few terms: 
speech is defined as verbal expression and includes articulation: the consonant and vowel sounds a child is saying.
language is much broader.It is defined as receptive language (for understanding such as following directions) expressive language (for communicating such as saying words, asking questions) and pragmatics (social use of language such as gestures and turn taking in play and conversation).
Often, parent concerns initially emerge between 18 and 24 months, specifically around speech production. Typically parents will notice that their child is not saying much or as much as other children around the same age. Concerns about speech should arise if a child did not babble at all, is not producing word like approximations ("ba" - for bottle), does not imitate speech sounds or is not pointing or gesturing in any way. At this point, parents should discuss their concerns with their pediatrician. In fact, your child's communication skills should be discussed at every well visit with your pediatrician. Parents are often less aware of language development and when children should be following directions or answering questions. If concerns about speech or language development persist after 2 years of age, seek out an evaluation by a speech-language pathologist. Keep in mind though, that child development in general is extremely broad, wherein each child develops individually. Seeking out help does not necessarily mean that your child has a delay in speech or language, it just means you are asking the questions and trying to find out more about your child's current skills.
The following are general guidelines for speech and language development from 1 year to 4 years of age:
1- 2 years old
speech: Your child's speech around 1 year of age will often be hard to decipher. Their speech should contain a variety of sounds such as 'b', 'p', 'm', 'w' and vowels. Around 1 year of age, first words should emerge. Your child should be using varying intonation (voice going up and down). Your child should be combining consonants and vowels together more and more ("bye", "moo"). As they approach 2 years of age, more consonant vowel combinations should be heard ("my ball", "more push")
receptive language: Your child should be able to point to a few body parts, point to pictures in books when they are named and follow simple commands ("don't touch. it's hot!).
expressive language:  Your child is moving from babbling to jargon (sounds like adult speech but is unclear) to saying single words ("no", "yes", "mama"). Around 18 months of age, your child should be saying about 20 words. Around 2 years of age, your child should be saying about 50 words. As your child approaches 2 years, some 2 word phrases should be heard ("more milk", "my doggy") along with some early question words ("who?", "what's that?", "go bye bye?)
social language: Your child should be interested in the world around them. This year is full of curiosity - opening and closing boxes, turning pages in books, bringing items over and over to adults in their life. your child should be using a combination of jargon, real words, facial affect and gestures to communicate  with you, more than crying.
2-3 years old
speech:Your child's speech should becoming clearer. Final sounds on words should be added ("home" instead of "ho"). By 3 years of age, these sounds should be heard: k, f,t, d, n and approximately 75% of what your child says should be understood by others.
receptive language: Your child should understand some early concepts (up/down, open/close, hot/cold, in/on). Children approaching 3 years of age should attend to and follow 2 step directions (get your shoes and come here).
expressive language: Your child's vocabulary is typically exploding at this age. Your child should have a word for most things in their environment. They should be combining words together to say short phrases or sentences ("open da box?). Your child should be beginning to use pronouns such as "I", "my", "me",  "you" 
social language: Your child should be using language to gain your attention, to talk about what they see around them and to respond to others. Your child should be commenting while playing or narrating their own actions ("got ball. uh uh. no ball. I go")
3-4 years old
speech: Most of what your child says should be understood by family members and other people who do not know your child as well. By the end of 4 years, your child should be saying two consonants next to each other clearly ("play", "snake", "stop")
receptive language: Your child's conceptual knowledge should be growing. They should understand on/off/out/under/next to. They should answer most 'wh' questions correctly (who, what where)
expressive language: Your child should be saying short sentences with 3-4 words or more. They should be asking questions, telling little stories and talking while playing with peers. Additional pronouns should be heard (he/she/they).
MB: My father didn't speak until age 4 and I have heard other instances of this. My father is now in his 70's, speaks very well in two languages, and is quite smart. How can you tell the difference that a child is just incredibly shy versus the child has a delay?
social language:
Your child should be using language for all kinds of reasons. They should be able to talk about something that just happened, to negotiate a bit ("no that was mine", "I had it"), to speak about their favorite toy and to pretend play and express humor. There should always be forward movement here in these early years of speech and language development.
Yes there are many people in life who begin as late talkers and then develop into fluent speakers. I, in fact, am one of those people!  All children deserve to be listened to and given the time and space to develop. This question really is about defining a behavior (such as what it means to be shy: needing time to warm up to others, turning away from others, hiding behind a parent, withdrawing  etc)  and understanding the cause or causes of this behavior. All children demonstrate behaviors for a reason (crying to let you know they are in pain, laughing to let you know they are enjoying themselves, pushing to let you know they want something moved away from them, etc). Think about your child and the many behaviors they exhibit in just one hour.
In this case, the first thing to look at is how a parent/teacher/family member is defining or describing their child's 'shyness.' The speech therapist and parent must work together, to ensure they are talking about the same behavior, no matter what it is called. Then the therapist would want to learn how much this behavior, or any behavior, is impacting how the child is functioning in their family, preschool or community. If their 'shyness' is getting in the way of them playing with peers, exploring materials or connecting with others, then further information should be gained. A speech-language therapist would find out when the child is demonstrating these behaviors and if there is a pattern or  an underlying  weakness in speech/language skills that is resulting in this shyness. A child's hearing abilities would be assessed and formal and informal testing would be conducted to find out about the child's speech and language skills. Based on many sources of information, not just one description, a more informed conclusion can be drawn about why a child may be exhibiting certain behaviors, such as those that make up shyness. 
MB: My son who is almost 4 is speech delayed. He has made strides in his speech (through Speech Therapy) however he still struggles. He tends to get frustrated and upset when we question a word he is struggling on. What is your advice on how I should deal with his frustration?
First and foremost acknowledge with your child what is happening. Your child needs to understand that you are sharing this experience together and that you are there for him/her. You can say supportive, calm statements such as "You're trying to tell me about camp. I heard you say 'falling' but I don't understand after you said 'water'. I see you are getting upset. I'm going to try and help you'" Then try to teach your child strategies of what he can do next to continue the interaction. - .  
-Teach him to 'show' you by acting out or gesturing. For instance if your child keeps saying 'I wa a dee, I want a dee!" and they are getting progressively frustrated as you don't understand, have your child 'show' what he means by acting it out. He may then say "I we a dee" and pretend to drink from a cup - conveying the message,"I want a drink." 
-Also, teach him to point to something similar nearby.For instance, if your child is saying "ween" instead of "green," teach him to point to something green close by to repair the interaction. Remember how fast conversations happen and how quickly ideas change when 4 year olds are playing together. Now on top of that, think of the added difficulty of struggling to communicate clearly or fast enough to be successful. Talk with your child both in these moments of struggle/frustration and later, when he is calmer and more likely to be able to take in your support ('Remember earlier at the park, you got so upset when the kids didn't understand your idea. It's hard for you to say some things right now. But you're learning to say your sounds so it gets easier. Just like it got easier to....')
Overall, be supportive and part of your child's learning process.

Vanessa D'Auria provides home based services to families in Greenpoint, Williamsburg and Long Island City. Email: speechtherapynyc@gmail.com Phone:  718-350-4601 

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