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Speech and Language Impairments

Definition
Normal Speech and Language Development
The Difference Between Speech and Language
Warning Signs of a Possible Problem

Causes of Delayed Speech or Language
What Speech-Language Therapists Do
What Parents Can Do To Encourage Speech and Language Development
Overview of Speech Disorders
Overview of Language Disorders
How Speech-Language Disorders Affect Learning
How Can Parents Support Children with Speech and Language Disorders

Definition
A Speech and Language Impairment is defined as "a communication disorder such as stuttering, impaired articulation, a language impairment, or a voice impairment, which adversely affects a child's learning."

Normal Speech and Language Development
It can be difficult to tell whether a child is just immature in his or her ability to communicate or has a problem that requires professional attention.  These developmental norms may assist you in knowing what's "normal" and what's not in speech and language development can help you figure out if you should be concerned or if your child is right on schedule.  :

Before 12 Months
Cooing and babbling are early stages of speech development. As babies get older (often around 9 months), they begin to string sounds together, incorporate the different tones of speech, and say words like "mama" and "dada" (without really understanding what those words mean).  Before 12 months of age, babies should also be attentive to sound and begin to recognize names of common objects (bottle, binky, etc.). Babies who watch intently but don't react to sound may be showing signs of hearing loss.

By 12 to 15 Months
Kids this age should have a wide range of speech sounds in their babbling (like p, b, m, d, or n), begin to try and imitate sounds and words used by family members, and typically say one or more words (not including "mama" and "dada") spontaneously. Nouns usually come first, like "baby" and "ball." Your child should also be able to understand and follow simple one-step directions ("Please give me the toy," etc.).

From 18 to 24 Months
Though there is a lot of variability, most toddlers are saying about 20 words by 18 months and 50 or more words by the time they turn 2. By age 2, kids are starting to combine two words to make simple sentences, such as "baby crying" or "Daddy big." A 2-year-old should be able to identify common objects (in person and in pictures), points to eyes, ears, or nose when asked, and follow two-step commands ("Please pick up the toy and give it to me," for example).

From 2 to 3 Years
Parents often see huge gains in their child's speech. Your toddler's vocabulary should increase (to too many words to count) and he or she should routinely combine three or more words into sentences.  Comprehension also should increase — by 3 years of age, a child should begin to understand what it means to "put it on the table" or "put it under the bed." Your child also should begin to identify colors and comprehend descriptive concepts (big versus little, for example).

The Difference Between Speech and Language
Speech and language are often confused, but there is a distinction between the two:

Speech is the verbal expression of language and includes articulation, which is the way sounds and words are formed.

Language is much broader and refers to the entire system of expressing and receiving information in a way that's meaningful. It's understanding and being understood through communication — verbal, nonverbal, and written.

Although problems in speech and language differ, they often overlap. A child with a language problem may be able to pronounce words well but be unable to put more than two words together. Another child's speech may be difficult to understand, but he or she may use words and phrases to express ideas. And another child may speak well but have difficulty following directions.

Warning Signs of a Possible Problem
If you're concerned about your child's speech and language development, there are some things to watch for. An infant who isn't responding to sound or who isn't vocalizing is of particular concern.

Between 12 and 24 months, reasons for concern include a child who:

  • isn't using gestures, such as pointing or waving bye-bye, by 12 months
  • prefers gestures over vocalizations to communicate at 18 months
  • has trouble imitating sounds by 18 months
  • has difficulty understanding simple verbal requests

Seek an evaluation if a child over 2 years old:

  • can only imitate speech or actions and doesn't produce words or phrases spontaneously
  • says only certain sounds or words repeatedly and can't use oral language to communicate more than his or her immediate needs
  • can't follow simple directions
  • has an unusual tone of voice (such as raspy or nasal sounding)
  • is more difficult to understand than expected for his or her age. Parents and regular caregivers should understand about half of a child's speech at 2 years and about three quarters at 3 years. By 4 years old, a child should be mostly understood, even by people who don't know the child.

Causes of Delayed Speech or Language
Speech delays in an otherwise normally developing child can sometimes be caused by oral impairments, like problems with the tongue or palate (the roof of the mouth). A short frenulum (the fold beneath the tongue) can limit tongue movement for speech production.

Many kids with speech delays have oral-motor problems, meaning there's inefficient communication in the areas of the brain responsible for speech production. The child encounters difficulty using and coordinating the lips, tongue, and jaw to produce speech sounds, and hence may even experience difficulties with sucking, swallowing, drinking, or eating. A speech delay may also be a part of a more general developmental delay.

Hearing problems are also commonly related to delayed speech, which is why a child's hearing should be tested by an audiologist as a critical first step whenever there's a speech concern. A child who has trouble hearing may have trouble articulating as well as understanding, imitating, and using language.

Ear infections, especially chronic infections, can affect hearing ability. Simple ear infections that have been adequately treated, though, should have no effect on speech. And, as long as there is normal hearing in at least one ear, speech and language will develop normally.

It’s important to realize that a language delay isn’t the same thing as a speech or language impairment. Language delay is a very common developmental problem.  With language delay, children’s language is developing in the expected sequence, only at a slower rate. In contrast, speech and language disorder refers to abnormal language development. Distinguishing between the two is most reliably done by a certified speech-language therapist.

Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, intellectual disabilities such as Down’s Syndrom, Cerebral Palsy or Autism; drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.  In this case, they are referred to as specific speech or language impairments.  Most children with specific speech or language impairments are of normal intelligence, but may have other specific learning difficulties such as dyslexia, dyspraxia or ADHD.

What Speech-Language Therapists Do
If you or your doctor suspect that your child has a problem, early evaluation by a speech-language therapist is crucial. Of course, if there turns out to be no problem after all, an evaluation can ease your fears.

In conducting an evaluation, a speech-language therapist will look at a child's speech and language skills within the context of total development. Besides observing your child, they will carry out some standard tests, and look for milestones in speech and language development.

They will also assess:

  • what your child understands (called receptive language)
  • what your child can say (called expressive language)
  • if your child is attempting to communicate in other ways, such as pointing, head shaking, gesturing, etc.
  • sound development and clarity of speech.
  • your child's oral-motor status (how a child's mouth, tongue, palate, etc., work together for speech as well as eating and swallowing)

If the speech-language therapist finds that your child needs speech therapy, your involvement will be very important. You can observe therapy sessions and learn to participate in the process. The speech therapist will show you how you can work with your child at home to improve speech and language skills.

What Parents Can Do To Encourage Speech and Language Development
Genetic makeup will, in part, determine intelligence and speech and language development. However, a lot of it depends on environment. Is a child adequately stimulated at home or at childcare? Are there opportunities for communication exchange and participation? What kind of feedback does the child get?

When speech, language, hearing, or developmental problems do exist, early intervention can provide the help a child needs. And when you have a better understanding of why your child isn't talking, you can learn ways to encourage speech development.

Here are a few general tips to use at home:

Spend a lot of time communicating with your child, even during infancy — talk, sing, and encourage imitation of sounds and gestures.

Read to your child, starting as early as 6 months. You don't have to finish a whole book, but look for age-appropriate soft or board books or picture books that encourage kids to look while you name the pictures. Try starting with books with textures that kids can touch. Later, let your child point to recognizable pictures and try to name them. Then move on to nursery rhymes, which have rhythmic appeal. Progress to predictable books (such as Bear Hunt) that let kids anticipate what happens. Your little one may even start to memorize favorite stories.

Use everyday situations to reinforce your child's speech and language. In other words, talk your way through the day. For example, name foods at the grocery store, explain what you're doing as you cook a meal or clean a room, point out objects around the house, and as you drive, point out sounds you hear. Ask questions and acknowledge your child's responses (even when they're hard to understand). Keep things simple, but never use "baby talk."

Whatever your child's age, recognizing and treating problems early on is the best approach to help with speech and language delays. With proper therapy and time, your child will likely be better able to communicate with you and the rest of the world.

Overview of Speech Disorders

Childhood Apraxia of Speech (CAS)
CAS is a motor speech disorder, whereby children have problems saying sounds, syllables, and words. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements in the lips, jaw and tongue, necessary to say those words.

Dysarthria
Dysarthria is a motor speech disorder which affects children as well as adults. The muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all after a stroke or other brain injury. The type and severity depend on which area of the nervous system is affected.  Some causes include stroke, head injury, cerebral palsy, and muscular dystrophy.

Orofacial Myofunctional Disorders (OMD)
With OMD, the tongue moves forward in an exaggerated way during speech and/or swallowing. The tongue may lie too far forward during rest or may protrude between the upper and lower teeth during speech and swallowing, and at rest.

Speech Sound Disorders (Articulation and Phonological Processes)
Most children make some mistakes as they learn to say new words. A speech sound disorder occurs when mistakes continue past a certain age. Every sound has a different range of ages when the child should make the sound correctly. Speech sound disorders include problems with articulation (making sounds) and phonological processes (sound patterns).

Stuttering
Stuttering affects the fluency of speech. It begins during childhood and, in some cases, lasts throughout life. The disorder is characterized by disruptions in the production of speech sounds, also called "disfluencies." Most people produce brief disfluencies from time to time. For instance, some words are repeated and others are preceded by "um" or "uh." Disfluencies are not necessarily a problem; however, they can impede communication when a person produces too many of them.

In most cases, stuttering has an impact on at least some daily activities. The specific activities that a person finds challenging to perform vary across individuals. For some people, communication difficulties only happen during specific activities, for example, talking on the telephone or talking before large groups. For most others, however, communication difficulties occur across a number of activities at home, school, or work. Some people may limit their participation in certain activities. Such "participation restrictions" often occur because the person is concerned about how others might react to disfluent speech. Other people may try to hide their disfluent speech from others by rearranging the words in their sentence (circumlocution), pretending to forget what they wanted to say, or declining to speak. Other people may find that they are excluded from participating in certain activities because of stuttering. Clearly, the impact of stuttering on daily life can be affected by how the person and others react to the disorder.

Voice Disorders
Poor quality of voice, including hoarseness, nasality, volume (too loud or soft) may impede normal speech and language development.

Overview of Language Disorders

Language-Based Learning Disabilities
Language-based learning disabilities are problems with age-appropriate reading, spelling, and/or writing. This disorder is not about how smart a person is. Most people diagnosed with learning disabilities have average to superior intelligence.

Preschool Language Disorders
Preschool children (3 to 5 years old) with language disorders may have trouble understanding and talking.

Selective Mutism
A child with selective mutism does not speak in certain situations, like at school, but speaks at other times, like at home or with friends. Selective mutism often starts before a child is 5 years old and is usually first noticed when the child starts school.

How Speech-Language Disorders Affect Learning
Speech and language skills are essential to academic success and learning, with language forming the basis of communication.  Children with communication disorders frequently do not perform at grade level. They may struggle with reading, have difficulty understanding and expressing language, misunderstand social cues, avoid attending school, show poor judgment, and have difficulty with tests.

Difficulty in learning to listen, speak, read, or write can result from problems in language development. Problems can occur in the production, comprehension, and awareness of language sounds, syllables, words, sentences, and conversation. Individuals with reading and writing problems also may have trouble using language to communicate, think, and learn.

How Can Parents Support Children with Speech and Language Disorders

  • Learn the specifics of your child’s speech or language impairment. The more you know, the more you can help yourself and your child.
  • Be patient. Your child, like every child, has a whole lifetime to learn and grow.
  • Meet with the school and develop a learning plan to address your child’s needs. Be your child’s advocate. You know your son or daughter best, share what you know.
  • Be well informed about the speech-language therapy your son or daughter is receiving. Talk with the Speech-Language Therapist, find out how to augment and enrich the therapy at home and in other environments. Also find out what not to do!
  • Give your child chores. Chores build confidence and ability. Keep your child’s age, attention span, and abilities in mind. Break down jobs into smaller steps. Explain what to do, step by step, until the job is done. Demonstrate. Provide help when it’s needed. Praise a job (or part of a job) well done.
  • Listen to your child. Don’t rush to fill gaps or make corrections. Conversely, don’t force your child to speak. Be aware of the other ways in which communication takes place between people.
  • Talk to other parents whose children have a similar speech or language impairment. Parents can share practical advice and emotional support.
  • Keep in touch with your child’s teachers. Offer support. Demonstrate any assistive technology your child uses and provide any information teachers will need. Find out how you can augment your child’s school learning at home.

Courtesy of:
http://nichcy.org/disability/specific/speechlanguage
http://www.afasic.org.uk/parents/what-are-speech-and-language-impairments/
http://www.asha.org/public/speech/development/schoolsFAQ.htm
http://kidshealth.org/parent/growth/communication/not_talk.html#

Unfortunately, there isn't currently a Speech-Language Therapist in Harare, however, there is a lady who travels up from South Africa to consult.