Speech and Language Disorders
How to help your preschool tackle the obstacles.
by Diane R. Paul, PhD, CCC-SLP


PARENTGUIDE NEWS DECEMBER 2006

Effective communication is fundamental to human functioning. The development of communication skills begins in infancy, before the emergence of the first word. Any speech or language problem is likely to have a significant effect on a child’s social and academic skills and behavior. The earlier the identification and treatment of a child’s speech and language problems, the less likely they will persist or worsen. Early speech and language intervention can help children with reading and writing, in school and with interpersonal relationships.

What Is Speech?
Speech involves the production of sounds through the coordination of the breath, lips and tongue. Sounds form the basis of words used for communication. Some sounds develop earlier than others. For example, in English, children usually produce p, b, m, f, t and d before they pronounce s, th and r correctly. As children develop, they acquire the ability to produce more sounds and sound combinations clearly.

What Is Language?
Language differs from speech. It is a code in which we learn to communicate ideas and express our wants and needs. Reading, writing, understanding, speaking and some gesturing systems are all forms of language. Language includes the meaning of words (semantics), the way words are ordered in a sentence (syntax) and the way messages vary depending on the listener and situation (pragmatics). For example, children learn to talk differently to an adult than they do to another child, or when they are in a classroom or on a playground. There are expected language behaviors for each age. However, children are individuals and may develop at different rates. This is also true of bilingual children. They develop language skills just as other children do; however, every bilingual child is unique. Developing skills in two languages depends on the quality and amount of experience the child has using both languages.

What Causes Speech and Language Disorders?
Speech and language disorders may occur for various reasons including hearing loss, intellectual disabilities, brain injury, autism, Down syndrome, or other genetic or medical conditions. The disorders may exist from birth or result from an illness, accident or disease. The cause may be unknown. Speech and language disorders may occur together or separately and may vary in severity. Sometimes, the speech and language disorder is the primary problem; sometimes it is secondary to other conditions, such as autism or cerebral palsy.

What Are Types of Speech Disorders?
Speech disorders involve problems with articulation (pronunciation of sounds), fluency (stuttering) and/or voice (rough, hoarse or nasal voice quality). For example, children with articulation disorders may only be able to pronounce early developing sounds like p, b and m. They may mispronounce later developing sounds like r, s and l even in the later preschool years, and leave out sounds in words or substitute one sound for another (e.g., fum for thumb).

What Are Types of Language Disorders?
Language disorders may involve speaking, listening, reading or writing. Some common ones for children in the preschool years include trouble understanding others (receptive language), making themselves understood (expressive language) or participating appropriately in social situations.

Children with receptive language problems may have difficulty understanding directions or questions, the meaning of word endings (such as not using “-s” for plurals, as in books, or not using “-ed” to indicate past tense, as in walked), or different types of words, such as prepositions, adjectives or questions. Also, they may not be able to follow a conversation or story, especially when a speaker talks fast or uses long sentences. In addition, they may misunderstand indirect or subtle requests (e.g., “It’s a good idea to share”) and only follow more direct instructions (e.g., “Give him the toy”). Furthermore, they may not pick up the meaning of gestures (such as shaking head or shrugging shoulders).

On the other hand, young children with expressive language problems may have limited vocabulary, use made-up words, leave off word endings (e.g., “-ing”), mix up words (e.g., remind and remember), leave out little words (e.g., the, and, is), use incorrect word order (e.g., “book me give”) and use only short sentences. They also may have problems with social language, such as being too blunt or direct, changing topics abruptly, interrupting or not taking turns during conversation.

What Are Indicators of Speech and Language Disorders?
It is important to be familiar with typical speech and language developmental milestones. Here are some general indicators of speech and language disorders in preschool children:
•Not crying to express different needs, responding to the human voice, or smiling or making pleasure sounds by 3 months.
•Not babbling, vocalizing to toys or imitating some sounds by 6 months.
•Not imitating gestures, imitating vocal quality of adult speech, understanding one-step directions or speaking a first word by 1 year.
•Absence of any words by 18 months.
•Absence of two-word phrases that have a message by 2 years.
•Not using three–four word sentences by 3 years.
•Echoing of speech after 3 years.
•Poor intelligibility of speech (unclear speech) with familiar or unfamiliar listeners after 4 years.
•Undeveloped play skills at any age.
•Word-finding problems.
•Dependence on gestures to follow directions.
•Need for frequent repetitions of directions.
•Poor social interaction with peers (does not get along with other children).

What Can Parents Do?
Parents can use various activities to help their child with his speech and language development. Here are some activities for preschool children (although specific ages are provided, most of the suggestions can be adapted and would be appropriate for children developing communication skills during the preschool years):
Children of any age—
•Talk to your child about what you are doing, what you see, what your child is doing and what your child sees.
•Repeat or expand on what your child says using correct sounds and words. Don’t call attention to speech errors your child may have.
•Ask your child to repeat or help with rephrasing if you don’t understand what he says.
•Take time to listen and respond to your child. Acknowledge, encourage and praise attempts to communicate.
•Read to your child often. Describe the pictures, ask questions and talk about the way you read (e.g., turning pages, pointing out the words).
•Use language tailored to your child’s speech and language abilities.
•Build and expand vocabulary by labeling and talking about objects and events in your child’s environment.
Birth–2 years
•Respond to your child’s early sounds and words (cooing, babbling, first words).
•Imitate your child’s vocalizations.
•Use gestures to convey meaning and teach your child to imitate your actions (throwing kisses, clapping, waving, playing finger games).
•Talk about ongoing activities (bathing, feeding, dressing).
•Acknowledge and expand on the words your child uses.
•It is okay to use a high pitched voice and “baby talk” on occasion to get your baby’s attention.
Two to 4 years—
•Repeat what your child says and indicate that you understand.
•Help your child understand and ask questions.
•Sing songs and recite rhymes to show the rhythm and pattern of speech.
•Use photographs of familiar people and places and retell what happened or create new stories.
Four to 5 years—
•Talk about spatial relationships (first, middle and last; right and left) and opposites (up and down; big and little).
•Offer a description or clues and have your child identify what you are describing.
•Work on forming and explaining categories (fruits, furniture, shapes).
•Help your child follow multiple-part directions.
•Follow your child’s directions as she or he explains how to do something.
•Play games and exchange roles.
•Use television and movie time as an opportunity to interact and talk.

Who Can Help?
Speech-language pathologists are the professionals who assess and treat speech and language disorders. The American Speech-Language-Hearing Association (ASHA) can help you find a certified speech-language pathologist to help your child. Go to www.asha.org and click on “Find a professional.” Or call (800)638-8255 for a referral or for more information.

You may also call your local school to request an evaluation for children. A federal education law, the Individuals with Disabilities Education Improvement Act (IDEA) provides federal funding for individuals who need special education or related services, including those with speech and language disorders. Services are made available through the public school system.

Diane R. Paul, Ph.D., CCC-SLP is the director of Clinical Issues in Speech-Language Pathology at the American Speech-Language-Hearing Association.