Speech delay in children: Issue beyond sounds, languages


Visual games can also help, as shown by Wong during a session with this little girl.

THERE is a question that is bound to incite the feeling of panic and deep concern in parents of very young children: “Why is my child not talking yet?”

The trigger scenario would be you seeing and hearing other small children able to hold simple conversations with their ‘mummy and daddy’, but yours struggling to get any words out.

Before getting into more details about speech delay in children, it is best to take a look at the basics.

Definition of speech, language

According to Wong Yee Ling, a visiting speech language therapist at Columbia Asia Hospital Bintulu, speech is how we say sounds and words, using the mouth, lips and tongue.

It includes articulation as well.

“For example, we need to be able to pronounce the ‘r’ sound to say ‘rabbit’, instead of ‘wabbit’.

“Using our vocal folds and breath, we also use the frequency of our voice to produce sounds that are loud, soft, high-pitched or low-pitched.

“Fluency matters too. This has to do with the rhythm of our speech. Stuttering is an example of what can happen when you have a problem with speech rhythm.

“Most importantly is the language that we speak to refer to the words that we use, and how we use them to share ideas.

“Language addresses what the words mean, and some words have more than one meaning.

“For example, ‘star’ can be a bright object in the sky, or it can mean someone famous.

“Language also allows for new words such as ‘friend’, ‘friendly’ or ‘unfriendly’, with each denoting different meaning.

“It is how we put words together. For example, in English we say: ‘Lisa walked to the new store’, instead of ‘Lisa, walk, store, new’,” Wong begins her explanation.

Common speech milestones of a child

According to her, before a child reaches one year old, he or she should be able to coo and babble. It is also normal for a toddler to mimic the different sounds and words that they hear, much to the amusement of parents who have no idea yet of what is being said.

“The child would also use gestures to communicate such as waving and pointing. When you call his name, he would turn around to look at you.

“He would understand names of common items like ‘ball’, ‘milk’ or ‘shoe’.”

Wong adds that between the ages of one to two years old, a toddler should be able to follow simple instructions, identify a few body parts, use single words consistently, start using some two-word phrases like ‘no milk’ or ‘Mommy go’.

They can also ask simple questions such as ‘what is that’, says the therapist.

“When they reach the age of two to three, they can follow two-step instructions like ‘take the book and give it to Daddy’.

“They also understand concepts. They use two- to three-word utterances like ‘Daddy shoe blue’. They understand simple questions.

Some of the books recommended by the therapist that can help improve a child’s speech development.

“At age three to four, they can identify colours. They can also use four- to five-word utterances. They can answer ‘where’ questions. Most importantly, their speech is easily understood by most listeners.

“Upon reaching the age of four and above, they can follow longer and more complex instructions. They can even tell a simple story, and use conjunctions such as ‘and’, ‘but’ and ‘so’, in order to connect phrases and sentences.”

Red flags

Wong describes speech and language delay as the situation where a child is unable to reach the afore-mentioned speech milestones as expected.

“Referring to these milestones, you can see if your child’s development tallies with them. There are certain occurrences that should raise an alarm for concern, other than not showing an interest in communicating.”

Elaborating, Wong says they include no babbling by 12 months of age; not responding to his or her name by 12 months; not using gestures like waving ‘bye bye’ or shaking head for ‘no’ by 12 months; not pointing at objects or pictures when asked to, by 17 months; not uttering first words by 18 months; not exhibiting consistent words by 18 months; not understanding basic commands by 18 months; and having no word combinations by 24 months.

Wong says there are several causes for speech delay in children.

“They can be related to the ‘global developmental delay’ where a child takes a longer time to reach certain development milestones, compared to others their age.

“This may include learning to walk and to talk, movement skills, as well as learning new things and interacting with others, socially and emotionally.

“If the child has Autism Spectrum Disorder, Down’s syndrome, cerebral palsy or hearing impairment, he or she would most likely experience a delay in speech development.

“Another reason for speech delay is excessive screen time. Long hours of being on the phone or tablet tend to create a breakdown in two-way communication, resulting in poor parent-child interaction.

“The child may also imitate cartoon-like speech, preferring to use gestures rather than talking, and being seemingly obsessed with visual lightings and sounds,” says Wong.

Language stimulation

Experts use four types of language stimulation to help with speech delay, says Wong.

One of them that parents can emulate is ‘Self-Talk’.

“Whenever parents are engaged in an activity, they can describe their actions to the child by using short and simple sentences –  for example: ‘Mummy is cooking’ or ‘Daddy is eating biscuits’.”

Another is ‘Parallel Talk’, which is the reverse of the first type of stimulation, says Wong.

“This is where you (parents) describe the actions of your child. Likewise, use short, simple and easy-to-understand sentences such as ‘you are kicking a ball’ or ‘Aishah is drinking milk’.”

Then there is the ‘Repetition’, where parents repeat what their children say.

“For example, when your child points at a car, you can reiterate by saying: ‘Yes, that is a car’.

“If he points at a bird in the sky, you can say: ‘Yes, that is a bird’.”

Wong also uses interactive toys, like the ones pictured here, in her sessions.

The fourth is ‘Extension’, where you build up your child’s vocabulary by adding on suitable words to what he or she says.

“For example, when your child says ‘teeth’, you can add by saying ‘brush teeth’.

“If he or she says ‘water’, you can add like this: ‘You are drinking water’,” says Wong.

Time to ‘PLAY’

Wong points out that the core job of a speech therapist is to provide clinical services for speech, language, communication, feeding and swallowing problems.

According to her, experts use ‘PLAY’ activities during therapy.

According to Wong, the core job of a speech therapist is to provide clinical services for speech, language, communication, feeding and swallowing problems.

This literally refers to the acronym: ‘P’ for ‘people skills’, ‘L’ for ‘language skills’, ‘A’ for ‘attention, and ‘Y’ for ‘youthful imagination’.

“The people skills are about requesting, asking permission, taking turns, sharing, negotiating, and discussing; the language skills consist of new vocabulary and concepts, as well as sequence and narrative skills, and also the ability to follow simple to complex commands.

“Attention means that this requires attention to details and information; thus, it focuses on listening skills, following instructions and rules.

“Youthful imagination is when the children’s brains are stimulated to create endless ideas and stories,” she elaborates.