How to know if your child has a speaking disorder -- and when to seek a therapist

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Sitting, crawling, walking, talking — they’re all major milestones parents eagerly anticipate from their bundle of joy. But when Junior hits his sixth birthday and he’s still asking for a “nana” instead of a banana, he may have a speech delay or disorder. Most kids learn to speak just fine; others are simply late talkers and will eventually catch up. If, however, you find his speech is lagging well behind what is considered normal, it may be beneficial to seek the help of a therapist.

Speech-language pathologists Dr. Rosalee Shenker, Ph.D, founder of the non-profit Montreal Fluency Centre and adjunct professor at McGill University, and Edmonton-based Judy Meintzer, R.SLP, and former chair of Speech-Language & Audiology Canada (SAC), offer the following insight into speech development, delays and disorders, as well as where you can get help.

Early words

Both SAC and Alberta Human Services offer useful guidelines and checklists of what speech sounds to expect from baby to eight years, the age when the typical child’s speech resembles that of an adult’s. For example, at one, she may say her first words. Within another six months, she’s starting to put sounds into sentences. By two, she’s pronouncing vowels correctly; at three, you can understand her between 75 and 100 per cent of the time; and by four you should be able to understand her all the time. At five he may still be struggling with letters R, V, Ch and Th, but he should be easily understood by everyone. Same with six and seven; he may still stumble over the r and th, but most people will get what he’s saying. By eight, he has a way with words, using all sounds correctly.

Slow but steady

If your child is not reaching the stages noted above, if she’s constantly frustrated or hard to understand, there could be other issues at play besides a speech problem. “It’s normal for children to use fillers like ‘um’; it’s not normal for children to use fillers for every other word,” says Shenker. “It’s a question of frequency, of what we would consider typical. It just depends on whether it has an effect on communication.”

In addition, particularly in Shenker’s home province, bilingualism can further challenge speech development. Some of the first or most obvious red flags, says Meintzer, include not using sounds for pleasure or distress in the child’s first month, and not nailing the noted markers in a reasonable amount of time. Later signs include inconsistent pronunciation of the same word, i.e., nunny, munny, bunny to indicate mommy, as well as inconsistent, unclear vowels and sounds that are distorted.

Mitigating issues

Your child’s speech problem could actually be a hearing problem. “If you suspect any communication disorder or problem, the first and easiest thing to do is get your child’s hearing tested,” Shenker explains. If he has difficulty hearing your sounds, he can’t replicate them. He could also have an ear infection, which could result in delayed speech. Premature babies often take longer to hit those benchmarks, but do eventually catch up. Some pediatricians suggest counting from your baby’s due date, not the birth date, to gauge natural development.

Twins, triplets and other multiples also face greater challenges — up to 50 percent of them, say some speech pathologists — because of premature birth, low weight, or medical intervention at birth, which often affect multiples. Boys often develop speech later than girls, but only by one to two months. At 16 months, boys typically use about 30 words compared to girls’ 50, but they, too, eventually catch up.

Autism can be a contributor to language difficulties, but, as Shenker says, it’s usually easy to discern, but if it’s subtle, not so much. Autism Speaks is a good resource for help with that. Attention Deficit Hyperactivity Disorder (ADHD), she says, is difficult to rule out in children under five or six because “what looks like a lack of attention or focus could represent all kinds of things,” so parents should seek the help of a professional. Dyslexia can also play a role. “Literacy is one of the foundations for learning, so if you can’t match the sound to its letter, if you can’t break up the sound into syllables,” you’ll have language challenges. Shenker says the International Dyslexia Association can provide helpful information.

Sing away stuttering

Stuttering affects between five to eight per cent of Canadian children of preschool age, says Shenker, but most make a natural recovery without treatment. “Children who persist in stuttering make up about 1 percent of the population.” And, as with other communication disorders, boys are more prone than girls. Stuttering can, in fact, run in the family if a relative didn’t resolve the issue. “Genetics account for about 35 per cent of stuttering incidents, the rest is considered to be a speech motor problem,” Shenker adds. Strike up the band, however, and the problem magically disappears.

Nearly three years ago, Lazaro Arbos, a contestant on “American Idol,” stuttered his way through the show’s interview segments but sang fluently. “Singing is dominated by a different part of the brain than speaking,” explains Shenker. “What breaks down in stuttering are the syllable boundaries where you have to stop and start. Singing is kind of a rhythmic way of speaking, and there is actually a sort of sing-song therapy that gives affected children the feel of fluency.”

Shenker says treatments for stuttering and stammering consist of two approaches, the direct, such as that used in the Lidcombe Program at the Montreal Fluency Centre, and indirect, such as the one used at The Michael Palin PCI Centre.

How To Help

“Parents can copy the sounds their baby is making and wait for a response,” says Meintzer, even if it takes a slow, patient count to 10. “Also, talk, sing and play games with your baby; label and talk about important objects and people throughout the day. Some children need to hear a sound many times before they will use it.”

Get down to their level so they can see your mouth and tongue when you’re pronouncing words, she says. Hold objects near your face and slowly articulate what they’re called, then encourage your toddler to repeat them. Show him how to place his tongue to form letters such as the l. Try not to correct or tell her to take her time; that will just make her more self-conscious. Also, resist interrupting or saying the word for her; like anything, she’ll learn by doing it herself. “Once she can say the sound by itself, encourage her to play with it,” says Meintzer. “Encourage her to practice the words that she can say rather than trying to get her to say those she can’t.”

Definitive Diagnosis

“We really don’t have standardized tests that are useful for children under the age of three or four, so we do authentic evaluations for screening assessments to get an idea of where there might be a delay,” says Shenker. “A lot of the information comes from the parents because they know the child best.” The Hanen Centre has tips, programs and checklists to help parents communicate with their children, she says.

Treatment Options

Besides struggling with clear communication, kids with speech challenges are often teased and misunderstood. “For children around the age of four, social language kicks in. This is when he really wants to communicate with his peers,” Shenker says. “But if he can’t, he usually walks away. The negative effect of this on a child’s confidence or self-esteem can be really devastating. That’s why we urge parents to get intervention as early as possible. If you have a serious problem, the longer you wait to get therapy the wider the gap becomes between the child’s ability to function at the level of his peer group.”

For treatment options and resource information, talk to your pediatrician, or consult websites such as the Canadian Psychological Association, the Canadian Pediatric Association, Speech-Language & Audiology Canada or Dr. Shenker’s Montreal Fluency Centre. The therapist will assess your child’s specific challenge and level of difficulty and tailor a program that works best. Before you know it, Junior will not only be walking the walk, he’ll be talking the talk. And making his desire for a banana quite clear.