Why it’s important to read the signs of speech and communication problems in your child early
Communication is one of the important developmental domains that helps a child to label, explore and learn new things about its own self and the environment around.
It exposes a child to new stimulus and helps build social connections which are important for a developing nervous system. It enables a child to express, understand and share his/her joy and convey distress as well. Language and communication are the keys towards good scholastic performance as phonological awareness, thought processing and expression are shaped when a child starts remembering and distinguishing sounds or using words to describe objects.
A delay in language development can be because of various developmental or psychological disorders, such as intellectual disability, learning disability, hearing impairment, language disorder, psychosocial deprivation, autism, elective mutism, bilingualism, receptive aphasia and cerebral palsy, among others. Early identification and intervention for these children can have significant impact on the quality of their lives.
Speech is an act of the production of sound — challenges in speech may manifest themselves in trouble with specific sounds, patterns of words, or intelligibility. Types of speech challenges include articulation or phonological disorders.
Language is the ability to use speech for making others understand what we express and comprehend what others say. The deciphering of messages and its correct delivery is language. A child with language challenges may not use proper sentence construction and grammar or may have trouble deciphering complex sentences or thoughts.
For examples, such a child may say, “I goed to school.”
The ability to express oneself is called 'expressive language ability'. The ability to decipher and understand language is called 'receptive language ability'.
Communication is the broadest category of them all.
Communication not only includes spoken language but also many other non-verbal cues — essential for interacting and communicating with others.
It is quite common that even if a child or adult has proper speech and language, they still struggle with communication. This could take the form of not understanding, for instance, sarcasm, gestures or facial expressions, which are also cues as to what someone is trying to communicate to them.
Children with autism spectrum disorders (ASD) often exhibit these characteristics.
Speech, writing, art, body and sign language are all methods of communication. Because communication is central to the development of a child, the failure of a child to speak by the age of 1.5 years should be taken seriously.
Language problems interfere with a child’s ability to communicate effectively, both in the expression and the understanding of ideas. The outcome of such a delay may have widespread consequences, ranging from academic to social adjustments.
In children not meeting the expected milestones for speech and language, a comprehensive developmental evaluation is essential, because atypical language development can be a secondary characteristic of other physical and developmental problems that may first manifest as language problems.
Types of primary speech and language delays include developmental speech delays, expressive language disorder and receptive language disorder. Secondary speech and language delays are attributable to other conditions, such as hearing loss, intellectual disability, autism spectrum disorder, physical speech problems or selective mutism. When speech and language delay is suspected, the primary care physician should discuss this concern with the parents and recommend referral to a child development team.
Several studies have shown that children with speech and language problems at 2.5 to 5 years of age have increased difficulty reading in the elementary school years.
Children in whom speech and language impairments persist past 5.5 years of age have increased instances of attention and social difficulties. Children with specific speech and language impairments at 7.5 to 13 years of age have been known to have impaired writing skills, with marked deficits in spelling and punctuation compared with children without speech and language impairments.
It is important for parents to have an understanding of milestones of speech and language — so that any delay or deviation of any kind can be determined in early childhood. Normal speech progresses through stages of cooing, babbling, words and word combinations, whereas normal language progresses through stages of understanding and expressing more complex concepts.
When to refer — When speech and language delay is suspected, the child should be referred to early child developmental centre for screening. Based on the screening results, multimodal intervention, if needed, should be developed by a team of early developmental interventionists.
The primary goal of an evaluation should be to rule out cognitive deficits with language delay.
Doing away with certain myths like ‘Boys speak late’ or ‘With age, speech will come’, ‘Let’s wait for some more time’ is the need of hour.
As professionals, we need to distinguish between expression and understanding by going through age-appropriate milestones. Taking parental concerns seriously and ruling out red flags should be a priority.
Management of language disorder is dependent on the type of processing error or expression. If the understanding, which manifests with poor expression, is affected, focus of the therapies should be comprehension and cognitions.
The primary goals of therapy are to teach children strategies for comprehending spoken language and producing appropriate communicative behaviour to help parents learn ways of encouraging their children’s communication skills. There is good data available to support the effectiveness of multidisciplinary intervention — which includes special education and speech-language therapy, particularly for children with primary expressive language disorder.
The effect of speech-language therapy for children with receptive language disorder appears to be much smaller than it is for other groups as the concern is understanding, which results in other associated behavioural problems as well.
Hence, a multidisciplinary developmental team approach is a must.
Parents can effectively administer speech-language therapy — but they must first receive training. The response to treatment is more varied when using parent administrators, which suggests some parents may be more suited for providing therapy than others.
Parent counselling
Parents can be counselled that once a diagnosis is made, there are professionals who can work with the child and parents, and that many a time, children show a positive response to this intervention.
Looking at the increased instances of developmental disorders like autism, communication disorder and social communication disorder, it is advised that a child with complaints of language delay with associated behavioural problems must be referred to a multidisciplinary team of child development consisting developmental paediatrician, psychologist, special educator, speech therapist and other allied rehabilitation professionals — a comprehensive evaluation should be done as early as possible.
Research shows that early diagnosis has better prognosis than late identification and referral.