Speech Problems and Language Disorders in Children
As parents, we monitor our children from infancy, eagle-eyed and ear to the ground, noting whether they start babbling at the age appropriate time, when they say their first word and if they have enough words in their repertoire. We collect cues and celebrate every developmental milestone and silently worry if something seems delayed. While one child can be slower than the other in reaching a specific milestone, there is always the heart breaking possibility that your child could be developmentally delayed, or have a disorder. Some of the most common disorders that are likely to start in childhood are related to speech and/or language, as these are two of the key areas that reflect your child's development.
It is a simple mistake to assume that there are no differences between speech and language disorders because both are tools of communication. Even though both are means of communication for your child, it is likely that the underlying cause or mechanism in a speech or language delay or disorder would be distinct regarding its biological or physiological underpinnings.
Speech refers to how your child verbalizes; this could mean how words and syllables are pronounced, the application of different speech sounds and whether the communication is fluid, or if there is a stammer or stutter. Language deals with how your child verbalizes concepts and thoughts, deals with syntax and grammar and the scope of expressive vocabulary.
At times parents and even educationalists assume if the child is behind the rest of the class or other children of his/her age group, they will eventually out grow it. As a parent you might reassure yourself by thinking your child is just not chatty, is more of a thinker, or is just being stubborn! Studies show that many times a late talker or a child with a language delay seems to spontaneously recover at a later age. This recovery is not always reflective of the assumed linear relationship between early language delays with language, reading and comprehension disorders that arise as the child grows older. Similarly, a nervous stammer or a repetitive vocal disruption (a tic) might resolve with time but it is highly likely these are symptomatic of a more serious underlying disorder.
Either ways, familiarizing yourself with some of the common communication disorders means that you can be reassured when you hear your child learn and progress and you will be well equipped to notice if your child is struggling to communicate.
One of the concerns parents automatically have when they think their child has a developmental delay or disorder is: is my child normal? Will he/she grow up to be an astronaut, physicist, writer or a senator? Many communication disorders do not reflect intellect; most children with speech and language disorders show normal or above normal intelligence. When a communication disorder is a symptom in itself, then diagnosing the underlying condition is most essential. The key is to identify the issue and for you as a family to help work through the solutions available.
Expressive Language Disorder
As evidenced by the name, children with this disorder find it hard to express themselves. The problem lies in trying to construct a meaningful sentence, and the child might struggle to apply the correct word, or grammatical structure. There is no problem in comprehension; only in expression. Usually family members or teachers are well placed to spot whether the child has any problems with expression. Often the fact that there are no problems understanding other peoples speech, written words or directives, but there is a distinct issue with verb tenses, or substituting vague words instead of specific ones, is a clear indication that your child might have an expressive language disorder.
There are diagnostic tools, including standardized tests, which can help to determine if a child suffers from expressive language disorder. Low scores in these measures while normal or above average performance in non-verbal intelligence measures and receptive language tests indicate an expressive language disorder. Additionally, in order to make a confirmed diagnosis the following criteria need to be met:
- Problems with expressive language hinders academic progress or social interaction
- Criteria for no other disorder cannot be met and there are no underlying pervasive disorders of which problems with expression are just a symptom.
Treatment typically involves a speech and language therapist. You can work in conjunction with the therapist to ensure your child is being exposed to words and language structures that your child needs for regular communication.
Mixed Receptive-Expressive Language Disorder
Mixed receptive-expressive language disorder causes problems in both understanding and communication. As noted above, your child will find it hard to articulate his/her thoughts to communicate simple things and will also find it hard to understand words and sentences, especially abstract words such as those signifying temporal or spatial concepts. These problems will be evident in your child's speech and behavior.
Standardized tests of receptive and expressive language disorder will be below normal and criteria for other disorders would not be fulfilled. Treatment involves speech therapy where communication with peers and academic stability is emphasized using tools such as practicing reading or specific communication skills.
A receptive language disorder or a mixed receptive-expressive disorder could also be part of more complex and pervasive problems such as aphasia, autism, brain injury or deafness. Receptive language disorders are also known as central auditory processing disorder or comprehension deficit. To ensure that a receptive language disorder or a mixed receptive-expressive language disorder is not a symptom of a more serious disease, the diagnosis has to identify the cause or pathology behind said disorders, using a battery of tests and eliminating other contenders. Treatment for receptive language disorder as a symptom would depend on the underlying cause.
Summary of receptive language disorders and an overview of mixed receptive-expressive language disorders.
Phonological disorder is often known as articulation disorder or speech sound production disorder. If no underlying cause can be established, it is known as a developmental phonological disorder and can be expected to be resolved more easily. More serious forms of phonological disorder are known as dysarthria, apraxia or dyspraxia: these have neurologic or muscular causes and the phonological disorder is just a symptom of the overarching disease or disorder. Understanding phonological disorders is the key to the treatment which is then dependent on working with the underlying problem;
A child with a phonological disorder will not make all the sounds that are expected as a milestone. Children usually learn consonant sounds in a similar sequence. Divided roughly in three groups, the early sounds are the toothless m, b or p. The group acquired second is t or g and the last being Sh, z, th. While learning how to make these consonant sounds, children will make common mistakes in a normal developmental scheme. If your 8 year old, however, is making the same mistakes as a 4 year old, then this is cause for concern. Problems include substituting certain sounds with others. Sounds that originate from the back of the mouth like k, g, ca often are replaced by sounds that originate at the front of the mouth such as d or t. Cat can be replaced with tat.
A speech language therapist will help your child understand mouth and tongue formations so that your child can learn how to pronounce certain sounds and consonants. Your child will be taught to recognize correct and incorrect sounds and practice different phonemes. Tools like repeating rhymes, words, reading and word games will also be employed.
Stuttering is the repetition, prolongation and breaking of words and sounds. Often the person can seem blocked or hesitant as there will be noticeable gaps and interjections between words or even sounds. Examples of these types of stuttering or stammering are c-c-cat, or cccccat or How how how do you do?or the lion aaa, umm, umm, umm attacked. These disfluencies can vary in the same individual from day to day and moment to moment and understanding stuttering as a disorder rather than a phase can be monumental for your child's wellbeing.
There are several degrees of stuttering; ranging from mild to severe, each range categorized by the rate of syllables stuttered. Your child's speech and language pathologists will use these rates, observe how your child copes with or tries to resolve the stammer and is able to catch the more subtle characteristics to diagnose stuttering, such as circumlocution. In children, stuttering can occur spontaneously or develop gradually. With children, prediction of whether they will continue to stammer helps guide effective treatments. Identifying the causes helps this. Concurrent speech or language disorders can be a contributing factor. Causes of stuttering are mostly unknown but studies show increasing evidence towards a genetic predisposition as indicated by identical twin studies. There is also some research indicating that people who stutter process language and speech differently from those who don't.
Treatment for stuttering is mostly behavioral therapy. Speech therapists will teach your child how to monitor the rate of words uttered, be physically relaxed when speaking, repeat problematic words, and of course there have been cases of spontaneous recovery.
Stuttering should not be confused with vocal tic disorder which is characterized by involuntary sounds, words or even sentences. Vocal tics range from meaningless clicking sounds, barking, to whole sentences like there you have it.
Language and Learning Disabilities
Even though learning disabilities fall under a completely separate diagnostic and clinical category, it is important to note that there are some links between early language delays and disorders and learning and social behavior disabilities in a child's later years.
One of the most common learning disabilities is dyslexia: caused by an inherent neurologic structural problem, this is a language-based learning disability where the child has problems with the written word. Often dyslexia presents itself with an overarching language disability where understanding and focusing on both spoken and written words might be a problem.
Resources for understanding speech and language:
- DARC, Dyslexia Awareness and Resource Centre.
- Understanding the Relationship between Language and Learning Disabilities: a research based article on communication delays and the possible risk of learning disabilities.
- A brief summary dispelling common myths about speech and language disorders by Saraswathy Ramamoorthy with Judith A. Myers-Walls, PhD, CFLE.