Deciphering your child’s speech problems
Saturday, July 23, 2005
Tweety needs to go see Mr. Ernie,” my sons agree recently after watching a cartoon. “Mr. Ernie” is Ernest Cherullo, their former speech therapist.
“Why do you say that?” I ask, chuckling.
“Because Tweety can’t say his ‘k’ sounds,” one replies.
In just one year, the boys have gone from calling their grandmas “drama” to diagnosing the speech impediments of others.
When the boys were 3—and talking like Tweety—I took my sister’s advice and had them evaluated at our school district’s free preschool screening. As a kindergarten teacher, my sister knew the potential problems if my sons couldn’t be understood in school. Both boys were diagnosed with a mild articulation disorder. Though reluctant, we signed them up for therapy. Now we understand them perfectly.
My boys are not alone in their speech challenges. According to the American Speech-Language-Hearing Association, 15 percent of preschoolers and 6 percent of kids in first through 12th grades have speech disorders.
The key, experts say, is diagnosing speech problems early and getting help, perhaps by finding a speech therapist. While some speech problems disappear over time, others may lead to social and academic problems or signal more serious disorders.
A common disorder
“That’s a fairly high prevalence of children who just aren’t meeting basic developmental speech and language milestones,” says Cheryl M. Scott, a certified speech and language pathologist at Rush University Medical Center in Chicago.
While the spectrum of speech and language disorders is broad, the American Speech-Language-Hearing Association estimates that three-fifths of them are related to articulation problems—mispronouncing words—that make speech difficult for others to understand.
Articulation errors include omitting sounds (“baseball” becomes “ba-ball”), substituting sounds (“cookie” becomes “tookie”) and distorting sounds altogether.
Some errors simply come from learning how to speak—no easy feat, considering the twists and turns your tongue, lips and cheeks must make to produce words correctly.
And while kids learn sounds in a logical order, the time frame can vary by as much as two to three years, says Dorothy P. Dougherty, a certified speech and language pathologist in New Jersey and author of Teach Me to Say It Right: Helping Your Child with Articulation Problems. To make sure kids are on track, parents should be familiar with the important speech milestones (see “Missing milestones” sidebar). For example, “m,” “p” and “b” sounds are some of the first kids acquire, but the “th” sound (as in “thumb”) is one of the last. Some kids may not form all their sounds properly until age 8, Dougherty says.
While half of articulation hang-ups are resolved over time, the other half aren’t—and may be symptoms of more complex language disorders or autism. They can have long-term effects, too. Many kids with articulation problems have other academic issues, such as difficulties with reading, writing and math, Dougherty says.
Speech disorders can also lead to social problems, says Colleen Cicchetti, a staff psychologist at Children’s Memorial Hospital. “So much of the social world revolves around being able to communicate your needs, and it’s harder [for kids] to do that if they’re self-conscious about their speech.”
While articulation issues may not prompt teasing in preschool, speech and language difficulties can be harder on school-age children. “We know that pretty much anything that makes you stand out or be different from your group can make you be a target, and certainly speech issues can be challenging,” Cicchetti says.
Look for red flags
Sometimes there’s a physical reason for the speech problem, such as a cleft palate or a hearing loss, and it’s obvious that intervention is necessary.
Palatine mom Kristi Beening gave birth to her now 3-year-old daughter, Morgan, at 28 weeks. As a preemie, Morgan experienced difficulty feeding and swallowing, and began speech therapy at 6 months. With the help of therapy, Morgan has blossomed, Beening says. “She used to be quite shy, but now has the confidence to go up and say ‘Hi’ to people.”
When doctors can’t pinpoint a physical cause for a speech disorder, the problem may be due merely to slow language development. It could also signal a more serious developmental disorder. The only way to know, experts say, is to have a child evaluated.
Whatever the root cause, there are some red flags that signal that your child may need help with his articulation problem, says Scott—such as when a child omits many sounds, particularly at the beginning of words, or uses one sound for many different sounds. Problems with sounds commonly used in our language, such as “s” or “r,” “can really make a child sound very different,” Scott says.
Just as important as a child’s expressive language—the words coming from his mouth—is his receptive language—how he listens and responds. While kids develop speaking skills at different rates, listening and response skills typically follow a more predictable timeline, says Christina Rees, co-clinical manager at the Center for Speech and Language Disorders in Elmhurst (www.csld.com). “One of my big focuses is what the child understands,” Rees explains. For example, a child’s inability to follow simple directions may indicate a problem.
The screening stage
Since speech and language problems can be difficult to diagnose, a screening by a speech-language pathologist is key. “If you have any concerns, it’s always wise to seek a professional and get an evaluation,” Dougherty says.
Don’t wait until your child is in school to find out. “The best age to start is really when someone’s concerned,” says Judy Michels Jelm, president of the Illinois Speech-Language-Hearing Association (www.ishail.org).
And don’t take “no” for an answer. Carol Stream resident Karen Goldsmith, mom of 5-year-old Matt, is glad she followed her maternal instinct rather than her doctor’s advice. She was worried when Matt’s language skills declined at 15 months. “I had one doctor who thought I was overreacting and overanxious about getting him services, but despite that, I pursued it,” Goldsmith says. “If I had not acted as early as I did, I would’ve had some regrets.”
Matt has since been diagnosed with pervasive development disorder, a form of autism, and now receives therapy twice a week.
“There’s no one with more power than a parent,” Jelm says, “and there’s no one who knows their child better than a parent. If a parent does not get the answer that they feel they need, they should seek other resources to get that answer.”
Choosing therapy, or not
Whether a speech pathologist recommends therapy depends on the individual case. But it’s important to get that professional evaluation—every child’s needs are different.
Take stuttering, for example. The National Stuttering Association (www.nsastutter.org) reports that three-fourths of preschoolers’ stuttering resolves itself within a year. In some cases, therapy might actually put too much emphasis on the problem, causing the child stress, Rees says.
But in more extreme stuttering cases, therapy is necessary.
If a speech pathologist does recommend therapy, it’s important to avoid delay. “The earlier you start, the better,” Jelm says.
Rees’ own son, 3-year-old Zach, receives speech therapy. While Rees could help Zach at home, she finds it hard to carve out time and believes it’s more effective for him to see another professional. “Kids do respond to parents differently,” she says.
Whether you begin speech therapy through a school, a private practice or at home, it shouldn’t seem like work, Dougherty says. “It should be engaging. It should be educational,” she says. “But it also should be fun.”
If you’re working on sounds at home, follow your child’s lead. If he’s tired, stop. If he wants to talk about something else, change topics. Otherwise he’ll lose interest.
When choosing a therapist, it’s important to look at credentials. But it’s also important for your child to respond positively to that person—he or she will accomplish more. Rees suggests parents attend the first few sessions with their child to establish a good relationship.
Thirteen-year-old River Forest resident Kyle Hedlund is an 11-year veteran of speech therapy and can attest to the fun part. But he quickly cites the benefits, too. “We usually play games together and it increases brain power,” he says.
Kyle had articulation problems as a 2-year-old and has since been diagnosed with a language-processing disorder, which makes it harder for him to learn language.
But therapy is more than a place for kids to have fun. Parents should help set goals with the therapist to ensure that their child realizes his full potential. “The more involved the parent is ... the greater the progress that we see,” Jelm says.
If a child cannot speak correctly or is teased about his speech, he may become frustrated—or, even worse, stop talking altogether. Getting help can turn that frustration around. “When you empower a child, confidence levels go right along with it,” Jelm says.
“[Speech therapy] is a good chance for kids to have a better social life, so that way they won’t feel embarrassed around other people,” Kyle agrees. What would Kyle say to concerned parents who don’t know whether speech therapy is right for their child? “Go for it—it’s the best place ever.”
Speech problems? Don’t delay Many language screenings are free—and so are some services.
• For infants through age 3, call the state’s “Help Me Grow” line, (800) 323-4769, and ask for the nearest Child and Family Connections site.
• For children ages 4 and up, call your local school principal.
• For a referral to a certified speech-language pathologist or audiologist, contact the American Speech-Language-Hearing Association, (800) 638-8255 or www.asha.org.
Nurture speech from the start How you talk to your child from the day he’s born matters. Though you may feel silly, speaking in a high-pitched voice and elongating certain syllables (“Ohhhh, baaaaby’s soooo cute”) are important. This language, called “parentese/caretakerese,” helps prepare a baby’s brain for learning sounds.
But don’t confuse parentese with baby talk. While it might sound adorable when your child asks for his “yunch,” respond that “lunch will be ready soon.” Resist the temptation to repeat mispronounced words—repeat them correctly. “They’ll get the idea that something they have said is not quite the same as what you have said,” says Dorothy P. Dougherty, a speech-language pathologist,”so they focus and they learn to discriminate between the sounds.”
Jill S. Browning is a writer living in Downers Grove. She has three children, all of whom were born on the same day.