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  1. 1. our son is 2 years old and still isnt talking. He says a few words, but compared with his peersyou think hes way behind. You remember that his sister could put whole sentences together atthe same age. Hoping he will catch up, you postpone seeking professional advice. Some kids areearly walkers and some are early talkers, you tell yourself. Nothing to worry about...This scenario is common among parents of kids who are slow to speak. Unless they observeother areas of "slowness" during early development, parents may hesitate to seek advice. Somemay excuse the lack of talking by reassuring themselves that "hell outgrow it" or "shes justmore interested in physical things."Knowing whats "normal" and whats not in speech and language development can help youfigure out if you should be concerned or if your child is right on schedule.Understanding Normal Speech and Language DevelopmentIts important to discuss early speech and language development, as well as other developmentalconcerns, with your doctor at every routine well-child visit. It can be difficult to tell whether achild is just immature in his or her ability to communicate or has a problem that requiresprofessional attention.These developmental norms may provide clues:Before 12 MonthsIts important for kids this age to be watched for signs that theyre using their voices to relate totheir environment. Cooing and babbling are early stages of speech development. As babies getolder (often around 9 months), they begin to string sounds together, incorporate the differenttones of speech, and say words like "mama" and "dada" (without really understanding what thosewords mean).Before 12 months, children should also be attentive to sound and begin to recognize names ofcommon objects (for example bottle, binky, etc.). Babies who watch intently but dont react tosound may be showing signs of hearing loss.By 12 to 15 MonthsKids this age should have a wide range of speech sounds in their babbling (like p, b, m, d, or n),begin to imitate and approximate sounds and words modeled by family members, and typicallysay one or more words (not including "mama" and "dada") spontaneously. Nouns usually comefirst, like "baby" and "ball." Your child should also be able to understand and follow simple one-step directions ("Please give me the toy," for example).From 18 to 24 MonthsThough there is a lot of variability, most toddlers are saying about 20 words by 18 months and50 or more words by the time they turn 2. By age 2, kids are starting to combine two words to
  2. 2. make simple sentences, such as "baby crying" or "Daddy big." A 2-year-old should also be ableto identify common objects, common pictured objects, indicate body parts on self when labeled,and follow two-step commands (such as "Please pick up the toy and give it to me").From 2 to 3 YearsParents often witness an "explosion" in their childs speech. Your toddlers vocabulary shouldincrease (to too many words to count) and he or she should routinely combine three or morewords into sentences.Comprehension also should increase — by 3 years of age, a child should begin to understandwhat it means to "put it on the table" or "put it under the bed." Your child also should begin toidentify colors and comprehend descriptive concepts (big versus little, for example).ContinueThe Difference Between Speech and LanguageSpeech and language are often confused, but there is a distinction between the two: Speech is the verbal expression of language and includes articulation, which is the way sounds and words are formed. Language is much broader and refers to the entire system of expressing and receiving information in a way thats meaningful. Its understanding and being understood through communication — verbal, nonverbal, and written.Although problems in speech and language differ, they often overlap. A child with a languageproblem may be able to pronounce words well but be unable to put more than two wordstogether. Another childs speech may be difficult to understand, but he or she may use words andphrases to express ideas. And another child may speak well but have difficulty followingdirections.Warning Signs of a Possible ProblemIf youre concerned about your childs speech and language development, there are some thingsto watch for.An infant who isnt responding to sound or who isnt vocalizing is of particular concern. Between12 and 24 months, reasons for concern include a child who: isnt using gestures, such as pointing or waving bye-bye by 12 months prefers gestures over vocalizations to communicate by 18 months has trouble imitating sounds by 18 months has difficulty understanding simple verbal requestsSeek an evaluation if a child over 2 years old:
  3. 3. can only imitate speech or actions and doesnt produce words or phrases spontaneously says only certain sounds or words repeatedly and cant use oral language to communicate more than his or her immediate needs cant follow simple directions has an unusual tone of voice (such as raspy or nasal sounding) is more difficult to understand than expected for his or her age. Parents and regular caregivers should understand about half of a childs speech at 2 years and about three quarters at 3 years. By 4 years old, a child should be mostly understood, even by people who dont know the child.auses of Delayed Speech or LanguageMany things can cause delays in speech and language development. Speech delays in anotherwise normally developing child can sometimes be caused by oral impairments, likeproblems with the tongue or palate (the roof of the mouth). A short frenulum (the fold beneaththe tongue) can limit tongue movement for speech production.Many kids with speech delays have oral-motor problems, meaning theres inefficientcommunication in the areas of the brain responsible for speech production. The child encountersdifficulty using and coordinating the lips, tongue, and jaw to produce speech sounds. Speechmay be the only problem or may be accompanied by other oral-motor problems such as feedingdifficulties. A speech delay may also be a part of (instead of indicate) a more "global" (orgeneral) developmental delay.Hearing problems are also commonly related to delayed speech, which is why a childs hearingshould be tested by an audiologist whenever theres a speech concern. A child who has troublehearing may have trouble articulating as well as understanding, imitating, and using language.Ear infections, especially chronic infections, can affect hearing ability. Simple ear infections thathave been adequately treated, though, should have no effect on speech.What Speech-Language Pathologists DoIf you or your doctor suspect that your child has a problem, early evaluation by a speech-language pathologist is crucial. Of course, if there turns out to be no problem after all, anevaluation can ease your fears.Although you can seek out a speech-language pathologist on your own, your primary care doctorcan refer you to one.In conducting an evaluation, a speech-language pathologist will look at a childs speech andlanguage skills within the context of total development. Besides observing your child, thespeech-language pathologist will conduct standardized tests and scales, and look for milestonesin speech and language development.The speech-language pathologist will also assess:
  4. 4. what your child understands (called receptive language) what your child can say (called expressive language) if your child is attempting to communicate in other ways, such as pointing, head shaking, gesturing, etc. sound development and clarity of speech. your childs oral-motor status (how a childs mouth, tongue, palate, etc., work together for speech as well as eating and swallowing)If the speech-language pathologist finds that your child needs speech therapy, your involvementwill be very important. You can observe therapy sessions and learn to participate in the process.The speech therapist will show you how you can work with your child at home to improvespeech and language skills.Evaluation by a speech-language pathologist may find that your expectations are simply toohigh. Educational materials that outline developmental stages and milestones may help you lookat your child more realistically.What Parents Can DoLike so many other things, speech development is a mixture of nature and nurture. Geneticmakeup will, in part, determine intelligence and speech and language development. However, alot of it depends on environment. Is a child adequately stimulated at home or at childcare? Arethere opportunities for communication exchange and participation? What kind of feedback doesthe child get?When speech, language, hearing, or developmental problems do exist, early intervention canprovide the help a child needs. And when you have a better understanding of why your child isnttalking, you can learn ways to encourage speech development.Here are a few general tips to use at home: Spend a lot of time communicating with your child, even during infancy — talk, sing, and encourage imitation of sounds and gestures. Read to your child, starting as early as 6 months. You dont have to finish a whole book, but look for age-appropriate soft or board books or picture books that encourage kids to look while you name the pictures. Try starting with a classic book (such as Pat the Bunny) in which the child imitates the patting motion, or books with textures that kids can touch. Later, let your child point to recognizable pictures and try to name them. Then move on to nursery rhymes, which have rhythmic appeal. Progress to predictable books (such as Eric Carles Brown Bear, Brown Bear) that let kids anticipate what happens. Your little one may even start to memorize favorite stories. Use everyday situations to reinforce your childs speech and language. In other words, talk your way through the day. For example, name foods at the grocery store, explain what youre doing as you cook a meal or clean a room, point out objects around the house, and as you drive, point out sounds you hear. Ask questions and acknowledge your
  5. 5. childs responses (even when theyre hard to understand). Keep things simple, but never use "baby talk."Whatever your childs age, recognizing and treating problems early on is the best approach tohelp with speech and language delays. With proper therapy and time, your child will likely bebetter able to communicate with you and the rest of the world. children with speech and language difficultiesSpeaking, listening, reading and writing are four aspects of language development that are at thecore of the school curriculum. There is evidence that children with speech and languagedifficulties suffer difficulties with all four skills that adversely affect their educational progressand vocational prospects.The project evaluated two theoretically motivated interventions for young children with speechand language difficulties. One intervention involved training phonological skills in the context ofstructured literacy teaching. A second intervention involved training children’s receptive andexpressive oral language skills.It was predicted that the phonological intervention would primarily facilitate children’sphonological and phonic (reading and spelling accuracy) skills, while the language interventionshould have improved children’s receptive and expressive oral language skills.How to Help Overcome Speech-Language Difficulties in theHomeschooled ChildDateline: 2/19/09By Dr. Linda Kennedy MS SLP NDver 1 ½ million children in the United States alone are homeschooled, this represents 2.9% of allschool-age children in the U.S. According to the National Center for Education Statistics, thethree main reasons parents give for homeschooling include concern about the public schoolenvironment, to provide religious and moral instruction and dissatisfaction with public schoolacademic instruction. Choosing to homeschool is an important decision. Children and theirfamilies enjoy several distinct benefits: Homeschooled children score higher on standardizedtests than children educated in public schools, by large margins. Homeschooling allows a child tolearn at their own pace, rather than at the pre-determined pace that the public schools mandate.Homeschooling also minimizes the impact of negative peer influences outside of the home.Finally, recent studies show that homeschooled kids enjoy a similar number of social activities
  6. 6. outside of the house compared to children in public schools, thereby destroying the myth thathomeschooled children are socially isolated.However, there are a few challenges that some homeschooled children and their parents mustcope with. Namely, the lack of taxpayer funded resources typically available to full time publicschooled children. For example, public schools often offer free tests for vision, hearing andspeech. Even in schools where these services are not offered, experienced teachers and nurses inpublic schools usually have worked with enough children to have a good idea if a child may havea learning or developmental problem, and they can make referrals to appropriate specialists forfurther testing.In the homeschool setting there are no such experts available on a day-to-day basis. Therefore,you, as the parent and teacher, must be attentive to potential learning or developmental deficits inyour child. Speech-language disorders are common in children and are among the most difficultproblems to detect, especially in a homeschool setting. Most parents lack formal training in thisarea and only have experience with teaching a few children with whom they are very familiar familiar in fact, that in many cases it is difficult to step back and evaluate the childrenaccurately, objectively and without bias.Although this is by no means an exhaustive list, the following are possible symptoms of a childthat may be presenting with a speech-language disorder: Trouble pronouncing sounds Trouble understanding words Trouble expressing thoughts in words Difficulty with memory, reasoning, or imagination Stuttering Voice problems such as nasally speech, hoarseness, or excessively loud or soft voiceThere are several different types of speech and language disorders, each with differentsymptoms. The main types of speech and language problems are briefly discussed below:Receptive Language DisorderReceptive language disorder is a learning disability that limits the childs understanding oflanguage. Common characteristics of this disorder are trouble following verbal directions andunderstanding word problems. Children with receptive language disorder may also have poorlistening skills, low academic performance or behavior problems. There is no known cause forthis disorder, although some believe there may be a genetic link. This disorder may be related toother conditions such as autism, attention deficit disorder or dyslexia. Receptive languagedisorder does not affect intelligence since these children usually have average to above-averageIQ.Expressive Language Disorder
  7. 7. Children with expressive language disorder have no problems understanding language, but theyhave difficulty expressing themselves through speech and writing. These children often have anabnormally small vocabulary and difficulty understanding the basics of grammar. These childrenhave the communication skills of children younger than themselves and they may not speak veryoften because of their impairment. This disorder may cause difficulty with schoolwork,especially writing and answering questions. As is true with receptive language disorders, there isno known cause.Motor Speech DisorderMotor speech disorder is caused by poor muscle control of the muscles used in speaking. Thisdisorder makes it difficult to articulate sounds, resulting in slow, distorted or slurred speech.However, there are no problems with understanding or expression. Motor speech disorders areoften a result of congenital neurological problems or from a prior stroke, traumatic injury orinfection.Cognitive DisorderA cognitive disorder describes the inability to communicate effectively because of damage to thepart of the brain that controls your ability to process language. This brain damage limits a childsability to express themselves in speech or writing. Depending on the exact location and extent ofthe damage, the child may struggle to speak clearly, initiate a conversation and/or organize andprocess language. In children, these disorders are usually caused by birth defects, prior infectionduring infancy or traumatic brain injury.Phonetic DisorderPhonemic disorder describes a condition in which a child has difficulty articulating certainsounds. This results in common enunciation errors such as omitting sounds from words,distorting sounds or substituting one sound for another. Phonetic disorder may be the result of amotor speech disorder or oral/dental problems.Speech-language problems can be further described based on the cause andseverity: The term acquired describes a problem that results from an event after birth such as illness ortrauma. The term delayed implies that the child is developing the correct patterns of speech andlanguage, just at a slower rate than other children of their age. The term disorder describes a condition where the child is not developing the correct speechand language patterns, which results in an obvious deficit compared to their age-matched peers.If it is suspected that a child may have a speech-language disorder, professional guidance is mostdefinitely in order. While the internet offers much information on speech language disorders, notwo cases are the same - each child and situation is unique and an evaluation from a healthprofessional is the only way to find out for sure. If, in fact, a child has a speech-language
  8. 8. disorder, early diagnosis and treatment results in a greater chance for long-term treatmentsuccess.One of the challenges of homeschooling is that parents may not have access to the free healthscreening and treatment that is usually available in public schools. The guidelines vary from stateto state. Check to see if your local school district offers free or discounted services for yourhomeschooled child. If the school district does not offer these services and insurance does notcover the expense, the diagnostic testing and subsequent therapy required for a child with aspeech-language disorder can be a large out-of-pocket expense. Check to see if there is anaudiologist or speech language pathologist (SLP) in your area that offers discounted fees basedon income earned.The initial step in diagnosing a speech-language disorder is to visit an audiologist to rule out ahearing problem. Audiologists are trained professionals who specialize in diagnosing people withsuspected hearing loss and other hearing or balance disorders. Hearing problems are commonlyrelated to delayed speech, which is why a childs hearing should first be tested by an audiologistwhenever there is suspicion of a speech-language disorder. A child who has trouble hearing mayhave trouble understanding, imitating and using language. If the audiologist detects a hearingproblem, he or she will determine an appropriate course of treatment. On the other hand, if thereis no hearing deficit, the next step is to visit an SLP. Speech language pathologists are highlytrained professionals with expertise in diagnosing and treating speech-language disorders. Mosthave a graduate or doctoral degree.The initial visit to the SLP will consist of a series of tests lasting from 2 to 8 hours, depending onyour childs unique situation. The SLP evaluation will include an assessment of your childsspeech and language skills with standardized tests that will compare them to their expecteddevelopmental level. These tests will include language understanding, language expression,speech clarity and identification of ways the child may compensate for lack of effectivecommunication, such as pointing and gesturing. If a speech delay or disorder is identified as aresult of the diagnostic procedure, the SLP will make a diagnosis and recommend an appropriatetreatment for your child, which may include speech therapy and daily home programs. Make sureto tell the SLP that your child is homeschooled so that the SLP can be certain that youunderstand how to administer your part of the daily curriculum. This is where parentalinvolvement in a homeschool situation is vital. A childs improvement will, in part, depend ondiligence in maintaining the daily therapeutic program prescribed by the SLP.If efforts have been made for a formal evaluation and treatment plan, your SLP will periodicallymonitor your child to make sure that the treatment protocol is indeed effective. The SLP willcollect data over subsequent therapy sessions and make changes to the treatment protocol asneeded. The SLP may also choose to administer testing again, as yet another means of crossreferencing data to insure progress for the child.If a speech-language problem is suspected, quick and early intervention by a professional is thekey to helping a child overcome this issue and insure future scholastic success.
  9. 9. Dr. Linda Kennedy MS SLP ND: Has a graduate degree specializing in Communication Sciencesand Disorders. She owns a laboratory that specializes in the production of custom vitamins,liquid vitamins and whole food vitamin supplements for health care professionals around theglobe. Contact her at: ezdoc26@bellsouth.netLanguage Impairment LinksApraxia KidsFrequently asked questions answered about children who are slow to speak clearly, and what canbe done about it.Can We Talk?We specialize in free, quickly read and easily understood materials about working with speechdelayed children.Carols Speech and Language Disorders Professional ResourcesThese sites will give you information about specific speech and language disorders, articles youmight wish to use, such as lesson plans and reference materials.Homeschooling Language Impaired ForumMany of the people who belong to this list are homeschooling parents of language-impaired orlearning-disabled children. Difficulties Associated with Specific Language ImpairmentIn addition to students with specific speech disorders, you will also find students who havelanguage disorders but no other disabilities. These students may be classified as having aSpecific Language Impairment (SLI). The table below lists some key facts about languagedifficulties associated with Specific Language Impairment at different ages.Age Language Difficulties Late appearance of first word (average age of 23 months); delayed use of present progressive (-ing), plural (s), and possessive (s); late use of two-wordInfancy and combinations (average age of 37 months); less frequent use of verbs and lesstoddlerhood variety in verbs; slow development of pronouns; longer reliance on gestures for getting needs meet; difficulty initiating with peers; difficulty sustaining turns in conversation Use of grammar that resembles that of younger children (e.g., pronoun errors, as in me want dolly); late use of verb markers (e.g., third person singular is asPreschool an auxiliary); frequent errors of omission (e.g., leaving out key elements of syntax); shorter sentence length; problems forming questions with inverted
  10. 10. auxiliaries; difficulty with accurate use of be as an auxiliary or copular verb form; slow development of pronouns; requests similar to those of younger children; difficulty with group conversations (i.e., conversing with more than one child); difficulty with verbal resolution of conflict Word-finding problems accompanied by circumlocutions and pauses; naming errors (e.g., shoes for pants); slower processing speed; use of earlier developingEarly and later pronoun forms; low sensitivity to the speech of others (e.g., difficultyelementary responding to indirect requests); difficulty maintaining topics; difficulty recognizing need for conversational repair Difficulty expressing ideas about language; inappropriate responses to questions and comments; poor social language; insufficient information forAdolescence listeners; redundancy; inadequate sense of limits or boundaries; difficulty expressing needs and ideas; difficulty initiating conversations with peers; immature conversational participationSource: From L. Justice, Communication Sciences and Disorders (2006), p. 224, publishedby Merrill/Prentice Hall. Copyright © by Pearson Education. Reprinted with permission. 10 Things You Should Know About Children With Specific LanguageImpairmentPrint EmailFacebook Twitter Buzz
  11. 11. By Joy Simpson|Mabel L. RiceMerrill Advanced Studies CenterSpecific Language Impairment has been actively studied for more than 40 years. Languageacquisition is the primary area of concern as the child grows and develops. There are no obviousrelated causes such as hearing loss or low IQ. The condition appears in young children and isknown to persist into adulthood. Although the causes are unknown, current research focuses onpossible inherited tendencies. Early identification and intervention are considered best practices,in order to minimize possible academic risks. 1. Specific Language Impairment has many names and it is surprisingly common. SLI is just one of the many communication disorders that affect more than 1 million students in the public schools. If your child has been evaluated by a speech pathologist, you may have heard its other names: developmental language disorder, language delay or developmental dysphasia. Specific language impairment is the precise name that opens the door to research about how to help a child grow and learn. SLI is more common than you might think. Research over the past ten years has generated accurate estimates of the numbers of young children that are affected by SLI. We now know it could be as high as 7 to 8 percent of the children in kindergarten. In comparison, Down syndrome or autism affects less than one percent of the five-year olds. 2. Late talking may be a sign of disability. As they enter their twos and grow into three and four, children have a remarkable number of ways to tell adults what they need. Even if the words dont all sound right, a normally developing child will make many efforts to communicate and will make his point effectively. Young children ask so many questions -- often exhausting their parents and care providers. Children who dont ask questions or tell adults what they want may have a communication disorder. Children with SLI may not produce any words until they are nearly two years old. At age three, they may talk, but cant be understood. As they grow, they will struggle to learn new words, make conversation and sound coherent. Today, research is underway to determine which children do not outgrow this pattern of delayed speech. By age 4 to 5 years, SLI could be a signpost of a lasting disability that persists throughout the school years.
  12. 12. 3. A child with SLI does not have a low IQ or poor hearing. Several other disabilities involve difficulties communicating, but for these children the primary diagnosis will be mental retardation, or autism, or hearing loss, or cerebral palsy. A child with SLI scores within the normal range for nonverbal intelligence. Hearing loss is not present. Emerging motor skills, social-emotional development and the childs neurological profile are all normal. The only setback is with language. SLI is the primary diagnosis.4. Speech impediments are different from language disorders. A child with a speech disorder makes errors in pronouncing words, or may stutter. Recent studies find that most children with SLI do not have a speech disorder. SLI is a language disorder. This means that the child has difficulty understanding and using words in sentences. Both receptive and expressive skills are typically affected.5. An incomplete understanding of verbs is an indicator of SLI. Five-year old children with SLI sound about two years younger than they are. Listen to the way a child uses verbs. Typical errors include dropping the -s off present tense verbs and asking questions without the usual "be" or "do" verbs. For example, instead of saying "She rides the horse" the child will say "She ride the horse." Instead of saying "Does he like me?" the child will ask "He like me?" Children with SLI also have trouble communicating that an action is complete because they drop the past tense ending from verbs. They say, "She walk to my house yesterday" instead of "she walked to my house."6. Reading and learning will be affected by SLI. SLI does affect a childs academic success, especially if left untreated. Forty to seventy-five percent of the children have problems learning to read.7. SLI can be diagnosed precisely and accurately. In the last ten years, researchers have documented the ways that SLI occurs. Clinical practice is catching up to these advances in research. In the past, SLI has not been included on educational classification systems used by speech pathologists or psychologists, and when identified, it was called a language delay. In 2001, the Psychological Corporation released the first comprehensive test for SLI. The Rice/Wexler Test of Early Grammatical Impairment is based on research funded by the National Institutes of Health, and carried out at the University of Kansas and the Massachusetts Institute of Technology. Speech pathologists and preschool educators can use this test with children ages 3 to 8. It will point to the specific gaps in a childs language abilities so that treatment can be more effective. It is especially useful for identifying children with SLI at the time of school entry.8. The condition may be genetic. The genetic origin of SLI has not yet been proven, but studies show that fifty to seventy percent of children with SLI have at least one other family member with the disorder. Several researchers are studying twins, looking for the genetic link. In 2001, British researchers successfully found the chromosome that affected 15 of 37 members of a London family with a profound speech and language impairment.9. The nature of the disability limits a childs exposure to language. Children with SLI need extra opportunities to talk and to listen, but because of the disability, they may actually have fewer chances. At a young age, curious children ask questions over and over as they see, touch, and experience the world. The adults in their life respond, giving them vocabulary and grammar in a spontaneous teaching format. A child with SLI has trouble asking "Do you?" and says instead "You like ice cream?" This kind of question is easily misunderstood. A child who cannot get the message across may simply stop trying. Interactions are especially difficult with other children because they are less supportive and patient than adults.
  13. 13. 10. Early intervention can begin during preschool. By age five, parents can secure a conclusive diagnosis, but being proactive in the preschool years is often time well spent. Equipping a child for success at ages three and four will lead to positive experiences in kindergarten -- and the signs of SLI are present by age three. Some preschool programs are designed to enrich the language development of students with disabilities. This classroom may include normally-developing children who will act unknowingly as models. The focus of class activities may be role-playing, sharing time, or hands-on lessons with new, interesting vocabulary. This kind of preschool will encourage interaction between children, and will build rich layers of language experience. It may even include techniques from speech pathology that solicit from children the kinds of practice they need to build their language skills. Parents can also send their preschool child to a speech or language pathologist in private practice. This professional can assess the childs needs, engage in structured activities, and can send home materials for enrichment.This fact sheet was written by Joy Simpson in collaboration with Mabel L. Rice, an internationalexpert on language disabilities in children. Dr. Rice is the Fred and Virginia MerrillDistinguished Professor of Advanced Studies at the University of Kansas. Queries may bedirected to the Merrill Center at