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Does Your Child Have a Speech Disorder?
By Debbie Feit

Mama. Dada. Wow. Oh no. What’s that? And, hi.

At age 2 and a half, when most of his peers had between 50 and 200 words in their repertoire, my son Max spoke fewer than 10. But it wasn’t his lack of vocabulary that finally convinced me something was wrong. It was Max’s alternate methods of communication—shrieking, hitting and banging his head against the floor—that prompted me to take action.

It took two different speech therapists and about six months to learn that Max had apraxia, a neurological speech disorder that impairs motor planning—Max had difficulty planning and sequencing the movements of the tongue, jaw, lips, and palate necessary for intelligible speech. Simply put, his brain knew what he wanted to say but it had trouble relaying the message to his mouth. 

Max wasn’t alone in his struggle to speak. Three to six million children in the United States have speech or language disorders and according to the American Speech-Language-Hearing Association, about 15 percent of them are preschoolers. Yet making a diagnosis is difficult, even for the experts. How are you, as a parent, supposed to know if your child’s language development is something to worry about?

What Are The Signs?

A general rule of language development is that most children use single words at age 1, two-word combinations at age 2, and three word phrases at age 3. But, in addition to vocabulary size, it’s also important to consider a child’s clarity of speech, comprehension, nonverbal communication, and social development.

Because the symptoms of some disorders may overlap—and kids can have more than one disorder—determining the exact problem isn’t always easy. Of course, any diagnosing is best left to a licensed speech-language pathologist. But, if you know what characteristics to look for, your child will have a head start on getting the help he may need.

Articulation Disorders 

Articulation disorders are characterized by difficulties with the physical production of individual sounds. A child might omit a sound (“bu” for bus), substitute (“wun” for run), distort (“thith” for this) or add extra sounds (“animamal”) to a word. If he has trouble with consonant blends, “black” becomes “back” and “stop” may be pronounced as “top.” If he has weak oral muscles, a condition known as dysarthria, he may have trouble placing his lips, teeth or tongue in the right positions to clearly produce sounds. Articulation errors are developmentally appropriate for toddlers, so if your 2 year old is having trouble with his m, n, p, b, h or w sounds, don’t worry—many kids don’t master them until 3. But if your child seems to be struggling to communicate and is making a lot of consonant deletions (“ca” for cat), these may be early signs of a problem.

Expressive Language Disorders

A child with an expressive language disorder may have trouble putting words together to express his thoughts and be unable to produce developmentally appropriate sentences in terms of length and complexity. For example, a 2 year old should be able to say “no mommy sock;” but, if he’s delayed in his expressive language, he might only say “no mommy” or simply “no.” At 4, he might say “that not mommy sock” rather than “that’s not mommy’s sock.” If he has issues with word retrieval he may misname things despite recognizing them or he may talk in “circles,” that is he may say more than is needed without ever getting to the point because he can’t come up with the right words. He may have a harder time than his peers in mastering elements of grammar, such as plurals and past tense. The earliest clues you’re likely to see would be if he’s using one-word phrases long after his peers have stretched theirs to two- and three-words (about 18 months), or if he isn’t asking questions or using negatives such as can’t, don’t and not by age 4.

“You would say a child has slow expressive language if he’s not babbling by about one, if he doesn’t have words by about 16 months or if he has a small vocabulary—fewer than 50 words—by two years,” says Heidi M. Feldman, M.D., Ph.D., a communication disorders researcher and an endowed professor of developmental-behavioral pediatrics at Stanford University School of Medicine.

Receptive Language Disorders

Children who have difficulty attending to, processing or comprehending spoken language may have a receptive language disorder. They repeat words or phrases (echolalia), have trouble following directions and give off-target responses to questions. Or their speech may be unintelligible: they  have a particular message they’re trying to get across, but it doesn’t make any sense. If your child is not turning to his own name by 9 months, following a simple command by 15 months or doesn’t know his body parts by 18 months, those could be early signs of a receptive language problem.      

What Can I Expect?

Treatment will depend on the disorder. “If a child has muscle weakness of the mouth, jaw or lips, he may do activities that involve blowing and sucking to help him learn to retract his tongue and round his lips,” says Nancy Kaufman,  director of the Kaufman Children’s Center for Speech, Language, Sensory-Motor, and Social Connections in West Bloomfield, Michigan. “If she has trouble combining consonants and vowels, we work on teaching word approximations, such as ‘bubboh’ for bubble or ‘tuhtee’ for cookie.”

It may be called therapy, but really, it’s all play. A good therapist knows she’ll get the most out of your child if she can hold her interest—which is why her office is stocked with board games, puzzles, dollhouses, books, action figures and puppets. She combines the actual “work” with an activity, such as rewarding your child for each attempt to imitate a sound with a marble for a game of Hungry Hungry Hippos. Although the duration of your child’s therapy will depend on the quality of the services, as well as her willingness to participate, Kaufman says, “If a child is receiving private therapy two times a week you should see significant improvement over a year’s time.”

Thanks to intensive speech therapy, my son Max went from having only a handful of words to having so many it became impossible to track each new one. And once he was better able to talk, his behavior improved as well. Today, at age 8, communication is still somewhat of an issue. But this time, happily, it’s getting him to stop talking that’s often our goal.

Where do I start?

See your pediatrician for a referral to both an audiologist (to rule out hearing loss) and a speech-language pathologist. It’s better to have your child evaluated and be told there’s nothing wrong than to let a possible problem go untreated. You can find a licensed professional in your area through the American Academy of Audiology ( www.audiology.org  ), the Academy of Dispensing Audiologists ( www.audiologist.org ) and the American Speech-Language-Hearing Association ( www.asha.org  ) Call the early intervention program in your area, often run through the public schools for a free assessment of your child under the Individuals with Disabilities Education Act. Not sure how to find it? Start by contacting your neighborhood public school; they’ll point you in the right direction.

I Knew Something Was Wrong When…

“At 18 months my daughter Lauren had no vocabulary. At 24 months she had less than 20 words and most often pointed, grunted or screamed to get her wants and needs across.” —Jean, mom to 3-and-a-half-year-old Lauren, expressive and receptive

speech and language impairment, Howell, Michigan      

“Jordan started to speak later than her sister and the speech was not as clear. At first it was kind of cute—“Garah” for her sister Sarah—but at 2 and a half, when it didn’t show signs of clearing I became concerned.” —Sharon, mom to 4-and-a-half-year-old Jordan, articulation disorder, Farmington Hills, Michigan

“A little before Ben was 2, we noticed that he seemed to understand things, was very curious about the names of things—he’d point and grunt until we said the word to him—but he never repeated words.” —Sandy, mom to 9-year-old Ben, severe verbal apraxia, Buffalo Grove, Illinois

Debbie Feit is the author of The Parent’s Guide to Speech and Language Problems (McGraw-Hill) and the mother of two apraxic children who now talk non-stop. She runs www.ourspecialkids.com,  a website for parents of children with all special needs. Contact her at debbie@ourspecialkids.com.