Speech delay has a number of causes and these vary from it being a variation of normal through to the child having neurologic or developmental problems causing this. Generally a child by age 12 months should have several words and by 18 months should have 10-20 words and be attempting 2 word phrases. By age 2 years a child should have 50-60 words and perhaps 3-4 word sentences. These are a guide only and certain children such as twins or children who were premature may well be delayed in their speech.
The commonest cause of speech delay is hearing loss due to middle ear fluid or glue ear (otitis media with effusion). The hearing loss can also be sensori-neural. The child may have an intellectual disability, may suffer from lack of stimulation, may have a neurologic condition and uncommonly suffer from autism. Children in families where two languages are spoken often have speech delay in one or other language but usually catch up.
Our primary investigation of this condition is to assess the child and the history and establish that there is no hearing loss. This hearing test can be done at any time and at any age. If the child does have a hearing loss then if this can be managed the child will often catch up subsequently. The child with recurrent acute otitis media and glue ear may require speech therapy but there are some listening and language strategies for children with frequent otitis media and these are included below.
Some children require investigations by paediatric developmental specialists in addition to Speech Pathologists to rule out specific or global causes of the child’s speech delay.
Make speech louder or clearer
- Get down on the child’s eye level to talk whenever possible. Get close (no more than 3 feet away) and face the child to provide clear visual and auditory information.
- Gain the child’s attention before speaking to make sure that the child is listening. Remind the child to listen when necessary.
- Speak clearly and repeat important words, but use a natural speaking intonation or pattern.
- When possible, use visual support to help the child understand what he or she is hearing. For a young child, point to objects, pictures, or people and gesture when talking. For an older child, give written as well as verbal instructions.
- When there is a speaker in a classroom, seat the child close to the speaker but where the child also can see other children (e.g. at the side of the room).
Minimize background noise
- Turn off record players, radios, recorders, and television playing in the background, which can interfere with children hearing ongoing conversation.
- Repair noisy appliances (e.g., air conditioners, heaters, fans, vacuum cleaners) that make it hard to hear speech clearly.
- Reduce distractions by using movable barriers (e.g., bookshelves, flannel boards) to create small areas in a classroom where small-group and one-to-one interactions can take place.
- Hang washable draperies over windows to absorb sound, and close doors and windows if there is noise that makes it hard to hear.
- Promote language learning
- Show an interest in what the child is talking about and in things that interest the child, and follow the child’s topic.
- Play interactive games with children to encourage turn taking (e.g., peekaboo).
- Model desired language by describing ongoing activities.
- Respond immediately and consistently to a child’s communication attempts.
- Pause to give the child time to talk.
- Check with the child to see if directions and new information are understood.
- Give positive feedback for language attempts.
- Elaborate on what the child says by adding words to the child’s utterances.
- For older preschoolers, encourage discussions that explain things, predict what will happen next, describe feelings, and refer to children’s own experiences.
Increase children’s attention to language
- Sing simple songs with repeated words and phrases (e.g., The Wheels on the Bus).
Play word and listening games (e.g., I Spy) in which children listen to familiar patterns and fill in words.
For older preschool children, play rhyming games (e.g., cat, fat, bat).
Read frequently with children, labeling and describing pictures and referring to children’s own experiences.
(Roberts, J.E., Wallace, I.F. & Henderson, F.W. (1997) Otitis Media in young children. Paul H. Brookes Publishing Co: Baltimore MA, p. 155)