The sound pattern of language that we call speech or articulation is made up of combinations of sounds that form words. Speech development is a gradual process. It begins in infancy and continues through a childs seventh or eighth year. Children develop speech abilities at different rates and ages. Some children develop slower of faster than the average.
Milestones of Speech Development
Newborn – 3 months
The newborn baby is very limited in making sounds because the oral structures and vocal cords are not fully developed.. Newborns are limited to crying, which signals hunger or discomfort, and to other non-cry sounds such as burps, coughs and sneezes.
Between two and three months of age your baby is better able to control the vocal muscles of the mouth, larynx and throat. During this period your baby begins to laugh.
4 – 6 months
During the period of 4 – 6 months, babies develop greater control of their oral structures. They can produce sounds that are more like speech. They begin to put sounds together, making syllables out of vowel and consonant-like sounds. They also make non-speech sounds like raspberries, squealing, yelling and growling. This experimentation with sound production is called vocal play.
6 – 11 months
Between 6 – 11 months of age, infants begin to babble. In babbling, a syllable is repeated two or more times in sequence, like ba-ba. Babbling is a way for your infant to practice the oral motor speech skills needed during actual speech.
12 – 18 months
Between 12-18 months, babies begin to produce strings of sounds made up of different syllable combinations such as ba-da-na. These sequences are produced with adult-like speech patterns. Your baby seems to be really talking, asking questions, making statements or demanding action. However, when you listen closely to these combinations, you will find they are mostly jargon. Sometime around the babies first birthday, the child begins to produce some true words. However, babies are very limited in the consonants and vowels they use in these first words.
18 – 36 months
Rapid Speech Development
Between 18 – 36 months children develop speech rapidly. They use a greater variety of sounds and sound combinations. When they encounter a word that is difficult to pronounce they usually simplify the pronunciation. A child might:
Leave off the final consonant of a word. Dog would be pronounced da.
Simplify the production of a consonant blend (two or more consonants in a sequence), so that plane would become pane.
Substitute one sound that is easier to make than another which is more difficult to make. For example, ring becomes wing.
Repeat one of the syllables in a word. For example water might become wa-wa.
Drop one of the syllables in a word so that telephone becomes tephone.
Apraxia of speech is a motor-speech programming disorder resulting in difficulty coordinating the oral-motor movements necessary to produce and combine speech sounds to form syllables, words, phrases and sentences.
Apraxia of speech is often treatable with the appropriate techniques. It is not just a simple articulation disorder, nor a phonological disorder but a motor-speech programming disorder. Traditional therapy as well as minimal pairs techniques are often unsuccessful.
Early signs and symptoms:
Lack of cooing or babbling as an infant, first words may not appear at all, pointing and grunting may be all that is heard.
Delayed first words with many phonemes deleted or replaced with other easier phonemes.
Lack of a significant consonant repertoire: child may only be able to use /b,m,p,t,d,h/.
All phonemes may be imitated well in isolation, but any attempts to combine phonemes are unsuccessful.
Words may be simplified by deleting consonants or vowels, and/or replacing difficult phonemes with easier ones.
A syllable is favored, and used for all words.
A word (may be real or a nonsensical utterance) is used to convey other words.
Single words may be articulated well, but attempts at further sentence length becomes unintelligible.
Oral scanning or groping may occur with attempts at speaking.
A whole phrase may be clearly said and never heard again, or cannot be imitated.
Other fine-motor problems may be present.
Verbal preservation: getting stuck on a previously uttered word, or bringing oral-motor elements from a previous word into the next word uttered.
Receptive Language Disorder
Receptive language refers to the skills involved in understanding language. Difficulties in receptive language may be present in the ability to attend, process, comprehend, retain or integrate spoken language.
Early signs and symptoms:
Inability to follow directions
Echolalia (repeating back words or phrases either immediately or at a later time.)
Inappropriate, off-target responses to WH questions
Repeating back a question first and then responding to it
Difficulty responding appropriately to:
Not attending to spoken language
Jargon (sounds like unintelligible speech)
Using memorized phrases and sentences
Expressive Language Disorder
Expressive language refers to the skills of being precise, complete and clear when expressing thoughts and feelings, answering questions, relating events, and carrying on a conversation.
Word retrieval difficulties.
Dysnomia (misnaming items)
Difficulty acquiring the rules of grammar
Difficulty in verb tense changes
Difficulty in word meaning
Milestones of Language Development At the following ages, your child should:
Listen to speech
Startle or cry at noises
0 – 3 Months:
Turn to you when you speak
Smile when spoken to
Recognize your voice and quiet down if crying
Coo and goo
Cry differently for different needs
4 – 6 months:
Respond to no
Look around for the source of a new sound
Imitate different speech sounds
7 months – 1 year:
Recognize words for common items
Begin to respond to requests (Come here)
Have one or two words
Use speech or non-crying sounds to gain attention
1 – 2 years:
Understand a variety of words and should be using a few single words.
Point to pictures in a book when named
Point to a few body parts
Follow simple commands
By age two, words should be combined into two and three-word phrases and sentences.
2 – 3 years:
Understand differences in some opposites
Follow two requests
Have a word for almost everything
Use 2 – 3 word sentences
3 – 4 years:
Answer simple who, what, where and why questions
Use sentences of 4 or more words in length
4 – 5 years:
Pay attention to a story and answer simple questions about it
Communicate easily with children and adults
Use the same grammar as the rest of the family
During speech, the air stream passes through the larynx, causing the vocal cords to vibrate. The size and shape of a persons vocal cords, along with the size and shape of the mouth influences a persons voice. There are several aspects of voice:
Quality (hoarse, weak, strident, husky or breathy)
Resonance (vibration of air in the throat and nasal cavity during speech)
The child with a voice problem should always be seen by an ear, nose and throat doctor (Otolaryngologist). Any hoarseness or vocal strain that lasts for more than two weeks should be investigated. The most common voice disorder in children is vocal nodules. These are hard calluses that develop on the vocal cords due to harmful use of the voice. Nodules cause the childs voice to be hoarse and/or sometimes weak and breathy if they are very large. Everyday misuse of the voice is a serious problem. The management of vocal nodules should always include voice therapy by a speech pathologist. Occasionally, vocal nodules require surgery.
Children seem to be most disfluent during the preschool years, particularly during the ages of 2 – 4. Generally, revisions, interjections, and word and phrase repetitions are very common in children’s speech. Sound and syllable repetition, sound prolongation, and broken words are less common. However, there is a wide range of behavior considered to be normal. Most children show each type of disfluency from time to time. This is considered to be normal disfluency.
While disfluency is common in most children, certain patterns of disfluent speech are not quite as typical. The presence of some of these behaviors may indicate that the child is having dysfluency and beginning to react to the interruptions:
Frequent sound and syllable repetition
Syllable repetition in which an uh vowel replaces the correct vowel in the word (puh-puh-peach)
Frequent prolongation of sounds that become longer in duration
Tremors (trembling of the muscles) round the mouth or jaw during speech
Rises in pitch or loudness of the voice during the prolongation of sounds
Tension and struggle behavior while saying certain words
A look of fear in the child’s face while saying a word
Avoidance of or delay in saying certain words
It is estimated that seven out of every 1,000 school-aged children have a hearing loss. These hearing losses are often mistaken for learning or behavior problems. A permanent or even temporary hearing loss can have serious effects on a child’s speech and language development.
Many parents and teachers fail to notice that a child may have difficulty hearing because they do not know what signs to look for. The following signs may indicate a hearing loss. If your child shows one or more of the following signs, seek professional help from an audiologist.
Signs which may indicate that your child is having difficulty hearing:
Unable to localize sounds or locate a person calling their name
Fails to pay attention when spoken to
Gives the wrong answers to simple questions
Frequently asks for repetition of words or sentences
Often confuses consonant sounds
Pronounces some speech sounds incorrectly
Has frequent earaches, colds, running ears, upper respiratory infections or allergies
Functions below potential in school
Has behavior problems at home and at school
Is often withdrawn and moody
Exhibits squelching (posturing and facial expressions indicating strain while listening)
Demonstrates poor responsiveness to verbal requests (especially when not face to face)
Don’t neglect the warning signs of a hearing loss. Early discovery and treatment can minimize the learning delays caused by hearing loss.
Central Auditory Processing Disorder (CAPD or APD)
In 1992, ASHA described CAPD as deficits in the information processing of audible signals NOT attributed to impaired peripheral hearing sensitivity or intellectual impairment. A CAPD occurs when the brain is not able to understand clearly, remember correctly or efficiently manage auditory information (i.e.speech). CAPD may exist as either primary or secondary disorders. CAPD may be viewed in relationship to other disorders (i.e. speech or language disorders, attention deficit disorder, dyslexia, learning disabilities, etc.) However, this does not imply that all children with these other disorders will necessarily also evidence a CAPD. There is no known cause for CAPD, however, frequent ear infections may be an underlying factor.
Deficits in central auditory processing may range from mild to severe and may involve a single skill area or a combination of skill areas. Several skill areas have been identified, and they may be known by more than one term. They include but are not limited to:
Auditory Speech Recognition/Discrimination
Auditory Closure (including phonetic synthesis and decoding)
Auditory Memory (including sequencing and organization)
Auditory Comprehension and Cohesion
If you suspect CAPD, an audiologist can evaluate children as early as age six years old. Some early signs and symptoms of CAPD are:
History of allergies, frequent colds, or ear infections
Speech/language delays or poor progress in therapy
Easily distracted by background noises
Says huh or what frequently or requires information to be repeated
Frequently repeats what was said without comprehending it (echolalia)
Appears pre-occupied or inattentive (daydreams)
Difficulty following verbal requests/directions
Slow or delayed responses to verbal requests
Repeats what is heard, and then slowly shows comprehension (re-auditorization)
Difficulty with phonics and speech sound discrimination
Difficulty with reading, spelling and/or writing
Difficulty with right/left discrimination
Limited abstract abilities (difficulty pretending)
Difficulty organizing information
Difficulty memorizing names and places
Difficulty remembering words or numbers in sequence
Exhibits a poor attention span or is easily distracted
A loner, often plays alone
Hyperactive, impulsive or hypoactive
What can be done to help children with CAPD?
Once a child has been identified to have a CAPD, the type and severity is classified. Recent research suggests that the neuroplasticity and neuromaturation of the central auditory nervous system is dependent, at least in part on stimulation. Therefore, a comprehensive approach to management of CAPD, including auditory stimulation designed to bring about functional change within the central auditory nervous system, should be undertaken in all cases of CAPD (Chermak & Musiek, 1995). According to Teri Bellis (1996), management of CAPD is children may be divided into three main categories:
1. environmental modification and teaching suggestions designed to improve the child’s access to auditory information
2. remediation techniques designed to enhance discrimination, interhemispheric transfer of information, and associated neuroauditory functions, and
3. provision of compensatory strategies designed to teach the child how to overcome residual dysfunction and maximize the use of auditory information
4. Auditory Training therapy comprises the last two management categories, or more simply stated, remediation activities and compensatory strategies that focus on improving a child’s auditory learning and listening skills. This service may be provided by an audiologist or a speech/language pathologist.