#2Speech Development

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
First Sounds
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
Vocal Play
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
Babbling
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
First Words
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.

This chart demonstrates the average ages of customary consonant articulation acquisition
This chart demonstrates the average ages of customary consonant articulation acquisition

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

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.

#5Early 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:

WH questions

yes/no questions

either/or questions

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:

Birth:

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

#44 – 6 months:

Respond to no

Look around for the source of a new sound

Babble

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

Voice Disorders

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:

#8Loudness

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.

Stuttering

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

Hearing Loss

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.

#10Signs 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 Figure-ground

Auditory Speech Recognition/Discrimination

Auditory Closure (including phonetic synthesis and decoding)

Auditory Memory (including sequencing and organization)

Auditory Integration

Auditory Attention

#9Auditory 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

Behavior problems

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.