When our children are born we see them as perfect little beings. The doctor’s count their fingers and toes, check their hearing and sight, and hopefully hand us healthy babies. After that, for most parents checking their child’s milestones at home is just a formality; something to mark down in their baby books. It is typically not something that should cause anxiety or worry. However, what happens if those milestones are not being met? That is when anxiety starts to creep into your mind and you wonder “Is there something wrong with my child?”
This happened to me with my first born. He was a healthy baby boy – responsive, adorable, and had an impressive 9:9 Apgar score. Despite this I started to have anxiety that something was not quite right. I would check his milestones and he seemed behind based on the baby book charts but right when he would be officially late he would amaze me with his new skill. This happened for everything – raising his head, sitting up, crawling, and walking. Then when it came to for him to talk he passed the late end of the scale and officially entered the delayed zone.
At 2.5 years old I spoke to my pediatrician about the delay and she suggested getting an assessment by a speech therapist. She knew I had been worried for a while – I had noticed a slight delay at 15 months (yes I was that Mom) but she said “Don’t worry he’s a boy, it is normal.” I mentioned it again at 18 months, and at 2 years but she was not concerned until now. Let me say here that I had a really good pediatrician and I do not blame her for not sending us for a consultation earlier. Josh was so responsive with her I understand why she was not worried. However, I wish I had followed my instincts and had him evaluated. Early intervention is a lot easier to get prior to the age of 3 so if you are reading this and you are worried it does not hurt to get an evaluation. It will give you peace of mind and if nothing is wrong – great – if there is a delay you have caught it early and increased your child’s chance of a good outcome.
Although I had done a lot of research on what was normal I did not really understand the complexity of speech issues. Once I realized my son actually had a speech disorder I learned so much more so I thought I would share some of the information and resources that I found to be helpful. Please remember I am not a speech therapist – I am just a Mom who has learned a bit along the way. Please consult a speech therapist for more specifics but maybe this information will help you formulate the questions you want to ask them.
There are three basic categories of speech and language related issues:
Speech, Language, and Oral Motor Feeding Disorders.
Speech disorders can be broken down into four basic categories: articulation, phonological, oral motor, and fluency.
· Articulation: with articulation disorders people have difficulty making specific sounds beyond the expected age of development. For example a child might have difficulty closing their lips to make early developing sounds like p/b/or m. There is a good list of age specific sound development on talkingchild.com. Click hereto see the list.
· Phonological: with phonological disorders people have sound errors with specific patterns (for example, a child may produce all “back” sounds /k/ and /g/ as “front” sounds /t/ and /d/).
· Oral Motor: with oral motor speech disorders like children have difficulty coordinating the movements of speech to produce sounds, syllables, and words. The two main types are Apraxia and Dysarthria. When a person is Apraxic the difficulties are typically caused by motor planning and coordination deficits in the brain- not muscle weakness or paralysis. Whereas Dysarthria is typically a reduced ability to motor plan volitional movements needed for speech production as the result of weakness/paresis and/or paralysis of the musculature of the oral mechanism.
· Fluency/Stuttering: Fluency or stuttering issues are typically disorders caused by disruptions of speech production. Characteristics of a fluency disorder include word repetitions, prolongations of sounds and/or words, and at times, a complete “block” of speech.
Language disorders can be broken down into three basic categories: Expressive, Receptive, or Pragmatic.
What is language? Language is a set of rules shared within a society that may include word meaning, word endings (plurals, past tense, adverbs), sentence formation, and symbols. Language disorders can be considered expressive, receptive, or both.
· Expressive: An expressive language disorder is an issue when a person has difficulty expressing (speaking) wants and thoughts. Children with expressive language disorders often use pointing or gestures to communicate. While learning verbal communication it is helpful to teach them to use tools like sign language, picture symbols, or augmentative communication to reduce frustration.
· Receptive:A receptive language disorder is an issue when an individual has difficulty comprehending directions, age appropriate concepts, and the written/ spoken rules of language. Basically they are not receiving the information correctly.
· Pragmatic/ social skills: A pragmatic/social skills language disorder is an issue when there is a delay in a person’s ability to communicate with others in an age appropriate manner. Children suffering from this disorder often display characteristics like poor eye contact, poor topic initiation and maintenance, decreased awareness of emotion and non-verbal cues, and poor awareness of personal space.
Oral Motor & Feeding: These issues are classified as a disorder when there are any issues with eating and/or drinking that could lead to the inability to thrive, poor nutrition, aspiration (when food or drink enters the airway), and decreased social participation and/or acceptance during mealtime. Some symptoms of an oral motor or feeding disorder are coughing, choking, or gagging during meals, poor weight gain, history of traumatic oral experiences (choking or surgery), poor transition to age appropriate food, aversion of specific textures, tastes, and/or temperatures, and crying or turning away during feedings. Sometimes oral motor & feeding disorders are present with other speech issues like Apraxia which is an oral motor speech disorder.
The bottom line is knowledge is power. When you child is born they depend on you for everything – including having the information to help them is they are struggling with their speech. If you understand the various types of speech issues out there you can better advocate for your child. No one knows your child better than you do. They might know more about speech therapy but you are spending your time with your child every day. If you see something that seems quirky mention it to your doctor or therapist. It might mean something to them even if it just seems a little odd to you. They can help you help your child more effectively if you have the information you need to describe what you are seeing. I hope this was helpful. If you have any questions or need resources please email me at firstname.lastname@example.org.
Written by Alycia Shapiro