Helping kids with delayed speech problem needs patience

Donya Betancourt, Pediatrician, drdonya@hotmail.com

Parents should be concerned if their child is not babbling by the age of 12 to 15 months, not comprehending simple commands by the age of 18 months, not talking by two years of age, not making sentences by three or is having difficulty telling a simple story by the age of four to five.

If a child's speech is largely unintelligible after three years of age or if it is more than a year late in appearance in comparison with normal patterns of speech development, parents should consider seeking professional advice.

Your physician will perform a thorough developmental history, with special attention to language milestones; this is extremely important in making the diagnosis. The medical history should include any maternal illnesses during the pregnancy, trauma, infections or asphyxia, gestational age at birth, birth weight, past health or use of ototoxic (toxic to ear) drugs. Psychosocial history, language(s) spoken to the child and family history of significant illness or speech delay are also included.

A precise measurement of the child's height, weight and head circumference is necessary. A review of the appropriate parameter on the growth chart can also help in early identification of some types of speech delay. Any abnormal features or abnormal physical findings should be noted. A complete neurological examination should be performed and should include vision and hearing evaluations.

All children with speech delay should be referred for a hearing check (audiometry), regardless of how well the child seems to hear in an office setting and whether other disabilities seem to account for the speech delay.

Special earphones that shut out background noise may improve the study result. Tympanometry (middle ear function test) is a useful diagnostic tool. Additional tests should be ordered only when they are indicated by the history or physical examination. A karyotype (chromosome study) for chromosomal abnormalities and a DNA test should be considered in children who have the phenotypic appearance of fragile X syndrome.

The management of a child with speech delay should be individualized. The health care team might include the physician, a speech-language pathologist, audiologist, psychologist, occupational therapist and a social worker. The physician should provide the team with information about the cause of the speech delay and be responsible for any medical treatment that is available to correct or minimize the handicap.

A speech-language pathologist plays an essential role in the formulation of treatment plans and target goals. The primary goal of language remediation is to teach the child strategies for comprehending spoken language and producing appropriate linguistic or communicative behavior. The speech-language pathologist can help parents learn ways of encouraging and enhancing the child's communicative skills.

Parents and caregivers who work with children with speech delay should be made aware of the need to adjust their speech to the level of the particular child. Teachers should consider the use of small group instruction for children with speech delay.

The things that a parent can do to improve their child's speech (in addition to regular speech therapy) include:

* Read to your child, especially picture books, where you can make a game of pointing and naming familiar objects.

* Use simple language when you talk to your child and ask him a lot of questions. You can also be sure you are talking to your child a lot by narrating out loud the things you are doing.

* Respond to your child's speech to give him positive reinforcement when he does talk.

* Repeat and expand on what he says by turning his single words or simple phrases into longer sentences or phrases.

* Be patient by being forgiving of errors in his speech and give him time to say what he wants to say. Don't rush him.

* Don't force him to talk by withholding something he wants until he asks for it. Instead, when he points to an object he wants, such as a cup of juice, say "Do you want some juice?" or "Oh, you want the cup," etc. and then give it to him.

Forcing him to talk, or constantly reminding him with "use your words," can lead to increased stress and frustration.