If a child is slow to learn to speak, he or she does not necessarily have a speech disorder. Most young children are able to express themselves in short phrases or sets of words by the age of 2 years. However, some take longer than others to start speaking. Each child has his or her own pace of development that should be respected, but if a child does not reach developmental milestones at the expected time, it is normal for parents to start worrying. But do you know what are the warning signs of a speech disorder? Speech therapists perform the evaluation, prevention, detection, diagnosis and indication of speech therapy for disorders of oro-facial functions such as dysphagia, communication, language, speech, voice and hearing, in premature infants, children and adults. In addition, specialization as a rehabilitation physician allows a global medical perspective, thus assessing the disability that causes any problem in communication.
Dr. Amalia Sánchez López, rehabilitation physician and speech therapist, answers one of the most frequent questions asked by parents in consultation: Why doesn’t my child speak or doesn’t speak as he/she should?
What is a speech disorder?
A speech disorder is a condition that causes problems for the person who suffers from it to create or form the speech sounds needed to develop oral language correctly and communicate with others.
The most common speech disorders are articulatory, phonological, non-fluent, or voice disorders. These are different from language disorders in children. Speech disorders and language disorders are considered two distinct categories within the so-called communication disorders.
On the other hand, language disorders refer to difficulties in getting meaning or message across to others (expressive language) and/or in understanding the message of others (receptive language). Up to 1 in 20 children have symptoms of a language disorder. Children with disorders can sometimes produce sounds and their speech can be understood.
What are the causes of speech disorders?
Defining the exact cause of a child having a problem with language skills can be difficult before the age of 3 years because, up to this point, it is not considered alarming if a child does not speak as much or as well as others.
After age 4, such difficulties may occur in children with other developmental problems, autism spectrum disorders, hearing loss and learning difficulties. Speech problems can also occur because of damage to the central nervous system, problems or changes in the structure or shape of the muscles and bones used to produce speech sounds (such as cleft palate or problems with the teeth), damage to parts of the brain, or hearing loss.
Speech disorders are different from speech delay. With the latter, the child develops speech and language in the same way as other children, but later and/or more slowly. In speech disorders, on the other hand, speech and language do not develop normally.
On the other hand, there are speech disorders related to voice disorders, caused by problems when air passes from the lungs, through the vocal cords and then through the throat, nose, mouth and lips. A voice disorder may be due to problems of the palate, conditions that damage the vocal cords, congenital anomalies, benign neoplasms (polyps, nodules, cysts, granulomas, papillomas or ulcers) or deafness.
What are the symptoms of a speech disorder?
Up to three levels of severity can be differentiated, with different symptoms, the limits of which depend largely on the age of the child:
- Mild delay: the child frequently substitutes sounds that are difficult for him/her to pronounce with sounds that are easier for him/her (e.g. “ela” instead of “grandma”). These changes are known as phonological simplification processes. Their semantic level is also slightly lower. Their comprehension and morphosyntactic development, however, are perfectly normal and, at the pragmatic level, no distortions or special difficulties are noted.
- Moderate delay: the phonological processes of simplification are more evident and numerous. The child shows an evident lack of vocabulary at the semantic level and comprehension is limited to the child’s closest and most familiar environment. At the morphosyntactic level (e.g. gender and number), a greater deficit is also evident. However, where the delay is most noticeable is in the distortion of articles, in the use of few prepositions and in the difficulty to elaborate simple sentences. The child tends to express him/herself with gestures and shows little initiative and participation in social conversations.
- Severe delay: the phonological patterns of these children are reduced to a minimal repertoire of consonants (/m/, /p/, /t/, /n/), vowels (/i/, /u/, /a/) and CV (Consonant+Vowel, e.g. /ma/) and CVCV (e.g. /mama/) word structures. Uses words that function as phrases (holophrases) and speaks telegraphically (zapato-nene). Understanding is therefore difficult without the help of a context.
How is it diagnosed?
The first people who may suspect that a child may have a speech or language disorder are usually those who have the closest relationship with the child, usually the child’s parents or preschool or elementary school teachers. Language skills are measured using assessment tools that determine the child’s ability to construct sentences and keep words in the correct order, the number of words in his vocabulary, and the quality of his spoken language. There are also a number of tests specifically designed to diagnose these cases and propose appropriate treatment to the family.