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It’s Just a Little Lisp... Or Is It Time for Speech Therapy?

Speech pathologist Terri Stewart uses sign language, play and other tactics when working with Zeke Tillman, 2, and his mother Tonya.

Speech pathologist Terri Stewart uses sign language, play and other tactics when working with Zeke Tillman, 2, and his mother Tonya.

Photo Courtesy of Danielle Wong Moores

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Which one is the boat, Zeke? Can you show Mommy the boat?”

As speech pathologist Terri Stewart gestures in sign language and shows him the illustrated puzzle pieces, 2-year-old Zeke points to the boat, then grabs a set of plastic keys. “Whose keys are those? Are those Eden’s keys?” prompts Stewart, referring to Zeke’s younger sister. “My keys!” he responds with a grin.

While it may seem like play, Stewart, CCP/SLP, a senior speech pathologist at Georgia Health Sciences Children’s Medical Center, is actually working on Zeke’s speech, by using tactics like speaking to him face-to-face at his eye level, repetition and sign language.

By the time children reach first grade, roughly five percent have a noticeable speech disorder, according to the National Institutes of Health. But in order for children to become fully competent in speech, development of language skills needs to occur well before school age—in fact, the first six months of life are considered the most crucial.

Zeke’s mom, Tonya Tillman, noticed a problem early on when Zeke didn’t seem to be reaching the same speech milestones as other children his age. “Four of us at work had babies about the same time,” says Tillman. “And they were coming into work and saying, ‘Kayla said, Hey, Mommy,’ and other short sentences, and Zeke wasn’t. Their kids were talking, and you don’t want to compare kids or measure kids to each other, but I also didn’t want him to be behind. It just really struck home, when I heard other people talking about their kids.”

According to Stewart, it’s not uncommon for her to treat children as young as Zeke, or even younger, especially if there are underlying causes for speech conditions such as hearing loss or cleft palate. And there are certainly red flags that parents should be aware of that may indicate speech therapy may be needed:

• 0 to 1 year: If children do not appear to be hearing sounds or are very quiet.
• 1 year: If children are not babbling sounds or speaking words.
• 18 months: If children are not speaking in short sentences or naming objects.
• 2 years: If children do not have a vocabulary of around 50 words or if they seem frustrated because they can’t communicate.

“Parents worry when children don’t talk,” says Stewart. “Often speech therapy can assure them that their child may just be a later or slow talker and give them that peace of mind. And if there is a speech delay, we can provide guidance on what to do.”

Causes of Speech Delay

When a child has a speech delay, the first thing many parents worry about is autism. While delayed speech is a sign of autism, there are other symptoms too—including lack of interaction and poor social skills, repetitive behaviors and sensitivity to light, sound and touch. “Pediatric speech pathologists are trained to look for signs of autism,” says Stewart. “If we do feel there is a problem, we refer parents on.”

However, in children with no other health problems (for example, mental retardation or hearing loss), autism is actually not the most common cause of speech delay, according to the American Academy of Family Physicians. A simple maturation delay—being a slow talker—is very common. This delay happens more in boys than girls and can be hereditary. Yet these children have often caught up by the time they reach school age and go on to have no further language difficulty.

Apraxia and aphasia are two developmental disorders that can also cause speech delays, and specific interventions are necessary in these cases. It is sometimes difficult to distinguish between a maturation delay and apraxia or aphasia at an early age.

What Can Parents Do?

According to Stewart, there are a number of simple things that parents can do starting in infancy to help their child reach appropriate speech milestones.
Turn off the TV. Studies have shown that children benefit more from 15 minutes of one-on-one time with parents than an hour of the latest DVD to help babies learn to read. “I have to get on my soapbox here,” says Stewart. “Children don’t learn from TV.” While TV engages children’s visual and auditory senses, it doesn’t engage their language skills. One-on-one interaction, with parents speaking to and engaging with children face to face, is the single most important thing parents can do to help build language and speech.

Studies have shown that children benefit more from 15 minutes of one-on-one time with parents than an hour of the latest DVD to help babies learn to read.

Speak. Then repeat. Repetition helps build your child’s vocabulary. It’s a form of baby talk in a way—“Is that a dog? Do you like that dog? It’s a pretty dog”—but is grammatically correct, repetitive and spoken slowly and clearly to ensure that children can hear and understand all the sounds.
Sign for success. “Sign language is very beneficial to learning to speak,” says Stewart. In using baby sign language—whether learned from a structured class, online or developing your own signs—parents spur intellectual stimulation, helping children learn how to communicate, which aids in language development.

The most important component, however, is interaction and keeping the environment conducive to interaction and speech, says Stewart. “We know that’s what seems to make the difference—interaction—especially face-to-face interaction.”

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