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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

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.”


What To Expect From Speech Therapy

If parents are worried that their child is not speaking as he or she should, the first step is to obtain a referral from their pediatrician or family practitioner for a speech therapist—specifically one trained in pediatrics and appropriate for the age of the child. Some therapists specialize in older children and others specialize in younger children and infants. And no time is too early. “If a family has a concern about speech, then early intervention results in a better prognosis,” says Stewart. “And it doesn’t have to be intrusive.”

A speech therapist will conduct an evaluation to help identify the cause of the speech delay. If autism or other disorders are suspected, the therapist may refer the family to a developmental pediatrician. The therapist will also work closely with the family as practice at home and parental involvement are key in helping children with speech. “It’s all based in play,” says Stewart. “I get parents involved and play with children, and give them ideas to elicit speech…and build language and vocabulary comprehension. I tell families, ‘Make it part of everyday.’”

With Zeke, Stewart suggested that Tillman continue to work at home on Zeke’s focus and listening skills, through repetition and routine. Tillman put together a book of family photos and sat with Zeke to look at and identify the people in the photos. And she’s continued to work on enunciating words clearly and putting actions to words, especially during playtime (for example, “The truck goes vroom, vroom”), to engage with him and encourage communication overall.

And Tillman has seen results. Zeke’s attention span and his ability to speak in short sentences is much improved, she says. “His development in speech overall as far as clarity and actually being able to understand him is better, and he’s building his vocabulary more,” says Tillman. “And instead of saying just, ‘Mama,’ and pointing or dragging me somewhere, he’ll actually say what he wants.”

Tillman encourages other parents not to wait if they think there’s an issue with their child’s speech. “Don’t be in denial and don’t be afraid. Be encouraged that it’s O.K. for your child to go to speech therapy,” she says. “Don’t think they will outgrow it because you never know. I would hate for my child or anyone’s child not to be where they could be when they could have gotten help in the beginning. If you think your child isn’t hearing properly or their speech seems a little delayed, don’t make excuses, but take those steps to have your child evaluated.”

Danielle Wong Moores is an Augusta freelance writer.

When To Seek Help
Stewart bases her therapy on the practices of the Hanen Centre, which focuses on parental involvement to promote speech development. They recommend that you seek the advice of a speech language professional if your child:

By 12 Months
• Doesn’t babble with changes in tone (e.g. dadadadadadadadada).
• Doesn’t use gestures like waving “bye bye” or shaking head for “no.”
• Doesn’t respond to her/his name.
• Doesn’t communicate in some way when s/he needs help with something.

By 15 Months
• Doesn’t understand and respond to words like “no” and “up.”
• Says no words.
• Doesn’t point to objects or pictures when asked, “Where’s the...?”
• Doesn’t point to things of interest as if to say “Look at that!” and then look right at you.

By 18 Months
• Doesn’t understand simple commands like, “Don’t touch.”
• Isn’t using at least 20 single words like “Mommy” or “up.”
• Doesn’t respond with a word or gesture to a question such as “What’s that? or “Where’s your shoe?”
• Can’t point to two or three major body parts such as head, nose, eyes, feet.

By 24 Months
• Says fewer than 100 words.
• Isn’t consistently joining two words together like “Daddy go” or “ shoes on.”
• Doesn’t imitate actions or words.
• Doesn’t pretend with toys, such as feeding doll or making toy man drive toy car.

By 30 Months
• Says fewer than 300 words.
• Isn’t using action words like “run”, “eat”, “fall.”
• Isn’t using some adult grammar, such as “two babies” and “doggie sleeping.”

3-4 Years
• Doesn’t ask questions by 3 years.
• Isn’t using sentences (e.g., “I don’t want that” or “My truck is broken”)  by three years.
• Isn’t able to tell a simple story by four or five years.

Source: The Hanen Centre

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