learning to talk

by Fiona Marshall

learning to talk | help and info

Learning to speak is a natural process, which follows a certain pattern. But, around 14-20% of pre-school children, and 5% of school-age children have problems with language – though usually these are temporary and nothing to worry about.

© Getty

putting it into words

'It is terribly important that children feel they're understood,' says Jayne Comins, speech and language therapist at the Queen Elizabeth hospital and the Wellington hospital, London. 'If they feel that parents and others are focussing not on what they say, but how they say it, they may come to feel they're being attacked for expressing their feelings and thoughts, which can have negative emotional consequences.'

Normal speech development covers a wide range of styles. Some children speak clearly but say very little; others chatter away but in a language which others may find hard to understand. In general, if your two-year-old child understands what is said to her, uses gestures and facial expressions to communicate, and uses some words, she's well on track.

what to look out for

You can assess how well your child speaks in a number of ways, says Jayne Comins.

• speech – sounds made and their clarity
• language – sentences and understanding of language
• fluency – whether your child speaks easily or has a tendency to stammer
• language – how wide her vocabulary is
• articulation – how clear her pronunciation is
• voice – whether she speaks easily or has to force her voice or shout
• comprehension – how well she understands.

type of problems

'Children are constantly experimenting with sounds and languages which means making errors, and indeed they need to do so in order to work out how to use words properly,' says Jayne Comins.

Most children do grow out of initial speech problems but parents tend to have a good instinct when something isn't right, so contact your health visitor or GP if you have concerns about your child's speech and keep in contact with them. Your health visitor will also check your child's hearing at different stages, and any concerns with this will be followed up with a referral to a specialist service.

watch for:

• Delayed language development. Your child speaks later or uses fewer words than expected. Don't worry, a number of studies have shown that children who learn no language at all in their early years can still learn it perfectly well later. However if your 18-month-old has fewer than 10 words or appears not to understand simple commands, such as 'bring me teddy', contact your health visitor or GP and ask for a referral to a speech and language therapist.
• Difficult-to-understand speech, for example a lisp. This is when a child has problems pronouncing sounds or words (delayed phonological development). Some children have trouble with sounds such as S, R and SH, which are among the last to be learned. 'The organisation of these sounds is quite sophisticated as they are made with the groove of the tongue and many adults cannot pronounce their Rs and Ss properly,' says Jayne Comins. Referral to a speech and language therapist can help but often it's a question of allowing your child time to develop the muscles they use for speech.
• Stammering or stuttering. Stammering is normal between two and five. It is four times more common in boys than girls and often runs in families. Usually they just cannot match their words to their fast-moving brains and think quicker than they can talk. Your child may repeat words or phrases or use lots of 'ums' and 'ers'. Children usually grow out of it but you may want to seek help for them sooner from a speech and language therapist. For more on stammering, check out the help for stammerers feature.
• Playground /screamers voice. When your child speaks or shouts with a hoarse or breathy voice. This is not usually something to worry about unless it becomes a prolonged problem when there is a risk of the screaming damaging the throat. If you're concerned talk to your health visitor or GP.
• Baby talk. Your child regresses and starts to use baby talk – quite common when there's a new baby in the family
• Accent. Children may imitate a friend's speech mannerisms or accent.

why does it happen?

'It can sometimes be hard to establish an exact cause for variations in speech,' says Jayne Comins. 'It may be emotional, linked with physical disability, or just due to normal delay, which simply means that some children naturally develop later than others.'

• Genetic. Some children inherit a tendency to later maturation of the speech-processing parts in the left hemisphere of the brain.
• Social/environmental. Children whose parents talk and listen to them tend to have more advanced speech.
• Emotional trauma. Stress at home, nursery or school may affect your child's speech.
• Neurological. Occasionally late development may be related to a neurological disorder such as autism, or to specific brain damage.
• Deafness. Repeated ear infections can cause glue ear – a build-up of mucus that blocks hearing. If your baby suddenly stops babbling at around seven to nine months, ask for his hearing to be checked.
• Dyspraxia. This is when a child is disorganised in her speech. This may go with the 'clumsy child' syndrome in which the child also has difficulty organising motor movements.
• Playground voice is due to enlarged or roughened vocal chords caused by constant shouting. This happens in a noisy family where the child literally has to shout to be heard.
• A child may speak late because she is focussing on some other aspect of her development – for example a child absorbed in motor development may spend all day running and climbing.

early checks

Routine developmental checks as a toddler, may pick up or help prevent early speech problems.

Developmental reviews are carried out at different stages by different health authorities, but guidelines suggest that one takes place around 18 months, and another between three to four years.

Your health visitor can use these reviews to assess your child's emerging speech – its clarity, how well she understands language, the range of her vocabulary, and the complexity of her sentences. Tell her if you have any concerns.

where to get help

'Apparent speech problems can cause distress, so do consult someone you trust, such as the practice nurse or nursery nurse teacher, to chat things over and find out what the local services offer,' says Jayne Comins.

Your health visitor or GP may refer you to a speech and language therapist, or you can contact a speech therapist directly at your local health centre or hospital. Speech and language therapy is available on the NHS, though you may have to wait several weeks; or you can arrange private treatment.

With your help, the therapist can assess your child's fluency in the context of her general health and development. As well as speaking and listening with your child, she may also look at other aspects of your child's communication, such as how she interacts and plays with others. She may then suggest ways you can help at home.

what parents can do

• Talk to your child when you are playing together.
• Enjoy songs and nursery rhymes together, especially those with actions.
• Gain your child's attention when you want to talk together.
• Listen to her carefully and give her time to finish. Take turns to speak and encourage other members of the family to take turns too.
• Slow down your own rate of talking.
• Talk about things as they happen, for example as you run the bath or unpack the shopping.
• Increase her vocabulary by giving choices, for example, 'would you like orange or blackcurrant to drink'?

mutism

Selective mutism, which affects one per cent of children, is when a child can speak but does not do so in certain circumstances. For a real life story, see the Rose family box below.

'Mutism frequently happens at school after a traumatic start, and in children who have had little previous separation from their mothers,' says Maggie Johnson, speech and language therapist based in East Kent specialising in childhood communication disorders. 'Usually the child can speak at home and sometimes in other selected situations, but not at school or where she feels threatened or overwhelmed.'

Mutism is thought to be a form of extreme anxiety. It is most common in the first two years of school and more common among girls than boys. It's rare after that age, although in some cases it can persist – among older children the rate drops to around one in 1,000. There is much to be said for accepting the problem, along with the child's nonverbal efforts at communication. In older children, or where the problem is more persistent, some types of behavioural therapy may reduce the child's anxiety about speaking.

• Stimulus fading, which involves the child in a relaxed situation with someone they talk to freely, and then very gradually sliding a new person into the room.
• Shaping, where a helper (speech therapist or another adult) gradually reduces the anxiety associated with speech by encouraging your child to work through a number of challenges. She may then start to communicate using gestures, mouthing or whispering until finally speaking aloud.
• Anti-depressants – selective serotonin re-uptake inhibitors (SSRIs) including Prozac may help some children, particularly when associated with a behavioural programme. However, they're rarely used for this in the UK.

See help and info for more details of the support and treatments available for this condition.

(April 2002)

Read on for details of relevant organisations, websites and reading.