Speech Delays

Overview
We eagerly await our children's first words, so it can be disappointing  -- and worrisome  -- if they're slow to come. But the good news is that most kids who seem to talk "late" catch up without any problems by the time they're around 2. About one in four children is a late talker  -- and most don't need special help to get them on track. Here's what to expect with your child's speech development, and how to tell if you need to see a specialist.

What's normal
Though speech develops pretty much the same way for all children, the pace can vary considerably from child to child. As a rule of thumb, children should be able to say one word at about 1, two-word combinations at 18 months to 2 years, and three-word sentences before turning 3. When speech specialists evaluate delayed speech, they care as much about a child's understanding as they do about how much he speaks. For instance, although a typical 18-month-old can say 50 to 100 words, he can understand far more. Making gestures and following directions indicate that your child is understanding and communicating, and there's likely little reason to worry. The American Speech-Language-Hearing Association offers a detailed chart of language development.

Reasons behind speech delays
Heredity and temperament can make for a linguistic late bloomer, as can a parent's anticipating a child's every need ("Do you want your bottle?") rather than letting her speak for herself. Some kids who tend to be late talkers include:

Boys: They often develop speech later than girls, though there's usually only about a one- to two-month lag. At 16 months, boys use an average of 30 words, while girls tend to use around 50.

Preemies: Babies born early often take longer than others to reach milestones, but by age 2 they usually catch up to their peers. Pediatricians say that when gauging a preemie's development, parents should begin counting from the child's due date, not her birth date. A child born three months early can seem like a later talker but might be progressing just fine.

Multiples: Speech pathologists estimate that as many as 50 percent of all multiples have some language delay. Prematurity, low birth weight, and medical intervention at birth  -- all of which occur more often among multiples  -- can contribute to language delays.

Children with chronic ear infections: If fluid in the ear persists for months at a time  -- especially during the first year, when a child is starting to process language  -- it can result in poor hearing, and thus delayed speech.

Kids who are focused on other skills: If a child is late to talk but her overall development is progressing on schedule, she may just be trying to perfect one skill, like walking, at the expense of speaking.

Signs your child might have a delay
Before your child reaches age 2, there's wide variation in what's considered normal. But some signs that may indicate he needs help:

At 1 year: He isn't babbling or speaking in mock sentences at all. He doesn't seem to understand or respond when you talk.

At 18 months: He hasn't said at least one word.

At 2 years: He says only a few words and communicates mostly through grunting and pointing, or he's losing language skills  -- either his vocabulary has shrunk or he no longer talks very much.

At 2 1/2 years: He's still speaking in single syllables, drops final consonants, or doesn't have a vocabulary of 50 words.

At 3 years: Strangers can't understand his pronunciation, or he speaks using only simple two-word phrases.

What to do
The best time to get professional help is when your child is around 2 1/2  -- the age when late bloomers usually catch up. Language problems are addressed with speech therapy or by treating undiagnosed ear infections or hearing problems. Your pediatrician can recommend a speech-language pathologist; the American Speech-Language-Hearing Association, in Rockville, Maryland (800-638-8255), can also provide a referral.

Before age 2 1/2, listening to your voice is a great way for your child to learn to talk, so read aloud, sing songs, and ask open-ended questions to invite conversation. Blowing bubbles can develop oral muscles, and toy phones and pretend play encourage talking.

Speech Development 

Newborn to 3 months
Babies begin to coo and gurgle at 1 to 3 months. Instead of simply being startled by sounds, babies start to respond more specifically to sounds — first by turning their heads and changing their facial expressions and then by actually cooing and gurgling. These sounds will probably be music to your ears, as well they should be. You can consider these sounds to be your child's first words to you, as simple cooing and other verbalizations represent the very beginning of language development.

3 to 6 months
Babies at this age enjoy making sounds. Not only do they like to laugh and squeal with pleasure and excitement, but they perfect their ability to gurgle, coo, and blow raspberries. Some begin to make consonant sounds (n, d, p, b), most can link sounds with the objects that made them, and by the time they reach 6 months of age, they often start to actually imitate sounds.

6 to 9 months
Babies will babble at this age. During these months, most babies start to vocalize a lot more in ways other than crying, not the least of which is laughing more frequently. You're also likely to notice a progression in your baby's talking abilities — from making four different consonant sounds or stringing together chains of vowel-consonant sounds to combining syllables into word-like utterances and shouting to attract attention.

9 to 12 months
Babies will say their first words during this time. At 9 months, infants are often fairly talented at multi-syllable babbling and imitating sounds. Over the subsequent months, you may find that your baby starts to imitate the tone and inflection in your voice as well and may even say his first word.

Words such as "mama" and "dada" clearly have meaning to infants at this age, and some will even say them by the time they turn 1. ("Dada" is much more common than "mama," not as a reflection of a baby's preference, but because "da" is a much easier sound to make than "ma.")

Also at this age babies develop improved nonverbal communication skills. This is a fun age, where many babies not only start to communicate verbally, but clearly seem to understand more and interact more. They typically learn to point in response to simple questions such as "Where's the ball?" or "Where's Mommy?" and to wave good-bye.

12 to 18 months
Kids this age will continue to improve their communication skills. By 12 to 15 months, the average child says two or more words besides "dada" and "mama." Some 18-month-olds will even begin to put two words together, although this is considered to be a 2-year-old accomplishment.

In addition to talking, most toddlers at this age can imitate animal sounds, recognize objects by name, and follow commands. You're likely to find that this newly developed ability to follow directions is particularly endearing when your toddler begins to give a hug or kiss when asked.

While your toddler is probably making great strides in communicating at this age, it helps to be aware that toddlers at this age can become very frustrated because they can understand a lot more than they can say.

18 to 24 months
Toddlers at this age will greatly increase their vocabulary and ability to understand. The average toddler toward the end of the second year can say 30 to 50 words and make two-word sentences. Even more impressive is their ability to understand and follow simple commands.

2 years
Two-year-olds talk in sentences. While the typical 2-year-old has a vocabulary of 30-50 words and can put two words together, another year of language development usually brings the ability to make three-word sentences and communicate more effectively.

Not only do children start to use pronouns such as I, me, you, and we, but they also start to use them to express emotions (in ways other than through tantrums!).

Two-year-olds also learn to name and categorize. They commonly learn the names of five or more body parts and are able to recite their own names (first and last) by the time they reach their third birthday. Sorting objects according to category and understanding descriptive categories like "big" and "little" or "soft" and "hard" are also typical accomplishments at this age.

By the time a child is 3 years old, grown-ups should be able to understand at least 75 percent of what he says.

3 years
Three-year-olds have greatly expanded language skills. During this year, you're likely to notice that the length of your child's sentences increases from around three words at her third birthday to five (or more) by her fourth. By this time, most children have also become fully understandable.

As your child masters the use of pronouns (I, me, you, we, etc.) during the upcoming months, be forewarned that you're also likely to find that she has entered a new stage of development that includes asking a whole lot of questions.

4 years
Four-year-olds make good use of their language skills. During this year, you're likely to notice that your child masters language well enough to put sentences together into full stories and just generally talk your ear off.

5 years
Five-year-olds can understand harder concepts and begin to increase their vocabulary. They typically can understand and apply concepts such as "under," "over," "because," "why," "before," and "after." They often have vocabularies of more than 2,000 words.

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 If your child has been diagnosed with a learning disability, you may immediately begin thinking about school — homework, tests, projects — and wondering how your kid will get through. How can you make sure your child has the best chance to reach his or her full potential? If you slow down for a moment, you may realize that while academic success is important, what you really want for your child is a happy and fulfilling life. Your influence on your child outweighs that of any teacher, tutor, therapist or counselor. If your child has a learning disability, your love, encouragement, and support can make all the difference, helping him or her emerge with a strong sense of self-confidence and the determination to succeed.

What Are Learning Disabilities?
Interestingly, there is no clear and widely accepted definition of "learning disabilities." Because of the multidisciplinary nature of the field, there is ongoing debate on the issue of definition, and there are currently at least 12 definitions that appear in the professional literature. These disparate definitions do agree on certain factors:

1. The learning disabled have difficulties with academic achievement and progress. Discrepancies exist between a person's potential for learning and what he actually learns.
   
2. The learning disabled show an uneven pattern of development (language development, physical development, academic development and/or perceptual development).
   
3. Learning problems are not due to environmental disadvantage.
   
4. Learning problems are not due to mental retardation or emotional disturbance.

How prevalent are learning disabilities?
Experts estimate that 6 to 10 percent of the school-aged population in the United States is learning disabled. Nearly 40 percent of the children enrolled in the nation's special education classes suffer from a learning disability. The Foundation for Children With Learning Disabilities estimates that there are 6 million adults with learning disabilities as well.

What causes learning disabilities?
Little is currently known about the causes of learning disabilities. However, some general observations can be made:

• Some children develop and mature at a slower rate than others in the same age group.
  
• As a result, they may not be able to do the expected school work. This kind of learning disability is called "maturational lag."
  
• Some children with normal vision and hearing may misinterpret everyday sights and sounds because of some unexplained disorder of the nervous system.
  Injuries before birth or in early childhood probably account for some later learning problems.
  
• Children born prematurely and children who had medical problems soon after birth sometimes have learning disabilities.
  
• Learning disabilities tend to run in families, so some learning disabilities may be inherited.
  
• Learning disabilities are more common in boys than girls, possibly because boys tend to mature more slowly.
  
• Some learning disabilities appear to be linked to the irregular spelling, pronunciation, and structure of the English language. The incidence of learning disabilities is lower in
  
• Spanish or Italian speaking countries.
  

What are the "early warning signs" of learning disabilities?
Children with learning disabilities exhibit a wide range of symptoms. These include problems with reading, mathematics, comprehension, writing, spoken language, or reasoning abilities. Hyperactivity, inattention and perceptual coordination may also be associated with learning disabilities but are not learning disabilities themselves. The primary characteristic of a learning disability is a significant difference between a child's achievement in some areas and his or her overall intelligence. Learning disabilities typically affect five general areas:

1. Spoken language: delays, disorders, and deviations in listening and speaking.
   
2. Written language: difficulties with reading, writing and spelling.
   
3. Arithmetic: difficulty in performing arithmetic operations or in understanding basic concepts.
   
4. Reasoning: difficulty in organizing and integrating thoughts.
   
5. Memory: difficulty in remembering information and instructions. 

Among the symptoms commonly related to learning disabilities are:

• poor performance on group tests
• difficulty discriminating size, shape, color
• difficulty with temporal (time) concepts
• distorted concept of body image
• reversals in writing and reading
• general awkwardness
• poor visual-motor coordination
• hyperactivity
• difficulty copying accurately from a model
• slowness in completing work
• poor organizational skills
• easily confused by instructions
• difficulty with abstract reasoning and/or problem solving
• disorganized thinking
• often obsesses on one topic or idea
• poor short-term or long-term memory
• impulsive behavior; lack of reflective thought prior to action
• low tolerance for frustration
• excessive movement during sleep
• poor peer relationships
• overly excitable during group play
• poor social judgment
• inappropriate, unselective, and often excessive display of affection
• lags in developmental milestones (e.g. motor, language)
• behavior often inappropriate for situation
• failure to see consequences for his actions
• overly gullible; easily led by peers
• excessive variation in mood and responsiveness
• poor adjustment to environmental changes
• overly distractible; difficulty concentrating
• difficulty making decisions
• lack of hand preference or mixed dominance
• difficulty with tasks requiring sequencing

When considering these symptoms, it is important to remain mindful of the following:

• No one will have all these symptoms.
  
• Among LD populations, some symptoms are more common than others.
  
• All people have at least two or three of these problems to some degree.
  
• The number of symptoms seen in a particular child does not give an indication as whether the disability is mild or severe. It is important to consider if the behaviors are chronic and appear in clusters.

What should a parent do if it is suspected that a child has a learning disability?
The parent should contact the child's school and arrange for testing and evaluation. Federal law requires that public school districts provide special education and related services to children who need them. If these tests indicate that the child requires special educational services, the school evaluation team (planning and placement team) will meet to develop an individual educational plan (IEP) geared to the child's needs. The IEP describes in detail an educational plan designed to remediate and compensate for the child's difficulties.

Simultaneously, the parent should take the child to the family pediatrician for a complete physical examination. The child should be examined for correctable problems (e.g. poor vision or hearing loss) that may cause difficulty in school.

How does a learning disability affect the parents of the child?
Research indicates that parental reaction to the diagnosis of learning disability is more pronounced than in any other area of exceptionality. Consider: if a child is severely retarded or physically handicapped, the parent becomes aware of the problem in the first few weeks of the child's life. However, the pre-school development of the learning disabled child is often uneventful and the parent does not suspect that a problem exists. When informed of the problem by elementary school personnel, a parent's first reaction is generally to deny the existence of a disability. This denial is, of course, unproductive. The father tends to remain in this stage for a prolonged period because he is not exposed to the child's day-to-day frustrations and failures.

Research conducted by Eleanor Whitehead suggests that the parent of an LD child goes through a series of emotions before truly accepting the child and his problem. These "stages" are totally unpredictable. A parent may move from stage-to-stage in random. Some parents skip over stages while others remain in one stage for an extended period. These stages are as follows:

DENIAL: "There is really nothing wrong!" "That's the way I was as a child--not to worry!" "He'll grow out of it!"
BLAME: "You baby him!" "You expect too much of him." "It's not from my side of the family."
FEAR: "Maybe they're not telling me the real problem!" "Is it worse than they say?" "Will he ever marry? go to college? graduate?"
ENVY: "Why can't he be like his sister or his cousins?"
MOURNING: "He could have been such a success, if not for the learning disability!"
BARGAINING: "Wait 'till next year!" "Maybe the problem will improve if we move! (or he goes to camp, etc.)."
ANGER: "The teachers don't know anything." "I hate this neighborhood, this school...this teacher."
GUILT: "My mother was right; I should have used cloth diapers when he was a baby." "I shouldn't have worked during his first year." "I am being punished for something and my child is suffering as a result."
ISOLATION: "Nobody else knows or cares about my child." "You and I against the world. No one else understands."
FLIGHT: "Let's try this new therapy--Donahue says it works!" "We are going to go from clinic to clinic until somebody tells me what I want to hear.!"

Again, the pattern of these reactions is totally unpredictable. This situation is worsened by the fact that frequently the mother and father may be involved in different and conflicting stages at the same time (e.g., blame vs. denial; anger vs. guilt). This can make communication very difficult.

The good news is that with proper help, most LD children can make excellent progress. There are many successful adults such as attorneys, business executives, physicians, teachers, etc. who had learning disabilities but overcame them and became successful. Now with special education and many special materials, LD children can be helped early.

Pointers for parents of children with learning disabilities:

1. Take the time to listen to your children as much as you can (really try to get their "Message").
2. Love them by touching them, hugging them, tickling them, wrestling with them (they need lots of physical contact).
   
3. Look for and encourage their strengths, interests, and abilities. Help them to use these as compensations for any limitations or disabilities.
   
4. Reward them with praise, good words, smiles, and pat on the back as often as you can.
   
5. Accept them for what they are and for their human potential for growth and development.
   
6. Be realistic in your expectations and demands.
   
7. Involve them in establishing rules and regulations, schedules, and family activities.
   
8. Tell them when they misbehave and explain how you feel about their behavior; then have them propose other more acceptable ways of behaving.
   
9. Help them to correct their errors and mistakes by showing or demonstrating what they should do.
   
10. Don't nag!
    
11. Give them reasonable chores and a regular family work responsibility whenever possible.
    
12. Give them an allowance as early as possible and then help them plan to spend within it.
    
13. Provide toys, games, motor activities and opportunities that will stimulate them in their development.
    
14. Read enjoyable stories to them and with them. Encourage them to ask questions, discuss stories, tell the story, and to reread stories.
    
15. Further their ability to concentrate by reducing distracting aspects of their environment as much as possible (provide them with a place to work, study and play).
    
16. Don't get hung up on traditional school grades! It is important that they progress at their own rates and be rewarded for doing so.
    
17. Take them to libraries and encourage them to select and check out books of interest.
    
18. Have them share their books with you.
    
19. Provide stimulating books and reading material around the house.
    
20. Help them to develop self-esteem and to compete with self rather than with others.
    
21. Insist that they cooperate socially by playing, helping, and serving others in the family and the community.
    
22. Serve as a model to them by reading and discussing material of personal interest. Share with them some of the things you are reading and doing.
    
23. Don't hesitate to consult with teachers or other specialists whenever you feel it to be necessary in order to better understand what might be done to help your child learn.
    

The Survival Guide for Kids with LD*: *(Learning Differences)
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