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Why is my child not talking

Why is my child not talking

Why is my child not talking?

Communication disorders are one of the most common developmental disorders in children – around 1 in 5 in preschool-aged children and 1 in 15 in school-aged children. When working with a speech pathologist or a Paediatric Occupational Therapist Sydney, the first thing we do is work out if there is a problem, then we start to work out why.

 

Sometimes we don’t know exactly why a child isn’t talking yet at two or three. It is often difficult to pinpoint an exact diagnosis during the first visit or two (or 10!) with a toddler, but there are many common communication difficulties in this age group.

 

Below is a list of the most common types of speech disorders and diagnoses associated with communication problems with a basic explanation for each one. The communication diagnosis may be just a part of a condition that affects a child’s overall developmental picture, or it could be the only issue a child faces. Many children with developmental difficulties have issues that overlap the motor, social, cognitive, and communication domains.

 

Receptive language disorder

A receptive language disorder is a difficulty understanding language. Kids who have receptive language disorders don’t follow directions – not because they’re ignoring you, but because they don’t understand what’s being said. When a kid gets a little better and understands a little more, a receptive language disorder may look like repeating a question rather than answering it or giving an incorrect response. A child who doesn’t understand much generally doesn’t talk much either. We need to work on teaching and helping a child understand before we expect them to talk. Most of the time, speech pathologists work on receptive and expressive language together.

 

Expressive language disorder

An expressive language disorder is when a child is having difficulties talking – using vocabulary, combining words into phrases, and beginning to use the early markings of grammar. An expressive language disorder isn’t difficulties saying words, but difficulties learning and retrieving new words and putting sentences together. A child may rely on non-specific words such as “that” and “there” rather than learning specific names for objects. They may also have difficulties using verb tenses such as adding the “s” on to the end of a word when there is more than one thing. Expressive language disorders can happen at the same time as difficulties with speech sounds.

 

Phonological speech sound disorder

A phonological disorder is a difficulty with the “rules” or “patterns” for combining sounds intelligibly. This is where a child may replace a sound with a different one (e.g. “tat” for “cat”). There are many patterns for analysing a child’s speech according to a phonological processes model. Phonological processes are the ways that a child will simplify a sound as they are learning it and are typical until a child reaches a certain age. After this age, if the child hasn’t learnt to change the pattern or say the sound correctly, they need support from a speech pathologist. For example, a child may use final consonant deletion (leaving the last sound off words) and this is typical until they reach 3 years old. If they continue to use final consonant deletion after this age, it would be considered “disordered” or “atypical” because their peers have learnt a more mature pattern.

 

A child with just a phonological disorder exhibits typically developing language, meaning that their vocabulary and utterance length are the same as their peers, but they continue to exhibit patterns that are consistent with a younger child’s speech errors. It can be common to have receptive/expressive language difficulties and a phonological speech sound disorder at the same time.

 

Articulation speech sound disorder

An articulation disorder is a difficulty with the production or pronunciation of speech sounds. That is, difficulty using the muscles of the mouth, teeth, jaw, lips and tongue to correctly say a sound. An example of this is a lisp – the tongue comes between the teeth and has the wrong placement when trying to say the /s/ sound. This is different to a phonological disorder because it is difficulty with a specific sound rather than a pattern.

 

Childhood apraxia of speech

Childhood apraxia of speech is a neurological speech disorder that affects a child’s ability to plan, execute, and sequence the movements of the mouth necessary for intelligible speech. Characteristics of apraxia include:

  • Limited or little babbling as an infant (void of many consonants). First words may not appear at all, pointing and “grunting” may be all that is heard
  • The child is able to open and close mouth, lick lips, protrude, retract and lateralize tongue while eating, but may not be able to when directed to do so
  • Poor ability to imitate sounds and words
  • The child substitutes and/or omits vowel and consonant sounds in words. Errors with vowel sounds are not common with other speech disorders
  • Often their errors are inconsistent, or they may be able to say a word once and then never again
  • They may use a sound (such as “da”) for everything
  • Their word attempts are “off-target” and may not be understood even by parents
  • Prosody is unusual, there is equal stress or lengthy pauses between or within syllables or words, and sometimes a monotone quality
  • Single words may be articulated well, but attempts at further sentence length become unintelligible
  • Receptive language (comprehension) appears to be better than attempts at expressive language (verbal output)
  • One syllable or word is favoured and used to convey all or many words beyond age two
  • Oral groping may occur when attempting oral motor movements or consonant/vowel production

 

Many children with apraxia also have difficulty with sensory integration, or how he processes information from all his senses including visual, auditory, tactile, and proprioceptive (or movement) skills.

 

Stuttering/dysfluency

Dysfluency is the more professional term for stuttering. It is the repetition of individual speech sounds, usually at the beginning of words or phrases. Kids who repeat individual sounds at the beginnings of words with facial grimaces or tremors, tense their muscles, blink their eyes repeatedly, or tap their feet are at greater risk for difficulty with fluency than those who repeat whole words and who don’t seem to be phased physically by this. Often there is a family history of stuttering. The Lidcombe Program is the treatment approach most supported by research evidence to treat stuttering in preschool aged children. If you’re seeking effective Autism Treatment Sydney, including support for dysfluency, our team at Chatterbox is here to help. 

 

Speech pathologists can help your child with all of these communication difficulties. The earlier your child starts paediatric speech therapy and receives support, the less long term impacts their communication difficulties will have.