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Children’s Speech: When Should a Parent be Concerned? – Part 1

By Pam Gentry

Angela is a talkative seven-year-old with an endearing lisp. Even though her permanent front teeth have grown in, Angela still pronounces some words like she did when her baby teeth fell out. Her mother wonders if she should be concerned.

Five-year-old Robert likes to talk a lot, too, but he is hard to understand.  Family members usually understand his unique pronunciation of words, but people who don’t know him well are often uncertain about what he is saying. This is frustrating to him. He is frustrated by school, too. He wants to learn to read, but he can’t remember which letter makes which sound.

Stephen’s parents have noticed that sometimes he has a hard time getting his words out. For weeks at a time his speech will seem normal, and then he begins “tripping” on words. His parents want to know if this is stuttering.

In home countries, there are many resources to which parents could turn. But what can a parent do whose family is living in an isolated location? With some patience, an informed parent can do a lot.  

The types of speech problems most likely encountered by field teams do not require the attention of a specialist. Even parents of children with cerebral palsy or cleft palate can carry out a program of therapy detailed by a cooperating speech therapist.

What qualifies as a speech problem?

If a child is frustrated in his oral communication, if he is difficult to understand, or if his speech is the object of amusement for others, he probably would benefit from remediation.  

What specifically should I look for in my child’s language and speech development?

Language

Most child development books outline the milestones of language acquisition. If your child is unusually delayed according to those norms, you should speak to your doctor.  

It is important to remember, however, that language acquisition is hard work, even for a child. Many young children have a period of rapid physical development accompanied by little growth in the area of language, or vice versa. In most children, the overall development eventually evens out. In addition, parents of children who are growing up in a multi-lingual environment should remember that "mixing" of the languages is a very normal part of language development. Children growing up in a multi-lingual or bilingual environment are learning when to use each language at the same time that they are learning the content of the language. Eventually their brains will sort things out.

Occasionally a baby who is otherwise developing normally stops babbling and experimenting with sound. This is a warning of possible ear infection which could result in hearing loss. The child should be examined by a doctor.

Fluency

Speech fluency is easily monitored by the parent. Most children go through a normal period of dysfluency between the ages of three and six. Many stuttering problems begin at this time when an anxious parent draws attention to the dysfluencies and interrupts the child’s attempts at communication. The best approach to a stuttering problems is patience, acceptance, and an attentive ear. If the dysfluencies become a noticeable problem (using the definition of a speech problem stated earlier), then additional help may be warranted.

Pronunciation (Articulation)

The most common speech deviation that parents notice is pronunciation. When listening to your child’s pronunciation, note:

• the sounds he has problems with (i.e., sounds made with the lips, teeth, tongue, etc.)
• the position of those sounds in a word (initial, medial, or final)
• the frequency/consistency of misarticulation.  

These observations can help you determine the severity of your child’s speech problem and whether he is developmentally delayed in this area. Sounds which are made toward the front of the mouth (such as m, n, p, b, t, d) are the easiest to make. They are usually acquired first. Sounds requiring special placement of the tongue (l, r, s, voiced th) are the most difficult.  

Usually, sounds in the initial position of words are the easiest, followed by sounds in the final position. Consonants which appear in the middle of words are the most difficult. Any sound which occurs in a “blend” is particularly difficult to pronounce.

Consistently mispronounced sounds are a concern as the child gets older. However, if he pronounces a sound correctly some of the time, he may be moving toward standard pronunciation on his own. Most children develop standard speech by the age of six, although some children still have problems pronouncing the more difficult sounds at age seven or eight.

A loosely-drawn developmental scale for standard American speech production would look something like the following:

    By age 3  —  vowels     p, b, m, n, d, g, h

    By age 4  —  k, t, th, f, v, ng, j, ch

    By age 5  —  sh, zh

    By age 7  —  l, r, s, th

A comment about vowels. Among English speakers, differences in vowel production are usually considered dialectic rather than misarticulations. It is possible, however, to have a nasal or “gravelly” voice quality that is magnified during vowel production. This type of problem should be referred to a speech therapist or physician for consultation.

Voice

Voice disorders are not usually identified by parents because they are accustomed to the sound of their child’s voice. A voice problem may be noticed first by a family friend or teacher. An unusual-sounding voice can indicate physical problems which should be investigated by a qualified physician. Listen for an unusually high or low pitch, pronounced nasality, or a chronically scratchy or gruff voice quality.

Can children outgrow their speech problems without intervention?

As they are learning to talk, all children go through an unconscious self-correction process. They are constantly receiving new language information and adjusting their use of previously-acquired language in order to communicate more clearly. Parents can observe this process in action as they watch their preschooler become more precise and fluent in his verbal expression each successive year.

When standard speech is used in the home and children have plenty of opportunity for interactive communication, most naturally develop standard speech patterns by school age.  For some children, however, the usual exposure is not sufficient.

If a child is of school age and the parent is concerned about some aspect of his language, it is quite possible that he or she would benefit from some sort of therapy program.

How can I tell if my child’s speech development is following the usual pattern?

This is where an observant parent has the advantage over a professional speech therapist. Parents can watch their child’s speech development over time and note improvements. If the child’s speech is improving from year to year, then it is likely that he will eventually use standard speech.

Watch your child’s learning curve as he acquires spoken language. If he started talking later, then it is likely that he will also put the finishing touches on his speech at a later stage of development. Parents should watch their child’s:

• general use of language
• rhythm (or fluency) of speech
• pronunciation of words.

Besides voice disorders, are there other speech problems that should be referred to a physician?

If your child has multiple errors in articulation, it would be wise to have a qualified medical person check to be sure there is no chronic ear infection which can impair hearing. If auditory screening is available, it would also be good to have the child’s hearing screened. An oral examination to identify possible irregularities in the structure of the child’s mouth is also warranted.

Reprinted from April 1993 issue of Parents Teaching Overseas. Used with permission.

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