Speech Problems

What are speech problems?

Speech problems are delays or difficulties in your child’s ability to talk. There may be problems with understanding language and communicating. Your child may have trouble pronouncing words or speaking fluently. Speech problems include stuttering or lisping. 

Signs and symptoms of speech problems

There are many milestones of “normal” speech development. These milestones may vary from child to child. In general, speech milestones include:

Eight to 13 months

• points at objects
• shakes head to indicate “no”
• waves good-bye
• uses sounds as if they were words
• imitates adults’ sounds

12 to 18 months

• begins to develop a receptive vocabulary of words he understands, for example, he is able to point to objects when named by an adult
• understands a number of single words and short phrases
• uses approximately 10 to 20 words for objects

18 to 24 months

• understands simple questions and commands
• begins to combine two words to form a sentence
• the child’s expressive vocabulary, or the words he uses when speaking, increases to about 200 words
• begins to use negatives: “no juice”

24 to 36 months

During this period, your child should begin to use three-word sentences. His sentences will increase in length over this period. His grammar will become more precise. Here are a few other milestones:

• uses prepositions such as “in” and “on”
• adds “ing” to verbs: “go” becomes “going”
• auxiliary verbs added: “He can play”
• adds “s” to words to indicate more than one: “dogs”
• begins to add “a” and “the” to sentences
• learns to use pronouns, negatives, and conjunctions in the middle of sentences: “he,” “can’t,” “and”

Your child will also begin to use language for more complex purposes:

• understands many concepts: in/out; big/little; go/stop; animals; toys; top/bottom
• follows two-part directions: “get your coat and mitts”
• follows simple stories in books
• begins to ask “why?”
• becomes a story teller
• can say the following sounds: h, p, m, d, and k
• the child’s speech is 75% to 100% intelligible

Three to five years

Now your child will understand most of what is being said to him. His sentences and stories will become more complex. His conversational skills will improve.   He will understand how to get someone’s attention to begin a conversation and how to take turns in a conversation. His vocabulary will grow from about 1000 words at three years of age to 5000 or more words by five years of age.

At age three, 75% of what a child says should be understandable to a complete stranger.

His grammar will be come more complex, for example: 

• links ideas in sentences using “and,” “because,” “what,” “when,” “but,” “that,” “if,” “so”
• pronouns used correctly: I, she, he, her, him, me, mine, they
• reverses order of words to ask questions: “What is he doing?” as opposed to “What he is doing?”
• auxiliary verbs used in questions: “Is he sick?”
• uses more advanced forms of negatives: “didn’t”
• overgeneralizes some rules: “I runned”; “two gooses”

Between three and five years, your child’s ability to pronounce letters and blended letters will grow. Children are able to produce the following specific sounds:

• at 4 years: w, b, t, f, g, ng, n
• at 5 years: l, sh, ch, s, j
• at 6 years: z, r

Causes

Genetics

Family history of speech problems or learning difficulties, or developmental delays may lead to language delays.

Hearing loss

Mild or severe hearing loss can affect your child’s communication. If you suspect that your chld is not hearing well or if he has had many  ear infections, ask your doctor to check his hearing (see otitis media).

Another condition

Language problems can be a sign of another condition like autism (see autism). Physical disorders like cerebral palsy can also affect your child’s ability to speak.  Any condition which can cause developmental delay may cause speech  problems.  Meningitis, severe jaundice as a newborn or prematurity can cause hearing loss.

What your child’s doctor can do

Your doctor will assess the cause of the speech problem. Treatment will depend on the cause of  the speech problem, and on how severe the speech problem is. The doctor may refer your child to a speech language pathologist or another specialist.

Treatment

If possible, the underlying cause should be treated (for example hearing loss). If the speech problem is part of another disorder, that should be addressed (for example autism). All children with significant speech problems should be seen by a speech pathologist.

A speech language pathologist will help your child develop his language skills. She may teach you how to help your child to speak at home. Special education may be required for a child with learning difficulties or a permanent hearing problem. Speech therapy may also be required for children with articulation difficulties like lisping or stuttering if they persist.

When to contact get medical assistance

Monitor your child’s speech and language development. If you have questions, speak to his doctor on the next visit. If you are concerned, see your doctor as soon as possible.

Key points

• Development of speech varies tremendously in different children.
• Children who are at risk for speech delay should be assessed and followed by a speech pathologist.
• Children with speech delay and difficulty communicating should be assessed as early as possible.
• Articulation difficulties and stuttering may be normal untl about 5 years of age.
• Speech therapy is very helpful for many children with speech difficulties.