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Dealing with speech problems in a child

Two-year-old Jake is brought in by his parents because they feel he should have started talking clearly by now ­ his speech is mostly babbling. Jake has a five-year-old sister who could talk clearly when she was Jake's age. His parents ask you if there is any cause for concern. He does not suffer from ear infections. Looking at his notes you find he has passed all his other developmental checks, including hearing. Dr Tanvir Jamil discusses.

How common are speech or language problems in children?

One in every 10 to 15 children has trouble with language comprehension or speech. Hearing problems (usually due to glue ear), global mental retardation, a family history of deafness or lack of verbal stimulation at home are the commonest factors that may affect the development of speech. At school entry 5 per cent of children are unintelligible because of poor articulation, 1 per cent have a limited vocabulary and 0.1 per cent have severe language difficulties that are not due to deafness or mental retardation.

What is the difference between a speech problem and a language problem?

Speech problems are mainly concerned with articulation (pronouncing sounds), fluency (such as stuttering or stammering) and voice (problems with pitch or hoarseness). Children who have language problems have trouble working out when to use words: for instance he or she, and trouble naming or remembering things (such as parts of the face).

How can doctors assess whether a child may have a problem?

Parental concern is important. If parents think their child's speech is delayed, they are usually right. New parents often bring their child in at a later stage. It is only when they compare their child with others at nursery or school that they realise there may be a problem. There are three main questions to ask the parents:

lare you worried about the way your child communicates?

lis your child finding it difficult to communicate his needs?

ldoes your child sound like other children his or her age?

Basic developmental markers you can use as a guide include:

lat six months, babies should be able to make several different sounds, try to get your attention by looking at your face or making sounds, and smile and make sounds in response to your own facial expressions

lby 15-18 months a child should be babbling or using its own language

la child of 18 months should be able to identify objects or body parts

la child of two can combine words and form simple sentences like 'Daddy go'.

Don't most children just catch up if you leave them?

Many will, but others will not and are at serious risk of continuing problems with spoken communication and literacy skills. It is difficult to predict which children will improve spontaneously so early detection is important. Timely intervention may prevent the problem interfering with learning in other areas.

Where would you refer the child?

This depends on where you live. In many areas at-risk children get the otic emission tests shortly after birth which are more reliable for neurological deafness than the distraction test at eight to 12 months. Many health visitors now do not bother with distraction tests but rely more on a parent questionnaire and a referral protocol. Children are usually referred to the audiology department for a formal hearing test. In my area

pre-school children with a hearing problem are seen by health visitors first. Children over five are referred to audiology. A failed hearing test or obvious ear problems (such as glue ear or recurrent otitis media) would require ENT referral. If there are no ENT problems and hearing is fine, referral to a speech and language therapist is recommended. Assessment of the child is done by history, assessments and by watching the child playing and interacting with parents and staff. The child may then be taken on for therapy, just monitored or the parents may be given a programme of training.

What does speech therapy involve?

Most therapy takes place as the child plays, often in a group setting. Children may need help hearing the difference between sounds and learning how to make the sounds. They may need to look in a mirror and recognise where their teeth and tongue need to go, or where their lips need to be placed. Sometimes the therapist will work directly with the parents helping them change their behaviour and interaction. Some may even be advised to attend parenthood classes.

What can we tell the parents?

Parents often ask how long their child will take to improve. This greatly depends on the nature of the problem and how quickly he is able to understand, recognise and change his behaviour. Reassure them that the probability is that their child will catch up. Parental involvement is one of the keys to success.

 · One in 15 children has language or speech difficulties

 · Parents are usually right when they suspect problems

 · Early detection is important but many children will catch up naturally

 · Parental involvement is key to success

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