Speech & Language Therapy
INTRODUCTION TO SPEECH AND LANGUAGE THERAPY DEPARTMENT OF RISING SUN INSTITUTE:
Speech and language therapy department is an integral part of Rising Sun Institute for Special Children, founded in 1984 by Prof. Dr. and Mrs. Abdul Tawab Khan. Speech and Language therapy department deals with children with speech and language problems. Children who develop normally master the fundamentals of language and speech in the toddler-preschool years. Language and speech skills serve an important role in learning and social relationships. Delays in the early development of language and speech skills will affect several domains of function. Management of language and speech can improve language and speech skills. Therefore, identifying children who have language and speech delays in the toddler-preschool period should be a priority for the parents.
What is Language?
According to Richard Nordquist (2017), Language is a mode of communication used by humans through the use of arbitrary signals, such as voice sounds, gestures, and/or written symbols.
Language is further categorized as receptive language and expressive language.
- Receptive language is the ability to understand the verbal, written or expressive gestures given by others (Frazier, 2011)
- Expressive language is the ability to use of words, sentences, gestural and written mode of communication to convey meaning to others (Kids Sense, 2017).
What is Speech?
Speech, the verbal mode of communication is described through its following characteristics (ASHA, 2017):
- Articulation–the skill to produce various sounds (e.g., the “s” sound in “spoon” to differentiate it from “poon”).
- Voice- sound produced through using vocal folds and breathing to produce sound Fluency–The flow of speech which may be smooth or involve hesitation or stuttering
Difference between speech and language difficulties
The speech difficulties are the problems caused in sound production due to reasons which may be physical such as cerebral palsy, cleft palate or inaccurate learning of the production of sound. Language difficulties are characterized by difficulty communicating or understanding others’ communication. This involves difficulty finding accurate words to share their ideas or difficulty using grammatically correct structure of sentences. Moreover, they also experience difficulty understanding the gestures of others during social interactions.
Typical developmental milestones of language and speech
| AGE | RECEPTIVE SKILLS | EXPRESSIVE SKILLS |
| Birth | Turns to source of sound | Cries |
| Shows preference for voices | ||
| Shows interest in faces | ||
| 2 to 4 months | Coos | |
| Takes turns cooing | ||
| 6 months | Responds to name | Babbles |
| 9 months | Understands verbal routines (wave bye-bye) | Points |
| Says ma-ma, da-da | ||
| 12 months | Follows a verbal command | Uses jargon |
| Says first words | ||
| 15 months | Points to body parts by name | Learns words slowly |
| 18 to 24 months | Understands sentences | Learns words quickly |
| Uses two-word phrases | ||
| 24 to 36 months | Answers questions | Phrases 50% intelligible |
| Follows two-step commands | Builds three- (or more) word sentences | |
| Asks “what” questions | ||
| 36 to 48 months | Understands much of what is said | Asks “why” questions |
| Sentences 75% intelligible | ||
| Masters the early acquired speech sounds: m, b, y, n, w, d, p, and h | ||
| 48 to 60 months | Understands much of what is said, commensurate with cognitive level | Creates well-formed sentences |
| Tells stories | ||
| 100% intelligible | ||
| 6 years | Pronounces most speech sounds correctly; may have difficulty with sh, th as in think, s, z, th as in the, l, r, and the s in treasure | |
| 7 years | Pronounces speech sounds correctly, including consonant blends such as sp, tr, bl |
Detection of language and speech delays
| AGE | FINDING |
| Birth and at any age | Lack of response to sound |
| Lack of interest in interaction with people | |
| 4 months | Lack of any drive to communicate |
| 6 to 9 months | Loss of the early ability to coo or babble |
| Poor sound localization or lack of responsiveness | |
| 12 months | No verbal routines |
| Failure to use ma-ma or da-da | |
| Loss of previous language or social milestones | |
| 15 to 18 months | No single words |
| Poor understanding of language | |
| 24 months | Vocabulary less than 50 words |
| No two-word phrases | |
| Less than 50% of speech intelligible to strangers | |
| 36 months | Rote memorization of words or phrases |
| Frequent immediate or delayed repetition of others’ speech | |
| Flat or stilted intonation | |
| More than 75% of speech unintelligible to strangers | |
| 48 months | Inability to participate in conversation |
| Stuttering of initial sounds or parts of words | |
| 6 to 7 years | Immature or inaccurate speech sound production |
Common Speech and Language Disorders
Delays in the milestones of language and speech development can be due to numerous reasons such as hearing disability, intellectual disability, Global Developmental Delay, Autism spectrum, communication disorders, and Cerebral Palsy. Hearing loss is most often suspected as the child produces inaccurate speech due to experiencing restricted pattern of the child’s understanding. This often results in speech delay also. Global developmental delay is evidenced from delays in developmental milestones generally. If the problems persist till the school age then it is best for the child to start speech therapy. Autism disorder may be suspected if the child have problem in social interactions and when language is not only delayed but deficits in vocabulary, grammar, or age specific communicative pattern are not developed properly. If language skills, either receptive or expressive or both, are poorer than the cognitive skills of the child often indicate Language impairment.
Assessment of Language and Speech Delays in Children
Firstly, full audio-logical assessment is important for every child experiencing speech and language difficulties. Moreover, age appropriate assessment techniques should be applied. If audiometry is clear then who have to get the child assessed for intellectual or learning disability.
Early intervention program for children from birth to 3 years is preferred for treating the children with speech and language disability and delays as at this age the child has tremendous capacity to learn different words. Children with normal development, apart from the speech and language issues, may be referred to speech-language pathologist for the assessment and therapeutic purposes. Children who have language or speech delays comorbid with neurodevelopmental problems also can benefit from the speech-language pathologist’s evaluation.
Management
Children with speech and language problems are assessed and IEPs according to their individual needs are made. Early intervention plays an integral role in the development of language and speech delays. Individualized plans are developed for children with Autism, Cerebral Palsy, Intellectual Impairment and Down’s syndrome after the assessment. Consistent benefits of early intervention and its effectiveness is shown in the children.
Prognosis
Early and appropriately treated delays and Language and speech disorders usually show progress over time.
Conclusion
Children who have genetic, chromosomal, or neurologic disorders require evaluation and treatment appropriate to the underlying condition. Children who have language and speech disorders need speech and language therapy sessions according to their need.