Delayed Speech Late Talkers

Delayed Speech: Identification and Treatment

One common question parents ask is if and when they should be concerned when a child manifests delayed speech. For an infant, delayed speech is of concern when the baby "isn't using gestures, such as pointing or waving bye-bye by 12 months; prefers gestures over vocalizations to communicate by 18 months; has trouble imitating sounds by 18 months; [and] has difficulty understanding simple verbal requests" (Delayed speech or language development, 2012, Kid's Health: 1). In an older child, a lack of developmentally-appropriate speech becomes worrisome when the child does not engage in spontaneous speech; repeats words or phrases without apparent understanding; cannot follow simply instructions; and has difficulty being understood by members outside of the family (Delayed speech or language development, 2012, Kid's Health: 1).

Early intervention for children who exhibit language delays has a significantly higher success rate than later interventions. "First, there is evidence that a lack of early intervention services for children with language delays is associated with an increased risk for difficulties in other adaptive areas," both academically and socially (Kelley et al. 2007). Maladaptive social behaviors such as aggression and self-harm are associated with untreated communication delays. While this may be because children with speech delays are more likely to be co-morbid for ADHD and other disorders, the frustrations of being unable to communicate with one's peer group can enhance the negative social behaviors.

Delayed speech can be manifested in children for a wide variety of reasons spanning from social phobia to mental incapacity. Causation will affect the treatment of the child, as will the manifestation of the delay. For example, "children with delayed speech have an instructional advantage if they emit frequent and varied vocal play and can repeat, even imprecisely, what they hear. Such fledgling speech can be shaped into accurate, complex topographies" (Esch, Carr & Grow 2009). In this 'shaping,' "a child may say 'juice' after a period of time of not having juice; contingent on the response 'juice,' a therapist may provide juice (Kelley et al. 2007). Gradually, the therapist will move on to more conceptual articulation. The "therapist may say, 'What's juice for?' The child may respond, 'drinking;' and the therapist may deliver praise (Kelley et al. 2007).

In terms of treating children with delayed speech from autism, some children do not have a meaningful repertoire of even a few sounds. "In children with speech delays, auditory speech stimuli may not function as reinforcers for vocal behavior, as evidenced by a weak repertoire of few or inconsistent responses that result in such stimuli" (Esch, Carr & Grow 2009). Thus, encouraging speech production for children with delayed speech due to autism may be far more difficult and stubborn to treat. However, "children with ASD appear to have an intact ability to perceive and produce speech patterns and demonstrate Gestalt processing in their language acquisition, such as echolalia. They also have intact auditory areas and function to process various patterns in musical sounds" (Lim 2009). Even if children with autism do not react 'normally' to speech and to sound, they may be skilled mimics, and using such innate mimicry can be a way to encourage the children to engage in more conventional forms of speech. Drawing upon the child's special interests to engage his or her attention is also helpful when dealing with children on the autistic spectrum.

Using music and other forms of creative play is often designed to elicit spontaneous and more nuanced use of language in autistic children, given that this empathetic aspect of speech often is often lacking in children with autism. "Children with ASD also differ by the prevalence of higher order processing disorders such as lexical or syntactic impairments and of impaired semantic classification of words" (Lim 2009). Even when they do speak, they may organize speech in an odd fashion, and learning musical patterns, rules, and rhythm can help normalize their use of words, as can asking them about the feelings of people in stories.

But despite the attention that autism has received as a cause of speech delays, it is important to remember that not all delayed speech is due to autism. Other causes of speech delays include learning disabilities which impede cognition and disorders such as apraxia, in which the brain has difficulty coordinating the child's muscles to make the needed speech sounds (Speech delay and disorder, 2012, University of Michigan). Physical causes must be evaluated when treating the individual child, as hearing loss can cause speech delays. The possibility of elective mutism, a disorder in which the child, despite lacking any other existing pathology, still refuses to talk, must also be explored. And some electively mute children may only refuse to talk in certain situations -- talking at home, but not at school, for example (Speech delay and disorder, 2012, University of Michigan).

Once again, the multitude of causes underlines the need for the treatment to address not simply the symptoms but also the cause of speech delays. Treatments may be as diverse as providing the child with a hearing aide or psychological counseling to deal with his or her social anxiety. The type of intervention that is required for a child with elective mutism, such as relaxation techniques and self-modeling upon adults who are speaking, would not be appropriate in most cases for a child with language delays due to cognitive impairment (Selective mutism, 2012, ASHA). However, some of the techniques, such as 'shaping' or reinforcement, recording the child to help normalize his or her speaking patterns to reduce social anxiety (if the child speaks to quietly or too fast) may have greater application across a wide range of speech-related disorders.