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Introduction
Fluent speech and appropriate language use are some of the key prerequisites for further academic success and normal functioning of an individual in the society. Speech and language development is a complex, gradual process that has its own pace and important milestones. Sometimes, this process is impeded due to a number of reasons. The umbrella term for this phenomenon is atypical language development. Speech and language delay with an early onset is characterized by increased difficulties with reading, writing, focus, and communication. This paper highlights the complexity of the diagnosis and goes in detail about its key aspects: prevalence, types, screening, treatment, and prognosis.
Definitions
Before approaching the subject matter in detail, it is essential to explain the key terms used in this paper. First and foremost, the difference between such phenomena as speech and language, even though informally, these terms are often used interchangeably. According to Webb and Adler (2016), language refers to the entirety of the system consisting of words and symbols. These can be written, spoken, or expressed otherwise, for instance, through gestures or body language. It is a linguistic conceptualization of reality and its encoding using the means of an existing language system. Speech is the actual spoken realization of language; it is the oral form of communicating. In this sense, speech can be equaled to talking: using facial muscles and vocal tract in an orderly and coordinated way to produce certain sounds recognizable and understandable by other humans.
Now that the two terms are compared and contrasted, it becomes clear how speech and language disorders differ. As Webb and Adler (2016) explain, a speech disorder typically has something to do with a person’s inability to produce sounds. For instance, a child’s inability to pronounce a sound and substituting it with another that is somehow similar to it is a speech problem. Language development delays deal with a person’s inability to understand the language, express themselves, and communicate effectively. The types of speech and language disorders falling under these two broad categories will be explained in more detail in subsequent sections of the present paper.
Normal Development
Defining atypical language development in young children is impossible without introducing the frame of reference, which is normal speech and language development. In her systematic literature review, McLaughlin (2011) provides the following normal developmental “chronology” with as many as 90% of children passing each of the enlisted milestones. Under expressive developmental milestones, McLaughlin understands a young child’s ability to use a language and produce speech. Receptive developmental milestones, on the other hand, deal with a child’s mental faculties allowing them to react to other people, understand their speech, and follow commands.
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six to nine months. During this stage, infants are expected to react to rattling noises as well as turn to their caregivers’ voices. As for the expressive developmental milestones, at six months, healthy infants laugh and vocalize (the so-called cooing). Later during this period, they start babbling, pronounce single syllables (often echoing an adult or older children), learn how to wave goodbye, and utter simple words such as “mama” and “dada”;
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15-18 months. During this time period, an infant is expected to be able to point to at least one body part. Their vocabulary ranges between one to six recognizable words;
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two to two-and-a-half years old. At this point, a child’s receptive speech and language development allows them to point to two pictures, point to six body parts, as well as follow a two-step command. This stage is characterized by a young child’s ability to combine words into simple sentences with their speech being at least semi-understandable. Apart from that, they are able to name actions and pictures;
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three to four years old. A child’s speech becomes fully understandable; they name actions, pictures, and colors. Children pick up on others’ emotions and learn to communicate using speech and language (McLaughlin , 2011).
Types of Atypical Language Development
Primary Speech and Language Problems
If children are not meeting essential developmental milestones, they might need a comprehensive evaluation. If atypical language development is recognized, the next task is to differentiate between primary and secondary disorders. Dockrell and Marschall (2015) show that primary disorders emerge on their own while secondary disorders are typically symptoms of some other disease. According to the researchers, primary speech and language problems can be broken down into three categories: (1) developmental; (2) expressive; and (3) receptive. It is argued that the first type presents the fewest challenges for both parents and healthcare professionals. In the case of developmental problems, a child shows steady progress in all other aspects but struggles with speaking. At this stage, interventions are highly effective and the overall prognosis is positive.
Expressive speech and language disorders may not be as easy to overcome; yet, as McLaughlin (2011) shows, therapy proves to be highly effective. Probably the greatest challenge is differentiation between developmental and expressive speech problems as in infancy, they might appear indistinguishable. Receptive speech and language disorders as primary problems are more resistant to therapy; the prognosis is not exactly optimistic. McLaughlin (2011) describes the following signs of this type of speech and language pathology: (1) being unresponsive to nonverbal auditory stimuli; (2) being unresponsive when talked to; (3) not looking at objects when other people point at them. McLaughlin (2011) writes that in this case, speech is typically not only delayed but also demonstrates other shortcomings such as poor articulation and lack of grammar.
Secondary Speech and Language Problems
Secondary speech and language problems are attributable to some other condition. Below is a list of conditions that may cause atypical language development. The list is not exhaustive by any definition but covers the most common disorders leading to speech and language issues.
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Autism spectrum disorder manifests itself in the inability to effectively communicate with others, read social cues, and navigate uncertain and unknown situations. Affected individuals struggle to initiate and sustain conversations, especially if the ASD diagnosis in them is accompanied by an intellectual disability. Young children are typically unresponsive: akin to the receptive developmental disorder, their condition manifests itself through the inability to react to external stimuli. Children with autism might experience speech and language regression even after receiving treatment (Gernsbacher, Morson, & Grace, 2016);
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Cerebral palsy. In children with cerebral palsy, speech and language issues are attributed to faulty coordination due to the spasticity of tongue muscles, hearing difficulties, coexisting intellectual disabilities, as well as defects in the cerebral cortex. Children with cerebral palsy might benefit from augmentative and alternative communication systems when taught from early childhood. Shin, Byeon, and Kim (2016) show that there is a possibility for other beneficial adjustments to facilitate speech in children with cerebral palsy. Shin et al. (2016) discovered the positive effect of anterior seat inclination for preventing respiratory difficulties that often cause speech problems in affected demographics;
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Dysarthria is a physical problem characterized by speech difficulties ranging from mild to severe. In the former case, children demonstrate slurred articulation and a low-pitched voice. Profound cases include an inability to produce any recognizable words. McLaughlin (2011) argues that speech and physical therapy might be effective in making individuals’ speech more clear and intelligible.
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Selective mutism. This disorder is characterized by an individual’s inability to speak in situations where it is expected, for example, at school. Children with selective mutism are typically referred to both speech language specialists and psychologists due to the psychological nature of the issue. Lang et al. (2016) claim that cognitive behavioral therapy so far has proven to the best solution in treating this rare and often elusive disorder. This type of therapy implies raising awareness of triggers and adopting effective behavioral strategies to address the issue (Lang et al., 2016).
Prevalence and Associated Factors
There have been extensive studies seeking to measure the prevalence of speech and language development delays in children under the age of three. Despite the presence of an ample body of evidence, the existing data is far from being uniform and shows significant variation. For instance, Mondal et al. (2016) discovered that as many as 28% of children in their study failed the administered language screening test, which is indicative of certain developmental issues. Mondal et al. (2016) cite other researchers who have conducted similar studies and came to dissimilar conclusions with the percentage of affected children ranging from 13% to 31%. According to Mondal et al. (2016), the variation in results can be explained by the diversity of tests used for screening. Besides, the researchers argue that the design of the study allows for possible volunteer bias (Mondal et al., 2016). Speech and language pathology clinics are primarily contacted by parents whose children already show signs of developmental delays or at risk of having such a condition.
Modern research in atypical language development has yet to pinpoint all the causes and risk factors. Hawa and Spanoudis (2014) argue that speech and language impairments are often inheritable. For instance, if a child has close relatives who were late talkers, he or she is at risk of passing important speech and language development milestones later than normal as well (Hawa & Spanoudis, 2014). Aside from the genetic aspect, family plays a significant role in children’s speaking abilities. Mondal et al. (2016) cite recent studies that show that children are more likely to have problems in large families, which might be explained by the decreased amount of attention that every child receives. Some studies also point out low parental education as one of the risk factors; even though this point is still debated (Mondal et al., 2016).
Mondal et al. (2016) themselves contradicted the relationship between maternal education and children’s progress. However, they showed the negative impact of poor home environment on infants’ linguistic development. This finding is consistent with the point made by Hawa and Spanoudis (2015). According to them, one of the characteristics of poor home environment is parental stress. Parents who experience frustration and other negative emotions cannot adequately support their child, which limits the ability and the willingness of the latter to express him- or herself.
Screening and Parental Counseling
Screening for speech and language delays is a challenging task for both parents and healthcare professionals. Wallace et al. (2015) argue that a thorough analysis of different screening methods has shown that not a single one of them was 100% precise. Besides, as McLaughlin (2011) states in her systematic review, in the US, there is no established standard for evaluating children’s linguistic capacities. This fact and the findings of the study by Wallace et al. (2015) suggest that speech language specialists might as well have to work on a case-to-case basis when screening children for delays. Wallace et al. (2015) suggest that healthcare professionals use the chronology of normal speech and language development as a frame of reference. Besides, the researchers say that it is advisable to single some infants out on the basis of their belongingness to the risk group. Some of the common factors include family history, male sex, low weight at birth, and premature birth (Wallace et al., 2015). These children might need more attention and monitoring to address speech and language delays promptly if necessary.
During the process of monitoring a child, it is important to work closely with his or her caregivers. Daniel and McLeod (2017) recommend parents to avoid jumping to conclusions if a child does not pass important milestones on time. It is not advised to take measures prematurely before knowing a child’s diagnosis. If anything, according to Daniel and McLeod (2017), an affected child’s caregivers should make an effort to look on the bright side of things. They should not dwell on the negative effects of a speech or language delay: instead, it would be more proactive to celebrate every little victory.
Besides, parents should be ready to provide sufficient emotional support for their child. As Daniel and McLeod (2017) highlight in their paper, speech and language disorders often become a source of frustration and insecurities for children. In this case, it is essential that a child’s family helps him or her develop self-confidence and does not cause any additional stress. Ideally, a speech language pathologist should communicate all these points to parents who just learned about their child’s condition. It may be advisable to refer parents to support groups or recommend them relevant books on the topic (McLaughlin, 2011).
Conclusion
According to different sources, up to 30% of children suffer from atypical language development. Their disorders may emerge independently or manifest themselves as part of a larger issue such as autistic spectrum disorder, cerebral palsy, dysarthria, and others. Treating speech and language delay is a challenging task due to the lack of formalized screening procedures. As of now, speech language specialists refer to the normal developmental chronology as well as pay more attention to children at risk of having a condition. Another obstacle is insufficient scientific evidence suggesting the prevalence of some methods of treatment over the others in terms of efficiency and sustainability. Besides, it seems that parents and even healthcare professionals might lack awareness in regards to the condition and fail to take measures timely. The prognosis depends on the cause of atypical language development and the adequacy and realization of a treatment plan.
References
Daniel, G. R., & McLeod, S. (2017). Children with speech sound disorders at school: Challenges for children, parents and teachers. Australian Journal of Teacher Education (Online), 42(2), 81.
Daniel and McLeod (2017) conducted a qualitative study in Australian schools where speech pathology services were non-existent. In conversations with teachers, parents, and children, Daniel and McLeod were able to pinpoint the main challenges accompanying speech language disorder cases.
Dockrell, J.E. & Marshall, C.R., 2015. Measurement issues: Assessing language skills in young children. Child and Adolescent Mental Health, 20(2), 116-125.
In their meta analytic review of recent literature, Dockrell and Marshall (2015) showed that there were certain issues with screening procedures when it came to speech language pathology diagnosis. Dockrell and Marshall (2015) claim that existing tests do not meet psychometric standards and may suffer from a high degree of imprecision.
Gernsbacher, M. A., Morson, E. M., & Grace, E. J. (2016). Language and speech in autism. Annual Review of Linguistics, 2, 413-425.
In their systematic review, Gernsbacher, Morson, and Grace (2016) describe the effects of having an autism spectrum disorder on an individual’s speech patterns. The researchers highlight the three key phenomena that are indicative of ASD: echolalia, the reversal of pronouns, and speech and language development regression.
Hawa, V. V., & Spanoudis, G. (2014). Toddlers with delayed expressive language: An overview of the characteristics, risk factors and language outcomes. Research in Developmental Disabilities, 35(2), 400-407.
Hawa and Spanoudis (2014) conducted a systematic review of recent literature on the etiology of delayed expressive language. The researchers were able to pinpoint genetic factors playing a role in developing a disorder as well as modifiable, environmental risk factors such as living conditions and parental stress.
Lang, C., Nir, Z., Gothelf, A., Domachevsky, S., Ginton, L., Kushnir, J., & Gothelf, D. (2016). The outcome of children with selective mutism following cognitive behavioral intervention: A follow-up study. European Journal of Pediatrics, 175(4), 481-487.
Lang et al. (2016) conducted an experimental study in which the parents of 36 children with selective mutism were subjected to cognitive behavioral therapy. This kind of therapy revolves around adopting and developing appropriate behavioral strategies. Lang et al. (2016) concluded that CBT was effective in treating selective mutism in the long term.
McLaughlin, M. (2011). Speech and language delay in children. American Family Physician, 83(10), 1183-1188.
In her article, McLaughlin gathered all the relevant information with regards to atypical language development in children. The author outlined what the normal development is and described the tell-tale signs of speech and language issues in infants and toddlers. McLaughlin touched upon the subjects of screening and treatment as well as prognosis depending on the severity of disorders.
Mondal, N., Bhat, B. V., Plakkal, N., Thulasingam, M., Ajayan, P., & Poorna, D. R. (2016). Prevalence and risk factors of speech and language delay in children less than three years of age. Journal of Comprehensive Pediatrics, 7(2).
The aim of the study was to measure the prevalence of speech language disorders in young children (under three years old) and define some risk factors. The study was motivated by the lack of consistent data on the subject matter and great variation in the existing evidence. Mondal et al. (2016) conducted descriptive, cross-sectional research on a sample of more than 200 children.
Shin, H.K., Byeon, E.J., & Kim, S.H., 2015. Effects of seat surface inclination on respiration and speech production in children with spastic cerebral palsy. Journal of Physiological Anthropology, 34(1), 17.
Shin, Byeon, and Kim (2015) sought to discover whether the seat inclination could facilitate speaking in children with cerebral palsy. Respiratory and speech problems are often found in cerebral palsy patients who are often not given option regarding the seat surface angle. Shin, Byeon, and Kim (2015) found the anterior, 15-degree inclination to be the most beneficial.
Wallace, I. F., Berkman, N. D., Watson, L. R., Coyne-Beasley, T., Wood, C. T., Cullen, K., & Lohr, K. N. (2015). Screening for speech and language delay in children 5 years old and younger: A systematic review. Pediatrics, 136(2), e448-e462.
Wallace et al. (2015) conducted a systematic review highlighting the vices and virtues of the existing screening methods in children at risk for speech and language delay. The researchers argue that as of now, not a single method is absolutely reliable. The findings imply that screening might as well be individualized to serve patients’ needs and heed vulnerable demographics.
Webb, W., & Adler, R. K. (2016). Neurology for the speech-language pathologist-E-book. Amsterdam, Netherlands: Elsevier Health Sciences.
This book is a concise and easy-to-understand guide for students and speech-language pathology (SLP) clinicians who want to understand the neurology of SLP. It gives the reader a good understanding of the nervous system in relation to speech and language development: the organization of the brain, protective mechanisms, descending motor and ascending sensory pathways, and cranial nerves.
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