Delayed speech: what could be causing it?

A significant delay in reaching critical milestones could be a red flag for a developmental delay
By Anel Lewis

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No two children are the same. I just need to look at my own two – Erin, aged 7, who can draw quietly for almost an hour at a stretch, and Conor, 6, who needs to jump 10 times on the trampoline before he can settle down to complete a puzzle – to see how they tackle tasks differently. Conor is more advanced socially, but Erin is able to concentrate for a longer period on activities requiring fine motor skills. Although there are physical and developmental milestones that children are expected to reach by a certain age, it’s important to remember that they will do so at their own pace. However, if you are concerned that a developmental delay could be more than just a timing issue, it’s best to seek professional guidance from an expert such as a speech or occupational therapist.
 
The early years – up to the age of 6
Child magazine receives numerous letters from parents who are concerned about their children’s development. A common issue is poor concentration. One parent explained that her two-year-old son, while on track with his physical development, struggled to do simple tasks requiring concentration. He also battled to look at her while she was talking.
 
Jade Shield, a Cape Town-based occupational therapist, says that children under the age of three do display varied periods of attention and concentration. “Even at three years of age, a child’s attention span remains short with roughly 10 minutes seen as the norm for individual tasks and activities.” However, if a child has six or more symptoms of inattention, hyperactivity or impulsivity that affects a child’s daily functioning, a child should be assessed for possible attention-deficit/hyperactivity disorder (ADHD).
 
“Speech is a critical milestone in a child’s development, and between the ages of two and three, a child should be comfortable using sentences of up to five words,” says Shield.
 
One reader told Child magazine: “My son turned three in March, and he has not started speaking. He babbles a lot, but that is just it. We have taken him for all the necessary tests and everything came back clear. He is an active, energetic little boy; it is just his speech, and because of that there is not much interaction. His paediatrician has recommended occupational and speech therapy.” Another explained that her child is almost six years old, and still unable to talk. “I need help. He can’t talk yet, he repeats everything when you speak to him, but he can’t give answers. He can say a few words, but cannot put a sentence together.”
 
Gauteng speech therapist Laura Cramb says children from about the age of three should be able to talk about what has happened during the day. “They are also able to start using more complex concepts in their speech, such as pronouns. Since a lot of speech and language development has occurred by now, a child who hasn’t reached these milestones needs help. By the time they turn five, children should have a vocabulary of about 2 500 words,” she adds.
 
Another reader consulted four speech therapists before her son was diagnosed at the age of two-and-a-half with childhood apraxia of speech (CAS). “I can’t begin to explain how hard it was for us to find a good speech therapist that could help our son. When we first started speech therapy, he could not speak more than 20 words, and after only six months, he was saying more than 50 words and learning more every day. He is now making sentences and his concentration has developed so much,” she relates.
 
CAS is a neurological disorder affecting speech and motor abilities. Apraxia Awareness South Africa (AASA), a group set up by parents of children affected by the disorder, says the overall warning signs of possible apraxia include any loss of speech, or babbling at any age, and the inability to use gestures or understand what is being said. “It is a myth that you should just ‘wait and see’ if your child is a ‘late talker.’ (This) approach can be appropriate in some circumstances, which a speech therapist may even recommend upon seeing your child, however, I strongly encourage you to have your child screened or assessed by a neuropaediatrician if you have any concerns with their development at any age,” says Deidre Warner, one of AASA’s founding members.
 
Laying the foundation – from 6 to 12 years
During the Foundation Phase, children are exposed to phonics and numeracy as they work on the basics needed for reading, writing and mathematics. While the journey is relatively easy for some, there are children who will struggle with letters and reading.
 
As one parent told Child magazine: “My son is six years old and he is in grade 1. He can’t read and writing is sometimes a problem. Is this normal?” Another parent said: “My son is seven years old and he is repeating grade 1 this year. He doesn’t participate in class, he can’t complete his tasks in class, and when his teacher is talking to him, he doesn’t respond. He can’t read, but he can write. While at home he seems like he is doing well, at school he is not. What should I do or do I have to visit an occupational therapist?”
 
Shield explains that the window period for reading readiness ranges from three to nine years of age, although most children will find their groove between the ages of five and seven. “Many factors play a part in the development of reading, including general brain development as a child grows, the relationship he or she builds between symbols and sounds, and the cultural and familial views on the importance of reading. There is a one-year gender difference in reading readiness – boys develop slower.”
 
An occupational therapist will be called in to help if your child is struggling with the basics of reading and writing.
 
On the spectrum
One reader found out that her daughter, aged 13, has Asperger’s syndrome. She explains: “As we are new to this, with no information, we are rather devastated as to what the future holds for us and our daughter. We don’t know which schools are best suited for her needs, or whether she will still have a normal career and future.”
 
Autism Western Cape says that the umbrella term for autism spectrum disorder describes a group of complex brain developmental disorders. According to Autism South Africa, signs of possible autism include having little awareness of others, self-harming behaviour and delayed development of speech and language. A child psychologist or paediatric neurologist can usually diagnose autism by the time your child is three years old.
 
Know who to call:
What does a paediatrician do?
Dr Hanneke Heyns, a Bloemfontein-based paediatrician, says paediatricians are usually the “very first stop” in all child-related issues regarding growth and development, medical advice, child illnesses, learning difficulties, and for medical check-ups for children. As such, a paediatrician is likely to be the person who will refer you to other specialists, such as a physiotherapist or an occupational therapist, if there are any developmental concerns.
 
What does a child psychologist do?
A child psychologist deals with “all manner of children’s and adolescent’s difficulties,” explains Cristine Scolari, a Gauteng-based clinical psychologist. A child psychologist is also involved in assessments such as school readiness, developmental and educational evaluations. Clinical psychologists may refer children to other specialists, or offer treatment through therapy sessions.
 
What does an educational psychologist do?
ChildPsych, a group of educational psychologists in all major areas around the country, defines its work as helping children with various problems such as emotional or social issues and learning difficulties through different types of therapy.
 
One technique is play therapy, helpful for children from the age of three to 12, with the child doing what he enjoys at his own level and pace.
 
What does an occupational therapist (OT) do?
An occupational therapist specialises in child development, treating sensory processing disorders, developmental delays and learning difficulties.
 
What does a speech therapist do?
A speech therapist helps children with communication problems, ranging from early intervention for infants who battle to feed, suck or swallow to assisting older children displaying difficulties with articulation and phonological processes. Treatment includes therapy for children with physical and cognitive disabilities, as well as those with neurological problems such as apraxia.
 
Common conditions:
Autism
Autism spectrum disorder is the general term for a group of complex brain development disorders, explains Autism South Africa. Autism affects the way a child communicates, behaves, interacts and learns. The severity of the symptoms – such as repetitive behaviour and poor communication – vary widely.
 
Asperger’s syndrome
Asperger’s syndrome also falls on the autism spectrum, but those with Asperger’s do not have the language development delays commonly seen with autism. Children with Asperger’s may have above-average intelligence.
 
Selective mutism
Selective mutism is an avoidance strategy to cope with severe anxiety in certain social situations. A child is able to speak and has a good understanding of language, but does not speak in certain situations or to specific people.
 
Attention-deficit/hyperactivity disorder
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders among children, estimated to affect at least one in 20 children in SA. ADHD is marked by symptoms of inattentiveness, hyperactivity and impulsivity. As it affects a child’s performance in school, multimodal intervention is usually recommended.
 
Sensory processing disorder
Sensory processing disorder is a neurological condition that makes it difficult for the brain to organise sensory information such as sound, touch and movement. Children may feel input more or less intensely than others, which makes it harder to interact with their environment and to perform regular tasks.
 
Childhood apraxia of speech
The brain has trouble planning to move the body parts needed for speech, making it difficult for a child to form sounds, syllables or words.

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