Understanding Childhood Language Disorders

I was a primary school teacher and felt that I didn’t have enough learning to do my main job, which was to teach kids to read. I decided to take a year off from teaching to get my master’s degree in reading. Part of the degree was a course in child language development — how kids learn to talk and the connections between oral language and reading.

I became deeply interested in these connections and after teaching for a few more years went on to get my PhD in child language development and disorders. As part of that course of study I learned about autism. When I graduated I was fortunate enough to get a position at the Yale Child Study Center, which had a very active clinic and research program on autism.

By the time they are two, children generally answer to their name, understand simple instructions (such as “get me your shoe”) and use 50 to 100 different words meaningfully to name things and express their ideas. They also begin to put two or three words together into simple messages (for example “my doggy!” or “no want bath!”). Children who reach the age of two and do not show these communication skills should have their hearing tested to make sure they are hearing the language around them. If their hearing is normal and the child still does not learn new words quickly or put words together, parents may seek an evaluation for a language disorder.

Speech disorders refer to problems in producing the sounds in words correctly. Many children make a lot of speech errors at age two or three, but by age three, family members should be able to understand most of what they say. By age four, everyone including strangers should be able to understand them. 

If children continue to be too hard to understand, again a hearing test is the first step. If their hearing is normal, the child may be referred for a speech evaluation.

Yes, children who are slow to begin talking at age two or are hard to understand at age three do sometimes outgrow their problems without extra help. However, if these problems persist to age three or four, parents are advised to seek evaluation by a speech-language pathologist.

The best support comes from a combination of professional help from a speech-language pathologist (SLP) and carry-over practice by parents. Parents may observe the child and SLP working together and ask how to do some similar activities in the home. 

Many SLPs provide parents with “homework” to do with the child between sessions. It is important, though, to always have a playful and positive attitude with the child. We want children to think communication is fun and worthwhile, so we want to be careful not to make talking and listening into a chore. 

It’s hard to say how long the support will need to last. Many children with speech and language problems learn basic skills by age five, but often come up against new problems when they try to learn to read and spell. The way the problem presents can change as children develop. As they grow out of one aspect of difficulty, new ones may arise as the demands of school become greater.

There are many apps for computers, tablets and phones that help children practice naming objects and recognizing words, letters, numbers and so on. There are also many apps that offer readings of illustrated children’s books. These are great if the child enjoys doing them but if we want children to learn to communicate, not just make sounds or name pictures, we need to involve them in interpersonal communication with other people. 

Parents may want to play the apps along with the child (at least some of the time) or offer similar activities in a parent-child game format. Parents may try this approach to see if it helps the child learn new words or sounds before seeking professional help. But what we really want children to learn is how to use their speech and language skills to interact successfully with others. This will require the active involvement of supportive adults.

Many parents enjoy teaching sign language to their babies before they begin to talk. This has been shown not to delay the acquisition of spoken language. For children under two who have not yet begun talking, a “watch and see” attitude is warranted. 

Some will begin to speak on their own or with a small amount of guidance from a SLP and parent support. For children over two who have not started to talk, who appear to have things they want to say and show frustration at their inability to communicate, help from an SLP in learning to use sign or another alternative form of communication is worth a try. The involvement of a professional at this point is useful. The SLP can help the child communicate with signs or pictures and also model clear, appropriate speech to accompany the alternative mode. 

Both these types of input delivered together have been shown to be effective in getting some preverbal children to start talking. It does not seem to be the case that using signs or pictures discourages the development of speech, but it is important to offer both forms of input together – not signs or pictures without accompanying speech from the adult. Similarly, if the child does use signs or pictures, the adult should use them too. Modeling how the signs and spoken words mean the same thing and convey the same message, adults can help the child learn that either form of communication accomplishes social goals.

Many preverbal children do begin talking with this kind of multi-modal input. However, for some children speech continues to be absent. When this is the case, particularly for children four and older, some form of alternative communication will be necessary to allow them to express themselves.

This is a question that we have a lot of research about. We know that children with both typical development and those with speech and language disorders can learn more than one language with no bad effects on either. Children with language disorders will learn two languages at about the same rate as they learned their first language, slower than peers, but showing growth nonetheless. 

The best advice for parents is to speak to the child in the language in which parents feel most comfortable. This will ensure that the child has a complete model of language used for a variety of purposes in the service of nurturing. This is needed as a foundation for learning both a first language and any additional languages later on. 

If parents feel most at home in a language other than English, they should speak that language consistently to the child. The child will have an opportunity to learn English in daycare or school, with support from SLPs and special educators if they need it. If parents are equally comfortable in English and another language, they can choose to use English at home, but there is no harm in speaking to the child in another language so the child can learn both at whatever pace they are able.

A large body of research has established that stuttering is a physiologically-based speech disorder. It can be made worse by tension or anxiety, but these are not the primary cause of the problem. Stuttering tends to run in families and to be more prevalent in boys. Some children show signs of stuttering (what speech-language pathologists call "dysfluency") in the preschool period. When this happens parents should model slow, relaxed speech for the child and try to wait patiently and not supply words the child gets stuck on.

When stuttering persists to age six or seven, parents may consider the services of a speech-language pathologist, but only if the child is willing and wants to change the behavior. Some people are comfortable talking with a stutter and don’t feel a need to change. When this is the case, parents should make an effort to support the child’s position. They can always try again in a year or two to see if the child has a change of heart. But the therapy will not be successful unless the child is invested in it, and it is wisest to wait until the child feels they want the help. 

One of the best ways to encourage language development is to read books to children as preschoolers. Children as young as 18 months can enjoy looking at a picture book with an adult and can learn many new words this way. Three-year-olds can follow a simple illustrated story. 

Parents should use interactive book reading techniques, stopping frequently during the reading to ask the child to fill in or guess the next word, guess what will happen next, talk about experiences they have had that relate to the story and so on. Again, the most important thing is to make the experience cozy and fun for the child so that they acquire a good feeling about books, reading and talking. Parents can let the child choose the book, establish a special chair for reading, let the child pretend to read some parts – anything that makes the interaction special and pleasant for the child. 

A second important tool for growing language is to gear our language to the child’s level. For children under three, we will want to talk mostly about what the child is seeing and doing in the here and now, showing how language is used to match and refer to things and actions in the world. 

Once the child gets to be three, parents will want to add talk about “there and then” in conversations: talking about what happened at grandma’s yesterday; about their upcoming vacation; about what mom did at work or they did at school. This kind of language helps the child learn to express more abstract ideas that will be helpful for succeeding at school.