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Children can add tremendous joy and fulfilment to a working parent?s life. They can also add a lot of extra work. It is not uncommon to put in 16 hour days after we tidy up the house, clean, make lunches, help with homework and handle the many other details of running a busy household. We get tired, but we perform our duties with love and care because the well being of our children is at stake.

But what can a busy parent do to help a child with a communication problem? What do we know about helping these children? How do we make the best use of our limited time? Most parents have little instinctive knowledge in this area. To make matters worse, we run the risk of hurting our children by ignoring a problem, or trying to help before fully understanding what we are dealing with.

Parents need to be aware of early warning signs for communication disorders and take these problems seriously. Untreated, problems with speech and language skills can fester and develop into more serious emotional, social and educational difficulties. A parents most important first duty, is to recognize early warning signs for problems and to arrange for necessary help as early as possible.

Warning Signs:

Preschool children have the daunting task of learning a very complex system of sounds, words, and organizational structures, called communication, within an extremely short period of time. Most children have become extremely capable communicators by the young age of three. Others learn this complex system more slowly and with more difficulty.

Approximately 10% of children experience delayed speech or language skills. Permanent or transient hearing difficulties are to blame for the communication problems of about half of these children; while there are no physical problems in about 5% of children. Communication delays are extremely common, and often affect children who are developing normally in all other areas. If your preschool child?s speech and language skills are behind, he or she is likely a bright and healthy child.

Because your child is doing well overall, it is easy to disregard his communication difficulties. Add to this, bad advice from well-meaning grandparents and even doctors (e.g. ?Don?t worry, he/she?ll grow out of it?) and it is easy to understand why parents sometimes completely ignore their child?s problems. This is often the worst thing you can do. Unaddressed communication problems can lead to social withdrawal, behavioural difficulties and later academic failure.

A parent?s first and most important role, is to seek help early for a child who exhibits any of the following warning signs for a communication delay.

At 1 to 2 years old:

• your child cannot understand simple instructions like ?sit down? or ?come here?
• has not demonstrated interest in imitating words or sounds
• has fewer than ten words in his/her spoken vocabulary, e.g. doggie, ball
• has not started to join two words together, e.g. ?go bye-bye? or ?more cookie?

At 2 to 3 years old:

• has not started to form three words sentences, e.g. ?See big tree?, ?Mommy coat here?
• cannot make him/herself understand at least half the time to people outside the family
• not interested in looking at books or learning new words
• trouble naming things correctly

At 3 to 4 years old:

• less than 70% of what he/she says is understandable to people outside the family
• has not started to form four or five word sentences, e.g. Mommy is in the car?
• rarely asks questions or initiates conversation
• frequently omits words or word endings in spoken sentences; or confuses word order

At 4 to 5 years old:

• has trouble following three-part oral directions, e.g. ?Go to the kitchen, get yours slippers and give them to Dad?
• less than 90% understandable to people outside the family
• frequently spoken language errors, e.g. naming errors, verb tense errors, omission of words
• has difficulty telling or retelling a story, or relating an experience

Other Signs:

Any child with...

• an unusual voice: nasal, breathy, hoarse, too loud/soft, too high/low pitched
• history of repeated ear infections in the first fives years of life
• a hearing impairment
• a disease or accident affect brain function
• a facial anomaly which affects speech, e.g. cleft lip and palate
• feelings of self-consciousness regarding their speech
• a developmental delay or syndrome effecting communication skills, e.g. autism, down?s syndrome

If your child demonstrates one or more of the above warning signs, arrange to see a Speech-Language Pathologist for a complete communication assessment. Hearing status should be determined first. Speech-Language Pathologists have Masters Degrees in the field of human communication disorders, and have the appropriate Certification. They work in hospitals, treatment centres and private clinics.

Specific Disorder Types

1. Receptive Language Delay: marked slowness in developing an understanding or spoken or written vocabulary, grammar or discourse (necessary for understanding the thoughts and ideas of others). Will affect child?s ability to understand teachers instructions, classroom lessons and, eventually, written information (often known as ?dyslexia?).
2. Expressive Language Delay: marked slowness in acquiring spoken and written vocabulary, grammar or discourse necessary for expressing thoughts and ideas. Will affect child?s ability to be clean and complete in conversations, express opinions in class and, eventually, to express himself well in writing.
3. Articulation/Phonological Delay: difficulty with sound production often characterized by the substitution of one sound for another (e.g. saying ?dod? for dog), omission of sounds (e.g. saying ?han? for hand), or distortion of a sound (e.g. saying ?shlip? for sip). ?Apraxia? is a severe form of this disorder, characterized by motor planning problems for speech. Affected children will have inconsistent articulation errors and progress slowly in speech development, even with therapy.
4. Stuttering: an interruption in the flow of speech characterized by hesitations, repetitions or prolongations of sounds, words or phrases. Very common among preschool children.
5. Voice Disorders: characterized by inappropriate vocal pitch, loudness or quality. May be associated with the existence of vocal nodules or polyps. Best ot see Earn Nose and Throat doctor first.
6. Pragmatic (i.e. Social Language) Disorder: difficulty with conversational skills (e.g. starting, ending, maintaining topics), understanding or using nonverbal forms of communication (e.g. eye contact, body posture), making or keeping friends, using socially appropriate behaviour. Difficulties are common among children with acquired brain injuries and Pervasive Developmental Disorders, e.g. Autism.

10 Tips for Helping your Child at Home:

1. Consult a Speech-Language Pathologist (SLP). This professional will be your biggest ally. Your child may benefit from individual or group therapy, and /or home programming. With the help of this professional?s detailed test results, a treatment program can be designed to fit your child?s specific needs, and your time and financial resources. Test results will also help the SLP design specific recommendations for use at home. Please do not attempt any specific speech practice exercises without a SLP?s advice. The next 9 tips are general in nature and can be used by any parent prior to the initiation of speech-language pathology services. They do not, however, supplant the value of professional input.
2. Replace T.V. with more talking time. The T.V. is a poor substitute for family conversation. Conversation teaches listening, speaking and social interaction skills. T.V. watching, on the other hand, is a passive activity. It does not foster the active involvement and human interaction required to develop good communication sills. Spend more time talking and playing with your child everyday.
3. Read to your child often. No child should go to bed without enjoying a book with you. Even when children start to read themselves, they still benefit from hearing you read more advanced materials that challenges their comprehension and memory skills, and stimulate their intellectual curiosity. Make reading a regular part of your day together.
4. Provide visual cues. Children who have difficulty learning to speak benefit from seeing how words look on the mouth. Try to bend down and speak face to face with your child whenever possible to provide visual cues along with your words.
5. Speak more slowly. Your child will benefit from hearing you speak at a slightly slower than average pace.
6. Reduce the complexity of your speech. Try not to say more than one or two sentences at a time. Keep your sentences simple, i.e. just slightly more complex than what your child can produce himself. This provides your child with speech models that are easier to learn.
7. Arrange regular play-time with other children. Peers with normally developing communication skills can be good role models and communication motivators for your child. Children often speak more to their peers than to adults. Take advantage of this. Nursery school and library programs and are good ways to provide regular contact with peers.
8. Provide ?Corrected Feedback?. It is important that you respond to the content of your child?s speech (i.e. his message) and deal with speech errors in a discrete, positive manner. Never draw negative attention to his errors. Instead, use ?Corrected Feedback?
   
   e.g. Child: Da do to the sore. Parent: Dad went to the store. I know. He will be back soon (emphasizing underlined words). Your response should be produced in a pleasant, conversational tone of voice. Do not ask your child to imitate your corrected sentences. The value in this technique lies in your child hearing your corrections.
9. Involve community. Members of the community can be extremely helpful if provided with information. For example; family and friends can be encouraged to spend individual time with your child; teachers can slow their speech and provide corrected feedback; babysitters can be instructed to keep the T.V. off and read, sing and play games instead; and neighbours can be encouraged to include your child in their activities through reciprocal invitations.
10. Build your child?s self-esteem. When a child has a delay of any kind, parents often focus on this and downplay the child?s other strong qualities. Don?t make this mistake. If your child is good at drawing, encourage it. If he is a sweet child, tries hard, or shares well with others, praise him for these things. For in the end, it is your child?s positive self-respect that will sustain him/her through life?s troubled times. Bolster your child?s self-esteem with your words and your actions.

There are many things a busy parent can do to help their preschooler with a speech problems. Most importantly, take advantage of the professional input available to you. Speech-Language Pathologists are specifically trained to help. At home, limit T.V. and spend more time reading, playing and talking with your child. And don?t be a martyr-involve others whenever possible. African tribesman really do speak for all of us when they say, ?it takes a whole village to raise a child?.

Kerry Erle, M.Cl.Sc.
Reg. CASLPO, S-LP(C), CCC-Sp
Speech-Language Pathologist, Director

London Speech and Language Centre
1135 Adelaide St. N., Suite #215
London, ON, Canada N5Y 5K7
Phone: (519) 642-7370 or (519) 642-2172
Fax: (519) 642-2470
Email: ferle@julian.uwo.ca

About the Writer:

Kerry Erle is a Speech-Language Pathologist and founder of London Speech and Language Centre, a successful private practice in London, Ontario, Canada. The Centre focusses on services for adults and children with a) acquired brain injuries, b) language based learning difficulties, c) pervasive developmental disorders, including autism, d) preschool speech and language delays, e) stuttering. The Centre offers Saturday treatment programs, summer camps, intensive in-home services for children with developmental delays (i.e. ?KISS? program), communicative disorders assistant services and in-home academic tutoring services.

Kerry has an undergraduate and graduate degree in Communication Disorders from the University of Western Ontario. She is licensed with the College of Audiologists and Speech Language Pathologists of Ontario, and is Certified in Canada and the United States. She has over sixteen years of clinical experience with adults and children. Kerry recently won the Her scope of practice includes the assessment and treatment of all areas of communication including reading, writing, articulation, listening and social interaction skills; and of all areas of cognitive functioning that impact on communication including attention, memory, organizational skills and higher level thought processes.