Speech Disorders Therapy In Children
Discourses such as ‘genetically late speech, both his mother and father spoke late’, which are not given much importance among the public in our country, actually show that there is no awareness that speech and language skills are an important problem. It constitutes one of the main topics of developmental pediatrics as a separate branch.
Since most of the time the focus is on physical problems in the impression of a healthy child, language and speech disorders can be overlooked unless there is a complaint by the family.
Language and speech are two different phenomena. Language is also divided into two: perception and expression. Perception; It is the interpretation of what is written and said. Expression, on the other hand, is the selection of target words by following the rules of grammar for the verbal and written transfer of thoughts and feelings. In addition, eye contact and speaking in harmony according to the conversation order are also part of the language.
Physical acts of verbal expression are defined as speech. The conversation takes place with the coordination of the relevant organs. These are concepts related to fluency, articulation of sounds, voice quality and speech. Language development is achieved by following certain developmental stages. Parents need to follow these steps. As time passes, new achievements are added to perception and expression:
6-month-old babies: Follow sounds with their eyes,
9-month-old babies: Turn to look at sounds, listen when spoken to, and recognize the names of frequently used objects,
12-month-old babies: Follow single-stage instructions,
18-month-old babies can: Point to at least one body part with their finger when asked,
Children aged 24 months can: Follow simple instructions, listen to simple stories and songs, and point to several body parts.
Children aged 3-4 years should be able to answer the questions “who”, “what”, “where” and “why”,
is expected.
Just as the steps mentioned above are perception, certain steps must be followed in expression. Observation of babbling, trying to imitate sounds, saying one or a few words even if they are not clear, and using body language is expected by the age of one. By the age of one and a half, 3 to 20 words should have been added to the repertoire, most of the words should consist of nouns, and the child should be able to communicate by adding sounds to gestures and facial expressions. It is expected of two-year-old children that they put two words together and imitate words with sounds. It is expected that their speech will be understandable to people outside the family and that they will be able to make sentences consisting of four or more words between the ages of three and four.
Reasons for the delay?
A comprehensive evaluation should be made in cases where the stages of language and speech development cannot be followed. This delay may have auditory, neurological (childhood apraxia, cerebral palsy, dysarthria, etc.), genetic (Down syndrome, cleft palate, Fragile-X, etc.) or neuropsychiatric (autism) reasons. ‘Second language and speech problems’ are the language and speech delays that occur due to these reasons. For example, syndromes with distinct physical characteristics (such as Down syndrome) and deafness may be diagnosed earlier. However, disorders that cannot be detected immediately and whose symptoms appear later (such as autism) may be diagnosed late (Toğram and Maviş 2009).
1-Genetic Factor: Language and speech delay may occur without any reason, or it may be the result of a genetic, auditory, neurological or neuropsychiatric disorder. As a risk factor, gender is the influential factor. The risk of language and speech delay is higher in boys than in girls. This rate is three times higher. Additionally, having members in the family with speech delay doubles this risk.
Another risk factor is events occurring at birth. It was determined as low birth weight and premature birth. The risk of language and speech delays is twice as high in children born prematurely at 37 weeks or less than 85% of their ideal birth weight.
2-Electronic Media: Electronic media is another factor that causes delays in language and speech development. Internet, playstation, television, computer, etc. Children who grow up in an electronic environment where technologies are concentrated begin to speak later and later due to the decrease in both family communication and communication with their peers. It is not recommended for children, especially before the age of two, to watch television as it negatively affects language and speech development.
3-Influence of the Family: It is dangerous and risky to wait for children with language delay to go away on their own. Waiting may counteract the benefits of early intervention. The risk of experiencing language disorders at school age is also seen in children with language delay. Research shows that children who have difficulties with reading at school age are observed to have language disorders between the ages of two and five.
The participation of families in the process of monitoring their children’s health and development is increasingly recommended, and the necessity of determining their own roles, obtaining their opinions, and early diagnosis of problems is emphasized (Hall and Elliman, 2003).
It is seen that the measurements used in evaluation and treatment services leave the information about children with language and speech problems to the information received from the family (Glogowska and Campbell, 2000). Therefore, families of children receiving therapy;
- Families should be supported and motivated to participate in therapy, and their role should be played fully in the treatment process with the awareness of this responsibility.
- Family participation is important because observation during the early diagnosis and prevention of problems is done by families who can observe the child at every opportunity. Families should be encouraged in this regard.
The Three Most Important Factors for Language and Speech Problems
Families, teachers and language and speech therapists are the most important factors regarding this problem, respectively. And all three of them should harmoniously inform each other about observing the child.
- Families: When families develop positive attitudes, therapies positively affect the child’s problem, speech therapy positively affects the child’s delays in other areas (if any), and the child with speech problems will be able to easily use what he/she learns in therapy in his/her daily life.
2.Teachers: Teachers are also required to observe the speech therapy sessions of school-aged children. In addition, the therapist and family should be informed about the child’s therapies.
They observe children with speech problems whether they exhibit maladaptive behaviors in lessons. They should know that the child’s speech problem will turn into a learning disability in the future. Also, knowing that some different behaviors can be seen in children with speech problems; They need to notice at school whether their friends are making fun of the child at school, whether they may be hyperactive and incompatible, or whether the child’s speech is impaired.
- Therapists: Therapists should work in coordination and give observation forms to families and teachers. Therapies should be ensured to continue everywhere and not to be stuck in the gutter environment. In addition, children should be encouraged to participate in social activities and activities should be provided for speech problems. Environments where children can feel comfortable and express themselves should be provided. ( Erdem Psychiatry Center , located in Kızılay, Ankara, provides speech therapy services with its expert staff in a suitable therapy environment .)
When Should the Child Be Referred to a Language Therapist?
Lack of babbling, limited use of consonants, and babbling predominantly with vowels are risk factors in nine-month-old babies. The absence of pointing and gestures indicates the need for evaluation in twelve-month-old babies. Not having at least three words and not looking at 5-10 objects or people when the parent asks is also a risk factor at fifteen months of age. If “mother”, “father” or other names are not used and simple one-step instructions are not followed, evaluation is required at eighteen months of age. If a two-year-old child does not accompany his body language communication with his voice, does not point to pictures or body parts upon request, and does not have at least 25 words, a speech and language therapist’s opinion should be sought.
If, at the age of two and a half, he does not respond to questions with words or nodding, and does not put two words together and make subject and predicate combinations, evaluation should be sought. If, at the age of three, he/she repeats phrases consisting of a few words in response to questions (echolalia), does not understand prepositions and predicates, and cannot fulfill two-stage instructions, gains are lost at any age and he/she does not use at least 200 words, does not express his/her wishes with their names, and if a regression is observed, he/she cannot use the language immediately. and should be directed to a speech therapist (Kayiran et al. 2012).
Children Raised Bilingually
Mixing of two languages can be observed in children growing up bilingual, but this situation decreases as language development increases. It is thought that children who grow up bilingually have more advantages than those who grow up monolingually in terms of conceptual flexibility.
The Effect of Language and Speech Disorder on Social Achievements
It appears to negatively affect attitudes towards academic/social success in children with language and speech disorders.
Language and Speech Therapy
It is possible to change the child’s developmental curve with treatment that starts before the age of 3, thanks to early intervention. It has been determined that early intervention is beneficial for both language and speech and other accompanying disorders. At the end of the evaluation for language delay, the speech and language therapist teaches the family what they need to do to support their child’s language development. In this way, target strategies are implemented by the mother and father within their daily routines. According to research, there is no difference between the application made by the trained parent and the application of the appropriate approach by the language and speech therapist, considering the gains achieved. This approach positively supports language and speech development in children.
resources
Glogowska, M., & Campbell, R. (2000). Investigating parental views of involvement in pre-school speech and language therapy. International Journal of Language and Communication Disorders, 35 (3), 391–405.
Hall, DMB, & Elliman, D. (2003). Health for all children (4th ed.). Oxford: Oxford University Press.
Kayiran, S., Şahin, SA and Sena, C. 2012. Approach to speech and language delay in children from the perspective of pediatrics. Marmara Medical Journal, 25(1): 1-4.
Toğram, B. and Maviş, İ. 2009. Evaluation of attitudes and knowledge of families, teachers and language and speech therapists towards language and speech disorders in children. Ankara University Faculty of Educational Sciences Journal of Special Education, 10(01): 71-85.
