Does my child need speech therapy?

Your baby’s first word is a memorable milestone, but what if she doesn’t seem to be communicating as effectively as other children her age?

“Speech therapy covers a wide spectrum of development in children, including feeding, speech, language and pragmatics [the social aspect of language],” explains speech therapist and audiologist, Ashira Segal. As a child grows, various skills are learned and developed, but sometimes a child needs therapy to help overcome an obstacle or to learn an age-appropriate skill. Speech therapists help children through oral motor therapy. For example, there may be a weakness in the jaw or lips, which affects their ability to articulate sounds. Oral motor therapy strengthens the muscles, helping them to speak more clearly, and various techniques are used to target specific speech sounds.

Your tot’s speech

Parents will often notice that something “isn’t right”, but they don’t know where to begin. “I am asked the same questions regularly,” says Ashira. “‘Does my child actually need speech therapy?’, When should he be saying the /r/ sound?’ and ‘Why am I the only one who can understand my child?’” Babies begin learning from birth, she explains. “They can’t say much, but they listen and learn language, as well as how to distinguish between sounds. “At about nine months, they have learned all of these sounds receptively and now need their motor skills to develop in order for them to start saying the sounds.” Early intervention therapy for children aged 0-3 years old focuses on pre-linguistic skills, which are the foundation of language and necessary for communication.

4 Pre-linguistic skills 

1. Turn-taking
2. Imitation
3. Joint attention
4. Requesting (achieved through play), which will then translate into aspects of communication

Good to know: Language therapy for children aged 0-5 includes basic concepts, such as colours, body parts, and shapes. Many children in Ashira’s practice also struggle with sentence structure, so correct syntax is part of the treatment protocol. Other aspects of speech therapy include auditory processing – the ability to understand speech, follow directions, distinguish between sounds, and comprehend spoken information. This is particularly important in the classroom environment. Feeding issues are also addressed through oral motor therapy. If the jaw isn’t strong enough to chew, or the tongue is unable to propel food back, this affects eating ability. Sometimes, children also have difficulty swallowing. This may be congenital or acquired and there are many ways to treat this.

Age-appropriate speech errors

Some speech errors are age-appropriate, while others are not, explains Ashira. If a three-year-old can’t say the /r/ sound properly, producing “wabbit” instead of “rabbit”, this is considered age-appropriate speech, as the sound is still developing. However, leaving out the initial sounds of a word, such as saying “ee” for “tree”, or “ick” for “stick”, is not considered age-appropriate and a speech therapy assessment should be conducted.

Reasons for speech problems and delays

There are several reasons for speech problems and delays. These include developmental delays, such as learning difficulties; prematurity; auditory processing difficulties; structural difficulties, including cleft lip or palate; apraxia of speech (a motor speech disorder in which a child battles with sequencing and executing speech movements) and disorders such as autism and Down’s syndrome.

Age-appropriate speech milestones

Below are the age-appropriate speech milestones that a parent or therapist looks out for in a developing child. These are general guidelines only. Birth – 6 months

• Speech sounds: Vowel sounds /a, o, u/. You may start to hear vocal play such as squeals, growls, or “raspberries”.

6 – 12 months

• Words: A child will start putting consonants and vowels together, such as “ba” followed by duplicated babbling, such as “baba” and babble combinations, “bamaba”.
• Sounds: You baby may mutter sounds like p, b, m/ usually followed by /h, y, n, w, d/.
• Other: May start responding to name.

1-year-old

• Words: Two to six words other than “mama” and “dada”.
• Sounds: You may start hearing /t, g, k, s/.
• Other: Answers “yes” or “no” to questions.

2-years-old

• Words: 50-200 words.
• Sounds: Same as above, including /ng/ as in “sing”.
• Speech intelligibility: The child should be understood 50% of the time.
• Other: Points to objects and body parts and follows two-step directions.

3-years-old

• Words: 300 to 1 000 words and uses three-word phrases.
• Sounds: Same as above. You may start to hear /f, r, l/ and other sounds developing.
• Speech intelligibility: The child should be understood 75% of the time.
• Other: Uses pronouns, present tense, and prepositions.

4-years-old

• Words: 1 600 to 2 000 words.
• Sounds: You may start hearing sounds such as /z, th, j, v, ch, sh/ developing.
• Speech intelligibility: The child should be understood 90% of the time.
• Other: Can ask and answer questions and follows three-step instructions.

5-years-old

• Words: 2 200 to 2 500.
• Sounds: Same as above; may start to hear /zh/ sound, as in “measure”.
• Speech intelligibility: Should be understood 100% of the time.
• Other: Understands opposites and time concepts such as yesterday, today, and tomorrow.

Common signs of speech problems

• A quiet baby who does not make sounds or babble.
• A child who does not respond to noise.
• A child who has not said his first word by 15 months.
• A child who is not social and shies away from making eye contact.
• A vocabulary of less than 50 words by two years of age.
• Inability to follow simple instructions by two years of age.
• Other people are unable to understand your child at three years of age.
• Has known speech difficulties, such as stuttering or lisping.
• Has any speech sound error after five years of age.