Learning a language is a lifelong pursuit. However, the first three years of life are the most important phase for language and speech development because that is the time the brain is developing at the fastest rate and maturing rapidly.

Speech and language skills develop best in an environment that is surrounded by real-life situations, activities, people, and objects. Most importantly there should be a lot of talking and interactions with people regarding various activities and objects.

Types of Delay in Speech and Language

A language delay can be expressive, receptive, or both. A receptive language deficit means the child has difficulty understanding the language. An expressive language disorder means the child has difficulty in doing verbal communication.

Signs and Symptoms of Delay in Speech and Language Development

Common symptoms of a speech and language delay include the child:

  • Not smiling, not playing with others, not reacting to things happening around in the environment
  • Poor social skills
  • Has no meaningful play
  • Finding it difficult to follow directions of others

Your child may have a delay in speech and language if he does not meet the language developmental milestones depending on his age. For instance:

  • Not starting to babble by the age of 15 months
  • Not starting to talk in single or double words by the age of 2 years
  • Unable to speak in short sentences by the age of 3 years
  • Finding it difficult to put words together in a sentence
  • Poor articulation or pronunciation

A child should have a vocabulary of around 500 to 1000 words.

Causes of Delay in Speech and Language Development

Some of the common causes include:

  • Hearing impairment
  • Other sensory deficits
  • TBI
  • Autism
  • An intellectual disability
  • Various psychosocial issues

Risk Factors for Speech and Language Delay

Some of the risk factors include:

Injury to developing brain

in pregnancy (eg mothers age medical conditiond mother had),

at birth  eg born prematurely, low birth weight,neonatal jaundice

 post natal causes

  • Twin births
  • Having a family history of speech and languge

Effects of Delay in Speech and Language Development

It has a ripple effect on many areas of development like social, emotional, and interpersonal relations. It has a direct effect on communication and the most important impact is on academics i.e. language, speech, and ability to communicate. It is the basics of learning academics thus ensuring good outcomes in terms of reading, writing, language development, and arithmetic.

It is an obsolete approach to wait and see till the age of three whether the child can speak or not. If your child does not start to talk properly by the age of three, approach a well-qualified speech and language therapist at the earliest.

Diagnosis and Role of a Speech Therapist in Assisting a Child with Speech and Language Development

After a doctor conducts a thorough medical assessment of your child, he would refer you to a speech-language pathologist or therapist. The therapistwould also do a thorough assessment. He would check the receptive language, expressive levels, and the communicative ability of the child to determine the condition. He will examine all the oral structures that are required for the speech and shall check the development of speech, sound, and clarity. The examination will focus on different forms of verbal and nonverbal communication. The assessment would be done using various informal and formal tools.

 informal assessment tools pertain to parental interviews and observing the child at the same during the session.

 Formal assessment is done using standardized testing tools. Based on the assessment, the speech therapist will do the diagnosis and accordingly design an intervention program. Speech therapists would generally conduct individual sessions to ensure proper speech and language development. A lot of counseling sessions and parental tips would also be provided.

After the speech and language evaluation is completed, the therapist may recommend other tests and examinations or paramedic intervention if he feels the reason for the delay needs to be further analyzed.

 For instance, a hearing examination can determine whether or not the youngster has a hearing impairment  Orofacial anomlies too need to be examined

Treatment and Areas Where a Speech Therapist Intervene

They generally intervene in the development of the basic speech and language concepts along with the pre-requisites required before the child has acquired speech. They work on the development of basic concepts such as size, shapes, colors. Then they work on enhancing the stock of vocabulary and on building vocabulary across nouns, verbs, adjectives.

If a child has to use these vocabularies that he has learned, he also needs to know the grammatical markers to string the words into sentences. A speech therapist would teach the child correct and adequate use of tenses, genders, and word modification according to singularity or plurality.

The development of vocabulary will be based on different categories. The speech therapist will work on different categories to teach the child nouns, verbs, adjectives, and other grammatical vocabularies. The categories a speech therapist would work on are teaching the names of fruits, vegetables, animals, body parts, clothing, etc. Now along with the development of vocabulary, the speech therapist would also need to work on the development of social and pragmatic skills of the child. It means the child needs to develop the skills for effective and efficient forms of communication. This involves the child making good eye contact, having good listening skills, and the need to develop his ability to initiate a topic. Once the topic is initiated the focus should be on developing the skill in the child as to how to maintain talking on that particular topic. It is also important for the child to be able to end a topic that he has started.

Sharing and caring skills are also extremely important. The development of play is a very important goal for speech therapists that they do while working alongside parents.

i. Things Covered in Development of Play

The therapist shall look at what stage the child is at when the play is concerned. It could be solitary play, non-functional play, and onlooker play. The therapist would work on these stages before getting into exploratory play, imaginary play, and ultimately coming to a level of social play where the child can follow instructions, rules of the game, learn to share and care followed by developing the skill of taking turns.

Asking relevant questions and getting proper answers from the child are very important skills or a very important goal that we need to remember.

One of the important skills or goals on the part of a child is his ability to give proper answers when he is asked relevant questions. Both the therapist and the parents have to work with the child for the development of these skills.

Every activity that is being done with a kid should have questioning and answering sessions. For instance, you need to ask questions such as “What did you play?”, “How did you play?” etc. Problem-solving exercises and logic exercises are also important parts of the therapy.

To ensure that the child does not lose out on the crucial years of language development due to certain situations when not able to consult a speech therapist, the parents can work with the child to develop the various skills mentioned.

ii. Three main strategies need to be remembered:

How to Speak?

Children learn language through interactive activities, observation, listening, and imitating the way other people talk. Thus the parents or family members need to be good models. It is important to be expressive while talking and also to speak clearly. One should use short, simple, and age-appropriate sentences. The age of the child needs to be kept in mind and accordingly use child-friendly language. It is very imperative on part of the parents to have a natural knack for talking to the child in normal intonation patterns.

In India, different languages are spoken, sometimes within the family. Thus, it is to be ensured that when dealing with a child with speech and language delay, only one language is spoken. This should be done in order not to confuse the child with too many languages or dialects. Use the same words consistently. Asking questions and expecting answers are important strategies as well.

What are the Kinds of Questions that need to be asked?

There are three main types of questions that need to be asked. The three types of questions need to be answered in three ways.

a. Firstly, ask the child to answer in a ‘yes’ and ‘no’ format.

b. Secondly, ask choice-making questions.

c. thirdly, ask open-ended questions.

What is meant by these three ways?

Asking ‘yes’ or ‘no’ questions means questions like, “Do you want a biscuit?” The child can say ‘yes’ or ‘no’ as per choice. The same question can be modified if required. The child can be asked to give a reply in a single word which means choice-making questions like, “Do you want a biscuit or chocolate?” The child may choose any as per preference. Now an open-ended question needs to be asked. For instance, you know the child wants something to eat. You need to encourage him to use words that he has heard and learned. So you ask him, “What do you want to eat?” The child can say what he likes. Now following answering a question, he did say a biscuit. You can continue with the conversation in this way.

Besides this, the techniques of repetitions, commenting, extension, and expansion of the child’s utterances are also very important strategies that need to be used. Repetition means to repeat what the child says and comment on it. These kinds of strategies make the child feel very happy and connected with the parents. They get the feeling that you are giving importance to everything that he is saying. Both you and the child have to repeat words based on the questions being asked and answers being given.

What is meant by repetitions, commenting, extension, and expansion?

For instance, the child said biscuit. You need to comment, “I know you want a biscuit.” Then extend by asking, “Which biscuit do you want? Do you want the salty biscuit or the glucose biscuit? Do you want the biscuit we bought from the shop? Where has mama kept the biscuit? Why do you want to eat a biscuit?” Continue with, “Oh. Baby loves salty biscuits. How many biscuits do you want? Do you want four biscuits? The biscuit is very salty, right? Look at the shape of the biscuit. Is it round or square?” So when you do a conversation based on the one single word the child uttered he is exposed to hearing new words and new ways of expression. He learns to use new words in sentences and also the meanings of the different words you used.

When to Speak?

Talking is an on-going process and people start to talk since waking up till the time they go to bed. However, when dealing with a child with special needs in terms of language stimulation, you need to do this targeted language-speaking exercise at the time when he is happy, healthy, alert, ready for participation and shows interest in a particular activity.

What to Talk?

It is the most important aspect of language stimulation exercises. There are two main techniques which are used by all speech therapists throughout the world. These two techniques are called self-talk and parallel talk. They involve a description of activities that happens throughout the day either with the child or what the child is observing or watching.

What is parallel talk or parallel play? 

There are various activities that parents do with their child throughout the day- right from grooming him, feeding him, taking him out, or making him do many other activities. So, these situations can very well help with language stimulation exercises. The parents need to talk about what the child is doing, touching, feeling, smelling, seeing, hearing, eating, etc. For instance, you are bathing your child. Use this situation to talk to the child describing everything that is involved in the activity. Say to him, “Yes baby we are going for a bath. How are you feeling? You do not feel fresh. Don’t we have to take a bath? Where do we take a bath? Come on let’s go to the bathroom.” So, here you have introduced another word, a ‘bathroom’, where everybody goes to freshen up.

So, once you go into the bathroom, describe the activity that you would do with the child or everything he is going to experience while taking a bath. So, you can say, “Come on let’s remove your clothes.” You can describe the different kinds of clothing that you or he is wearing. Then continue talking about the clothes, “It’s so dirty. It’s so smelly. Let’s put in in the laundry basket or for washing.” Carry on the conversation when you open the tap and speak about the sound of water splashing in the bucket. Make the child feel the temperature of the water and describe whether it is hot, cold, warm so that the child is experiencing the particular word hot when the water is hot and can relate the meaning of the word hot to that particular feeling.

Other activities happen when you are bathing the child, like applying the soap. So when you bring the soap, comment on it. Say, “See the soap is round. the soap is green. Look and feel the smell of the soap. Okay then let’s apply the soap. Oh, the baby is feeling so slippery.” Let him feel the texture and talk to the child about the textural experience that he is undergoing while taking a bath. Like wetness, slipperiness, freshness, and many other feelings. If your child does not like the activity of taking bath say words like, “Oh! Baby does not like to take bath”, or “You do not like to get wet” or “The water is too hot”, or “You are feeling too cold” or “You do not want to take bath.” So depending on how the child is experiencing, keep modifying your language.

So, what were you doing, you were bathing him. So how was he feeling? He was feeling happy or unhappy depending on the situation. What was the child touching? He was touching soap, water, bucket, towel and after the bath, he may touch oil, cream, or powder. What is he seeing? He is seeing the activity of bathing going on. Many activities are going on simultaneously like opening and closing of the tap, applying the soap, search for the towel, and other interrelated activities. And what did he smell? He smelled soap, oil, cream, powder, etc. He smelled the feel of freshness and also the feel of tiredness or dirtiness. He also heard the flow of water, the swishing of soap, and so many other sounds related to it. So this was one example of an activity of bathing.

You can continue to describe the things while carrying on other activities like feeding the child. What are you feeding? How is the taste of the food? Does the baby like it? Was the feeling hungry or is it showing protest to eating? So accordingly, you will speak about the events that are happening.

When you follow these techniques of parallel talk, you have plenty of things to talk about and speech comes automatically. The child is learning the meaning of the words in a natural environment. So, learning becomes intrinsic.

What is Self-Talk? 

The second most important technique that you need to use is self-talk. Apart from the activities that you are doing with the child, you also do some activities of your own on your own and the child invariably watches those things. So when the child is watching you do certain things, you can describe what you are doing, how you are feeling, things you smell, hear, touch, etc. For instance, you are dusting and the child is sitting on the chair. So, you can say, “See, mama is dusting. Things have become so dirty. Everything is scattered over here. Water has spilled over here. Food has spilled. We will all slip and fall if we do not clean it. Look I am dusting the table and dusting the furniture. Look at the shoe stand. Everybody’s shoes are out of place. Come-on I am going to put everybody’s shoes in place. This is mummy’s shoe, this is daddy’s shoe, this is your shoe.” etc.

So, when you talk about something that you are doing naturally, the child is automatically learning. And he will show interest in watching in what sequence you are using. He may use imitation skills and learn to do the same activities from the next time. He has also learned the meaning of all these words especially when you say it appropriately.

Many times the child is sitting next to the kitchen counter and watching the things you are doing. It is a very good opportunity for you to talk about chopping, washing, cleaning, utensils, cutleries, and everything else that you are using in the kitchen related to food and otherwise. Say to him, why you are cooking the food, what are you cooking, describe and make him experience the smell of food, the sound of the whistle of the pressure cooker, the sound of vegetable sizzling, and sautéing, etc. together. All these things are very beautiful learning experiences for children in terms of language concepts and speech.

So basically you have to describe in detail all the activities that are being carried on throughout the day with the child or in front of the child in a natural and comfortable environment.

There are certain things or objects easily available at home that you need to incorporate along with the activities to develop language. Although, parents are encouraged to buy toys to use them as learning tools in most cases the strategy does not work to its full potential, especially in India because it does not fit in the economics of the country and most of the toys are kept inside showcases and children are hardly allowed to play with them. So it is not a feasible option to buy toys just for teaching certain concepts. Moreover, children lose interest in a particular toy after a few days. So learning does not happen but clutter builds up. Learning mainly happens in a real interactive environment only. Of course, toys will be there for certain activities but very basic ones which can enhance language and stimulation activities.

Use real objects wherever and whenever possible so that you can teach the basic concepts, size, shape, color, and building vocabularies across different categories. Use real fruits, vegetables, clothes, grooming articles to teach your child. Teach them the names, size, shape, color, and overall appearance of the objects. Sit down with your child and mix up all the vegetables and fruits. Ask him to sort them out and talk to him as much as possible about them. These activities help with naming, numbering, identifying the shape, size, and color. Using real objects is a strong counseling technique that should be used. It is not a helpful idea to start with pictures to teach the child about different things. It is better to start with real objects and then shifting to pictures. Then grade down to symbols, words, and pictures. These types of activities conclude sorting, matching, naming games.

You can also use clothes as a teaching material. Sort the clothes as per the types, colors, or based on the owner of the clothes in the household while putting them for washing in the bucket or washing machine. Simultaneously, go on describing each item to your child while he watches you do the activity.

Grooming items like a comb, toothbrush, toothpaste, lipstick, bindi, bangles, etc. can be used as teaching tools as well. While teaching colors to your child, use real things only. Like, if you are teaching red color, wear a red dress, a red bindi, red bangles, etc. Decorate your house with red cushions or red curtains and even cook food which is red like tomato chutney or use ingredients which are red like red bell pepper, apple, etc. You need to be innovative in every way possible.

You can also use water play, sand play, blowing bubbles, art and craft activities, drawing, coloring, playing with modeling clay. All these activities are very much loved by children and thus you do not have to use special effort to make them do these activities as they will automatically play with these items.

Besides language stimulation all these activities help the child to develop sitting tolerance, making good eye contact, paying attention to the activities, completion of the activities, and most importantly following directions. They are also paying attention to what you are trying to teach. It helps them to think and to be creative. It also works in developing motor functions. It helps the children to be organized and break up the task into sequences. Developing task analysis skills, motor planning skills are also very important. They also learn cause and effect.

Blowing bubbles is also a very interesting activity through which you can teach a lot of preposition like ‘in’, ‘out’, ‘up’, ‘down’, ‘far’, ‘near’, ‘more’, ‘less’, ‘here’, ‘there’, ‘up’, ‘down’, etc.

Reading books, storytelling, singing, music, nursery rhymes are other interactive activities which are very stimulating. Nursery rhymes can be sung according to various concepts. They are based on numbers, body parts, sequencing. You can teach poems based on positions and movements. The singing of shlokas is also a very important activity because it gives the child an idea of rhythm.

Nursery rhymes can be used to teach language concepts along with good body image and also to use the body for better verbal expression. People do not only communicate through speech, but also by using body language, facial expressions, and gestures. So these are very interesting activities and important too to develop in the children.

Storytelling is also a vital activity. It should be age-appropriate. Start with simple stories using two or three sentences. You can also come up with a story related to nursery rhymes.

Actions play a very important role in language stimulation as these activities teach children to give good expressions.

What Toys to Use and How to Use Them?

Let us look at some of the basic toys that can be used for developing concepts. Some of the common toys that can be used are stacking cups, nests, beads, ball, doll, doll sets, animal sets, etc. You can use stacking cups, nests to start pre-math skills like making the child understand the concept of big, small, less, more, etc. Tell your child to arrange the toys from small to big or vice-versa. Instruct them to give you one or two cups or put the cup on the table, pour water in the cup, etc. You can give as many types of instructions, as many times you want based on the present mood and mindset of the child. This is again basically an activity to develop skills related to matching, sorting, naming, number works, and positions. It develops motor planning automatically as a child is using his hand and moving his body to keep the items or doing the things as per your instruction. He is using his brain and mind to decide where to keep the items and how to follow certain instructions. He is also learning the concept of comparing similar or different items. He is learning by trial and error method along with cause and effect.

The ball can also be used in addition to these things. It helps to develop eye-hand coordination and social skills. While playing with you or others, he learns the rules of the games, ascertains other’s body language, facial expressions, and gestures.

Inserts puzzles are quite interesting toys to use as the child is allowed to sit independently and use his thinking abilities and complete the puzzles. He can learn from whole to part and part to a whole, which is the basic to all future learning skills.

To develop the skills of pretend play or imaginary play toy phones can be very helpful. You can take the phone and say “Let’s talk to the milkman”, grocer, doctor, etc. Then elicit vocabulary relevant to that particular topic.

Teach your child about body parts, clothes, similarities, differences, etc. through doll play, dollhouse.

Teach your child the sounds of animals and birds, their looks, body parts, types of houses and nests they live in, their food habits, etc. with animals and birds figurine toys. Toy vehicles can also be used to teach things similarly.

There are other such activities that parents can do to build and improve the speech and language ability and development of the child. Language stimulation strategies are incredibly helpful when it comes to helping a child communicate. As the name suggests, these are strategies that parents can use to stimulate the language of a child, allowing their communication skills and hold over the language to grow and develop. Use the speech development therapist as a facilitator. Language development is an on-going process and there are multiple effects of it. It only grows in a naturally stimulating environment.

Please do not ignore if you see signs of language delay as language is the basis for all learning skills right from basic to advance. The speech therapists at Nightingales provide assessment, diagnosis, and intervention at an individual level in the comfort of your home. During this period of lockdown, we are offering telerehabilitation services so that the speech and language development of your child is not hampered. Log on to https://www.nightingales.in/services/speech-and-language-therapy or call us at 1800 103 4530 to avail of the services.