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Understanding Communication Disorders

“What does my baby want?”

“He is crying and wriggling about. I don’t understand what he is feeling and needing!!

“My 2-year-old isn’t using words yet. He just babbles. What is he trying to say?”

“My 4-year-old doesn’t speak clearly and is not using full sentences yet. Is something wrong?”

“My 10-year-old doesn’t use language as well as his classmates. His teacher is failing him in Language Arts. Is he being lazy, or does he have a problem?

Communication consists of speech, oral language, writing, and actions such as behaviors. Infants are not born knowing how to communicate, which is as frustrating to them as it is to you. But over the months you both begin to understand how to communicate with each other.

SPEECH:

First, you begin to learn what different sounds mean as well as the different pitches and intensity of crying.

Over the first six months, your infant begins to realize that the sounds you make have meaning, so he begins to try to imitate them. He also notices that your different facial movements have meaning, such as smiling, sticking your tongue out, and blowing bubbles.

By one year of age, you should notice your child using specific sounds to label you, foods your child likes, any pets you have, and favorite toys. This is the beginning shift from overall communication to the use of speech and language to communicate. Your child is also frequently pointing at objects or things that he wants and waving bye-bye.

By 18 months of age, your child should be using more of a combination of pointing and sounds that have language meaning. If your child is not appearing to learn more words (understanding) or is preferring to use gestures, rather than words, your child is showing language delays.

Many times, you will bring this up to your child’s doctor but get the reassurance that some children develop slower in language because they are more interested in hands-on activities. Or you may be told that older siblings are speaking for him, so he doesn’t feel the need to speak. These are misconceptions that need to be addressed with a request for a speech/language referral. The longer that a child lags his peers, the higher the rate of social problems, behavior problems, and academic problems.

If you have problems getting your child’s doctor to make a speech/language evaluation, you can contact your state’s Early Intervention Program for ages 0-3 years. They also provide other services for children from birth up to age 3 years such as physical therapy or occupational therapy. The Centers for Disease Control and Prevention (CDC) has a page with links for each state’s early intervention services. If your child needs services after age 3, your local school district will be where you start.

In addition to speech word problems, your child may have issues with pronunciation or fluency. Pronunciation is also called articulation. Most children have problems with pronunciation as they are learning to speak. But by 8 years of age, most of these dysfluencies should have resolved. Children who have problems with articulation are frequently labeled as having a phonologic disorder. This increases their risk of being diagnosed with dyslexia in school since the reading and writing of words are tied into the ability to match the correct sounds to the correct letter or letter groups (words).

A second speech disorder is due to problems with the coordination of oral motor actions with speech sounds. This is frequently called developmental verbal apraxia disorder. Your child may sound like he is gargling when speaking. He is extremely difficult to understand. There have not been any muscle or nerve problems found to explain it. Your child will need speech/language assistance as soon as possible. Most times, this doesn’t start till 2 years of age, due to the misconception again of speech and language development by many physicians. Your child will not necessarily have any problems understanding words or language, but rather in responding in words or sentences.

The third speech sound disorder is called stuttering, which is a problem with fluency or rhythm of speech. Your child will make errors that consist of repetitions of sounds and syllables, prolonged sounds of consonants and vowels, and the breaking up of words with pauses between the parts. About 2% of children will develop stuttering with 65-85% of them growing out of it. This also requires help from a speech pathologist for the best chance of the child overcoming it. There have been many well-known people, including President Joe Biden, who have struggled with stuttering. Here is a list of some of them.

LANGUAGE:

According to the dictionary, language is “how humans communicate with each other using words in a structured and conventional way through speech, writing, or gesture.” Humans are the only members of the animal species that have language to communicate, although many animals make sounds and gestures.

There are several layers to language:

  • Receptive – understanding what is being communicated
    • Vocabulary – single words
    • Phrase or sentence – series of words to convey more complex meaning
  • Expressive – Being able to communicate to others
    • Vocabulary – single words
    • Phrase or sentence – series of words having more precise meaning than can be given with a single word

As a baby, your child at first has no words and knows no words. He must rely on your actions to know what is happening. He watches your face and listens to your voice and other vocalizations, such as lullabies, attempting to connect them to how he feels with you. You also watch his face and his sounds, looking for common ground to communicate with him.

Over the first six months, you each get better at communicating with facial and sound gestures. Then your baby begins attempting to repeat the sounds you make to increase your ability to speak to each other. Your baby begins with vocabulary, so the meaning of a word, such as “Ma” and “Da” as labels for mother and father. By a year of age, he may be accurately using these initial sounds and soon after will begin to use sounds to label other objects, such as his bottle, a blanket or favorite toy, or even a family pet.

Phrases or sentences come later, between 18 months and two years, as he understands more about the different purposes of words, such as “Me hungry” being different from “Big puppy.”

Most children increase their receptive vocabulary first, then their expressive vocabulary (knowing what you mean for bye-bye or bedtime), followed by receptive sentences and then expressive sentences.

COMMUNICATION:

You likely don’t think about the nonverbal ways that your child communicates with you. You may, in fact, mislabel some of his communication efforts as behavior problems. This may be whining, crying, yelling, or plopping down on the ground when he doesn’t want to go any further. Your child has a reason for his behavior, but may not have the words, or feels that you are not listening and taking his words seriously, so he reverts to behavioral communication. This is particularly important to understand and will be the focus of another article. Basically, the more you understand how to get to the root of his behavior and any emotions which are fueling it, the better the relationship with your child will be.

What you definitely don’t want to ever say is “If you are going to cry, I will give you a reason to cry.” Your child has a reason, and as his parent, teacher, and protector, it is your duty to find out why, so that he can grow in his communication skills as well in his ability to regulate his emotions and his behavior.

If you are interested in an in-depth look at 3 factors of children and adolescents that can create positive or negative futures, check out my program, Never Assume: Know Children Before Labeling Them.

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