Speech Development Delays

posted by Karen Quinn, The Testing Mom - July 5th, 2019

This mom asks a great question regarding her daughter’s speech development–while she is ahead in some things, she has fallen behind here.  Here are some great tools if your child, too, is experiencing some speech development delays.

Question from a Concerned Mom

My daughter just turned 3 and seems to be bright as she has been reading for the past year and seems to enjoy it. However, when she was born she had some fluid in both of her ears and this went unnoticed for 1 year. At 1 year we had tubes put in but then battled infection after infection for another year, finally figuring out she has a MRSA in the actual tubes. We replaced the tubes exactly one year ago and have not had a single infection!

Needless to say her speech is not very clear (very nasal) and we are just now using 3+ word sentences. I am starting to get worried as we approach the “school age” in regards to her being “teased”. She seems to communicate just fine (you know exactly what she wants) but her sentences come out “I hungry” or “I watch Dora”. Over the last few months I have been having her repeat EVERYTHING using correct grammar “I AM hungry”.

First: Assuming that she could not hear/hear clearly for her first 2 years- How long do you think it should take her to “catch up” on her speech? She did pass a hearing screening while she was under sedation during one of her 3 tube placement/surgeries.

Second: As I mentioned, I have always thought she has fabulous memorization skills (word recognition, memorizing all of the States, ect.) but she is terrible on any abstract thinking- the Why, How or What will happen questions. You ask her Why do you think the bread is hot? Instead of saying “because it is smoking, you took it out of the oven, the oven is hot, etc.”, she usually says some random word like banana or something totally unrelated. Any suggestions? I’ve thought about going to a developmental psychologist is see if there might be a more serious problem than a speech delay. We have several friends who are pediatricians and they don’t think anything is seriously wrong (autism, genetic disease, etc.), so I guess I was hoping you might have seen some sort of similar “delay” from the children you have worked with.

Karen Answers

Thank you for your question. It sounds like you have had a pretty rough time with your daughter’s ear infections. I’m glad that she is finally infection-free! I am happy you brought this up as many parents out there are dealing with the same issue. Ear infections, or otitis media (OM), are a very common problem that can often go unnoticed. One of the effects of OM can be fluctuating mild to moderate hearing loss. Your instincts are correct, your daughter’s hearing may have been impacted during that time, and subsequently her language learning may have been as well.

How They Learn

A child learns language through imitation. If a child is hearing a degraded acoustic signal, he or she will speak imitating that distorted sound. To get a sense of what a child might hear in that situation, imagine how things sound underwater or if you are wearing earplugs; now try to imagine learning a new language with this muffled sound. The results can be distorted vowels, nasal speech, or even unlearned sounds. A child might also miss some of the markers in language such as the /s/ sound to indicate the plural or possessive forms. We know that birth to three is the critical time for learning speech and language. (Unfortunately the highest incidence of OM coincides with this window.) In terms of “catch up” there is no hard-and-fast rule. The long-term effects of OM on speech and language development are not fully understood; however, most published studies addressing this question find that the majority of children with a history of recurrent OM show no residual effects on language comprehension and use by age 7.

WH-Questions*

*WH questions are questions that are requests for information. Wh– questions usually start with a word beginning with wh-, but “how” is also included. The wh– words are: what, when, where, who, whom, which, whose, why, and how.

Onto the wh-questions: In order to understand more abstract wh-questions, there is a certain level of developmental (cognitive and linguistic) readiness required. Often children have a concept of wh-questions, but sometimes confuse them–for example answering Where for What questions. That said, there are ways to facilitate understanding these concepts.

First, make sure that she is able to understand basic Who, What, and Where questions. From there, I would see if she is just confusing the Why, How, or What will happen questions. Based on the results, I suggest engaging in some focused, semi-structured activities around each of the wh-questions.

Children this age have a great sense of humor. Use the silly factor in teaching these concepts, and target her everyday routines. For example, to teach How questions, talk about how we get dressed. Repeating, “How do we get dressed?” “Do we put shoes on our head?” (Physically putting a shoe on your head for dramatic effect.) Wait for her to answer no. Then playfully reinforce, “Nooo… that’s not how we get dressed.” Start over, “How do we get dressed? Do we put socks on our nose?” Wait for her response. Reinforce, “No!! That’s not how we get dressed.” Go on with this routine for as long as she is interested. Then start to discuss how one properly gets dressed, each clothing item at a time, repeating “How do we get dressed?” “Yes! First we put on our shirt. Then how do we get dressed? Yes, next we put on our pants…” You get the idea. You could easily do this with How do we make a sandwich?, take a bath?, etc. You can adapt this technique of playing with events in her daily routine for all wh-questions.

Secondly, as these concepts are more abstract, I would also suggest anchoring them with a visual image. Using simple books, have her try to guess or predict events on the next page (What do you think happens next?). Book reading is an excellent tool as each page provides another opportunity to practice the target skill, and you can repeat the book. I would also model the target questions throughout the day with other family members. Make sure she understands wh-questions in the context of her own life before expecting her to answer questions even more abstract such as “Why do we keep birds in a cage?”

A Final Recommendation

I hope you find these tips helpful. While these language stimulation activities will be great for you to do, considering your daughter’s history of chronic ear infections, “nasal” speech, and some slightly delayed language milestones, I would highly recommend having her evaluated by an ASHA certified Speech-Language Pathologist in your area. He or she will be able to assess your daughter’s current speech sounds (including the nasality), and her comprehension and use of language; the results of this evaluation will determine whether your child needs further intervention, or at the very least help you better understand the expected milestones, so you can stay on top of her development.