Speech-Language Therapy
The purpose of speech-language therapy is to enhance intentional communication via expression of ideas, obtaining
desires, sharing information and interpersonal interaction. Language is the means by which communication is

Components of language include but are not limited to:
•        understanding/verbal expression
•        facial/manual gestures
•        tone of voice
•        body orientation

In order to use our language knowledge of content (vocabulary, concepts), form (how words are linked into
phrases/sentences) and use (what the child wants to get from using his/her language) is necessary. Therefore,
speech therapy focuses around teaching the child what he or she needs rather than the use of language for

For the child who is not currently using words, language is still possible through other means.  A child may be
taught to use various ways of utilizing their language skills to convey meaning. These may consist of
gestures/signaling, eye contact, facial expression, vocalizations or manual tools such as communication

Oral-motor skills are also addressed within speech-language services.  Since proper structure and function of the
oral areas is necessary for speech and sound production, intervention to improve coordination, strength, movement
and placement of the lips, tongue, jaw and cheeks (both internally and externally) is required.  

What causes speech and language problems?

Developmental speech and language disorder is a common reason for speech/language problems in kids. This is a
learning disability that specifically affects five general areas:

•        Spoken language—delays and disorders in listening and speaking         

•        Written language—problems with reading, writing and spelling

•        Arithmetic—trouble doing arithmetic or understanding basic concepts

•        Reasoning—problems organizing and putting together thoughts

•        Memory—problems remembering facts and instructions

These kids may have trouble producing speech sounds, using spoken language to communicate, or understanding
what other people say. Speech and language problems are often the earliest sign of a learning disability or autism.

•        Hearing loss is often overlooked, and easily identified. If your child is speech/language delayed, their hearing
should be tested.

•        Mental retardation is described as below-average general intellectual function with associated deficits in
adaptive behavior that occurs before age 18, common cause of speech and language delay.

•        Autism, Developmental Disorders such as PDD, Aspergers

The diagnostic category of pervasive developmental disorders (PDD) refers to a group of disorders characterized
by delays in the development of socialization and communication skills. Parents may note symptoms as early as
infancy, although the typical age of onset is before 3 years of age. Symptoms may include problems with using and
understanding language; difficulty relating to people, objects, and events; unusual play with toys and other objects;
difficulty with changes in routine or familiar surroundings, and repetitive body movements or behavior patterns.
Autism (a developmental brain disorder characterized by impaired social interaction and communication skills, and a
limited range of activities and interests) is the most characteristic and best studied PDD. Other types of PDD
include Asperger’s Syndrome, Childhood Disintegrative Disorder, and Rett’s Syndrome. Children with PDD vary
widely in abilities, intelligence, and behaviors. Some children do not speak at all, others speak in limited phrases or
conversations, and some have relatively normal language development. Repetitive play skills and limited social skills
are generally evident. Unusual responses to sensory information, such as loud noises and lights, are also common.

Early Detection of Delayed Speech

Parents of children with autism most often report that the first sign of a problem with their child is either the
absence of language or the loss of language that had begun to develop in the second year of life. Sometimes the
initial concern may be that the child is deaf because they are unresponsive to the voice of others including parents
in their environment. In retrospect, many parents recollect that even during the first 12 months their infants were
unresponsive to adult contact, did not engage in turn-taking games, and failed to develop joint attention. By their
first birthday, many infants who later receive the diagnosis of autism do not respond to their own name and fail to
make eye contact. By the end of the second year, toddlers with autism still have no functional language and are
extremely limited in their communication with others, perhaps only engaging another person to fulfill requests using
protoimperative gestures (gestures or vocalizations used to express needs that one cannot fulfill him/herself). For
example pointing to an object one cannot reach.

To some extent, the principal social deficits in autism set the developmental path for deficits in language and
communication there is simply no interest or “appetite” for interacting with others at any level or by any means,
including language.
Nevertheless some children with autism, usually those that are less severely impaired overall, do increase the
frequency of their communicative attempts and begin acquiring language before their fifth birthday. Indeed,
acquiring some functional language by age 5 has been found to be the most powerful predictor of a more positive
outcome in autism.

A child’s communication is considered delayed when the child is noticeably behind his or her peers in the
acquisition of speech and/or language skills. Sometimes a child will have greater receptive (understanding) than
expressive (speaking) language skills, but this is not always the case. Because all communication disorders carry
the potential to isolate individuals from their social and educational surroundings, it is essential to find appropriate
timely intervention. While many speech and language patterns can be called “baby talk” and are part of a young
child’s normal development, they can become problems if they are not outgrown as expected. In this way an initial
delay in speech and language or an initial speech pattern can become a disorder that can cause difficulties in
learning. Because of the way the brain develops, it is easier to learn language and communication skills before the
age of 5.

The use of sign language to facilitate the communication of children with autism has been a topic of interest for
many years. On the one hand, clinicians who teach sign language to children with autism may argue that the child
at least is provided with a means for communication, even if it may be limited in the extent and complexity of
information. Further, supporters might argue that the use of sign language serves as a mediator for the development
of oral communication skills once the child recognizes the social value of language usage. On the other hand, some
clinicians may argue that the use of sign serves as a communicative sustainer for which the child has little practical
use, and that teaching children with autism to use sign may conflict with the development of functional oral
language skills required in the social and educational environment.

Just as importantly, the critics also argue that there is no factual evidence that sign language improves
communication beyond a one or two word sign structure, as a result limiting the usefulness of sign language skills
to a communication equivalent. Certainly, they would point out that the efficacy of sign language as a remedial
program for children with autism is at best questionable.

•        Extreme environmental deprivation can cause speech delay. If a child is neglected or abused and does not
hear others speaking, they will not learn to speak.

•        Prematurity can lead to developmental delays, including speech/language problems.

•        Auditory Processing Disorder describes a problem with decoding speech sounds. These kids can improve
with speech and language therapy.

•        Neurological problems like cerebral palsy, muscular dystrophy, and traumatic brain injury can affect the
muscles needed for speaking.

•        Structural problems like cleft lip or cleft palate can also interfere with normal speech.

•        Apraxia of speech is a specific speech disorder in which the child has difficulty in sequencing and executing
speech movements.

•        Selective mutes are when a child will not talk at all in certain situations, often school.

How can I tell if my child’s speech and language development is on track? If your child is not on track with the
following speech/language development milestones, you should talk to your pediatrician.

Speech-Language Therapy

Speech-language pathologists assist children who have communication disorders in various ways. They provide
individual therapy for the child; consult with the child’s teacher about the most effective ways to facilitate the child’
s communication in the class setting; and work closely with the family to develop goals and techniques for effective
therapy in class and at home. The speech language pathologist may assist vocational teachers and counselors in
establishing communication goals related to the efforts and strengths of student and suggest strategies that are
effective for the important transitions throughout the child’s life.

Technology can help children whose physical conditions make communication difficult. The use of electronic
communication systems allow non-speaking people and people with severe physical disabilities to engage in the give
and take of shared thought. Vocabulary and concept growth continues during the years children are in school.
Reading and writing are taught and, as students get older, the understanding and use of language becomes more
complex. Communication skills are at the center of the education experience. Speech and/or language therapy may
continue throughout a student’s school years either in the form of direct therapy or on a consultant basis.
Here is a chart for age appropriate speech development.
Language Level
2 - 3 months
Cries differently in different circumstances; coos in response to you
3 - 4 months
Babbles randomly
5 - 6 months
Babbles rhythmically
6 - 11 months
Babbles in imitation of real speech, with expression
12  months
Says 1 - 2 words; recognizes name; imitates familiar sounds; understands
simple instructions
18  months
Uses 5 - 20 words, including names
Between 1 and 2 years
Says 2-word sentences; vocabulary is growing; waves goodbye; makes
“sounds” of familiar animals; uses words (like “more”) to make wants
known; understands “no”
Between 2 and 3 years
Identifies body parts; calls self “me” instead of name; combines nouns and
verbs; has a 450 word vocabulary; uses short sentences; matches 3 - 4
colors, knows big and little; likes to hear same story repeated; forms some
Between 3 and 4 years
Can tell a story; sentence length of 4 - 5 words; vocabulary of about 1000
words; knows last name, name of street, several words; knows last name,
name of street, several nursery rhymes
Between 4 and 5 years
Sentence length of 4 - 5 words; uses past tense; vocabulary of about 1500
words; identifies colors, shapes; asks many questions like “why?” and
Between 5 and 6 years
Sentence length of 5 - 6 words; vocabulary of about 2000 words; can tell
you what objects are made of; knows spatial relations (like “on top” and
“far”); knows address; understands same and different; identifies a penny,
nickel and dime; counts ten things; knows right and left hand; uses all types
of sentences.
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