Speech Delay Needs Urgent Testing and Therapy
14 October 2003
Q. In our circle of friends and relatives, there is a
three-year-old child who hasn't started to talk yet. This
child does not say da-da, ma-ma, or no-no, which are usually
some of the first words. The child will cry, yell, or make
complaining sounds. Is it too soon to be worried that this
child may never talk?
A.
No, it is not too soon to be worried. As a matter of
fact, you and your friends are very late to ask for help.
Let me explain to you why, and what the parents should do
immediately to get help for this child.
Speech development is totally dependent on a child's ability
to hear. Simply said, if a child cannot hear, he cannot speak.
The auditory system, which includes the outer ear, the ear
canal, the eardrum, middle ear with three tiny bones to conduct
and magnify sound, the inner ear that converts sound waves
into electrical signals, and the nerve that sends these signals
to the brain, is well developed even before a child is born.
That is why a foetus can hear the mother's voice as well as
her heart beat. Many young infants are comforted by their
mother's voice after birth.
Normal speech development requires stimulation from the
environment, whether it is spoken words from parents or laughter
from siblings. All sound waves are conducted through the
auditory system and then transmitted as electrical signals to
the brain. It is the richness of different sounds that helps
a child to distinguish comforting voices from threatening
sounds, and over time, gradually help them to develop their
ability to speak.
Speech development in children come in stages. During early
infancy, they make cooing sounds when they respond to pleasant
stimulation. When they are hungry or uncomfortable, they
would cry. Even those who are profoundly deaf would cry: this
is the natural ability of all human beings. With continuous
stimulation of sounds from the outside world, he will produce
more frequent and complex sounds himself. Around 6 to 12
months of age, most children would start to imitate sounds,
especially when they have the attention of their parents and
caregivers.
As you realized, the first words most often uttered by young
children are da-da and ma-ma, regardless of their ethnic
origin. Between one to two years of age, children would
acquire new words, sometimes more than one a day. Girls tend
to have more advanced speech development than boys.
Somewhere around two years of age, many children would start
to put two words together, followed closely by short phrases
and then full sentences. The speed of speech development at
this stage is quite variable, but it does follow a fairly
steady pace. Some parents are amazed by their children's
advancing vocabulary and speech after they have been away for
as little as a week.
Speech is one of the most important way that we communicate
with each other. A child who cannot speak can get extremely
frustrated when people around doesn't understand what he wants.
This frustration is often expressed as anger and aggression.
Research has shown that about 1 to 3/1000 children are born
with severe hearing loss. This can be the result of problem
conducting sound waves to the inner ear, or transmission of
electrical signals to the brain, or combination of both
problems. The end result is the same, these children live in
a world that is very silent, they cannot even hear their own
crying, let alone any sound from the environment.
These children can be completely normal at birth. They would
cry like all other children. Over time, parents may wonder
why their child seems to be more quiet than other children.
These children may not respond to calls, although they would
turn their heads if they see someone passing by. Not responding
to loud noises is another clue. Unfortunately, most children
with severe hearing loss are not recognized until they are
two to three years of age, very similar to the child that you
are describing here.
Fortunately, with improvement in medical technology, many
hospitals are purchasing specialized equipments that can detect
hearing loss in newborn infants. These machines are extremely
accurate, children with hearing loss can be confirmed within
days after birth. Once identified, they can receive help
right away, often by hearing aids which can amplify sound
waves. Early identification of hearing loss can prevent delay
in speech development.
In your friend's situation, the child likely has severe hearing
loss which prevented him from normal speech development. He
needs to be tested urgently in order to find out the cause of
his problem. Once identified, a plan can be put in place to
improve his hearing as well as training in speech development
by specialized speech-language pathologists. His problem is
very urgent. He needs immediate evaluation and intervention.
If your friend is one of those unlucky Canadians who doesn't
have a family physician, he should go to the local emergency
room in order to get the proper referral. Normally emergency
room should only be used for emergency problems. However,
this child cannot wait another few weeks or months to see a
physician and then referred to an audiologist for hearing
test. Any delay in diagnosis and treatment will have significant
impact on his ability to develop normal speech. This will
ultimately affect his future career opportunity and quality
of life.
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