Speech Disorder in Children: Symptoms, Causes, and Treatment Options
While every child is unique and follows different growth and development patterns, factors like speech and language skills usually follow a timeline in much the same way that motor skills like walking and running do.
It is not unusual for children to lag in their speech and language development. In time, many can catch up, but what of those who do not? Communication disorders are thought to cost the United States between $154 billion to $186 billion annually.
If your child's communication skills are a worry and you suspect they may have a speech impediment, Linguabilities Online Speech Therapy offers online speech therapy for kids - a flexible, convenient, and affordable alternative that can help your child overcome their speech barriers.
This article addresses speech and hearing milestones and what you should know about following up on potential problems for the long-term benefit of your little one.
What is a Speech Disorder?
A speech disorder reflects a situation where the individual's speech is difficult to comprehend because the creation and forming of sounds necessary for communicating is impeded in some way.
What are the Symptoms of Speech Disorder in Toddlers?
Have you noticed your toddler cries more than other children or is prone to tantrums, that they seem to have difficulty listening to, understanding, and following instructions, or they are slow in speaking or struggles with pronouncing words? These are red flags for speech, language, and/or hearing disorders in toddlers.
Other common signs of a language, speech, or hearing disorder include:
The child seldom interacts or smiles (birth - 3 months)
They don't make simple sounds like "ga" and "ba" or string together sounds such as "bababa" (4 -7 months)
The infant makes few sounds and/or does not use gestures (7 - 12 months)
They don't seem to understand what others are saying (7 months - 2 years)
The toddler says only a few words (12 - 18 months) and from 1½ - 2 years are not able to put words into simple sentences.
The toddler's vocabulary is smaller than 50 words at age 2 (animal sounds are included as words), and they may not play or interact with other children (2 - 3 years)
Signs your child may have a speech disorder:
They are unable to say the letters "p", "b," "m," "h," and "w" properly (1 - 2 years).
They say "k," "g," "f," "t," "d," and "n" incorrectly (2 - 3 years).
Even to familiar people such as immediate family, the child's speech is garbled (2 - 3 years).
They struggle with forming sounds or words correctly (2½ - 3 years).
Hearing Problems in Toddlers' Speech Delay
Imagine not being able to hear speech sounds properly. This ultimately means you would be likely to reproduce the sounds incorrectly. During wellness visits, pediatricians usually check their hearing and screen their patients to ensure there are no signs of a child's speech impediment and that they are meeting the language milestones outlined above.
What are the Signs of Hearing Loss?
Shows lack of response to sounds (birth - 1 year)
If you call the child's name, they are unlikely to respond. (7 months - 1 year)
The child cannot follow simple basic instructions like, "Roll the ball to Daddy." (1–2 years)
Importance of Early Intervention
The early childhood period is key to speech and language learning, and the necessary skills can be tested even in babies, where the pediatrician may recommend a speech-language pathologist (SLP) to assist parents in stimulating the child's development at home.
Speech Disorders in Toddlers
Trouble in producing speech sounds, fluency (the flow of speech), and voice or resonance can all indicate signs of a speech disorder in toddlers.
Speech Sound Disorders
There may be cause for concern if:
By 8 or 9 months, the child has not begun to articulate consonant sounds (particularly b, d, m, and n – as in "mama, baba.”) Letter sounds such as "m" or "b" are easier for babies to pronounce, whilst letters like "r" and "th" usually develop when the child is older.
From 18 months, they tend to use mostly vowel sounds or gestures.
From age 3, people are unable to understand what the child is saying.
When a child struggles to voice the speech sounds, their speech may be difficult to understand. Often they will be frustrated in their attempts to make themselves understood. Whilst this can be attributed to factors such as hearing loss, cleft palate, teeth issues, and problems controlling mouth movements, the disorder's cause may also be unknown. Functional speech sound disorders include not only articulation but less common speech sound disorders such as dysarthria, where the muscles used for speaking are weak.
Dysarthria
This may be a symptom of nerve or muscle damage to the diaphragm, lips, tongue, and vocal cords used in producing speech. Dysarthria is often apparent in slurring or slow speech or where there is limited tongue, lip, or jaw movement.
Articulating words may be difficult, and rhythm and pitch is abnormal. Voice quality varies, and speech may be labored.
Dysarthria may occur during development in the womb or as a result of muscular dystrophy or cerebral palsy post-birth. Muscle damage and nerve damage cannot generally be reversed, so management of symptoms might include exercising the muscles involved in speaking, breath training, and speaking at a slower pace.
Apraxia of Speech (AOS)
Apraxia of speech is a motor disorder where neural pathways between the brain and speech muscles are disrupted. While the speaker knows what message they want to share, the brain cannot communicate this to the speech muscles, even though these muscles are functional. Where children are born with AOS, there is often a close family member who suffers from learning or communication disorders, suggesting a genetic link.
Lisping
Lisping is a common functional toddler speech disorder that is often outgrown. An SLP usually ensures the lisp is not confused with another disorder, such as a
hearing loss-induced speech impediment, apraxia, or impaired expressive language development. The interdental/dentalised lisp is the most common of the five types of lisp and involves the speaker making a "th" sound when trying to voice the "s" sound.
If the child still has an interdental/dentalised lisp by the age of four, an SLP will usually coach the child in pronouncing words. Practice before a mirror is often encouraged, and exercises such as drinking from a straw to strengthen speech muscles may be suggested.
Fluency Disorders
Stuttering/stammering
Stuttering is a common variety of fluency disorder, where the usual rhythm of speech is affected by an excess of pauses, repetition in, for example, first sounds of words, blocks in the flow of speech, or involuntary drawing out speech sounds – prolongation The face, neck, shoulders, and fists may also be visibly tensed. Stuttering can also include non-verbal involuntary or semi-voluntary actions (tics) like blinking or abdominal tensing.
There is cause for concern if:
The child seems stressed and tense while speaking. Alternatively, if they see themselves as someone who stutters or avoids speaking because of anxiety surrounding their stutter.
There are unusual hesitations or perceived obstructions, repetitions, and prolongations.
The stuttering causes the parents distress on behalf of their child.
Most people have experienced stuttering once in a while. A stutter can be triggered by events like talking on the phone. If such activities are avoided because the person does not want to trigger their stutter, then the stutter has reached the level of a speech disorder.
Cluttering
While the stutterer usually knows what they want to say and is temporarily unable to say it, cluttering is a fluency disorder, which seems to stem from speaking too fast, or when one is uncertain what to say.
Cluttering sees the speech flowing too fast or being characterized by stops and starts. There are also speech disfluencies such as "well," "um," and "like."
Voice Disorders
There is cause for concern if:
The child's pitch is inappropriate for their gender or age, or if they suddenly change pitch mid-conversation.
If the voice is gruff and raspy, hoarse or whispery, too soft or loud, or if there is often a loss of voice.
Voice disorders as described above may result from cysts, papillomas, vocal nodules, paralysis, or weakness of the vocal folds which vibrate as air from the lungs flows through them.
Resonance Disorders
There is cause for concern if:
The child sounds hyponasal (an absence of resonance in the nose when speaking, which affects nasal consonants and vowels such as /i/ and /u/ making the child sound as if they are congested). Allergies or a nasal blockage can cause this.
The child sounds hypernasal (when excess noise resonates in the nose on voiced oral consonants and vowels, so that the person appears to be talking through their nose and air escapes during the sounding of vowels or letters such as "s", "b" and "k" – hearing impaired children usually exhibit hypernasality.)
Air can be heard emanating from the nose when speaking
The voice sounds muffled due to an obstruction of sound in the nose, mouth, or throat - known as Cul-de-Sac Resonance.
Resonance is the overall quality of the voice. A resonance disorder might be caused by a blockage in the nose or by allergies, which impact the voice quality as it moves through the throat, nose, and mouth. Such disorders usually occur when the velum - the soft moveable tissue of the palate at the back of the throat - does not close off the nasal cavity, so too much sound escapes through the nose when speaking.
Receptive and Expressive Language Disorders
Children with receptive language disorders cannot understand the meaning of words. Their comprehension of the spoken word is often poor and they may struggle to follow directions and interact with others.
If there is an expressive language disorder, the child would have difficulty expressing their needs and might express this in the form of tantrums since their limited language skills hold them back and can be frustrating.
Social Communication Disorder
Some children are unable to read and respond to non-verbal social cues such as facial expressions and body language. This thwarts them in the social aspects of communication with other people.
If your little one's communication skills are in question, it is best to discuss your worries with your doctor, who may refer you to a speech-language pathologist (SLP).
Selective Mutism
There are different kinds of mutism, and here we are talking about selective mutism, where someone does not speak in certain situations no matter that they are perfectly capable of doing so – for instance, a child may choose to speak at home but may be too shy or anxious to speak at school. These psychological factors should be dealt with through counseling or another type of psychological intervention. Diagnosing the condition requires a team that may include an SLP, pediatrician, and psychologist.
Since there are speech-language disorders that have the same effect as selective muteness – stuttering, aphasia, apraxia of speech, or dysarthria, these must be eliminated by an SLP.
An SLP may also work with such children to tailor a behavioral treatment program and address disorders such as stuttering which may have contributed.
Alalia
A speech delay (also known as alalia) refers to the condition where a child does not make verbal attempts to communicate. This may be because the toddler simply takes longer than their peers to speak, or it may be for some more serious reason such as the child having brain damage. The SLP will evaluate the likely reasons for the alalia until they have a valid explanation.
Treatment and monitoring follow the SLP's diagnosis, and it stands to reason that early intervention can have a significant impact.
Diagnosis and Treatment of Speech Disorders in Toddlers
With so many causes of toddler speech disorder, ranging from impaired hearing to developmental disorders, brain injury, and genetic and environmental factors such as older maternal age, low parental education level, and low-income family income, concerned parents should pay heed to the advice of SLPs who have extensive knowledge in this field.
Promoting Toddlers' Speech
Here are some suggestions to get your toddler talking:
Model sounds and don’t interrupt the child while they’re trying to speak.
Switch off the TV and sing with your child. Children learn through music. Pick songs or action nursery rhymes they might enjoy, like "The Wheels on the Bus," "Incy Wincy Spider," "I'm a Little Teapot," or "Twinkle, Twinkle Little Star," and spend some quality time together.
Read to and with them. Ask questions about what the characters are doing, or talk about colors used in the illustrations or what they think will happen next.
Reinforce names and give directions. Say hello (child's name) when you see them. Point to Daddy or Uncle Joe and say his name. Tell them to call Daddy or the dog for their breakfast.
Name facial expressions so they can begin to understand what they are seeing.
Use gestures and signals. Wave hello when saying hello, smile in greeting, and raise your hands questioningly when asking, "What happened to your bottle?" Pretend to hold a tumbler when asking if the child wants a drink.
Use child-friendly explanations of what they are doing and visual cues. If the child is playing with a toy cow, you might say, "Johnny, I like the black and white cow you're playing with. What does the cow say? That's right. Moooo!"
Describe your actions even when your child is too young to talk. If you are sweeping the floor, tell your child, "Look, Mommy is sweeping the floor and making the house nice and clean." Little ones are learning all the time.
Give choices – "Which shirt do you want to wear? This red one or the blue one?"
Wait for answers. If you ask a question, give them a chance to answer.
Expand on what the child says to show them different alternatives. For instance, if your child says, "Let's go", you could say, "Yes, let's go to the park and see the puppy."
Provide positive reinforcement. Give them accolades if they get something right. "Well done, that was great Johnny!" If they mispronounce something like "wemote" instead of "remote," say, "Yes, you're right, it's the remote for the TV."
See a doctor immediately if your child suffers from hoarseness or a nasal-sounding voice.
Online Speech Therapy Services Available
If your child shows signs of a speech disorder, we can help!
At Linguabilities, we offer full speech therapy services from licensed professionals who can screen and assess your little one's speech and language skills. The SLP may suggest early intervention and speech therapy or medication and surgery (in severe cases).
If you are seeking an online program to help your child achieve their full potential, book your free 15-minute discovery session today.