“Vic has difficulty using adjectives and pronouns, and sometimes it sounds as if he doesn’t know the difference between male and female.”
“Our son, Camden, never jabbered. He would learn a few words and then we’d hear nothing. Time would go by and we would hear a new word, then not hear it again. It was as if he were learning them, storing them, and moving on.”
Like a child’s first steps, first words are a milestone that parents eagerly await. Typically, other words quickly follow, as the child learns the power of speech and masters the rules of language. By age 3 or 4, most children are adept at expressing themselves, are fairly understandable, and need to be reminded that someone else might have something to say.
But some children encounter difficulty expressing themselves, calling objects by the wrong name, or saying words that are hard to understand. Others may be unable to make sense of what is said to them. Speech and language skills are critical for young children as they begin to enter the world around them. Even a mild delay in language development may result in tantrums, interfere with learning, sabotage social skills, and undermine self-esteem.
According to the National Institute on Deafness and Other Communication Disorders, more than 10 percent of all preschool children have some form of language impairment. Studies show that as many as half the children in foster care have speech or language delays. And, according to Dr. Jane Aronson, a pediatrician specializing in international adoption, the majority of children who previously lived in orphanages have speech and language delays at the time of adoption. The good news is that, with early intervention, the great majority of language-delayed children will be successfully helped in their long-term language development.
Role of early “conversations”
One of the most important factors in language development is exposure to meaningful speech during the first three years of life. A baby learns the value of communication in the first few days of life, when her cry brings food and comfort. A child soon recognizes the voice of her parent(s) or caregivers and starts to sort out the building blocks that compose the words of her native language. But some children who join their families through adoption may have missed out on this intimate back-and-forth between child and caregiver. According to Dr. Aronson, “Children raised in institutions miss the eye contact, constant touching, and reciprocal communication needed for brain development at this age.”
The same is true for children who lived previously in homes with little stimulation or language directed towards the child. Reading and singing to children play an important role in language development, as does holding a child for her bottle. When no one responds to a child’s babble, she learns that her voice does not matter, and may not progress in language development.
Types of language delays
Although many people think of speech as a collection of words, much more is involved in communicating with others. Some children experience problems with the mechanics of speech. Most common are difficulties with articulation, the correct use of the tongue, lips, and jaw to produce the right sounds. Stuttering, lisping, breathiness, and sudden breaks in loudness or pitch may also make a child hard to understand.
Expressive language may also be an issue. Some children identify objects by the wrong names, jumble the order of words in a sentence, or have limited vocabulary. Other children may have trouble receiving language: although their hearing is fine, they are unable to make sense of certain words or sentences.
Even children who have language skills in their native tongue can run into problems, says Sharon Glennen, Ph.D., associate professor of Communications Sciences & Disorders at Towson University in Maryland. When faced with an abrupt change of language, internationally adopted children typically relinquish their first language while learning another. As a result, certain developmental and linguistic problems may emerge. Some children will need help adjusting to new sounds, especially if their previous learning environment was inadequate. Others, particularly those adopted after age 3, may experience delay with the abstract thought and cognitive skills needed for academic achievement, says Jeanne DeTemple, Ph.D., a developmental psychologist in Concord, Massachusetts. That’s because they are busy re-acquiring language for communication purposes – a task that takes up to three years – at a time when they would otherwise be developing reasoning skills.
Fortunately, mild developmental language delays caused by poor orphanage conditions often recede. In recent studies by Glennen and Karen Pollack of the Department of Speech Pathology & Audiology, University of Alberta, the vast majority of preschool-aged children from China and Eastern Europe made good progress in speech and language within two years of adoption.
For children whose delays are more severe, speech therapy can produce great strides. “Our sons weren’t saying any words by their second birthday, though they understood everything we said,” recalls Shannon Seymour, the mother of twins adopted abroad as infants. “Now, after ten months of speech therapy, we can’t get them to stop talking.”
Before communication issues can be addressed, families must determine whether their child is able to hear. Hearing loss, either permanent or temporary, interferes with a child’s developing ability to speak and comprehend language. Children with ear infections often hold fluid behind their eardrums for extended periods of time. Sounds become muffled and indistinct. Other children may have difficulty coordinating the muscles in their mouths. Parents, who speak with their children daily, are the first to notice problems but may be uncertain as to how to proceed, says Diane Paul-Brown of the American Speech-Language-Hearing Association (ASHA). Although some delays go away with the passage of time, Paul-Brown strongly advocates early intervention.
In addressing speech and language concerns, many families start by consulting their child’s physician, who can help to determine if the child is on target for his age. A child should have a hearing screen and examination of the mouth to ensure there are not medical reasons for limited language production. When a child’s hearing is normal, it may be reasonable to wait two to three months to see if he catches up, says Dr. Aronson. “But if delays are dramatic, or the child’s language isn’t improving, don’t continue to ‘wait and see.’ We have to be aggressive about treatment.”
Many experts now recommend that children adopted internationally after the age of 2 be evaluated in their native language within three months of arriving home. This evaluation should include not only words and diction, but also the structure and understanding of spoken language. If a child is not speaking or understanding his mother tongue, language delays will affect his ability to learn the language of his new family. Children who have not yet mastered their first, native language require language intervention above and beyond English as a Second Language (ESL).
Speech services: Public and private
Under the Individuals with Disabilities Education Act (IDEA), a child suspected of speech delays is eligible for a publicly funded evaluation. If found in need of treatment, a child may be eligible for services through several age-based programs. Children up to 3 years of age are usually treated through the Early Intervention program in his home or in a day-care setting. In some states these services are free; in others, fees may be based on family income.
Preschool children are typically treated in a classroom setting, while elementary school children receive treatment from a school professional. These programs are free, but they require an evaluation by the school system.
For children not eligible for public services, parents should seek a referral to a private, licensed speech-language pathologist (SLP), preferably one who is certified by the American Speech-Language-Hearing Association (ASHA ).
Many insurance companies cover speech therapy; however, some pay only for delays that are shown to be medically or neurologically based, rather than developmental in nature. In some states, adoption subsidies may be available to assist with the expense of such services.
Speech and language evaluations include a comprehensive medical and developmental history, including questions about a child’s language milestones, past illnesses, birth family, and care before adoption. The SLP should also examine the mouth to ensure that there are no medical problems, such as tongue-tie, that interfere with sound production. Speech and language assessments usually include phonology (making and understanding sounds), semantics (word meaning), syntax (word order), morphology (word forms), and pragmatics (social language).
Following an evaluation, the speech therapist will put together a treatment plan tailored to a child’s unique needs. For children under 3 years old, the programs are usually home-based. Families are given individualized instruction for working with their child. An older child may work with the therapist individually or as part of a group of children. Typically, therapy involves a variety of exercises: repeating sounds, playing naming games, or encouraging interactive speech and dialogue. Families are often given specific activities to continue at home to aid in ongoing language development.
Most children enjoy speech therapy. Good speech-language pathologists create fun activities, such as blowing through a straw or making silly sounds. Given the linkage of language to self-esteem, it is important to elicit cooperation in a positive manner. “Going to speech once a week makes my daughter more willing to practice her exercises at home,” explains Dana Moock, whose daughter was adopted from Vietnam. “Her speech therapist points out her strengths and celebrates each accomplishment.”
The bottom line: most children show improvement with intervention, whether through a home program, individualized private program, or school-based services. Families need to work hand-in-hand with health and school professionals to identify and address delays early, rather than waiting to see if they subside. We cannot overestimate the value of language to a child. He may need help, hard work, and celebrations along the way, but the results will be something to talk about.
Milestones to watch for
Consider an evaluation if your child’s language development falls outside this timetable:
Birth to 5 months: Turns head toward sound, makes noise when spoken to
6 – 11 months: Babbles (“ba-ba-ba”), tries to repeat your sounds
12 – 17 months: Answers simple questions nonverbally, follows simple directions with gestures, points, says two to three words to label an object
18 – 23 months: Follows simple commands without gestures, says 10 or more words and begins to combine them (“more milk”)
2 – 3 years: Speaks about 40 words at 24 months; understands some spatial concepts (on, in), descriptive words (big, happy), pronouns (you, me); begins to use plurals, regular past tense verbs, and two- to three-word phrases
3 – 4 years: Uses most speech sounds, though some (l, r, th) may be distorted; groups objects such as food and clothes; expresses feelings and ideas; recognizes language absurdities (Is that an elephant on your head?)
4 – 5 years: Speech is largely understandable; describes how to do things; answers “why” questions; lists items in a category, such as animals
5 years: Engages in conversation, uses complex sentences, carries out a series of three directions, uses imagination to create stories
Concerned about your child’s language development? Five steps to take:
1. Ignore advice to wait and stories about the cousin who did not speak until age 3. It’s never too early to address language delays.
2. Contact Early Intervention for an evaluation.
3. Have your child’s hearing tested.
4. Evaluate your child’s oral motor functions.
5. Read either The Late Talker or Childhood Speech, Language & Listening Problems
How parents can encourage language skills
1. Have a give and take. Whether it’s bath time, dinner time, or drive time, respond to your baby’s babbling or engage your preschooler in a discussion about something that interests him. Ask open-ended questions and elicit his opinions.
2. Read together. Ask questions about the story and illustrations: What’s happening in this picture? Why did the character do that? What do you think will happen next?
3. Keep up a running commentary. Describe what you and your child are doing and why, whether it’s feeding the dog or putting away toys. This technique helps build vocabulary and comprehension
4. Keep corrections subtle. When your child makes an error in speech, gently rephrase what he was trying to say. If he says “I runned to the car,” you can respond with: “Oh, you ran to the car?” If a child is prone to short sentences, elaborate on what she says to encourage longer statements.
5. Be patient. Some children need extra time to process a question, think of an answer, and get it out. Giving your child as much time as she needs shows that you’re interested and encourages communication.
Find out more:
Vision and hearing testing
Downloadable worksheets to help you budget for and navigate the adoption process
Allison Martin and her family live in Virginia, where she’s involved in adoptive family support
Copyright © 2014 Adoptive Families