18 May Speech and language problems needn’t be a life sentence

Early intervention is most important, writes Catherine Best.

Every parent cherishes their child’s first words, those meaningful, gabbled sounds that chart their development from passive infant to interacting person. Speech and language define how we engage with the world and are the building blocks of learning, yet many children of pre-school age struggle with these early life skills.

Speech and language delays affect as many as one in five children by the time they start school, and half of them have a stutter. Some children overcome these problems naturally, but many others require early intervention, including speech therapy.

While speech and language problems vary in severity and can initially be difficult for parents to detect, stuttering – characterised by the prolongation and repetition of sounds and words – is more apparent. Clinicians aren’t certain what causes stuttering but believe it is the result of a breakdown in the neurological pathways governing speech.

Elaina Kefalianos, speech pathologist and researcher at Murdoch Children’s Research Institute, says stuttering can present as early as age two, but onset is most common between two and three when toddlers begin combining words. “Stuttering can be a repetitive behaviour, such as repeating whole words, syllables or sounds,” she says. “Other types of stuttering include sound prolongations, where the person stretches out a sound, and blocks, where a person tries to speak but nothing comes out. They know exactly what they want to say, but sometimes they have difficulty actually saying the words.”

According to the Australian Stuttering Research Centre (ASRC) at U.T.S, 8.5 per cent of three-year-olds stutter, increasing to 12.2 per cent by age four. Research shows that while anxiety is not the causal factor, if stuttering is left unchecked it can trigger mental health problems such as social phobia and affect socialisation and academic outcomes. Children can also suffer bullying and disengagement from their peers, which can begin as early as preschool.

Fortunately, stuttering is treatable with speech therapy, and most children will overcome the disorder. However, ASRC founding director Professor Mark Onslow says it is crucial to intervene when children’s speech patterns are not yet fixed before the child turns five. “If a child over the age of four-and-a-half comes to us, we get a bit panicky,” he says. “There’s clear evidence that during the school years it becomes less tractable, that you can’t hope for good outcomes. The neurology that supports language isn’t fully developed by the time you’re five… but by the time you’re an adolescent, all the pathways for speech are laid down.”

The warning signs of a language delay become apparent at age two if a child speaks fewer than 50 words, can’t combine words, or has difficulty following simple instructions. Behaviour can also be an indicator, as children who can’t communicate properly can exhibit frustration. Conversely, they may also be quiet and become socially withdrawn.

Professor Sheena Reilly, previous director of speech pathology at Melbourne’s Royal Children’s Hospital and the Murdoch Childrens Research Institute and recently appointed Director of the Menzies Health Institute Queensland (MHIQ), says if parents have any doubts about their child’s speech or language development, they should have them assessed.

“Early intervention is really critical. Language is one of the most important skills children master in those early years. It’s the foundation of their academic achievements,” she says.

“If you have a speech problem or you’re stuttering, you’re more likely to get teased and bullied by other kids. If you’re not able to express yourself in the playground, kids aren’t going to interact with you in the same way. It does have a major impact, not just educationally, but we really worry about the children’s social and emotional development.”

Listen to the podcast on the BBC of The Travelling Speech Therapist, Mary Weinder, who travels to the Turks and Caicos islands here