Blank white speech bubbles

The joy that parents experience when their child utters his or her first words is immeasurable. Conversely, if those words are slow to be heard, parents are understandably concerned.

The good news is that about one in four children is a late talker, and most that are seem to catch up without specialised help by the time they’re about two years of age. Albert Einstein only started to speak when he was about three or four years old, and was seven before he started reading. And then he discovered the theory of relativity, so there you go.

The question then is how do we know what’s ‘normal’ and what’s not? We speak to Mr Brian So, Speech Therapist at the Singapore General Hospital’s Speech Therapy Department and Dr Phua Sin Yong, Speech-Language Therapist at Speech Matters – Centre for Speech, Language, Learning and Swallowing Disorders, to learn more about delays in speech and language development.

‘Late Bloomer’?

While the pace varies from child to child, the general rule of thumb is that first words are uttered at age one, two-word combinations between 18 and 24 months, and three-word sentences before turning three. When a child does not produce accordingly, parents are naturally concerned if their child is just a slower developer or has a speech delay.

According to Dr Phua, children with delayed speech and language development may also have difficulties with variations during play and even with other motor skills, such as walking, running, jumping and even chewing.

On the other hand, a ‘late bloomer’ tends to have good social skills and is creative during play. They also understand instructions that are age-appropriate, and have ways to communicate their needs beyond directing someone’s attention to a specific object.

Mr So advises that if in doubt, to consult a speech therapist for a thorough assessment of the child’s speech and language skills. If the child has a speech and language delay, then both comprehension and spoken language skills are not developing as quickly as compared to others of the same age.

Adopting the ‘wait and see’ approach is not ideal as the child will not outgrow this problem. In addition, there are some studies that suggest that while ‘late bloomers’ do catch up in the school years, they may still have relatively weaker language skills as compared to their peers.

Tell-Tale Signs

There is a wide variation in what is considered ‘normal’. But here are some indications that professional intervention may be necessary.

First two years:

• My child isn’t babbling or using gestures, such as pointing or waving bye-bye, by 12 months
• My child prefers using gestures over vocalisations to communicate by 18 months
• My child has trouble imitating sounds by 18 months
• My child has fewer than 20 words in his/her vocabulary and/or no word combinations at 18 to 24 months

Note: By two years, a child should able to speak in two to three word utterances, such as “I want milk”, “Mummy, look” and “Go away”.

Two to three years:

• My child can only imitate speech or actions and doesn’t produce words or phrases spontaneously
• My child says only certain sounds or words repeatedly and can’t use oral language to communicate more than his/her immediate needs
• My child can’t seem to follow simple directions
• My child’s vocabulary has fewer than 50 words

Note: By three years, child should be able to speak in short sentences, such as “Daddy’s car is over there.” or “I don’t like to eat this.”

Three to four years:

• My child’s vocalisations are not intelligible more than 50 per cent of the time, especially outside the home environment
• My child can’t tell me what he/she did at playschool that day
• My child’s vocabulary, sentence length, pronunciation of words and level of comprehension is not improving

Note: By four years, a child should be able to speak in more complex sentences, such as “I want the fries but not the veggies.” or “I am hungry and I want to eat.”

Four to six years:

• My child has difficulty understanding and remembering information
• My child has persistent difficulties paying attention in class
• My child has incorrect speech sounds even after the age of six years

Note: By six years, a child should be competent at telling stories and relating incidents that took place earlier.

What You Can Do

If you suspect that your child has a speech delay, don’t wait to seek professional help. Early intervention is critical, Mr So emphasises, as young children develop most of these skills in the first five years of their lives. It is better that such issues are addressed sooner to help your child better achieve his or her potential.

Even if your child is a ‘late bloomer’, intervention will have no negative effect. In fact, it will serve to further improve and stimulate his or her speech and language development.

Consult your family doctor or your child’s paediatrist or approach a speech and language therapist for an evaluation. At the Singapore General Hospital, for example, speech therapy services are provided to children from infants to 16 years of age.

Based on the results of the initial assessment and evaluation, a speech therapist will diagnose the problem and discuss with the family about future management and therapy goals. Therapy does not end in the sessions but often involves parents and caregivers following up with what was taught in the sessions, to ensure that the skills and strategies learnt can be applied in daily life.

Providing Support At Home

Parents play a key role in helping children develop speech and language, says Dr Phua. Communicating with children during play and exposing them to spoken language is crucial. Electronic learning tools, such as the TV, videos and computer games or applications are poor substitutes for helping children acquire language.

Here are five ways to stimulate your child’s speech development at home, as suggested by Mr So:

• Give your child time to respond. Don’t pressure them to talk; this will frustrate them and they will be less motivated to talk. Accept their mode of communication and gently model words for them.

• Work with items that are of interest to your child. It could be a simple cardboard box or even a spoon. Toys that claim to be able to stimulate your child’s language will not be useful if your child is not interested in them.

• Get up close to your child, about an arm’s length away. This way, your child will not miss out on crucial information such as the way you pronounce words, your facial expressions and the gestures you use.

• Use short and simple sentences. Choose five to 10 functional words that you can repeat in your sentences during daily routines or play time.

• While educational programmes on television and computers have their value, it is also important to spend the same amount of time interacting with your child.