"The Choice"

In honor of the month May being Better Speech and Hearing Month, I am sneaking in a post before the month is over!  As a pediatric speech language pathologist, my main obvious job is to help children learn to speak and communicate functionally.  My not so always obvious job is to educate caregivers on typical language and speech progression and provide support for implementing strategies in their home.  Sometimes my job is assuring a parent that he/she is making the right choice by seeking intervention.

I feel lucky that I work with children birth through 3 years (Early Intervention) because every parent that I work with has made “The Choice.”   My parents have made “The Choice” to ignore the doctors that have assured them that their child will catch up, or that nothing was out of the ordinary.   They have made “The Choice” to advocate on behalf of their non-verbal kiddos who did not have a voice of their own.  They have made “The Choice” to seek second and third opinions.  They have made “The Choice” to seek a professional evaluation and accept Early Intervention services.  They have jumped through hoops to get the best for their children and abandoned their own schedules to accommodate their child’s therapy schedules. For some, it has been at the referral of an awesome developmental pediatrician and for others it has solely been following their Mommy (or Daddy) gut and realizing that something was different about their child’s development. 

This blog post is to salute my parents and also to serve as a guide for parents who are just not sure or just not ready for their child to begin receiving therapy.  I need to stress the urgency of action during your child’s early years (think as early as 12-18 months). Please, please, please do not make the OTHER choice: “wait it out.”  You are very likely placing your child at a disadvantage.  An unnecessary disadvantage.  And your child may be missing out on services that could have a huge impact on his/her future.  For children with motor speech disorders, dysarthria or language disorders/delays -- NOW IS THE TIME!  

Now is the time for an evaluation, at the very least.  Do some children walk before they talk?  Sure do!  Are boys later talkers than girls? Sometimes!  But is your child progressing on his own in the absence of professional intervention? Is his vocabulary continually growing? Do you notice that she is demonstrating new communication skills on a weekly or even monthly basis?

Additionally, all this time you let your child wait to catch up, she is potentially falling further and further behind her typically progressing peers. The gap will widen and it may widen quickly!  Children with speech and language disorders that are unresolved often have difficulties in the academic arena as well as in socialization.  In addition, although this post is primarily focused on speech and language development, much of what I have written applies to developmental delays in other domains as well.  This is the time to intervene and make “The Choice” to let a professional help you and your child! 

This post is not meant to scare you—it is simply meant to urge you to follow your parental instincts, to listen to your gut, and to pay attention to that little voice in the back of your mind.  If you have any concerns about your child’s development in any area, please get an evaluation and find out if your child may benefit from some extra help!  That’s what we’re here for, after all -- just make "The Choice!"

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Speech vs. Language

Speech and language are two terms which are often used interchangeably in error! Though related, the two terms are clinically separate entities.  As they are both areas of potential delay in your child’s development, let’s get some clarification on the differences between them!

Speech is the sound system produced as a result of vocal fold vibration in coordination with respiratory support and shaping of the articulators (cheeks, lips, tongue, oral cavity).  Speech is what we hear.  More technically and specifically, speech is comprised of phonemes (sounds) that are labeled as consonants and vowels. Speech production becomes more complex as speakers combine consonants and vowels to form more complex syllable shapes

Take a moment and sound the following words out and you’ll become aware of just how many different actions your articulators are making in “elephant” compared to a more simple word “me.”  

In typical speech development, there are certain sounds that a child produces earlier vs later. The more visual sounds (bilabial) are those that are made with our lips such as “b” “p” “m” are our earlier sounds.  The more complex sounds that are produced inside the oral cavity using specific tongue placements come later in speech development, such as “r” “s” “l.” Parents can expect children to mispronounce words that are more difficult or have later developing sounds for a period of time, while they are honing their speaking skills.

Language is the way we exchange information.  “Exchange” implies the presence of two individuals, or communicative partners, because language requires a listener and a speaker.   Language can be verbal (speech) and non-verbal (gestural/graphic). Language is further broken down into receptive language (understanding gestures, eye contact, spoken and written words) and expressive language (using gestures, eye contact speech, and written words to communicate a message).

Common gestures that children use include pointing, waving, and shaking their heads “no” and “yes.” If the child is using words, is she starting to combine them? This typically happens when a child is approximately 2 years of age. Is the child using their words for different communicative functions? The main areas of communicative functions that I look for as an Speech Language Pathologist (SLP) include the following: labeling, commenting, calling attention, greeting, exiting, refusing, requesting objects, answering yes/no questions, requesting actions, and requesting information (e.g. asking wh-questions).  A huge component of language development is the function of language. A child may be able to name every animal while reading his favorite book, but can he use that same word to request an animal during play?

Some questions to ask about your child’s language development include:

Receptively, does my child …

Respond to his name with eye contact?

Following familiar commands?

Follow new commands?

Answer questions?

Locate familiar people and objects?

Identify his body parts?


Expressively, does my child…

Use gestures such as pointing and waving?

Look at the person he is communicating with?

Continue to add to his growing vocabulary?

Put words together to express his wants?

Ask questions about his environment?


As with all early childhood development, it’s important to understand that each child develops a little differently, some at slower paces than others.  In the early years, I always stress to parents to worry less about the articulation (speech) because to a certain degree, unintelligibility is typical! You really want to make sure that even if your child’s speech is not quite there yet, are they still communicating effectively through other routes of language?

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Nurturing Nature: Gaining Perspective

Language acquisition is a dynamic, complex, and natural process that our children go through to learn how to communicate with others and build meaningful relationships.  Like many other things in life, it’s not something that we question until something atypical occurs that raises concern.  As parents and caregivers, we want to make sure that we optimize our interactions with our children in such a way that we help them bloom into their full potential.  While this at times can seem as a subjective and daunting task, there are a few things that we can keep in mind to maximize our relationships and engagements to give us peace of mind.

While there are many different theories and beliefs about how children specifically acquire language, we all know for sure that there is an interaction of “nature” and “nurture.”  Most children are naturally inclined to extract sounds, words, grammar, and eventually conversational language that allows them to manipulate and control the world around them.  However, it’s our responsibility to nurture their natural inclinations to language acquisition with educated and careful techniques.

It’s important to remember that children have only been experiencing life and the world for a short period of time.  As adults, it’s sometimes easy to forget that we’ve been here for a long time and that we have a lot to teach to the following generation.  Sometimes it’s helpful to imagine placing yourself on a different planet, where you don’t speak the language, and where your environment is completely different than anything you’ve ever experienced before.  This is what our children are going through.  And they are sponges… for knowledge, information, communication.

Children explore their environment through play.  It’s meaningful.  It’s fun.  It’s interactive.  Through this natural and pleasant medium, we can teach children language and how to build relationships with others.  However, it’s important to put yourself in your child’s shoes and to see through their eyes, and provide them with language that’s developmentally appropriate in order for them to learn how to pair symbolic language with concrete things that are occurring in their environment.

While we’re engaging in play with our children, it’s important to be mindful of what their attention is focused on.  It’s very common that we have our own idea of what the direction and dialogue of the play should be; however, it’s meaningless if it isn’t in line with what our children have in mind.  For example, if we’re playing with a train set, and the child is focused on pushing “Thomas the Train” back and forth but we’re talking about how “Percy the Small Engine” is happy because he gets to play and is going “up” and “down” and “around” the tracks – we’re missing the point.  If our child’s attention is on pushing Thomas back and forth, our language is essentially meaningless if we’re talking about anything other than that.

In this particular situation, we can model nouns (i.e. Thomas, train, wheel), verbs (i.e. spinning, go, stop), and adjectives (i.e. fast, slow) – and make it meaningful by assuring that whatever words we’re producing are directly correlated with what’s happening.  In a way, we’re just narrating for our children.  And as long as their intentions and observations of their environment are aligned with the language that we’re providing them with – they will learn it.  And eventually, we help them progress by expanding on their play and the language models we provide them.  We show them that the “Thomas the Train” can go “under the bridge” and “over the bridge”, and can say “hello” to “Percy the Small Engine,” and request “help” when Thomas is “stuck” because the “tracks are broken” and “need to be fixed.”  However, we need to make sure that our children’s attention is also focused on and interested in our expansion of their play in order for the language to be meaningful and learnable. 

All in all, it’s important to know where our children are developmentally (i.e. single words versus three-word utterances versus conversational speech), and to dedicate some time each day to engage in play using language that is directly correlated with where they are developmentally, and to push the bar using language that’s just above their current threshold.  This is how we can teach and challenge our children to learn language and interact with us in a meaningful and fun way.

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