Four-year-old Colter likes playing with trains, and he's good at it. Sitting on the floor in his speech therapist's studio in Herriman, Utah, Colter has no trouble figuring out how to assemble the track, link up the cars and flip the switches. A rough-and-ready kind of guy with a buzzed haircut, he bends his head to the task, then gives a whoop as the train starts chugging.
There was never any question about whether Colter was smart. But, until recently, he was a "silent child," — his mother's description. For him, language development came slowly and with difficulty. It was obvious that he could understand and act upon what was said to him. But by age 2½, Colter could say only a handful of words, and they were garbled. Instead of "dog," the family pet was a "bob."
Between the ages of 2 and 3, when Colter should have acquired several new words each day, he added only a few more words to his vocabulary, and no phrases. But he knew what he wanted to say. His mother and his speech therapist, Jayna Collingridge, agree on that. Colter's frustration at not being understood began boiling over in passionate tantrums. Between those, he grew ever more quiet and withdrawn. He was shutting down — about to give up on trying to talk.
Colter has childhood apraxia of speech, a messaging problem between the brain and the mouth. It is a severe form of speech delay that affects both vowels and consonants and is resistant to intervention. He is receiving intensive speech therapy and has a good chance of catching up with his peers during the next few years. His parents don't want their son to be defined by a disability they hope he'll conquer, though, and asked that his last name not be used for this story.
About 15 percent of 4-year-olds have problems with delayed speech. Of those, 3 to 5 percent of children with speech delays have apraxia of speech, and Colter is among that number. Many infants who don't meet language development milestones right on time are simply late bloomers and will likely catch up on their own, said speech-language pathologist Julie Masterson, co-author of the book "Beyond Baby Talk."
National Health Institute statistics show that speech disorders resolve by age 6 for 75 percent of children who have them. It's important for parents to discuss any concerns about speech development with their child's doctor, Masterson said. If intervention is needed, the earlier it starts, the better. And children with speech delays who receive intervention have better school and social success later than those who don't get help, she added.
To worry, or not
When a baby is behind in reaching speech milestones, it can be tricky to tell whether the problem is a mild delay that will resolve, or something more serious. But parents can spot signs of speech development long before a child says "ma-ma" for the first time, Mastersons said. Babies begin communicating soon after birth, and that first "real" smile signals that language development is under way.
"We all know when that happens," Masterson said. "It just melts you. It shows that the child is developing, and it's incredibly powerful. An adult will do almost any foolish thing to make that happen again."
Babies who don't produce a social smile by age 4 months need immediate evaluation, Masterson said, to ensure that the communication delay is not part of a broader cognitive disorder, such as Down syndrome or autism spectrum disorder. Being delayed in more than one area — speech and physical development for instance — is another sign that evaluation is needed, as is being significantly behind on reaching developmental milestones in any area.
Most babies who are behind in developmental milestones will catch up, especially if they are only a little bit behind and are progressing steadily. If concerns about a child's development arise, a pediatrician can refer the child for evaluation, which is provided free of charge in all U.S. states under the federal Individuals with Disabilities Education Act (IDEA).
In Colter's case, evaluation revealed that his delay involves speech only, but his speech problem is severe. He scored above the 90th percentile for cognitive skills like comprehension and ability to follow multiple directions, but in only the third percentile for speech development.
Free early intervention services — usually weekly home visits from a speech-language pathologist — are available to all U.S. children under IDEA starting at age 2, though services may vary from state to state. The child’s pediatrician is the best source for connecting families with available services, Masterson said. Information can also be found through the National Dissemination Center for Children with Disabilities. For children with mild delays, such help will sometimes catch the child up to peers by age 3.
Colter received in-home visits from a speech-language pathologist (SLP) starting at age 2. “It was fine, but we weren’t seeing progress,” his mother said. When he turned 3, he began attending Canyons School District’s early intervention preschool for two hours and 15 minutes, twice a week. It's a free program, where he participates in group work with other children and receives a minimal amount of one-on-one time with an SLP.
U.S. children with disabilities ages 3 to 5 typically receive some services through their state school systems, but those services vary from state to state. Parents can contact their local school districts to learn about what is offered. In most states, some speech therapy will continue to be provided through the public school system after the child enters regular school, and for as long as problems persist.
Because Colter’s progress continued to be slow after he started the early intervention preschool, his mother decided to add weekly private sessions with Collingridge, a speech-language pathologist with national and state certifications. The American Speech-Language Hearing Association's website includes a national directory of SLPs to help families find providers in their area. Some insurance plans cover this service, and some of the listed providers charge their fees on a sliding scale based on income.
In the 14 months since Colter started private speech therapy sessions, his language skills have “exploded,” his mother said. During the first six months, Collingridge worked on vowel sounds with Colter — he wasn’t ready to take on consonants. Toys like the train set and a toy farm set are integral to her process — setting up situations that urge a child to communicate using the sounds being studied.
Colton says many words now, and links them into simple sentences. Some of his consonant sounds are still confused, though. On a recent morning, Collingridge worked to help him produce the initial “Y” sound correctly. She sat on the floor with him, her face bright, animated and encouraging as she modeled correct pronunciation.
“Do you want to add the red car?”
“Can you say eee-ess?” she asked, exaggerating the movements of her mouth and tongue to model the sound.
“Eeee-NESS,” said Colter, only partly right.
“Good!” said Collingridge, handing him the car. Perfection isn’t necessary, she explained, and good effort deserves a reward. The process of shaping words correctly is a gradual one.
“When you are working with a young child, it’s all about motivation and keeping him engaged,” Collingridge said. “That’s why I have so many toys and games. I have to find something he is willing to work for, but I have to be in charge. If I just let him have all the toys, he has nothing to work for.”
Colter has come a long way, but still has more work to do. He’s talking, but more like a 2-year-old than a boy who’s almost 4. There is much to celebrate, though. His mother noticed a big change in his level of confidence and happiness after he had been working with Collingridge for about six months.
“He started coming up and trying to tell me secrets,” she said. “Before that, he was just silent. He didn’t try to talk. Now, I can understand him sometimes, though sometimes I have no idea what is being said. The important thing is, he’s trying all the time.”
Speech development milestones
Ordered milestones form the building blocks of language development, and parents can help children reach them.
By age 1 a child should:
Say two or three words besides "mama" and "dada."
Understand simple instructions.
Recognize his or her name.
Parents can help by responding to their child's cooing and babbling, reading colorful books every day, telling nursery rhymes and singing songs.
Between 1 and 2 a child should:
Use 10 to 20 words, including names.
Combine two words, such as "daddy bye-bye."
Make the sounds of familiar animals.
Parents can help by talking simply and slowly to their child about everything that's going on throughout the day and providing children's recordings.
Between 2 and 3 a child should:
Carry on conversation with self and dolls.
Have a 450-word vocabulary.
Combine nouns and verbs: "mommy go."
Parents can help by encouraging children to answer simple questions, reading books daily and carrying on conversations with their children.
When a child is behind in reaching speech development milestones, parents should discuss concerns with the child's pediatrician, who can set up a free evaluation if warranted.
Source: PRO-ED Inc.