Karen Levin, Ph.D Speech Therapist, Johannesburg

Speech-language therapy in the first three years of life

 

Speech therapists start to work with babies who are at risk of communication impairments from the day that they are born. It is never too early to consult a speech therapist. We do not wait for a child to be "co operative". If you think that your baby or young child is at risk of delayed development, or if you are at all concerned, don't wait. Get in touch with a speech therapist. Don't listen to anyone who tells you that we wait for a child to be 2 or 3 years old before starting speech therapy. Don't listen to advice  from well-intentioned people that your child will 'grow out of it". Rather consult a professional. The earlier, the better.In the last 30 years or so, there has been a tremendous amount of research that has shown, without any shred of a doubt, that the earlier one begins to intervene, the better the outcomes. 

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Pre-linguistic or pre-verbal skills

Speech therapists have a thorough understanding of how babies learn to communicate, and we have evidence that babies communicate from the very moment that they are born. Babies and toddlers learn to do all kinds of things before they actually speak that determine whether they will talk or not. They babble, explore the environment, socialise, develop cognitively, and use non-verbal communication. They also use a range of behaviours -such as contact, noise making, body movement, laughs and so on to connect with and communicate with others, long before they learn words. We call these behaviours "pre-linguistic" or "pre-verbal" skills.  Many babies are at risk of losing out on this very early communication development such as babies  who are born blind; those who cannot hear or hear less well; babies who are premature or ill; babies whose mothers are ill or unavailable;  babies who are born with genetic syndromes that are known to be associated with communication impairments;  babies who live in deprived contexts, and so on.

 

Babbling:

Babies who do not babble are at risk of having delayed or abnormal speech development. Babies often babble when they are on their own, and do not always babble when in the company of people. Babbling is an essential part of speech development because babies learn to manipulate aspects of speech such as timing, frequency and loudness. Babbling is also a very important social behaviour.

 

We have very strong evidence that babies whose babbling does not sound like speech by 9 to 10 months of age

are a risk of later speech and language delays.

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Exploring:

Babies who do not explore their environments might not learn to talk about the environment. Some babies cannot see the environment; some cannot hear. Some have physical disabilities that prevent them from being able to interact easily with the environment. Some babies have intellectual disabilities that interfere with their ability to understand the environment.

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In the first 5 months of life, babies don't show terribly much interest in things - they prefer to look at faces. From about 5 months, they start to show an interest in things. At six months they can sit and probably by 7 months, they can sit independently and reach for and hold toys, looking at them exploring them, holding them, changing hands, and can release the toys.

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At around 8 or 9 months of age, babies start to get around by themselves. They bum shuffle; they crawl. Being able to get around independently opens up a whole new world to be explored and discovered. They learn about their bodies more; they learn about distance and height; they learn about space; they develop their curiosity; they learn about everything that they can touch and see and hold and look at. They learn about danger; they learn about rules. They also love to have others included in their exploration.

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By the first birthday party, babies can usually stand on their own feet, often still having to hold on to a table or chair. They have the opportunity to learn about the world now that they can go places.

 

Socialisation:

Babies respond to their caregivers from under 6-weeks of age. Sometimes, babies do not connect to others due to reasons such as a history of abuse; long-term institutionalisation such as orphanages; poor health or long-term or regular hospitalisation; or multiple sensory impairment. Babies at risk of autism spectrum disorder may not show interest in social communication. We have very good ways to determine whether a baby is responsive and whether parents are responsive to their babies' communicative attempts.

 

Cognitive development:  The golden triad at 9-months:

1.  We know that babies learn what is known as "joint attention" where they look at something that an adult looks at so that they both share the same focus. In this way they have one, specific,  thing to talk about - this is the beginning of the content or the topic of communication. We know that babies develop  joint attention by 9 months of age.

2.  We know that babies have to develop knowledge that if we do something, then something will result. thy learn that a means has an end. This is known as "cause -effect" and they learn it by 9 months.

3.  We know that babies learn that if  things are out of sight, that they still exist. This is known as "object permanence" and we need to learn this so as to be able to learn that the word that we use to represent something replaces, symbolically, the thing that is no longer present  This is learned by 9 months.

 

Gestures:

Babies understand basic gestures from about 8 months of age. They have developed good ability to track with their eyes and to follow our gaze.

• By about 10 months of age, they start to understand the difference in meaning when we point to something or when we show something.

• By about 11 months of age, babies start to use gestures, and often the first gesture that they use is pointing. They do not have the fine motor control to point like we adults do, so they may use a whole arm, an extended arm and a hand, but soon learn to point with the arm extended, the index finger pointing, and the other fingers kept in the hand. Now a baby can be more SPECIFIC. He or she can POINT to a SPECIFIC thing to get the communication partner's attention on that specific thing.

• A major step in development occurs after the first birthday. Babies now point to a place where a thing WAS. Now we know that they are REFERRING to something even if they cannot see it.

Researchers have shown that babies who use pointing learn words earlier and easier.  We also know that first words include the things that babies have pointed to.

Very often, babies vocalise at the same time as pointing. This is a very good sign of the beginning of true communication.

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Working with babies under a year of age

What we aim for in the first year of life is that the baby will develop many behaviours that teach them to communicate with another person.  The development of intentional communication means that the CHILD communicates about a TOPIC with a PARTNER.  This is an absolutely essential step in development that moves a child from a pre-linguistic stage to a linguistic stage. Without it, language development cannot happen (BUT, in some cases, language may not develop even if intentional communication behaviours develop).

A child who looks at a toy and cries about it has the intention to get the toy, but unless he or she looks at a communication partner to "tell" the partner that he or she wants the toy, we do not consider the actions of the baby to be intentional communication.

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We have certain "rules" that we follow to determine whether a baby is communicating intentionally.

These behaviours develop over time and are usually fully developed by 9 to 10 months of age

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• The child makes eye contact with the partner while gesturing or vocalising, often alternating his or her gaze between an object and the partner.

• The child's gestures and vocalizations have become consistent and ritualized. For example, a child uses a gesture of opening and closing her hand when she wants something, rather than attempting to reach the object herself. The vocalisation she uses, ""e.g. "uh" is one that she consistently uses in situations in which she wants something.

• After a gesture or vocalisation, the child pauses to wait for a response from the partner

• The child persists in attempting to communicate if he or she is not understood and sometimes even modifies behavior to communicate more clearly.

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To achieve intentional communication, the baby will have learned:

• to make eye contact and follow the gaze of another person;

• to look at the same thing that another person looks at

• to explore the environment

• to show interest in people and things

• to know that things can exist even if not seen or felt

• to understand cause-effect

• to point

• to vocalise

• to babble using mature syllable structure

• to use gestures ritualistically

• to respond to a communication partner reciprocally

• to recognise pictures and photographs as symbols

• to recognize that toys are symbols (e g a toy cup; a toy car).

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Working with toddlers age 12 to 24 months

Most babies start to say their first real words at 12 months of age, and over the next 12 months learn many, many words and start to make little 2 to 3 word sentences.

I always assess a little one :

1.  When parents are concerned  - because parents are usually right!

2.  If children do not develop vocabulary as per these guidelines recommended by the Hanen Centre:

• 18 month olds should use least 20 words, including different types of words, such as nouns (“baby”, “cookie”), verbs (“eat”, “go”), prepositions (“up”, “down”), adjectives (“hot”, “sleepy”), and social words (“hi”, “bye”).

• 24 month olds should use at least 100 words and combine 2 words together. These word combinations should be generated by the child, and not be combinations that are “memorized chunks” of language, such as “thank you”, “bye bye”, “all gone”, or “What’s that?”. Examples of true word combinations would be “doggie gone”, “eat cookie”, or “dirty hands”.

 

 3.  If they fit the following criteria as suggested by the Hanen Centre:

• quiet as an infant; little babbling

• a history of ear infections

• limited number of consonant sounds (e.g.: p, b, m, t, d, n, y, k, g, etc.)

• does not link pretend ideas and actions together while playing

• does not imitate (copy) words

• uses mostly nouns (names of people, places, things), and few verbs (action words)

• difficulty playing with peers (social skills)

• a family history of communication delay, learning or academic difficulties

• a mild comprehension (understanding) delay for his or her age

• uses few gestures to communicate

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Working with children 2-3 years of age

Children age 2 to 3 start to cry less. The reason for this is that they now have the words and sentences to communicate with. They no longer get that frustrated, and they are able to put into words their ideas. They also learn to use their language skills to manipulate their worlds...such as to ask, demand, request, describe, argue, negotiate ... all on a simple level, but with increasing sophistication.

They soak up new words, and learn a large number of words very quickly. They also learn that different words are used to describe different things with increasing specificity. So now not all animals are doggies, and not all fruit are apples! They combine the words into sentences and are now able to use a wide variety of language structures.

Children often start to attend a nursery school at around age 3. At this stage, they are often not all that happy about separating from their moms or primary caregivers but soon ease into a routine and are willing to say goodbye. The reason why they can now go to nursery school and leave their parents is that they have enough communication - speech and language - to understand what is being said to them and to say what they need to say in the school environment.

 

 

If you are concerned, consult a speech therapist who has the tools and the knowledge to determine

if a baby or a young child  would benefit from intervention.