Speech Disorder
Nanttana Pracharitpakdee
18th May 2010
Translated into English by Mayura Phitaksuksanti
"I don’t know what you’re talking about, you silly Babba!"
"Flatface is coming!"
"Your voice is so funny, go away"
No parents would want their child to suffer from mockery from friends. However, it’s common for young children to tease those they consider different. Therefore, parents should be prepared that children with cleft lip (cheiloschisis) and cleft palate (palatoschisis) will be mocked if they have speech disorders, even if they have already undergone a plastic surgery. However, parents can help their children and prevent it from happening.
Parents of children with cheiloschisis and palatoschisis usually wonder how those two craniofacial disorders affect their children’s speech and language development. Children with cleft lip only do not have speech problem; however, children with bilateral cleft lip and gum problem may.
Cleft lip and palate is a failure of the oral structure, resulting in a delay in muscle development, for example, sucking, chewing, swallowing or blowing, which are basic development of speech organs. Therefore, children with cleft lip and palate are more susceptible to various speech problems such as
- Articulation problems
- Hypernasality, Nasal twang
- Hoarseness or weakness to the voice
- Speech rhythm
Generally speaking, cleft lip and palate do not affect language development, unless there are other disorders involved, which should be informed to the parents early on. However, it is probable that children have a slower language development than others in the same age group due to several factors. For example, low self-esteem, low social skills, and unwillingness to talk to friends, as a result of a deformed face or muttering face; parents’ overprotectiveness; parents’ shamefulness; ear infections or hearing problems derived from cleft palate; delay in cleft palate repair; or frequent hospital visits, all affect language and speech development.
However, by the age of 4, children with cleft lip and palate should be able to develop normal speech, considering that language and speech development is different in each child, and not depending on the type of cleft clip and palate. Parents may be worried about articulation disorders in children with cleft lip and palate even after the palate is repaired and recommendations from speech therapist are followed. Every child has different period of language and speech development. Sometimes, parents are worried that their children have problems with articulation, but in reality, they may be still at the stage of normal language development. For example, small children, who may not be able to control speech organs well, may have mild hyper nasality, and articulation problem. Still it cannot be considered that they have a speech disorder. Therefore, parents should study Table: Normal Speech Development in Children for further observation.
| Age | Articulable in each word |
|---|---|
| 2 years – 2 years 6 months | Consonants / ค, น, ม, ย, ห, อ / |
| 2 years 7 months – 3 year | Consonants / ก, บ, ป, ว / Intonation Vowels Ending consonants Consonants / จ, ต, ท, พ, ล / Consonants / ง, ด / Consonants / ฟ, ซ, ส / Consonant clusters / กว, คว / |
| 10 years or more | Consonants / ร / |
After understanding speech development, parents should also pay attention to speech development stages. Since language development is expressed as both responsiveness and assertiveness, it is fundamental to observe them both. Parents should also watch for indicators of a delay in language development of their child unlike others of similar age.
| Age | Indicators | ||
|---|---|---|---|
| 3 months | Does not respond to environmental sounds or parents’ sound | ||
| 6 months | Does not utter any sound and does not try to reach for things | ||
| 8–12 months | Does not look into the eyes of the interlocutor Does not point or utter sound to indicate their needs |
||
| 15–18 months | Does not utter a clear word | ||
| 18-24 months | Cannot follow an order. Cannot pronounce two words | ||
| 2 years 6 months | Does not make a question. Does not respond to a yes/no question | ||
| 3-4 years | Does not construct a sentence. Cannot make others understand. Does not use language to solve problem or to learn | ||
To help your child speak clearly, parents should do as follows:
- Listen. Always pay attention to what your child say. If you don’t understand, let them know and correct it. Do not let them continue speaking incorrectly because they will unconsciously learn it so.
- Accept. Accept the fact that your child has a speech disorder. Each and every child has different speech development progress. If they start to speak unclearly, parents must speak the correct word or make the correct sound and tell them to repeat it. Normal Speech needs to be developed appropriately according to the development stage. Do not push too hard.
- Speak clearly. Be a good example to your child. There is no need to ask your child to repeat the correct word every time they say something incorrectly or unclearly. Parents must speak correctly and be a good example.
- Correct. If your child has a hearing disorder, it must be corrected, even though it’s temporary, because it may affect their articulation and language development. Parents should use short sentences and speak slowly and make sure that your child understands them.
- Consult. If parents are worried about their child’s speech and language development, they should consult a speech therapist in order to evaluate your child’s speech and follow their recommendations.
Moreover, parents might wonder when they should consult a speech therapist. Do they need to wait until their child starts to speak? Actually, the speech therapist will meet with the child’s parents just before the child undergoes a surgery, that is, the speech therapist will start giving recommendations to parents when the child is 3 years old, which is when their lip is repaired, then, a quarterly follow-up, until the child reaches the age of 12 months, which is when their palate is repaired (normally between 9 – 12 months old), then, a follow-up every 6 months until the child reaches the age of 3 years old. Table 5: Pre-school Appointments and recommendations.
| Age | Speech therapy | |
|---|---|---|
| 3 months | Exercise oral organs for sucking, swallowing, chewing and blowing | |
| 6 months | Practice pronunciations according to speech development stages | |
| 9 months | Practice normal language as speech organ preparation for further normal speech development | |
| 12 months, 18 months, 24 months | Stimulate language and speech development | |
| 30 months | Correct incorrect pronunciation | |
| 36 months | Correct any unclear sound and incorrect language use | |
When the children reach the age of 3, their speech should be evaluated by taking an articulation test in order to compare their speech development with normal children. This will also be served as a basis to correct any articulation problems. After the test, periodic appointments should be set up, depending on the abnormality and severity of the speech and language development of each child. If a speech therapy is required, they will have to take a Chula Articulation Test (or Chula-Art) at the age of 5 to evaluate their articulation, voice quality and speech rhythm. This test is used to evaluate articulation for children with cleft lip and palate in Thailand and to evaluate their voice quality to indicate whether they have hyper nasality, nasal emission of air or nasal twang, through the use of nasometer or a Chula 7-point scale nasality test. Moreover, a speech therapist may observe children’s behavior in speaking, language use and general communication. Therefore, it is essential that children with cleft lip and palate meet with their speech therapist periodically and follow their recommendations in order to have a normal language and speech development or at least to have fewer problems before starting preschool. This will result in more confidence in speaking and ability to communicate and socialize with friends. With this, they will not come crying to their parents with “I was mocked for my speaking!”