Because learning language is such a complex business, it is not surprising that problems sometimes occur. In addition to language delay, there are a number of other difficulties to look out for.
Stammering
Stammering is a disorder of speech rhythm and timing, where a child experiences episodes of speech breakdown. About 5 per cent of children will start stammering between the ages of two and five years, and one third of them will simply 'not grow out of it'.
Stammering can be a life-long disability that can affect all aspects of life -social, emotional, educational and employment.
Identification
Stammering can be both fluctuating and episodic, verbal (when we hear the disruption in the rhythm) or non-verbal (when we see the disruption). You may come across a child who stammers in a combination of different ways, or just in one or two.
Verbal stammering is when a child:
* repeats sounds, syllables, words and/or phrases ('H-h-h-h-hospital' or 'Hos-hos-hos-hos-pital' or 'I want the - I want the - I want the hospital') * blocks or pauses before a word ('I - pause - want a drink') * prolongs a word ('I waaaaant a drink').
Non-verbal stammering is when you see a child's attempts to talk being disrupted by:
* grimacing, blinking or twitching
* other physical movements (for example, jerking his head)
* tongue protrusion
* gasps or snorts.
Research has shown that early intervention from a speech and language therapist can prevent stammering, but the longer the problem is left untreated the more difficult it is to help the child.
Support
To support a child who stammers:
* Match your level of language to the child's ability to understand.
* Keep your sentences short and simple.
* Show the child (by facial expression, body language, etc) that you are interested in what she is saying - not how she is saying it.
* Show her that you have time to listen.
* Do not put pressure on the child to talk.
* Avoid asking lots of questions.
* Slow your rate of speech to make the interaction between you more relaxed.
Speech sound difficulties
We have seen that speech sounds develop in a fixed developmental order, and that it is inappropriate to expect a three-year-old to have the same range of sounds and sound combinations as a five-year-old. So if the former appears to have a slight lisp or has difficulty in combining consonant sounds (such as 'sl', 'sp, ' bl', 'fr'), this is not a cause for concern. But with some children these immaturities persist, or their speech sounds may not follow a normal developmental pattern. This can make it extremely hard to understand what they are saying, which can easily lead to frustration and behavioural difficulties. Children with a history of glue ear are particularly at risk, as are those with poor listening and attention skills.
Support
To support a child with speech sound difficulties:
* Listen to what the child is saying, not how the words are said.
* Do not make them repeat the word correctly, as this can increase the frustration. Instead, say the word correctly yourself, to provide a correct 'model'.
* Reduce background noise.
* Offer a variety of activities and games to develop listening skills.
* Make sure the child is referred to a speech and language therapist if the difficulties persist.
Dyspraxia
A small proportion of children have motor planning difficulties known as dyspraxia. Oral or verbal dyspraxia occurs when these difficulties affect the co-ordination of the movements needed to produce speech sounds. Children with this type of difficulty may have no problem in understanding what is said to them, but their ability to talk will be affected. They may have only a small repertoire of sounds and these may be very inconsistent.
Support
To support a child with oral dyspraxia:
* Discuss the difficulties with the parents and suggest a prompt referral to a speech and language therapist.
* Listen to what the child is saying, not how the words are said.
* Help other children to understand that the child has a specific difficulty with speech sounds. The child with oral dyspraxia is not being 'silly' or 'slow' and should not be teased or copied.
* Give as much positive feedback and praise as possible, as there may be problems with self-confidence and self-esteem.
* Once the child is being seen by a speech and language therapist, check whether there is a programme of exercises and activities that can be done on a daily basis.
* Consider using a system of signing, such as Makaton or Signalong, as it may help the child to communicate more effectively, and so reduce frustration.
Glue ear
About four out of every five children have at least one bout of glue ear before their fourth birthday. This condition occurs when fluid collects in the middle ear area of one or both ears, often after a cold or an ear or throat infection. Usually, the condition gets better by itself but there may be some degree of temporary hearing loss, which will, of course, affect a child's ability to understand what is being said.
If the glue ear persists, it can affect the child's language development. This type of hearing loss is quite different from permanent deafness, but if you suspect a child to be suffering from glue ear, make sure they see their doctor, in case they need to be fitted with grommets (small ventilation tubes fitted through a small hole in the eardrum to keep the middle ear aired and healthy).
Signs
A child with glue ear may:
* appear inattentive or prone to daydreaming
* appear not to listen or understand what is being said * talk too loudly or talk less clearly than usual * be in some discomfort from an ear infection which can make them fretful * be frustrated and prone to tantrums.
Support
To support a child with glue ear:
* Ensure the child has been seen by their GP. Tell the parents that glue ear is a fluctuating illness, so a child may need to be seen more than once to diagnose the condition.
* Wait until you have gained eye contact with the child before you give your message.
* Reduce background noise.
* Speak up but don't shout.
* Make directions short and simple.
* Give visual clues as to what you are speaking about.
* Seat the child near the front in group sessions.
Social communication difficulties (Autistic spectrum)
Autism is often talked about, but it remains comparatively rare. Most children on the autistic spectrum have additional learning difficulties as opposed to the unusual talents celebrated by the media. Children with this kind of problem may be able to talk and to put sentences together, but they will have problems interacting with others. Their eye contact will often be unusual and they can appear disinterested in any kind of interaction. Children may also have obsessive behaviours and be unusually distressed at any departure from familiar routines. As the word 'spectrum' suggests, their difficulties can range from the severe to the mildly 'odd'. Observing these children during group sessions and in play may be more revealing than during structured sessions.
