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From Their Mouths to Our Ears

It's never too early to assess our children's speech and language development -- and to seek support if needed.by Karen Gorman



Once there was a sweet 3-year-old girl, adopted from Eastern Europe, whose way of communicating with her family was to screech and scream. Her parents sought professional help, and, with the aid of speech and language therapy, the child found an appropriate sound level. As therapy progressed, the little pupil rapidly acquired other communication skills, even learning appropriate gestures as quickly as the therapist demonstrated them.

By age 3 or 4, most children can express themselves and are fairly understandable. However, 10 percent of all preschoolers have some form of language impairment, and the figure rises to nearly 50 percent for children who've been institutionalized or in foster care. Language delays are directly related to lack of stimulation in the orphanage setting, where the ratio of caregiver to child is too high to permit much interaction. Another important factor, especially for children adopted internationally, is that learning a second language is much easier after first language skills have been developed.

While there are general timelines for language milestones [see the box on page 44], language-skills development can vary greatly from one child to the next. Some children have an ear for language and imitate sounds and words quickly, while others easily comprehend language spoken to them but have trouble expressing themselves in words. In the long run, most children will do fine, but their paths to language will vary.

Listen Up for Language Delays

If, by preschool age or younger, you've noticed that your child has difficulty understanding language or expressing herself, or has trouble with the mechanics of speech-beyond what is developmentally appropriate-don't hesitate to have her assessed by a professional. Here are some things you should watch for:

Demonstration of motivation to learn language. If your child is very passive in her interaction with others, and about language in general, she may need help.

Babbling, jargoning, singing, parallel play, and imitation and pretend play by your young preschooler that reflect life and language experiences. When self-supporting language and play-skills such as these are not in evidence, it could indicate language delay.

Difficulty with age-appropriate reading and spelling and with following verbal instructions, shown by your older child (age 5 and up). These learning problems can result from poor language skills or gaps in language development.

Signs of confusion with language in a child who was adopted after some learning of her birth-country language. Differences in cultural approaches to language and communication can affect learning.

Inappropriate behaviors, like hitting or biting, extreme frustration and tantrums, insecurity, and stranger anxiety. While these are not exclusive to difficulties with language, they can be a red flag.

Benefits of Professional Attention

As a pediatric speech pathologist who works extensively with children adopted internationally, I believe that all adopted children should be observed by a professional for developmental speech milestones. Medical evaluation is also recommended to rule out health-related issues, like fluid in the ears from bottle propping in an orphanage, which can impede ability to discriminate and imitate sounds. Early assessment gives parents extensive information about the well-being, health, and development of their child, empowering them to offer her the best start in life.

Your child's physician can determine what type of evaluation is necessary, and whether therapy is warranted. A child suspected of speech delays is often eligible for publicly funded evaluation and treatment services. If your child is not eligible for public services, your physician can refer you to a private speech-language pathologist.

Children with speech and language problems need concentrated exposure to auditory feedback and reinforcement, particularly from someone other than their emotionally invested parents. Such exposure enables many children to overcome whatever they missed in the earliest stages of life.

For most internationally adopted children, speech delays are transitory. Success rates are very high following auditory stimulation therapy. Speech and language therapy often dramatically increases the rate of second-language acquisition and eliminates emotional distress by setting up opportunities for early success. It gives children the helping hand they need to catch up with their peers. The developmental improvements that follow speech therapy encourage not only children, but their families as well.

Karen Gorman is a speech-language pathologist working primarily with young children. She runs a communication evaluation program for the New York City Department of Education, and serves on the advisory board for the Spence-Chapin agency in New York City.

  1. Read and sing to your preschooler daily. Emphasize repetition by using a small selection of books and songs. This will promote language familiarity and foster spontaneous sound and language production.
  2. Introduce words during everyday experiences, to promote language comprehension. Describe things you see, what you're doing, how you're feeling.
  3. Converse often with your child, asking questions and allowing time for response. Avoid answering for him or finishing his sentences.
  4. Repeat and rephrase rather than correct. If your child says, “I runned to the car,” you say, “Oh, you ran to the car.” Do the same with mispronunciations.
  5. Encourage playfulness with language that includes sound production just for fun, such as imitating sounds and gestures without the use of words.
Milestones in Speech Development
  • Birth-5 months: Turns head toward sound, distinguishes mother's and father's voices from others, makes vowel sounds.
  • 6-11 months: Adds a few consonant sounds to vowel sounds, babbles (ba-ba-ba, da-da, ma-ma).
  • 12-17 months: Attaches “mama” or “dada” to the right person, answers simple questions nonverbally, follows simple directions with gestures, says a few simple words to label objects.
  • 18-23 months: Says 10 or more words, begins to combine them (“want ball”), may be able to follow a two-step command (“Go to the bedroom and get the toy”).
  • 2-3 years: Learns and speaks more words, making simple sentences two to four words long; follows simple instructions; repeats words overheard in conversations; uses descriptive words (big, happy), plurals, regular past-tense verbs.
  • 3-4 years: Uses most speech sounds, though some (l, r, th) may be distorted; groups objects like food and clothes; expresses feelings and ideas; can understand most sentences; understands physical relationships (on, in, under), uses sentences that are four or five words long.
  • 4-5 years: Speech is largely understandable; describes how to do things; answers “why” questions; lists items in a category, such as animals.
  • 5 years: Engages in conversation, uses complex sentences, carries out a series of three directions, uses imagination to create stories.
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