Max, adopted domestically at birth, was saying only three words by the time he was 18 months old. His mother, Krista DeMaster, of Lakewood, California, had noticed that her son had been on target at one year, then fell behind dramatically. "My gut told me there was something wrong," she says. But she was told by her doctor not to worry.
DeMaster is glad she trusted her instincts. She later read an article connecting multiple ear infections with hearing loss and speech delays. "My son had had plenty of ear infections his first year, so I pushed for a hearing test and ear tubes," she says. And when she brought her son in to see the specialist, the doctor said it was a good thing DeMaster pushed for it, since Max's ears were full of fluid. "With speech therapy, he's back on track," she says.
Experts believe that between eight and 12 percent of all preschoolers have some type of language impairment. Because early life experiences, such as lack of stimulation, improper feeding, or neglect, can have a dramatic impact on a child's development, the rate increases in children adopted internationally or from foster care. But all parents should be vigilant about monitoring their children's speech and language abilities, and seek help at the first signs that something may be wrong. Early intervention is usually highly successful.
Most children learn language skills in roughly the same order. For instance, a child should turn his head toward sounds soon after birth, and begin to babble around six months of age (see Speech and Language Milestones, below). There's a range for normal, and milestone charts should be taken as general guides, not exact timelines for development — but you should seek an evaluation if your child is markedly delayed.
Other red flags that indicate a need for immediate evaluation include:
- Lack of eye contact or interaction. A baby or child who does not make eye contact, does not look in the direction of sounds, or does not attempt to communicate with his parents after the first few weeks home.
- Problems producing speech. A baby older than six months of age who does not babble (ma-ma-ma, ba-ba-ba) or make jargon (sounds that imitate speech patterns). A child of two or older who only imitates, and cannot produce sounds spontaneously.
- Lack of progress. A child who fails to add new words to his vocabulary on a continual basis, or stops using the words he has acquired.
- Difficulties in prior language. If you're adopting a toddler or older child, and if anyone reports significant delays in the birth language, get intervention right away, says Sharon Glennen, Ph.D., professor of Audiology, Speech Language Pathology, and Deaf Studies at Towson University in Maryland. She advises waiting parents to find out as much as possible about the child's speech and language skills in the birth country.
Trust your Instincts
When parents first express concern that their child does not seem to be acquiring language readily, they may be told by friends, or even by professionals, that it's too early to identify a problem, and advised to wait and see.
Wendy Tepfer, a speech-language pathologist in private practice in New York City, believes there's no such thing as too early. She urges any parent who's concerned, especially if there is a significant difference in speech or language patterns between a new child and his siblings or a group of peers, to get the child evaluated. As she points out, there are two possible outcomes: Either the therapist will say, "It might be developmental. Let's monitor this for the next few months," or, "I'm concerned, too. Let's start getting your child the help he needs."
Parents who have been down this road concur. Jill Clapham, of Denver, Colorado, was told to wait, and that her daughter, adopted from China, would catch up on her own. "But she wasn't putting words together, and I could see that trying to communicate was frustrating for her." Clapham had her daughter evaluated just before she turned two, and she qualified for weekly speech therapy. "I am glad I made the call and got the ball rolling," she says. "She has made tremendous progress and will most likely not need services when she turns three."
Debbie Dunham, of Washington state, regrets not acting on her hunch. She adopted her youngest child, Halley, at 33 months, from Korea. "I asked about an assessment in kindergarten because she had so many pronunciation problems," says Dunham. "But the speech therapist dismissed my daughter's problems as typical kindergarten speech. I didn't like that answer, but I didn't pursue it. I thought that, with time, the delay would correct itself."
It wasn't until Halley's second-grade teacher recommended testing — which confirmed speech and learning problems — that Halley began receiving services. "Halley's made significant progress, though I do wish I had been more forceful about my concerns when she was in kindergarten," says Dunham.
Language and speech delays can cause problems in other areas. An inability to communicate can lead to behavior problems. Children may hit, bite, scream, or throw things to make their needs known. Treating the language delay often resolves such behavior.
Maria Pia Negron, of Hicksville, New York, was concerned about frequent tantrums from her son, Jeffrey, adopted from Guatemala at two years old. "We were told he had extensive speech delays. It made sense — I could tell he was frustrated," Negron says. Because Jeffrey qualified for early intervention services, he received in-home speech therapy twice a week. He has been home for eight months, and continues to receive therapy, says Negron. "He still babbles a lot for his age, but the words are starting to come. The tantrums are decreasing as communication gets easier for him."
Because language is the foundation for learning, you'll want to make sure that any problems your child has are being addressed before he starts school. Language is the first rule-based system children must learn. "If a child is having difficulty with spoken language, he may have difficulty with reading," explains Tepfer. But when children start school, at age five, they're expected to be ready to learn to read. Without the right foundation, they can fall behind. That's why early intervention is so critical.
Parents can use sign language to facilitate communication while a child is developing speech and language ability. Glennen signed with her son, adopted at 17 months, from Russia. "I used it as a bridge," she says. It doesn't matter what form of sign language you use — children can invent their own signs — because it will fall by the wayside later.
If you suspect that your child has difficulties with speech or language, speak with your pediatrician. Have him review your child's development and perform a hearing screening. Fluid behind a child's eardrum can muffle sound, and repeated ear infections have been associated with speech and language delays. He should also conduct an oral examination to rule out physical anomalies, such as tongue tie (reduced mobility of the tongue) or general jaw or mouth muscle weakness.
When he was one, Marcia Rojem's son, adopted from Guatemala, began saying Mama, Dada, and Nana, but Dylan didn't add any more words as time went on. At 29 months, the Rojems started speech therapy, but were frustrated by their son's lack of progress. "When Dylan was almost three, our pediatrician finally referred us to an ear, nose, and throat specialist," says Rojem. "It turns out, Dylan was tongue-tied and had fluid in his ears. He is still in speech therapy, but he is talking and singing like never before."
If your physician believes that your child's speech or language is delayed (or if your physician is not concerned but you are), seek an evaluation. Every state offers free or low-cost testing and therapy for children younger than three through an Early Intervention program. Preschool and school-age children are tested, and receive speech and language therapy, through the local school district, under the Individuals with Disabilities Education Act (IDEA). You may also want to consult a private speech-language pathologist. Ask your doctor for a referral or search the American Speech-Language-Hearing Association's directory.
Glennen notes, "It's difficult to make an accurate diagnosis of speech and language disorders in newly arrived international adoptees, but once the diagnosis is made, the recommended treatment for them is no different from what is used with other children. Some professionals and parents think they need a speech-language pathologist who is versed in international adoption issues. However, any skilled speech-language pathologist can provide a good treatment program."
A Little Therapy and a Lot of Love
Children with delays may eventually achieve normal speech and language skills even without intervention, but therapy can help them catch up more quickly and prevent future problems.
A child whose speech and language development is atypical — for example, a child whose development shows gaps, who skips a milestone entirely, or who picks up a few words and then stops using them — is more likely to have a speech or language disorder (see Common Speech and Language Difficulties, below). Speech and language disorders typically improve with intensive therapy, but the prognosis depends on many factors, including the cause of the disorder and the age at which therapy is begun.
Therapy may be conducted in 30- to 60-minute sessions, one day or several days a week, at home, at school, or in the therapist's office. Treatment may last from six months to several years, depending on the severity of the problem and the child's age.
A good speech-language pathologist can make therapy fun. Simple tasks, such as blowing bubbles, chewing gum, and drinking through a straw, can improve jaw and mouth muscle tone and breath control. The therapist may role-play with the child to demonstrate proper speech and language patterns and social interaction in a low-pressure setting. They may play word games or puzzles to expand vocabulary.
Parents are encouraged to maintain a language-rich home environment to support learning. Read aloud and sing to your child often. Carry on a running commentary about daily objects and activities. It may feel as if you are talking to yourself, but constant exposure to your words will reinforce your child's language skills.
At 18 months, Carole Kriessman's son, Curtis, adopted domestically from foster care, had a vocabulary of a few, mostly unintelligible words. "I repeated sentences many times and narrated everything we did, even if it seemed silly," says Kriessman, of Havertown, Pennsylvania. Within two weeks of being around people who spoke to him constantly, he had a vocabulary of 300 understandable words.
Therapy for speech and language delays and disorders takes time and effort, but it usually produces gratifying results. Lisa Leggett, of Little Rock, Arkansas, adopted her son, Joshua Marato, from Ethiopia, at age two. Because Joshua had suffered severe malnutrition, Leggett and her husband anticipated that he would have developmental delays. "We expected the worst," said Leggett. "When we came home, we immediately had him evaluated for speech therapy.
"After a year of therapy, his language skills jumped to a four- or five-year-old level. We are ecstatic. With a little therapy and a lot of love, he is now a normal, active three-year-old."
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