Speech Language Dysphagia

1. What are the important speech and language milestones we parents should look for in our child?

Speech, language and communication milestones compiled from www.asha.org, “How Does Your Child Hear and Talk?” are given below. Compare your child’s speech and language skills with the skills given for his/her age. This will give you a fair idea whether your child is at power with his/her age group with respect to speech and language skills or is there a delay in the speech and language development.

Birth – 3 Months:

  • Startles to loud sounds.
  • Quiets or smiles when spoken to.
  • Seems to recognize your voice and quiets if crying.
  • Increases or decreases sucking behavior in response to sound.
  • Makes pleasure sounds (cooing, gooing)
  • Cries differently for different needs.
  • Smiles when sees you.

4 – 6 Months

  • Moves eyes in direction of sounds.
  • Responds to changes in tone of your voice.
  • Notices toys that make sounds
  • Pays attention to music.
  • Babbling sounds more speech-like with many different sounds, including, p, b, and m.
  • Vocalizes excitement and displeasure.
  • Makes gurgling sounds when left alone and when playing with you.

7 Months – 12 Months

  • Enjoys games like peek-a-boo and pat-a-cake.
  • Turns and looks in direction of sounds.
  • Listens when spoken to.
  • Recognizes words for common items like “cup”, “shoe,” “juice.”
  • Begins to responds to requests (“Come here,” “Want more?”).
  • Babbling has both long and short groups of sounds such as “tataupup bibibibibi.”
  • Uses speech or non-crying sounds to get and keep attention.
  • Imitates different speech sounds.
  • Has 1 or 2 words.

12 Months

  • Responds to their name
  • Understands simple directions with gestures
  • Uses a variety of sounds
  • Plays social games like peek a boo

15 Months

  • Uses a variety of sounds and gestures to communicate
  • Uses some simple words to communicate
  • Plays with different toys
  • Understands simple directions

18 Months

  • Understands several body parts
  • Attempts to imitate words you say
  • Uses at least 10 – 20 words
  • Uses pretend play

24 Months

  • Uses at least 50 words
  • Recognizes pictures in books and listens to simple stories
  • Begins to combine two words
  • Uses many different sounds at the beginning of words.

2 to 3 Years

  • Speech is understood by familiar listeners most of the time.
  • Understands differences in meaning (go-stop, in-on, big-little, up-down)
  • Follows two requests (“Get the book and put it on the table.”)
  • Combines three or more words into sentences
  • Understands simple questions
  • Recognizes at least two colors
  • Understands descriptive concepts

3 to 4 Years

  • Uses sentences with 4 or more words.
  • Talks about activities at school or at friends’ homes.
  • People outside family usually understand child’s speech.
  • Identifies colors
  • Compares objects
  • Answers questions logically
  • Tells how objects are used

4 to 5 Years

  • Answers simple questions about a story
  • Voice sounds clear
  • Tells stories that stay on topic.
  • Communicates with other children and adults.
  • Says most sounds correctly
  • Can define some words
  • Uses prepositions
  • Answers why questions
  • Understands more complex directions
2. My child is 2yrs 6mths old and he does not speak yet. Does he need speech therapy?

A child begins speaking his first few meaningful words by 12-14 months of age. The first 3 years of life, are very crucial for speech and language development. A delay in speech and language development may be due to several reasons.

Concerned parents should consult a speech language pathologist to clear any doubt they have regarding their child’s speech.

A visit to a speech and language pathologist will not only help them identify the reason for the delay in speech and language development, but also guide them through the treatment required.

3. My child is 3yrs old and he stammers. Will he recover on his own?

The onset of stuttering is typically during the period of intense speech and language development as the child is progressing from 2-word utterances to the use of complex sentences, generally between the ages of 2 and 5. In most children the first signs of stuttering gradually diminish and then disappear, but some children continue to stutter.

There are adults who stutter whose parents were told “Don’t worry, he’ll outgrow it”. Thus they missed the opportunity for therapy when the disorder was most treatable.

Early intervention by a speech language pathologist can help parents understand what their child is going through and guide them in preventing their child’s stuttering from becoming a chronic problem.

4. My child is 5yrs old and he does not say a few sounds correctly. Can speech therapy help him?

Most children are able to speak clearly with correct articulatory placements for all sounds by 5 years of age. However there are some children (5 years and above) who have difficulty saying certain sounds. They either replace difficult sounds with simpler ones or omit sounds or add (unnecessary) sounds in words they speak. These errors make the child’s speech difficult to understand, especially by a listener who is not familiar with the child’s speech. These children need intervention by a speech language pathologist who will teach them the correct articulatory placements for the sounds.

5. My child has been diagnosed with Autism. Will he ever be able to communicate verbally?

Each child with Autism Spectrum Disorder (ASD) is different and each of them has different capabilities. Developing meaningful verbal communication skills is one of the primary goals of speech and language therapy. But for some children who do not pick up verbal language, other non-verbal modes of communication are taught like makaton, sign language, AAC’s (communication boards) etc.

As speech and language therapist we want to enable the child to communicate with the world around him/her in a manner (verbal or non-verbal) most suited to the child’s capabilities. Parents need to understand that, for a child with ASD ‘being able to communicate ones thoughts’ is more important than the ‘mode of communication used’.

6. How important is a child’s early speech/language development to later success in elementary school, middle school, high school and college?

Early speech and language skills are a foundation for the literacy skills that the child will develop later. Many children with a history of delayed or deficient speech and language skills in their early years often lag behind in their literacy skills in school. Speech and language delays should be considered as red flags suggesting the possibility of learning disabilities like dyslexia.

7. I am a 20yr old man and my voice is very feminine. Can you help me get a masculine voice?

The voice box for males is naturally designed to produce a low-pitched masculine voice. Males usually undergo a change in voice at puberty, when voice changes from a high-pitched child like voice to a low-pitched masculine voice. Many young boys do not adapt to this natural change in voice and continue using the high-pitched voice, which sounds feminine (the voice box females is naturally designed to produce a high-pitched voice).

A speech/voice therapist can teach you voice exercises that can help you attain the optimum pitch for which your voice box is designed.

8. I am 18yrs old and I have been stammering since I was a child. Can my stammering get cured now?

Developmental stammering/stuttering, which begins during childhood, is just a speech disorder where there is incoordination between breathing and speaking, resulting in dysfluent speech. However in adults psychological factors like fear, anxiety, avoidance and guilt accompany the dysfluent speech. Thus a speech and language pathologist needs to tackle both, the speech component and the psychological component of stuttering. Speech therapy helps reduce dysfluencies and also works on increasing the individual’s confidence in speaking.
Treating stuttering in adults is very much possible but it takes more time as compared to children. In case of adults the chances of relapse are higher and thus even after good speech is achieved, the individual requires consistent practice for maintaining the good fluent speech.

9. My father has lost his speech after he suffered from a stroke. Will speech therapy help him get back his speech?

>A stroke affecting the speech and language centers in the brain will cause a person to have speech and language difficulties like aphasia, dysarthria or both. In such cases a speech language pathologist works on strengthening the weakened speech musculature and retrieving lost language skills with various language-stimulating tasks. For individuals who do not regain their speech and language skills, a speech language pathologist will help them communicate using non-verbal modes such as AACs (communication boards). Research says that speech language therapy is most effective during the ‘spontaneous recovery phase’ that is within 6 months of the stroke.

10. My uncle has lost his voice after his voice box was surgically removed. Will he be able to talk now?

Surgical removal of the voice box (total/partial laryngectomy) leaves an individual with no voice. Such individuals are candidates for voice prosthesis like PROVOX, which help the individual produce tracheo-esophageal speech. Though the individual’s voice quality is different from his/her original voice, the individual does get a voice he/she can use to express one-self and communicate with the world around.

11. I am a teacher by profession. I am having a hoarse voice since 6 months, which has worsened with time. Who should I consult for it?

Treating a voice problem is the collaborative work of an E.N.T. specialist and a voice therapist. You will need to consult both these professionals for your voice problem.

The E.N.T. doctor will examine the laryngeal structures (vocal folds) in the throat to look for any vocal cord pathology and accordingly advice the treatment, which could be medical or surgical or therapeutic or a combination of any of these.

The voice therapist deals with the therapeutic management of any voice problem. They will first assess the voice attributes. Then depending on the vocal pathology and findings from the voice assessment tests they will advice voice exercises and a vocal hygiene program.

12. My wife has been diagnosed with Parkinson’s disease. She is gradually loosing her speech and swallowing ability. How will speech therapy help her swallowing ability and how long will she need therapy?

Parkinson’s disease is a degenerative condition of the central nervous system affecting the motor functions of the body. Speech and swallowing both get affected in this disease, and these symptoms can occur either together or separately at any stage of the disease. Speech language pathologists are the professionals that treat swallowing disorders (dysphagia). The dysphagia therapist works on strengthening the oro-pharyngeal musculature involved in swallowing and also teaches patients maneuvers to enable them to have safe swallows without aspiration into the lungs (food entering the lungs instead of the food pipe causing pneumonia).

In degenerative diseases like Parkinson’s disease, therapy is usually continuous and for a long-term, because as the disease progresses the motor functions deteriorate further. Thus the therapist needs to review and revise the therapy plan often to suit the patient’s current levels of functioning. Speech language pathologist are important members of the primary team of health professionals taking care of such patients because they are managing two important life functions that are speaking and eating.