IF YOU HAVE CONCERNS, ACT EARLY

What causes developmental delay?

Developmental delay can have many different causes, such as genetic causes (like Down syndrome), or complications of pregnancy and birth (like prematurity or infections), hearing loss from chronic ear infections, or lead poisoning.

What types of speech and language disorders affect children?

Children may experience one or more of the following disorders:

• Speech sound disorders – (difficulty pronouncing sounds)
• Language disorders – (difficulty understanding what they hear as well as expressing themselves with words)
• Cognitive-communication disorders – (difficulty with thinking skills including perception, memory, awareness, reasoning, judgment, intellect and imagination)
• Stuttering (fluency) disorders – (interruption of the flow of speech that may include hesitations, repetitions, prolongations of sounds or words)
• Voice disorders – (quality of voice that may include hoarseness, nasality, volume (too loud or soft) 

Do speech-language disorders affect learning?

Speech and language skills are essential to academic success and learning. Language is the basis of communication. Reading, writing, gesturing, listening, and speaking are all forms of language. Learning takes place through the process of communication. The ability to communicate with peers and adults in the educational setting is essential for a student to succeed in school. 

How may a speech-language disorder affect school performance?

Children with communication disorders frequently do not perform at grade level. They may struggle with reading, have difficulty understanding and expressing language, misunderstand social cues, avoid attending school, show poor judgment, and have difficulty with tests.

Difficulty in learning to listen, speak, read, or write can result from problems in language development. Problems can occur in the production, comprehension, and awareness of language sounds, syllables, words, sentences, and conversation. Individuals with reading and writing problems also may have trouble using language to communicate, think, and learn.

 What should I do if I suspect my child has developmental delay?

If you think your child may be delayed, you should take them to their primary care provider, or to a developmental and behavioral pediatrician or pediatric neurologist. An alternative to seeing a specialist is to work through your local school system (see below). If your child seems to be losing ground—in other words, starts to not be able to do things they could do in the past—you should have them seen right away. If your child is developmentally delayed, the sooner you get a diagnosis, the sooner you can begin connecting to developmental services and a medical plan if needed—and the better your child’s progress will be.

How can I help my child with language development?

It is important to identify speech/language problems early, so your child can begin treatment. Many people believe that speech and language treatment cannot begin until a child starts talking.  This is not true.  Treatment can and should begin as soon as possible.  Research shows that children know a lot about language long before the first word is ever said.  If your child has any risk factors (for example low birth weight) or any of the problems listed above, they should be tested early and periodically for speech/language problems.  

How do parents and school personnel work together to insure that children get the speech-language support they need?

Parents and teachers should refer any student who shows signs of a speech-language disorder or delay to the school-based child study team. Screening, assessment, and treatment of communication problems may involve cooperative efforts with:

• parents,
• speech-language pathologists (SLPs),
• audiologists,
• psychologists,
• social workers,
• classroom teachers,
• special education teachers,
• guidance counselors,
• physicians

SLPs work with diagnostic and educational evaluation teams to provide comprehensive language and speech assessments for students.

How can my child communicate, if not verbally?

Children who are nonverbal, or not communicating well enough due to hearing loss, autism, apraxia, or similar problems, can use other methods.  These include sign language, the Picture Exchange Communication System (PECS), and Augmentative and Alternative Communication. 

If there is a problem, early attention is important. If there is no problem, you will be relieved of worry. No child is too young to be helped and language is an important

It is most important to start a care plan as soon as you can, and make sure it includes lots of one-on-one interaction with your child.

References
American Speech-Language-Hearing Association.  Late Blooming or Language Problem?  Available at:  http://www.asha.org/public/speech/disorders/LateBlooming.htm.  Accessed 6 June 2008.

Coplan J.  Language Delays. In: Parker S, Zuckerman B, eds. Behavioral and Developmental Pediatrics.  Boston: Little, Brown, and Co.; 1995:195-199.

Leung AK, Kao CP. Evaluation and management of the child with speech delay.  Am Fam Physician. 1999 Jun;59(11):3121-8, 3135.

National Institute on Deafness and Other Communication Disorders.  Stuttering.  NIH Pub No 97-4232.   May 2002.  Available at:  http://www.nidcd.nih.gov/health/voice/stutter.asp.  Accessed 6 June 2008.life tool, so if you are in doubt have your child’s language and speech evaluated.

•   Start talking to your child at birth.  Even newborns benefit from hearing speech.
•   Respond to your baby’s coos and babbling.
•   Play simple games with your baby like peek-a-boo and patty-cake.
•   Be honest when you do not understand what your child says. Don’t pretend that you understand by saying “OK” or “Yes, that’s right.” Encourage, but don’t force, your child to try to tell you again. When you do understand what your child says letting her know will encourage good language use.
•   Listen to your child. Look at them when they talk to you. Give them time to respond. (It feels like an eternity, but count to 5—or even 10—before filling the silence).
•   Model good speech. When your child makes errors repeat what she attempted to say correctly. Children learn correct speech by listening to you talk and read correctly.
•   Talk a lot to your child.  Tell them what you are doing as you do it. Describe for your child what they are doing, feeling and hearing in the course of the day.
•   Encourage storytelling and sharing information.
•   Don’t try to force your child to speak.
•   Expand on what your child says.  (For example, if your child says, “Elmo!”, you can say, “You want Elmo!”)
•   Read books aloud to your child. Children acquire vocabulary and speech sound production gradually. Capitalizing on a child’s desire to repeatedly read the same book increases familiarity with language. The more she hears the words and sentences the more likely she is to retain and use the language. If your baby loses interest in the text, just talk about the pictures.
•   Sing to your child and provide them with music.  Learning new songs helps your child learn new words, and uses memory skills, listening skills, and expression of ideas with words.
•   Plan family trips and outings.  Your new experiences give you something interesting to talk about before, during, and after the outing.
•   Look at family photos and talk about them.
•   Answer your child every time they speak—this rewards them for talking.
•   Ask your child lots of questions.
•   Use gestures along with words.
•   Don’t criticize grammar mistakes.  Instead, just model good grammar.
•   Play with your child one-on-one, and talk about the toys and games you are playing.
•   Follow your child’s lead, so you are doing activities that hold their interest as you talk.
•   Have your child play with kids whose language is a little better than theirs.
•   Consult a professional if you have any concerns about your child’s speech or language. Your physician should be able to refer you to a speech therapist or speech pathologist if further evaluation is necessary.

References
American Speech-Language-Hearing Association.  Late Blooming or Language Problem?  Available at:  http://www.asha.org/public/speech/disorders/LateBlooming.htm.  Accessed 6 June 2008.

Coplan J.  Language Delays. In: Parker S, Zuckerman B, eds. Behavioral and Developmental Pediatrics.  Boston: Little, Brown, and Co.; 1995:195-199.

Leung AK, Kao CP. Evaluation and management of the child with speech delay.  Am Fam Physician. 1999 Jun;59(11):3121-8, 3135.

National Institute on Deafness and Other Communication Disorders.  Stuttering.  NIH Pub No 97-4232.   May 2002.  Available at:  http://www.nidcd.nih.gov/health/voice/stutter.asp.  Accessed 6 June 2008.life tool, so if you are in doubt have your child’s language and speech evaluated.

• Evaluation and Therapy of Sensory-Motor speech disorders in cerebral palsy
• Evaluation and Therapy of Speech and language delays
• Evaluation and Therapy of Hearing impairments
• Evaluation and Therapy of Physical disabilities of oral mechanism such as cleft lip or palate and Orofacial myofunctional disorders
• Evaluation and Therapy of Learning disabilities(reading and writing)
• Evaluation and Therapy of Articulation disorders
• Evaluation and Therapy of Voice disorders

Speech disorders include the following problems, according to the American Speech-Language-Hearing Association (ASHA):

• Articulation disorders include difficulties producing sounds or saying words incorrectly to the point that other people can’t understand what’s being said. Most children make some mistakes as they learn to say new words. A speech sound disorder occurs when mistakes continue past a certain age. Every sound has a different range of ages when the child should make the sound correctly. The incidence of elementary school children who exhibit delayed articulation development is 2% to 3%, although the percentage decreases steadily with age.
• Fluency disorders include problems such as stuttering, the condition in which the flow of speech is interrupted by abnormal stoppages, involuntary repetitions (st-st-stuttering), or prolonging sounds and syllables (ssssstuttering). The overall estimate for stuttering is 1%.

Resonance or voice disorders      include problems with the pitch, volume, or quality of the voice that distract listeners from what’s being said. These types of disorders may also cause pain or discomfort for the child when speaking or may have trouble with the way their voices sound. The overall estimate for voice disorders is 3%. A voice disorder may be due to cleft palate, conditions that damage the nerves that supply the muscles of the vocal cords, noncancerous growths (polyps, nodules,…) on the vocal cords, overuse of the vocal cords from screaming, constantly clearing the throat, or singing or colds, allergies, bronchitis,

• Dysphagia/oral feeding disorders including difficulties with eating and swallowing. Dysphagia is the medical term for the symptom of difficulty in swallowing. Many adults and children experience swallowing problems for reasons including gastroesophageal reflux (GERD), stroke, the presence of a tracheostomy tube, tumors, surgery, and other conditions.
  • Orofacial myofunctional disorders (OMD) with OMD, the tongue moves forward in an exaggerated way during speech and/or swallowing. The tongue may lie too far forward during rest or may protrude between the upper and lower teeth during speech and swallowing, and at rest. Allergies, enlarged tonsils, thumb-sucking, nail-biting, and teeth-clenching and grinding also can contribute to the disorder.
  • Dysarthria is a weakness or paralysis of speech muscles caused by damage to the nerves and/or brain. Dysarthria is often caused by strokes, parkinsons disease, ALS, head or neck injuries, surgical accident, or cerebral palsy
  • Apraxia of Speech Developmental apraxia is a disorder that affects the nervous system and affects a person’s ability to sequence and say sounds, syllables, and words. The brain does not send the correct messages to the mouth and jaw so that the person can say what he or she wants to say (“potato” may become “topato” and next “totapo”). Production of words becomes more difficult with effort, but common phrases may sometimes be spoken spontaneously without effort.

Usually, there is concern about a child’s speech and language skills if there is no speech by the age of 1 year, if speech is not clear, or if speech or language is different from that of other children of the same age. Though a speech therapist should be the final source for determining if a child has a speech delay. At four years of age, strangers should be able to understand 85% of the child’s spoken language, they speak in full sentences and speak and understand 1000+ words.

Language delay is a risk factor for other types of developmental delay, including social, emotional, and cognitive delay, though some children may grow out of these deficits, even excelling where they once lagged, while others may not. Another particularly common result of language delay is delayed or inadequate acquisition of reading skills. Reading depends upon an ability to code and decode script (i.e., match speech sounds with symbols, and vice versa). If a child is still struggling to master language and speech, it is very difficult to then learn another level of complexity (writing). Thus, it is crucial that children have facility with language to be successful readers. Without appropriate intervention children with communication disorders are at high risk for educational failure.

If you have any concerns about your child’s speech or language consult a professional. Your physician should be able to refer you to a speech therapist or speech pathologist if further evaluation is necessary. If there is a problem, early attention is important. If there is no problem, you will be relieved of worry. No child is too young to be helped and language is an important life tool, so if you are in doubt has your child’s language and speech evaluated.

Some characteristics of language disorders

• improper use of words and their meanings
• inability to express ideas
• inappropriate grammatical patterns
• reduced vocabulary
• inability to follow directions.

One or a combination of these characteristics may occur in children who are affected by language learning disabilities or developmental language delay. Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate.

Specific language impairment (SLI) is a developmental language disorder. SLI is defined as a “pure” language impairment; meaning that is not related to (or caused by) other developmental disorders, mental retardation, neurological (brain damage), or hearing impairment.

Symptoms include the use of short sentences, and problems producing and understanding syntactically complex sentences. SLI is also associated with an impoverished vocabulary, word finding problems, and difficulty learning new words, whereas the basic tasks for development of phonology and syntax are completed in childhood, vocabulary continues to grow in adulthood.

Learning disability is a classification including several disorders in which a person has difficulty learning in a typical manner, usually caused by an unknown factor or factors. The unknown factor is the disorder that affects the brain‘s ability to receive and process information. Of all students with specific learning disabilities, 70%-80% have deficits in reading. The term “Developmental Dyslexia” is often used as a synonym for reading disability. The World Federation of Neurology defines dyslexia as “a disorder manifested by difficulty in learning to read despite conventional instruction, adequate intelligence and sociocultural opportunity”. According to Bishop & Snowling (2004) among SLI children, about 50% will go on to experience reading difficulties and develop dyslexia.

A child’s communication is considered delayed when the child is noticeably behind his or her peers in the acquisition of speech and/or language skills. Sometimes a child will have greater receptive (understanding) than expressive (speaking) language skills, but this is not always the case.

Speech and language disorders refer to problems in communication and related areas such as oral motor function. These delays and disorders range from simple sound substitutions to the inability to understand or use language or use the oral-motor mechanism for functional speech and feeding.

Because language and speech are two independent stages, they may be individually delayed. For example, a child may be delayed in speech (i.e., unable to produce intelligible speech sounds), but not delayed in language. In this case, the child would be attempting to produce an age-appropriate amount of language, but that language would be difficult or impossible to understand. Conversely, a child with a language delay typically has not yet had the opportunity to produce speech sounds; it is therefore likely to have a delay in speech as well.

How Many Children Have Communication Disorders?

The prevalence in preschool children: 6-8%

In early school-age: 2-8%

The overall estimate for speech and language disorders is widely agreed to be 5% of school-aged children. Estimates of hearing impairments vary considerably, with one widely accepted figure of 5% representing the portion of school-aged children with hearing levels outside the normal range.

What are the causes of Communication Disorders?

The brain is complex and our understanding is very limited. For the majority of communication disorders we do not yet understand the cause. However, we do have an understanding of how to help many children to maximize their speech and language development.

A few known causes of communication disorders are:

• Hearing impairment full or partial hearing impairment may cause difficulty in speech and language development. An assessment of hearing is one of the first steps in the investigation of speech and language problems.

• Physical impairment of oral mechanism cleft lip and palate, or malformations of the mouth or nose may cause communication disorders.

• Congenital neurophysiologic problems such as cerebral palsy or brain injury

• Developmental disability some children (not all) with a developmental disability or Down’s syndrome may be slower to learn to talk and may need extra assistance.

• Pervasive Development Disorders (P.D.D.), or Autism spectrum disorders will also have communication disorders. Many children with PDD or Autism have difficulty with social skills and their behaviour and conversation skills may be limited or inappropriate. Often there is an associated language disorder.

• Bad Speech Habits When children are beginning to speak they say many words incorrectly. If a child repeats an incorrect pattern long enough they learn it as a habit. For example, a child may say “bor if” instead of “for if.” If uncorrected the bad speech will become habit.

• Genetic Inheritance It is common but not inevitable that late speech development runs in families.

• Behaviour or emotional problems

Language is an organized set of symbols used for communication. The use of language to reconstruct the past, represent the present, and consider the future has been a most remarkable human accomplishment. Through language we learn about things that we have never experienced and impart our own experiences. Language plays a role in solving problems, expressing feelings, and relating to other human beings.

Speech is the oral manifestation of language, as writing is the graphic form and sign language is the gestural form.

Communication is accomplished through facial expression, body movement, and gestures. These nonverbal components are of great importance in the communication process. If oral and written language is disrupted, facial expression and body language may be the only means of communication.

On 20^th and 21th of November 2010  a  work shop  was  organized  by Dr. Ali  Ashraf  Mojtahed  Shabestari  the head  of  OCHA’s  United  Nations office in Tehran.  The focus and the theme of this workshop was gender issues, quality  standard and  activities  in Red Crescent of Islamic   Republic of Iran. I this workshop the issue of gender and planning during a natural disaster was discussed.

In  September  2010  our office  organized  a dinner party  for  our  donors, clients  and  staff  members as a token of appreciation.   The financial  support  for this  gathering  was  supported  by  citizens who  always  support  our  organization.

In  this  gathering  our  activities  and  programs  were introduced  to  the  participants  followed  by selling of handcrafts  which  was  made  by  mothers  with  HIV/AIDS.