Welcome Kate! Thank you for giving up your time to answer our questions :)
Could you start by introducing yourself, telling us about your qualifications and where you've worked?
I am a Senior Speech Pathologist currently working with Autism SA. I began my working life as a primary school teacher, later returning to university to gain qualifications to become a Speech Pathologist. After completing a Bachelor of Education (Junior Primary/Primary) at the University of South Australia I began teaching in country South Australia, and then returned to metropolitan Adelaide to continue teaching for a time. I then went on to complete a Master of Speech Pathology at Flinders University. I have since worked as a Speech Pathologist with Education Queensland in Brisbane, a multi-disciplinary private practice in Adelaide, and now with Autism SA. I am a Certified Practising Speech Pathologist (CPSP) and a member of Speech Pathology Australia (SPA). I am also an Autism Spectrum Disorder (ASD) diagnostician registered with Autism SA. I have experience working in early intervention, with school aged children and with adolescents, who have communication difficulties. I have a particular interest and passion for working with people living with ASD.
What is a speech therapist? And how can they help?
Broadly speaking, the role of a Speech Pathologist is to diagnose and treat individuals with communication and/or feeding/swallowing difficulties. Communication is a broad area, which includes the diagnosis and treatment of difficulties with speech, language, social communication, fluency and voice. Feeding/swallowing difficulties may take the form of sensory preferences around mealtimes that impact the range and type of food someone allows in their diet, to physical difficulties that a person may have been born with or acquired, such as cleft palate or nerve damage as a result of a stroke.
People who may benefit from speech pathology services include those who do not develop communication typically, those who may have acquired communication difficulties and those who present with feeding/swallowing problems. Speech Pathologists work with a wide range of people, including children with communication delays and disorders, people with disabilities such as developmental delays, cerebral palsy and intellectual disability, people with acquired disabilities such as those resulting from injury or stroke, people with hearing loss, as well as many other presentations that can affect a person’s ability to communicate, or eat, drink and swallow safely.
At what age should a parent be concerned that their child isn't speaking?
Communication development begins from birth. Early communication skills, such as joint attention and turn taking, are the foundation on which later, more advanced, communication skills are built. In a child’s first few months of life, they should be developing emotional attachments to authority figures (i.e. their carers), beginning to express various emotions, smiling in response to stimuli, becoming more aware and interested in their surroundings and becoming responsive to those around them. A baby actively engaged in daily routines, such as bath and mealtimes, playing simple games, such as ‘peek-a-boo’, and who imitates and repeats behaviour that gains them attention is communicating. In doing so, they are developing the building blocks that support later communication development, such as verbal communication.
Typically developing babies will develop an interest and increased engagement in their surroundings, for example, by responding to and looking at/for their carers, interesting toys, and the activities around them. They will also typically be babbling (i.e. the early developing “bababa”, “mamama”, “dadada” sounds), either for their own enjoyment or in response to someone or something in their surroundings. Taking turns babbling with a communication partner, such as between baby and parent, forms the very early stages of two-way conversation.
By 12 months of age, typically developing children begin to be able to follow simple, everyday instructions, recognise the names of familiar objects, and understand the meaning of “no” – though I think many of us may have experienced the fact that understanding the word “no” does not necessarily mean that a child will comply with our wishes! Also around 12 months of age, typically developing children will often use what are called ‘syllable-strings’, which sound like words we are more familiar with, such as “no-no” and “go-go”. In the next six months, children typically develop the ability to use up to 20 familiar words, such as “cup”, “dog”, “mummy”, “daddy”; however, words spoken at this age may not always be completely intelligible to the listener. Also by 18 months of age, children will typically pair their words with gestures and pointing, which supports their spoken communication. Engaging in pretend play and imitating lots of the words and gestures of the adults around them continues to develop as well.
Typically developing children will understand between 200-500 words by the time they are two years old. Also by this age, typically developing children will be using 50 or more spoken words, which are becoming more easily understood by listeners, especially those who are familiar to the child. Around two years of age children also typically beginning to use short phrases, such as “go car”, “more milk”, “bye Nanny”. At this age, children possess the ability to use only some of the sounds in the English language, and may also present with other intelligibility issues, such as missing the ends off of spoken words. It is not uncommon for children’s speech to be intelligible only half of the time when they are two years old.
At what point should parents seek help? How do they go about getting help?
All children are different. The information about communication milestones that I have provided is meant as a guide only, as each child can move through the developmental stages at different rates and times. However, there are a few “red flags” that parents and carers can look for in babies and children, in order to help them decide if their child might benefit from speech pathology input. They are as follows:
- By eight-nine months of age the child is not interested or responsive to their surroundings, and does not engage in babbling.
- By 18 months of age the child has not used ‘syllable-strings’ (e.g. “no-no”, “go-go”, “ta-ta”), or produced up to 20 simple words (e.g. “up”, “go”, “cup”, “dog”, “mummy”, “daddy”), and does not understand simple, everyday instructions (e.g. “get ball”).
- By two years of age the child is not using around 50 spoken words, and is not pairing words to make simple phrases (e.g. “go car”, “bye mummy”).
If you are concerned about your child’s development, discussing this with your chosen General Practitioner (GP) or Paediatrician may be helpful. The Speech Pathology Australia (SPA) website provides information about the role of Speech Pathologists and also where you may find a suitable Speech Pathologist in your local area (http://www.speechpathologyaustralia.org.au/information-for-the-community/find-a-speech-pathologist). This list is not exhaustive, however, and you may also wish to discuss your options with your GP or Paediatrician. Local child care centre and kindergarten staff may also be able to provide you with information about services in your area.
For those who are eligible, services may be accessed using Medicare rebates, which can be discussed with your GP. Those who have private health cover may be able to access rebates on eligible services depending on the type of cover you have, and also the service provider that you choose to access. Speech pathology services can be accessed privately, publicly and through non-government organisations. Waiting lists and eligibility criteria can be different depending on the organisation.
What can parents do to encourage a child's speech?
Broadly speaking, spending quality time actively engaging with children, talking and allowing them time to talk, is one of the most beneficial things you can do to support their overall development. More specifically, the following provides some ideas about how parents and carers might actively engage their child to support their communication development:
- Sing, chat and use nursery rhymes with babies and children, using a gentle voice. Reading books with simple pictures may be of interest to even very young babies.
- Using emotive facial expressions and playing simple games (e.g. peek-a-boo, clapping/singing games – repetitive action songs are great) supports engagement, attention and turn taking skills.
- Imitate your baby’s sounds and babbling, as well as taking turns with them in this activity.
- Build anticipation and help develop your baby’s ability to request by stopping just short sometimes – e.g. play a light up toy briefly and then stop it, wait for your child to engage and show they want more by looking at you, then play it again.
- Later on, it doesn’t hurt sometimes to suppress your natural instincts as a parent/carer and stop short of providing what it is your little one is after. For example, you may know exactly what toy, food or drink they are after, but pretend you do not – give time, and options if needed (see below), for your child to attempt to label the item.
- Make use of everyday activities, such as mealtimes, getting dressed, bed time routine, etc., by engaging your child, encouraging eye contact during these times, and also chatting about what is happening and what you are doing – provide a simple commentary of the activity, while making it fun and interactive.
- Take note of what your child shows interest in – label it, talk about it, encourage your child’s engagement with it. By labelling items and talking about the environment you are helping the child connect language with their world.
- Allow your child time, in all things. While it is important to label and talk about what you see and do together, it is just as important that you allow your child time to be the initiator as well as the responder. For example, when your child shows interest in something you could label it, and bring it close but not provide the item – wait for the child to reach and make a noise or attempt the word. Give lots of praise for any attempt at labelling or requesting.
- Give options to your child to encourage speech as well. If your child reaches or points to their drink, you could ask, “Would you like water or milk?”. Options can be used at other times as well. For example, you might ask, “Is this a cat or a dog?”, “Is this your hat or your shoe?”.
- Expanding your child’s speech is a way of modelling and supporting how to use and put together words. If your child asks for, “drink”, you might say, “drink please”, and wait for them to imitate you. If your child comments, “dog”, you might say, “big dog”, or “dog running”.
- Retell and re-enact stories, nursery rhymes, favourite television shows and parts of movies. You could draw characters, make puppets, act it out, or simply go back through familiar books allowing your child to “read” the story in their own words.
- Take photos of activities and outings and talk about these with your child. Allow them to retell events and share these with others, using the photographs as a way to support their language.
These ideas and activities are provided as general information that may support your child’s communication development. It should not take the place of specialist support, tailored to your child’s individual needs, such as could be provided by a health professional specifically treating your child.
Kate, I can't thank you enough for taking the time to give such detailed and informative responses to my (and my reader's) questions. Thank you for sharing your wealth of knowledge and experience with our community.
I invite you to leave your positive words to Kate in the comments below. Have you had any experience with Speech Therapists/Pathologists? I'd love to hear your stories.
Linking with Jess for #IBOT
Linking with Jess for #IBOT