by modeling slow, clear speech
during play, while reading together
or during everyday activities.”
Children whose substitutions
persist beyond the age that is
developmentally appropriate may
have a functional speech sound
disorder, such as articulation and
phonological disorders. Other
less common speech sound
disorders include dysarthria, a
weakness of the muscles used for
speaking, and childhood apraxia
of speech, a motor disorder
in which a disruption occurs
in the pathways between the
brain and the muscles used for
making speech.

Receptive and
expressive language
disorders Children with receptive language
disorders struggle to understand
the meanings of words. This
struggle may impact their
comprehension of oral language,
making it harder for them to
follow directions, participate in
learning activities or interact
with their peers.

“A 2-year-old should be able
to follow simple one- and two-
step instructions. If we say,
‘Please get your shoes and put
them on,’ they should be able
to understand and comply,”
says Linda Heller, a speech-
language pathologist with Nyman
Associates in Pennsylvania. A
toddler who is unable to follow
such instructions may have a
receptive language disorder.

Children with expressive lan-
guage disorder have trouble using
language to communicate. This
difficulty may impair their ability
to express their needs. These kids
often have more tantrums because
they don’t have the language
skills to express what they want,
explains Heller. “As you can imag-
ine, this can be very frustrating,”
she says.

Social communication
disorder Social communication disorder
is characterized by difficulties in
the social
aspects of
communication — using lan-
guage with other people.

“Some children struggle with
social or nonverbal aspects of
communication,” says Timothy
Flynn, a school speech-language
pathologist and owner of Forward
Steps Therapy in Alexandria,
Virginia. “For example, they may not
be able to read facial expressions
or body language or respond to
social cues,” he says.

Fluency disorder
Children with a fluency disorder
have trouble speaking in a
flowing, uninterrupted speech
rhythm. This may include taking
long pauses between words or
saying sounds rapidly, several
times in a row — a condition
known as stuttering. Cluttering,
another fluency
disorder, involves breaks in the typical
flow of speech that seem to
stem from disorganized speech
planning, speaking too quickly
or being uncertain about what
to say. In contrast, a person who
stutters usually knows precisely
what he or she wants to say, but is
temporarily unable to say it.

As both a speech pathologist
and someone who stutters, Flynn
is an expert on fluency disorders.

“I can tell you that stuttering
is still greatly misunderstood by
most people,” he says. “Parents of
children who stutter are often told
to wait and see. While many chil-
dren do outgrow stuttering, there
are several factors that speech
pathologists consider to deter-
mine if intervention is warranted.”
Voice disorder
Problems with the sound and
production of a child’s voice may
indicate a voice disorder and
should be evaluated by an oto-
laryngologist. Speech therapy
with an SLP may be recom-
mended as part of the child’s
treatment plan.

NORMAL DEVELOPMENT
OR DISORDER?
How can you tell whether
your child is developing on track
or has a language or speech
disorder requiring intervention?
“Your child’s pediatrician
should be screening your child
at each well visit to ensure that
they are meeting their language
milestones,” says Heller. “For
example, a 2-year-old child should
be able to say around 50 words.

Remember, even animal sounds
count as words.”
A pediatrician should also
regularly test your child’s
hearing. “Hearing is incredibly important
for proper speech development,”
says Flynn. “Frequent middle
ear infections can build fluid in
the ear that mimics how difficult
it would be to hear underwater.

Imagine if you were at a swim-
ming pool and asked someone to
try to tell you something while
you were underwater. Naturally,
you would not hear the speech
sounds correctly, so you would
reproduce them incorrectly.”
HOW AN SLP CAN HELP
If you’re still uncertain about your
child’s speech progress, it never
hurts to seek out an assessment
from a certified SLP. All children
are eligible to seek services
from their county’s infants and
toddlers program or local public
school. If it’s decided that speech
therapy would be helpful, your
child will begin meeting with an
SLP on a regular basis.

According to Lindsay Lyons,
senior speech-language patholo-
gist with Sheppard Pratt School in
Maryland, speech therapy can
be fun.

“I love to play and use age-
appropriate toys to keep the
students’ hands busy and increase
their focus,” says Lyons. “My
favorite go-to activities are the
simplest activities, such as coloring,
listening to music and overall play.

Gross motor activities are also a
favorite go-to for me. Going on the
playground can increase a lot of
language production.” P
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