Children who develop language late often have experienced difficulty either processing the sounds of language or attaching meaning to those sounds. Some children have difficulty expressing their knowledge because they are unable to produce the oral motor movements required for speech or are unable to connect the movements together to form words. These children may only babble or produce initial consonant sounds of words.
Children who can not speak for physical reasons can be taught to sign. Children who can not sign can be taught to use other codes for expression (e.g. Morse code produced by a breath switch). The type of code chosen to express language is less important than helping the child develop the grammar, syntax, and pragmatics of language. This means that we must help a child not only learn what words mean but also how grammar and syntax express meaning and how non-verbal cues like eye gaze, body position, gestures, facial expression, context, and tone of voice are used to express meaning.
Language develops through a series of stages; these stages are slightly different for children who learn language late. The following stages of language have been identified by observing how our patients developed spoken or signed language. The children ranged in age from 3-23 and were in cognitive therapy for up to three years. The factors that seemed to improve a child's ability to develop language included:
an adult in the home who was consistently using sign language when they spoke
access to a variety of adults who were explaining what words and actions meant
an emphasis on the meaning of words rather than word or sound production
the ability of adults to match their speech to the child's stage of development
The first chart below describes the stages that we have observed in language development. The next chart identifies effective strategies for facilitating language at each stage of development.
STAGE Babbling Canonical Babbling
Single Words
Combination Words Phrases
Aphasic Sentences
"Tourist" Sentences
Fluent Language |
DESCRIPTION Child experiments with their ability to make sounds, babbling consists of noises or vowel sounds Consonant-vowel combinations called canonical syllables begin to appear in a child's babbling (e.g. baaa, dadadada, goo) As adults attach meaning to certain canonical syllables (e.g. dada, bow-wow, go, etc.), the child discovers that a certain sound (word) is consistently associated with a particular person, object, or action The child discovers that words can be combined to add meaning and obtain a more predictable response (e.g. "more juice" is more likely to produce a drink of juice than "more") The child combines nouns and verbs in short phrases; grammar and syntax may be incorrect or incomplete (e.g. "give book me" or "where go?") The child combines multiple words into a sentence but aphasia is often present (e.g. difficulty finding a word, jargoning, pantomiming instead of using a word, difficulty speaking, combining words without syntax or grammar, etc.); consonant production is often poor. Examples: "to the …… and house;" or "Table on sit dog
Mary." The child may have occasional symptoms of aphasia but sentences are usually grammatically correct; vocabulary is limited and the child does not use complex verb tenses (e.g. "might go" or "will have seen") or colloquial expressions. The child has fluent conversational speech, grammar and syntax are usually correct, colloquial expressions are used, and the child can express themselves in a flexible and creative manner. |
TECHNIQUES FOR STIMULATING LANGUAGE DEVELOPMENT
Babbling
Imitate child's sounds in face-to-face games, imitate and then vary the sounds
Canonical Babbling
Attach meaning to sounds: when child makes any sound that approximates a real word, demonstrate and acknowledge the meaning of the word. Use sign language and gestures when you demonstrate a word's meaning.
Single Words
Simplify your language, slow down, speak clearly, use one or two words (no more than short phrases) to mark the meaning of a word. Use sign language and gestures to mark the meaning of nouns, verbs, and prepositions.
Combination Words
Use short phrases or simple sentences to describe and explain things. Keep your speech slowed and clear. Talk to the child constantly during daily routines, explain and demonstrate what they are doing in simple terms. Emphasize how things are related and demonstrate meanings. Initiate or finish words that the child has difficulty expressing. Do not withold something to force speech. Act confused if a child requests something and offer two possible options for them to clarify. (e.g. child says "want water", you can say "want water to drink or water to wash?") Use combination signs to help mark the meaning of words.
Phrases
Repeat what the child says and then model the correct grammar. Use signs to mark verb tenses, prepositions, pronouns, and comparisons. Give the child a simple choice between two items (e.g. A or B) and use visual cues to emphasize what each choice means. If the child does not respond, model an appropriate response.
Aphasic Sentences
Repeat what the child says and then model the correct way to express the sentence. Fill in missing words, model the words if the child can not find them, explain things in great detail emphasizing how things are related, initiate a sentence and let the child finish, or finish a sentence if the child begins but can not finish it. Draw pictures and use photographs to explain meaning of events and relationships.
"Tourist" Sentences
Demonstrate other options for words or grammatical constructions (e.g. "you could also say.....") and ask for refined meaning (e.g. "do you mean A or B?"). Explain how grammar is used and what it means. Draw pictures and use photographs to explain meaning of events and relationships.
Fluent Language
Emphasize pronunciation by using signs for consonants, exaggerating the consonants, writing words, and drawing pictures. Use pictures, drawings, or photographs to explain the meaning of events and relationships. Introduce reading.
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