Communication is the exchange of information between people through speaking, reading, writing and also gestures and facial expressions. Communication difficulties may arise due to delayed development, autism, hearing loss, cognitive deficits, syndromes, cerebral palsy, stammering,
articulation disorders, learning difficulties and others.
Articulation disorders
We can see that most of the children learn to say the different sounds in a language with minimal effort. They develop sounds like ‘pa’, ‘ma’, ‘wa’ faster than sounds like ‘ra’, ‘fa’ etc. and clusters like ‘tr’, ‘cr’ and so on. However, some of the children do not develop the correct production of the speech sounds in accordance with their age. Children with articulation disorders may substitute one sound for another, may be distorting a sound, omitting a sound or adding a sound. This makes it difficult for the listener to understand what the child is saying and this affects the communication.
Assessment
The child’s structure and function of oral structures like the lips, jaw, teeth, tongue are checked for any abnormalities in the structure and function of these oral structures too. A detailed audiological evaluation is also recommended to rule out if hearing loss is causing the misarticulations. A detailed assessment of the child’s production of different speech sounds in isolation, words, sentences and connected speech is done. The type of errors (whether substitutions, distortions, omissions, additions etc.) and the position of occurrence of these errors (beginning of the word, middle, or end or in all positions) is also documented.
Treatment
Speech-Language Pathologists (SLPs) can teach the child how to produce the error sounds correct by teaching them how to position the different oral structures for a particular sound to be produced and how they can produce them correctly. A systematic approach of teaching the sounds in syllables, words, sentences and connected speech is used. Feedback is provided through multisensory means like auditory, visual and tactile modes.
Stuttering
Stuttering results in disruption to the smooth flow of speech. There can be blocks (I came home……yesterday), repetitions (ba-ba-ba-ba-ball), prolongations (boooooook), filled pauses (I want to um um go home) etc. Those with stuttering may also exhibit other behaviors like not maintaining proper eye-contact while speaking, tensing muscles, avoiding certain words or situations. Many children and even adults have dysfluencies while speaking, but if the child is exhibiting these dysfluencies for more than six months and beyond the age of around 3 to 4 years, it is advisable to consult an SLP.
Assessment
A detailed history about when the stuttering was noticed, since how long has it been persisting, any others in the family who have stuttering, and any significant reasons are noted. The type of dysfluencies and their frequency of occurrence are documented. Information about whether there is any difference in the frequency depending on the context or situation (while talking to superiors or while speaking to strangers etc.) is also gathered. The way in which the child reacts to these dysfluencies is also important information (whether he/she avoids saying certain words, gets upset when others ask for repetition etc.)
Treatment
Strategies to reduce the dysfluencies and other avoidance behaviors are used by the SLP. In addition, a clinical psychologist also works to reduce the anxiety or emotional stress that the child or adult might be experiencing.
Learning Disabilities
Children with learning disabilities may have difficulty in reading, writing, spelling, math, following long instructions, sequential tasks etc. Even though most of them have normal IQ, they still have difficulties.
Assessment
A detailed assessment about how the child is following instructions, performing on sequential tasks, reading, writing, spelling words, comprehending after reading, solving math problems, memorizing
different information, matching sounds to their letters, letter reversals, macro or micro letters etc. is done by the Special educator and SLP.
Treatment
Treatment would focus on the above mentioned areas depending on the child’s needs. Special teaching strategies and aids are used to help these children in their learning of academic skills.
Attention Deficit Hyperactive Disorder (ADHD)
ADHD is a disorder in which the individual has difficulties in sitting at a place, maintaining attention and concentration for a good amount of time and staying focused on a particular task, difficulties in planning, organizing and completing tasks, are restless, have poor on-seat behavior, difficulty in
waiting for turn and seem to be unaware of hazards most of the time.
Assessment
The Clinical Psychologist, SLP and Special Educator observe and also interview the caretakers about the child’s inattentive, hyperactive or impulsive behaviours in different environments like at home, school, outside.
Treatment
Some children might need to take medication to help improve their behaviors. The rehabilitation professionals work as a team to improve the child’s attention and concentration, on-seat behavior, language usage, planning and organizing using visual schedules and daily planners, reading and writing, turn-taking, waiting for turn etc. The teacher at school is also provided with guidelines to help the child in the classroom.
Autism
Individuals with Autism, referred commonly as Autism Spectrum Disorder (ASD) have difficulties in social interaction and communication, limited and repetitive patterns of behavior and sensory issues. These individuals fall on a broad spectrum as there is a wide range of symptoms and severity of the symptoms that they exhibit. Some of them may show mild symptoms whereas, some may show severe symptoms.
Some children appear to develop normally until around 18 and 24 months, after which the symptoms of autism appear. At the same time, some children show signs of autism even in early infancy, such as poor eye contact, lack of response to their names, or lack of attachment to their parents. Some of them may be able to communicate verbally, but others may lack the ability to communicate verbally.
Those with autism may have difficulties in understanding and using words and longer utterances to communicate, maintaining eye-contact, following directions, initiating conversations, mingling with peers, repeat questions instead of answering or utterances that were heard before and that are not relevant to the context (echolalia), difficulties in gross motor and fine motor skills, Mouthing inedible items, difficulty in adjusting to change in routine, repetitive play, smelling objects, flapping, rocking, spinning, eating limited food, auditory, tactile, visual, olfactory hypo/hypersensitivity, reading and writing difficulties, fascination about music, and advertisements. They may also exhibit temper tantrums.
Assessment
A team of professionals including doctors, Psychologists, SLPs, Special educators, Occupational therapists assess the child and find out about the severity of the condition, and all the behaviors of the child.
Treatment
Treatment is of a multidisciplinary and integrated type, where psychologists, occupational therapists, SLPs, and dieticians work together. Communication skills, Social, Behavioral, Motor, Sensory, Cognitive, Academic skills are targeted depending on the need of each child. It is a tailor-made individualized therapy program for each child, as no two children are the same.
Early Intervention
Identifying early signs of developmental delays will help us to start intervention as early as possible. It can prevent further delay and maximizes the outcomes of therapy as neuronal synaptic connections happen better during the first three years of life. As the learning happens, the synaptic connections increase in the brain, and this acceleration process in turn will help in faster and easier learning. Hence, the first few years are a critical period in a child’s life.
As a parent, one will have to keenly observe how their child’s motor, pre-linguistic skills, linguistic, social and cognitive skills are developing. Sometimes, impairments can be detected as early as six months. Some children do not fall into the category of those with typically developmental milestones; they may vary in development but may acquire adequate abilities with delay. Keeping that in mind, the caregiver should not take it for granted that all these children achieve age -appropriate milestones. Some might develop later but some may not. So, these kids can be put under ‘at risk’ babies.
Intervention
Pre-linguistic skills like eye contact can be improved by using face masks and eye masks, using a torch light in a dark room so that the child focuses on it and moving the light and using attractive material like an object emitting light and moving them up, down, and sideways, to improve the
child’s visual tracking. It is also important that when teaching is happening, the target item or object should be at our eye level. Using the mirror and teaching before the mirror, so that the child looks at you and himself that helps like a feedback.
Articulation disorder
It is characterized by difficulty in producing speech sounds correctly; sounds may be omitted, distorted, or substituted. Difficulty in producing new sounds with no pattern or derivable rules is often described as articulation disorders. Multiple errors that can be grouped on some principles or characteristics that form patterns are typically described as phonological disorders. Whenever such symptoms are observed in your child, make it a point to visit a psychologist or a speech therapist for the assessment of the disorder, as early intervention helps in early improvement. Log on to book an appointment with one of our experienced professionals, to clear your doubts, today.