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Shifting from ‘Wait and See’: Embracing Early Intervention for Language, Speech, and Fluency Concerns

EARLY INTERVENTION SPEECH & LANGUAGE THERAPEUTIC APPROACHES

The ‘Wait and See’ approach, once considered a standard practice, has grown outdated. Recent research underscores the significance of early intervention, as our brains exhibit heightened neuroplasticity (the ability to create and refine neural pathways) during the first five years of life. Waiting for children to ‘catch up’ independently carries numerous risks. In particular, it’s crucial to identify and address language, speech, and fluency delays promptly.

Language

The ‘Wait and See’ approach is frequently associated with late talkers. Traditionally, it was believed that late talkers would either persist in facing language acquisition difficulties and receive a language disorder diagnosis or eventually reach age-appropriate milestones. Those who fall into the latter category, often termed ‘late bloomers,’ are the reason some people advocate for a ‘wait and see’ approach. However, research has unveiled that late bloomers may continue to exhibit weaker language and related abilities well into their adolescent years. Even if they eventually reach age-appropriate language and reading skills, vocabulary, grammar, and verbal memory tasks can remain subpar.

Here are vital aspects to consider when evaluating early intervention versus ‘wait and see’:

  • It is never too early to initiate language therapy. Early intervention primarily focuses on parent-child interaction through interactive play rather than rigid drills. This not only sets children up for success in enjoyable, interactive ways but also enhances family dynamics by reducing stress and negativity that late talkers may cause within the family.
  • Younger siblings often develop stronger language skills because they have the advantage of communicating and interacting with their peers. A language delay should not be dismissed as mere shyness or as a case of siblings ‘speaking for them.’
  • Being part of a bi/multilingual family does not disadvantage a child’s language acquisition if they are appropriately exposed to both languages. For instance, parents should avoid mixing two languages within the same sentence, as this does not foster correct vocabulary or grammar usage.
  • A language delay can sometimes serve as an early indicator of an underlying disorder, such as language disorders, autism spectrum disorder, learning disabilities, attention deficit hyperactivity disorder, intellectual disabilities, or other developmental disorders. It is crucial to investigate further rather than relying on the hope that a child will ‘outgrow it.’

Speech

Speech intelligibility relies on the production of speech sounds during verbal communication. Children typically acquire specific speech sounds and eliminate certain speech patterns (e.g., substituting ‘k’ with ‘t’) at certain age ranges. Some children experience speech delays, arriving late in acquiring these speech sounds, while others exhibit atypical sound productions (e.g., lisps or vowel substitutions). Research suggests that children with a speech disorder are less likely to spontaneously resolve their speech issues. Therefore, speech delays should not be treated with a ‘wait and see’ mentality.

Several key research findings and clinical observations include:

  • A history of speech sound disorders in preschool is linked to a higher likelihood of reading disorders.
  • Speech delays or disorders in kindergarteners are associated with lower literacy outcomes.
  • Moderate to severe speech sound delays or disorders can significantly impact a child’s social communication development.
  • Difficulty with speech intelligibility can lead to increased negative behaviors due to the frustration of constant communication breakdowns.
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Fluency

Fluency relates to the ease, effortlessness, and rate of speech production. Naturally, dysfluencies are part of speech, involving elements such as filler words like ‘like’ or momentary hesitations. Stuttering, however, occurs when speech production is disrupted by repetitions (of sounds, syllables, words, phrases), prolonged sounds, or blocks. In severe cases, stuttering may include secondary behaviours like facial grimaces.

Childhood stuttering usually emerges around the age of 2 ½, with 95% of children who stutter experiencing onset before the age of 5. Approximately 60-80% of these children spontaneously recover from stuttering. While certain predictors, such as family history, gender, severity, and co-occurring conditions, may provide some insights, they alone are insufficient to determine who will experience natural recovery. Decisions regarding a ‘wait and see’ approach or intervention should involve a Speech Pathologist.

The Lidcombe Program is the gold standard therapy for childhood stuttering, advocating for early intervention shortly after onset, ideally before a child begins primary school, given the social implications. School-age peers become increasingly aware of stuttering, which can lead to negative social interactions, including bullying.

What to Do

In cases of concern, it is advisable to consult a Speech Pathologist. While there may be situations where a ‘wait and see’ approach is appropriate, this guidance should come from a Speech Pathologist, a specialist in communication.

You can also reference a helpful resource – a snapshot of communication milestones for children aged 12 months to 5 years, created by Speech Pathology Australia: Communication Milestones Snapshot.

  • Hawa, V. V. & Spanoudis, G. (2014). Toddlers with delayed expressive language: An overview of the characteristics, risk factors, and language outcomes. Researchers in Developmental Disabilities, 35, 400-407.
  • Committee on the Evaluation of the Supplemental Security Income (SSI) Disability Program for Children with Speech Disorders and Language Disorders; Board on the Health of Select Populations; Board on Children, Youth, and Families; Institute of Medicine; Division of Behavioral and Social Sciences and Education; National Academies of Sciences, Engineering, and Medicine; Rosenbaum S, Simon P, editors. Washington (DC): National Academies Press (US); 2016 Apr 6.