Getting the words right

Does your child need speech therapy?

My daughter Saskia said her first word — “Beah!” — at about nine months, in one of those light bulb moments when she made the connection between the TV character from the big blue house and the oversized teddy she got for Christmas. After that, I couldn’t walk her through a mall without shouts of “Bear! Bear! Bear!” at anything with fur.

As her vocabulary grew and she progressed to phrases and sentences, I happily interpreted her remarks for others. But I was so proud of what she was saying that I never questioned how she said it. It wasn’t until December of her second year at nursery school, when her teachers told me they were concerned about her speech, that I even considered there might be a problem. After that, it was so obvious I wondered how we had missed it.

Detecting a problem

The difference between Saskia’s speech and that of the other three-year-old girls in her class was not just that they talked about princesses while she preferred dinosaurs. Their words were clear and they’d already formed a social circle, leaving my daughter on the sidelines. The teachers were concerned that once Saskia started kindergarten, she would be excluded even more.

They handed me a checklist from Toronto Preschool Speech and Lan-guage Services (TPSLS), a provincially funded agency that offers free services for children until they enter senior kindergarten (see Pinpointing problems). By the time she was three, according to the checklist, people outside the family should understand at least half of what Saskia said. They didn’t.

I left the school feeling as if I’d entered a new world, where my bright and funny little girl was suddenly disadvantaged. I reminded myself that my husband had gone through years of speech therapy as a boy and emerged confident enough to take on radio and TV interviews, and even handle the occasional comparison to Frasier Crane. But I still worried. Would people assume Saskia was “slow”? Would she be ignored by teachers? Would other kids make fun of her?

I made an appointment with an audiologist to rule out hearing loss as a cause, and contacted TPSLS to book an assessment.

During the three-month wait, we began noting which sounds gave Saskia difficulty. N and s stood out — no was “mo,” and her own name came out as “Raksia.” The assessment report confirmed that she had an articulation disorder (in her case, substituting one letter sound for another) and listed problems we had never noticed, like k and g sounds. Did she really say “tookie” instead of cookie? Yes, she did. And the more we listened, the more problems we discovered: l, v, w, y. Now we knew why people could not understand her. And we asked ourselves how we could have been oblivious for so long.

“It can be difficult for a parent to know whether their child’s mispronunciations are something to be concerned about,” says Susan Rvachew, an associate professor in the School of Communication Sciences and Disorders at McGill University in Montreal. She notes that parents should seek a professional assessment if a two-year-old is not talking or is saying very few words, or if a three-year-old is not speaking clearly enough for people to understand.

Saskia was assigned to a TPSLS group therapy class with another girl who had similar speech problems. While the other anxious mother and I watched, the therapist used games to motivate the girls to produce the target sound — in this case, k. Each one had to try to make the sound before she could throw a beanbag at a picture or hunt for toy dinosaurs. I could see Saskia was interested, but she couldn’t make the sound and she soon stopped trying.

The therapy

Her block of therapy amounted to three 45-minute classes over a six-week period. During that time, the other student progressed from making the k sound in isolation to using it in words and even sentences, earning praise and more challenging work. Stuck on the sound itself, Saskia continued to sit silently and pulled away when the teacher tried to touch her face to help her form the sound. At our last session, in May, the therapist said Saskia would be reassessed in the fall and possibly offered more sessions then.

That weak assurance wasn’t good enough for us. With kindergarten only a few months away, I turned to the Ontario Association of Speech-Language Pathologists and Audio-logists (OSLA) to find a private therapist to work with over the summer (see Where to find a private speech therapist). The OSLA website allows you to search for a therapist by specialty and postal code, but there is no magic formula for finding the right one. Saskia hadn’t clicked with her first therapist, and there was no way to guarantee a better fit next time. With time short and costs high — fees can run as much as $150 for a one-hour session — I didn’t want to make a mistake.

The first three therapists I called turned out not to be taking students for the summer. With the fourth one, we got lucky.

We started weekly one-hour sessions with Sharon in July. Relying on the TPSLS assessment, she began with the k sound Saskia had grown to hate. The approach was much the same — games as a motivator for pronunciation drills, physical contact to correct mouth positions, and high energy and enthusiasm on Sharon’s part — but this time it worked. Why? My guess is that one-on-one classes meant Saskia could never feel ignored, but also couldn’t coast through the sessions. And once she had made the initial breakthrough, her motivation grew. Between classes, we did our homework: running through drills from the worksheets Sharon provided, reading books with emphasis on the target sound, and taking turns making up sentences that used the sound.

“The more practice parents do at home with children, the more a new skill becomes part of their thinking process, not just something they do in one place with one person,” notes Margit Pukonen, director of the Speech Foundation of Ontario in Toronto. “With any motor skill — articulation, piano — the more you practise, the more automatic it becomes.”

And indeed it does. By about three months into private therapy, Saskia had mastered five of the sounds that Sharon had targeted and taught herself s. Adults commented on how much her speech had improved. She was making new friends in JK, and meeting the world with a confidence I had never seen before. Around that time, I watched Saskia and Sharon play a game where each had to turn over a picture card and say the word shown. While Sharon was looking the other way, Saskia revealed a kite and quickly flipped it back again. Then she whispered confidentially to me: “It’s a good thing Sharon didn’t see the k picture!”

She still hates the k sound. But at least now she can say it.

One in 10 preschool children in Canada has speech or language difficulties. Such problems often run in families, or they may accompany other conditions, such as Down syndrome, hearing impairment, cerebral palsy or very low birth weight. Some theories suggest speech and language problems are on the rise because young children spend too much time engaged in passive activities, such as watching TV or playing video games, rather than interacting with others.

Success in treating speech and language disorders depends on several factors, notes Susan Rvachew, an associate professor at McGill University’s School of Communication Sciences and Disorders: How severe is the problem? How early was treatment started? How much treatment does the child receive? How involved are the parents in the treatment program?

Starting early is extremely important, says Margit Pukonen, director of the Speech Foundation of Ontario, a provincially funded clinic for children with more significant speech issues. “With younger children, motor systems are developing and patterns haven’t become habits yet.”

Early detection

For help with early detection, you can find developmental checklists on these websites:

• Toronto Preschool Speech and Language Services, tpsls.on.ca
• Alberta Health and Wellness, health.gov.ab.ca (click on Health Information, then Growing Up Healthy)

You might also want to check out:

• Speech Foundation of Ontario, speechfoundation.org
• Parent Link/Talk Box, parentlinkalberta.ca (click on Talk Box)
• Literacy Encyclopedia, literacyencyclopedia.ca
• American Speech-Language-Hearing Association, asha.org
• Apraxia Kids, apraxia-kids.org
• McGill University’s School of Communication Sciences and Disorders newsletter, mcgill.ca

Where to find a private speech therapist

Search for a therapist in your area on the Canadian Association of Speech-Language Pathologists & Audiologists website (caslpa.ca), which also provides links to provincial associations.