When should children go to speech therapy?

Series: Child and therapy - Part 2

Selma is four years old and says «hot» instead of «red». The nursery school teacher sees no need for action. Louis is six and speaks «l» instead of «r», which often leads to mockery in his class. This causes him problems. He has been seeing a speech therapist once a week for a few weeks now. Vincent, eight years old, has lost many teeth at once and has a slight lisp. The teacher recommends a speech therapy assessment to his parents.

Selma, Louis and Vincent: three typical cases of mild language difficulties. Nevertheless, parents are unsure. They ask themselves: Does the child really need support? Is my son or daughter now in the clarification loop? Won't the problem with the «R» and the «Sch» simply resolve itself as the child develops?

The answer from doctors and speech therapists is: Yes, but. On the one hand, linguistic abnormalities do indeed develop. After all, a lot can happen to children in the developmental phase from the age of four: «With children of kindergarten age, it often makes sense not to start the whole support machinery straight away when certain abnormalities occur,» says Peter Lienhard, an expert in special education at the Intercantonal University for Special Needs Education. «Not every linguistic abnormality is a disorder and needs to be treated,» says German paediatrician and author Herbert Renz-Polster. «Precisely because children learn to speak at such different speeds, it is often not easy for parents to judge whether their child is speaking at an age-appropriate level.»

«Not every linguistic
abnormality is a disorder and needs to be treated,» says paediatrician Herbert Renz-Polster.

On the other hand, it takes time for children to master language confidently, and sometimes they encounter problems that they cannot overcome themselves - be it in spoken language («F sharp» instead of «fish», for example) or in reading and writing skills («Fruend» instead of «girlfriend»).

«Small language anomalies such as «cup» instead of «till» can still be cute for a small child, but this can become a problem in kindergarten and school at the latest,» says Renz-Polster. The child is laughed at, ridiculed or perceives itself as «not right».

This is one of the purposes of speech therapy. It is a form of curative education therapy that covers a wide range of speech and language disorders, fluency, voice, swallowing, written language in relation to reading and writing, and communication. Dyscalculia (dyscalculia) is also part of the field of speech therapy.

Parents are very often confronted with this for the first time via the kindergarten during the annual assessment meeting. This is when they find out about any linguistic weaknesses in their child, which they themselves may judge to be «normal». Phonetic ambiguities or lisping are common in younger children. Around 40 per cent of all children develop a lisp in the course of their speech development with the sibilant sounds «S», «Z» and «X». The tongue normally lies a little behind the teeth when the «S» is formed. When lisping, it touches the front teeth so that the «S» sounds like «F» or similar to the English «Th». This also affects the sound combinations «ts» and «ks», which occur in German with «Z», «X» and in the letter sequence «chs». However, lisping can also affect the «Ch» and the «Sch» (known as chitism): The «Ch» is then pronounced like «Sch» or «S», the «Sch» like «S», «Ch» or «T».

Every fifth child affected

In Switzerland, special needs teacher and speech therapist Barbara Zollinger has spent decades researching the language development of young children. She says that language is much more than just speaking.

Language has three functions. «The ability to name existing images, objects or people has little to do with language. What constitutes language is the ability to speak of things and events that do not exist, i.e. that are in a different place, past or future. This is called the representative or symbolic function of language,» says Zollinger. Secondly, language is used to achieve something, to communicate something. This is what she calls the communicative function of language. «Thirdly, an important part of language is not reproducing words, but understanding what others are saying.» These three functions are analysed in speech therapy. However, according to Zollinger, it is precisely because children's language development is so varied that it is so important to differentiate between «language-delayed» children and «late talkers»: «Almost one in five children has a delayed onset of speech, which means that at the age of two they cannot yet say 50 words and/or link two words together,» says Zollinger. These children are also known as late talkers. Most late talker children begin to speak spontaneously at around the age of three: Around a third have caught up by this time and speak in complete multi-word sentences; these children are therefore called «late bloomers» (= late bloomers).

More than half of children with delayed onset of speech develop a language acquisition disorder as a result, their sentence formation is still faulty at the age of four or five, their sound formation is incomplete and their vocabulary is rather small. Many of these children later show difficulties with reading and writing at school and in some cases also in adulthood, for example dyslexia and acquired illiteracy. «Based on our knowledge of these correlations, it is important to identify children at risk as early as possible and support them accordingly,» explains Zollinger.

Speech therapy is also about strengthening the personality of a child with speech disorders.
to strengthen it.

This is the reason why most speech therapists are in favour of therapy as early as possible. Annina Sievi is no exception. As a speech therapist at Gerberacher primary school in Wädenswil ZH, she looks after around 18 children, which is just over 10 per cent of all pupils in the school. Speech therapy is primarily concerned with communication and speech development disorders, she explains, «but there are many different types of disorders in speech therapy,» explains Sievi. However, it is often also about strengthening the child's personality. «And the earlier this process can begin, the better,» says Sievi.

The earlier, the better

That's why she attends kindergarten once a week, «because the earlier a child experiences an improvement in their impairment, the better it is for their overall development». After all, how can a child go to school with confidence if they can't tell the difference between «F» and «W» or say «Tanne» instead of «Kanne»? How can they learn to write if the letters are not different? «Even at the age of three, it is possible to assess with certainty whether a speech development disorder is present,» explains Sievi. In many cases, even at the age of two.

Even younger children can already have a pronounced awareness of disorders and suffer, explains Sievi. It is certainly possible to address such complex issues in a suitable form at kindergarten age. Her aim in therapy is to minimise the children's distress and reduce the abnormalities as much as possible. Sievi's attention and trust should support the children's development. With younger children, a speech therapy session is mainly playful. For example, the children play memory games, name pictures or tell a picture story.

With older children, she organises the «logo lesson» specifically for school. With third-grader Kai, for example. The boy always comes to Annina Sievi's one-to-one lessons on Tuesdays. During our visit, the two of them want to continue with reading exercises and deepen their understanding of language. First, the speech therapist presents the boy with a sheet of paper with multiple choice exercises: one picture, three words. Kai has to match the correct words to the picture. Next to the flame is written: Fire, celebration, fire. Next to the picture of a church tower is: church/cherry. Kai ticks «church». Annina Sievi asks: «What's the cherry?» «Something to eat,» answers Kai.

During his logo lesson, Kai receives a full 45 minutes of attention from Annina Sievi. Sievi organises her lessons in a correspondingly varied way. The individual practice sequences last 5 to 10 minutes. Sometimes the focus is on grammar, then on the word picture, then again on reading or writing. After the multiple choice exercise, Sievi starts a conversation with the boy. He is asked to report on what he did during the big morning break. A storm was raging outside. So the pupils were told to stay inside. «I was inside during the break today because it was storming,» says Kai and writes this sentence down in his exercise book. While Kai is writing, Sievi takes out a box of plastic buttons. He should use the red dots to mark the nouns in the sentence that he already knows from his regular classroom lessons.

With younger children
a «logo lesson» is mainly playful,
with older children in a more academic way.

The speech therapist goes over the material with Kai in the individual lesson: «What does it take to form a sentence?» she asks, «Capitalisation, a full stop, nouns, adjectives, verbs.» The speech therapist and pupil collate the answers together. Then Sievi asks: «What are nouns, what are verbs?» Both look for definitions and examples. «You can touch nouns,» says Kai. «Exactly. And?» asks Sievi. «You can put the, the or that in front,» answers Kai. Sievi praises him: «Very good.» The praise visibly inspires the boy: «A verb is something you can do.» Sievi adds: «And the adjective describes what something is like.» Kai immediately has an example ready: «the big elephant».

For the next sequence, Sievi pulls out a crossword puzzle. The pupil is delighted. Kai reads the questions aloud: «It's in our mouth?»: «The braces,» he answers quickly. The word doesn't fit in the gap, Kai realises. And then he finds the right answer: «Tongue fits!» The next question: «20 plus 20 is a ... ?» Kai reads and immediately fills in the gaps with concentration: R-e-c-h-n-u-n-g. The two continue with their programme. At the end of the lesson, there are still five minutes left. Sievi takes out the Uno cards, shuffles them and deals them out. The two of them lay down card after card with concentration until Kai lays down the last card and shouts «Uno!». Just then, the school bell rings.

Language and learning

Annina Sievi explains the influence of language on cognitive abilities. «The older children get, the more their learning becomes intertwined with linguistic content. Until kindergarten, cognitive and linguistic skills can be tested separately. From around the age of eight, this is no longer seriously possible because, for example, the task has to be explained linguistically. In short: the more abstract the content, the more language is needed to explain it.»

If a child with speech development disorders and therefore also speech comprehension problems does not receive therapy, they develop strategies to deal with these difficulties. These strategies usually have a negative effect, says Sievi. These children often have low self-confidence, which they are unable to express due to their lack of language skills. Or they imitate their peers so as not to stand out. This is why early language support prevents many a later failure at school, says Sievi.

Why is language so important?

Our entire school system is based on language, explains Zurich psychology professor Moritz Daum. «If I'm good at maths but don't understand the text problems or take a long time to read them, I might get a lower grade than someone who may not be a maths genius but can read and understand well. In other words, if I understand language well and can express myself well, this is an important basis for success at school.» Language awareness, understanding and ability are decisively characterised by the environment in which a child grows up.

US researchers Betty Hart and Todd Risley have tried to prove this. They studied families from different socio-economic backgrounds and counted the number of words spoken in each household over a period of months. The results were spectacular: 45 million words are heard by wealthy and well-cared-for children in their first four years.

Less privileged children, on the other hand, only hear 10 to 13 million words during this period. This has consequences for vocabulary: a child from a higher class knows around 1,000 words at the age of three, while a child from a lower class knows only half that number. No school in the world can even come close to closing such a gap later on - no matter how hard the teachers try.

Every child with a
language acquisition disorder is
conspicuous, but not every
child with a speech therapy disorder has a disorder.

However, parents can help to ensure that the child has a large vocabulary, regardless of their background, says Moritz Daum. The more you talk to your child, show them things and interact with them, the better their language skills will develop. «This means that even if I may have a basic school-leaving certificate, I can still talk to my child as much as possible. This has a positive effect on language development.»

Many children between the ages of two and six are therefore prone to speech fluency in the form of word and phrase repetitions. However, if their speech doesn't flow or the words get twisted, if sounds form between tongue and teeth that can't be read anywhere, then speech therapy support is essential.

As a parent, how do you know whether your child simply has a developmental anomaly or a speech problem? According to Sievi, only a speech therapy assessment can provide clarity. In many cantons, this is carried out as standard in kindergarten.

«Every child with a speech acquisition disorder is conspicuous, but not every child with a speech therapy disorder has a disorder.» However, the decision in favour of speech therapy is not only based on the results of the speech therapy assessment. «It's a joint decision between the parents, the teacher and the speech therapist,» says Sievi.

How parents can recognise whether their child has a language delay

Tips from remedial teacher and speech therapist Barbara Zollinger
Children at risk can be identified well from the age of two by observing their symbolic and communicative skills as well as their understanding of language.
as well as their understanding of language:

• Gibt das Kind seinen Handlungen Bedeutung und macht es Tun-als-ob-Spiele?
• Interessiert es sich für Bilderbücher?
• Kann es seine Bedürfnisse ­ausdrücken und sich durch Nein abgrenzen?
• Sagt es seinen Namen?
• Kann es auf Aufforderung einen Gegenstand suchen gehen, auch wenn es nicht weiss, wo dieser sich normalerweise befindet?
• Interessiert es sich für Details in ­Bilderbüchern, zeigt darauf oder fragt danach?
• Kann es mit den gesprochenen Wörtern auf nicht Vorhandenes Bezug nehmen?
• Kann es sie schon zum Erzählen brauchen?

If a child has all of these skills, it is very likely to develop into a competent play and dialogue partner. If most of the skills listed are missing, parents should seek advice from an expert.

Speech therapy: When and why?

Whether therapy is indicated depends on various factors:

• Wie stark leidet das Kind?
• Wie sehr ist die Fähigkeit zur ­Kommunikation eingeschränkt?
• Wird es dadurch isoliert?
• Entstehen viele Missverständnisse?
• Wie reagiert das Umfeld?
• Wie ist der allgemeine Entwicklungsstand des Kindes?
• Eine logopädische Abklärung ist sinnvoll, wenn das Kind
• nicht oder sehr wenig spricht.
• nicht versteht, was andere sagen.
• bekannte Wörter nicht findet.
• nicht verstanden wird.
• beim Lesen und Schreiben ­Schwierigkeiten hat.
• Laute nicht richtig bilden kann.
• lispelt oder stottert.
• ständig heiser ist.

Quelle: Schweizer Fachverband Logopädie

Read more about children and therapy:

Part 1 The therapy dilemma
Part 2 Speech therapy
Part 3 Curative education
Part 4 Psychomotor therapy
Part 5 Ergomotor skills

All previously published articles from the Child and Therapy series

• Logopädin Vanessa Braun im Gespräch über Diagnosen und Trainingsmöglichkeiten
  Die Logopädin Vanessa Braun erklärt, warum regelmässiges Üben auch zu Hause für den Erfolg so wichtig ist.

• «Mit einer frühen Intervention kann die Negativspirale durchbrochen werden»
  Eltern sorgen sich, wenn ihr Kind stottert. Wolfgang G. Braun über den «Redeflusskompass online»für Eltern und Fachpersonen.

• Wann braucht mein Kind eine Therapie?
  Ein Kind hält den Stift nicht richtig, ein anderes kann beim Turnen nicht auf einem Bein hüpfen – diese Dinge kommen im schulischen Standortgespräch im Kindergarten zur Sprache. Oft folgt ein Therapieangebot: Welche Therapieformen gibt es und wie sinnvoll sind diese?