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INTRODUCTION

Language is defined as symbolic process for communication


The way we use language will determine communication in the next generation It is also a way in which one generation transmits its culture to another

Language is perhaps the greatest gift endowed to human

Speech on the other hand is the verbal form of language and is composed of a number of isolated sound or phonemes Language makes speech possible, even though we can have language without speech
Two important requisites for speech development - Intact hearing - Sufficient intelligence

Receptive language refers to the ability to understand, encompasses visual (reading, sign language comprehension) and auditory (listening comprehension) skills Expressive language refers to the ability to produce symbolic communication, this output may be either visual (writing, signing) or auditory (speech)

STAGES IN SPEECH DEVELOPMENT


Reflective vocalization New born Not yet able to respond differently to different stimuli Babbling 4 9 months of age He produces sounds when he is enjoying himself the child will produced vowels before consonants

Lalling
Hearing plays an important role Begins during the 6 months of the childs life Defined as the repetition of heard sounds or sound combinations

Echolalia At 9 or 10 months of age, the child may be heard imitating sound which others have made, and which are prevalent in environment Sounds which the child recognizes, are likely to be imitated first True speech

Between 12 and 13 months of age, the average child really begins to talk The child intentionally uses conventionalized sound pattern (words) Before the child can truly speak, he must himself be able to understand speech
Berry MF, Eisenson J. Speech Disorders : Principles and practices of therapy. London : Peter Owen Limited, 1973.p.18-22

LINGUISTS DIVIDE LANGUAGE INTO FOUR DOMAINS


PHONOLOGY The ability to produce and discriminate the specific sounds of a given language The underlying rules that organize any specific language

GRAMMAR

The study of meaning, includes the study of vocabulary and the number of words a child knows The ability of the child to use his or her language in interactions with others

SEMANTICS

PRAGMATICS

Fig1. Brocas area and Wernickes area

Santrock JW. Child Development. 7th Ed. Madison: Brown & Benchmark, 1996. p.321

Fig2. Localization areas in the cerebral cortex

Fig 3 . Human brain development


Myelinization of cerebral systems, and correlations with the development of language functions. (After Lecours, 1975, 1982; Yakovlev and Lecours, 1967)

To determine whether a child has speech delay, the physician must understand normal speech milestones

Table 1. Milestones of Language Development and Indications for Evaluation of Language Problems
Age of acquistion Birth Age at which skill is significantly delayed Shortly after birth Abnormal findings or red flags for full assessment at this age Lack of response to sound at any age

Skill
Response to sound

Birth

Social interest in faces and people

Shortly after birth

2 to 4 mos. 4 to 9 mos. 6 mos.

Reciprocal cooing, turn- 4 mos. taking Babbling (repetitive consonant vowel combinations) Response to name

Lack of interest in interaction with people at any age Lack of any drive to communicate after 4mos. of age Loss of the early ability to see or babble Poor sound localization or lack of responsiveness

9 mos.

9 mos.

Table 1. Milestones of Language Development and Indications

Age of acquistion 9 to 12 mos. 9 to 12 mos.

Skill Comprehension of verbal commands Pointing

Age at which skill is significantly delayed 15 mos.

Abnormal findings or red flags for full assessment at this age


Poor comprehension of verbal routines, such as wave bye-bye Some pointing to indicate wants and needs, but no pointing out interesting objects or actions Failure to use words, add new words, or loss of words previously learned Does not point to body parts or follow single step commands

15 mos.

10 to 16 mos.

Production of single words

18 mos.

10 to 16 mos.

Pointing to body parts or comprehension of single words

18 mos.

Table 1. Milestones of Language Development and Indications

Age of acquistion

Skill

18 to 24 mos.

Comprehension of simple sentences

Age at which Abnormal findings or skill is red flags for full significantly assessment at this age delayed 24 mos. Minimal comprehension and limited symbolic play, such as doll or truck play 30 mos. Less than 30 words at 24 months, 50 words at 30 months Lack of two-word utterances when vocabulary is > 50 words > utterances are unintelligible to family after age 2 years Frequent immediate or delayed repetition of what others say (echolalia)

18 to 24 mos. 18 to 24 mos.

Vocabulary spurt

Two-word utterances

30 mos.

24 to 36 mos.
30 to 36 mos.

Good intelligibility to familiar folks


Conversations through asking and answering questions

36 mos.

36 mos.

Table 1. Milestones of Language Development and Indications

Age of acquistion 30 to 42 mos. 36 to 48 mos.

Skill Short stories, asks why Good intelligibility to unfamiliar folks Full, well-formed sentences Correct production of basic consonants Correct production of all speech sounds

Age at which Abnormal findings or skill is red flags for full significantly assessment at this age delayed 48 mos. Rote memorization with failure to generate novel stories 48 mos. > utterances are unintelligible to strangers after age 4 years Consistent use of only short and simple sentences Errors in consonants such as b, p, d, t, p, k, m, n, l, r, w, s. Immature production blends such as st, sh,sp.

36 to 48 mos. 5 years

48 mos.

7 years

Feldman HM. Language disorders. Dalam : Berman S, penyunting. Pediatric Decision Making. Edisi ke-4. Philadelphia: Mosby, 2003.h.94-97

Speech may be considered defective if it is characterized by:


Not easily audible Not readily intelligible Vocally unpleasant Deviates in respect to specific sound (consonant, vowel, or diphthong) production Labored in production, or lacks either conventional rhythm or stress, tonal quality, or pitch change Linguistically deficient Inappropriate to the speaker in terms of age, sex, or physical development Visibly unpleasant
Berry MF, Eisenson J. Speech Disorders: Principles and practices of therapy. London: Peter Owen Limited, 1973