Milestone tracking!! Is it important??

Speech is defined as “the expression of or the ability to express thoughts and feelings by articulating the sounds where it allows to form connections, influence decisions, and motivate change “. On the other hand, communication refers to imparting or exchanging of information by speaking, writing, gestures or using some other medium. Communication is the essence of human life. Verbal communication is unique to human beings and it-is said to be the most efficient mode of communication. Without communication skills, the ability to progress in the working world and, life, -itself, would be nearly impossible. Communication disorder is a broad term which covers different types of disorders (Ruscello, Louis & Mason, 1991) which can be seen at the level of comprehension or production of speech sounds, words, phrases or sentences (ASHA, 2006). The spectrum of communication disorders includes problems in speaking, hearing and thinking such as voice disorders, phonological disorders, fluency disorders, language disorders, delayed and/or arrested speech and language development due to hearing impairment, mental retardation and other problems. Communication disorders may affect social and emotional well-being, cognition and behaviour (Felsenfeld, McGue, & Broen; Lewis Freebairn, & Taylor).

As per the country wide sample survey conducted by Government of India in 2011, census listed hearing impairment (18.9%) as the second leading disability and speech impairment (7.5%) as the fifth highest disability. Males outnumbered the females in both hearing (Males - 52.8%, Females - 47.2%) and speech impairment (Males - 56.25%, Females- 43.8).

Some normal children may begin talking at 9 months while for others, it may take up to 2 years of age before beginning to talk. The outline below will provide a summary of the developmental sequence of speech, language, and motor skills in normal children. Because children develop at different rates, avoid strictly applying the age approximations. The time intervals are provided only as a general guideline for age appropriateness. This information was compiled from a variety of sources, which includes Apel & Masterson (2001); Gard, Gilman, and Gorman (1993); Hegde (2001); McLaughlin (1998); Shelov & Hannemann (1998).

Speech and language milestones

0-6 months

· Frequently coos, gurgles (sounds like ahh, ohh)

· Uses a different cry to express different needs

· Smiles when spoken, recognizes voices, localizes speech

· Listens to speech

· Uses the sounds |b|, |p|; uses sounds or gestures to indicate wants.

7-12 months

· Responds to simple requests, understands and responds to own name

· Recognizes words for common items

· Babbling using long and short groups of sounds,

· Imitates some adult speech sounds and intonation patterns, begins to change from babbling (sounds like baabaa, papapa) to jargon

13-18 months

· Imitates individual words, produces mostly unintelligible speech

· Receptively identifies 1-3 body parts

· Has an expressive vocabulary of 3-20 words or more words

· Combines gestures and vocalization

19-24 months

· Has expressive vocabulary of 50-100 or more words.

· Has receptive vocabulary of 300 or more words

· Starts to combine nouns with verbs, adjectives and begins to use pronouns

· Uses appropriate intonation for question

· Understands basic categories

2-3 years

· Speech is 50-75% intelligible

· Requests items by name

· Asks 1-2-word questions

· Has a receptive vocabulary of 500-900 or more words

· Has an expressive vocabulary of 50-250 words or more words

· Exhibits multiple grammatical errors

3-4 years

· Understands opposites, analogies

· Uses 4-5 word sentences

· Has a 1200-2000 or more-word receptive vocabulary

· Has a 800-1500 or more word expressive vocabulary

· Increases speech rate

· Sentence grammar improves, although some errors still persist

4-5 years

· Has a receptive vocabulary of 10,000 or more words

· Uses adult-like grammar most of the time

· Has an expressive vocabulary of 900-2000 or more words

· Speaks at a rate of approximately 186 words per minute

5-6 years

· Uses past tense and future tense appropriately

· Has a receptive vocabulary of approximately 13,000 words

· Exchanges information and asks question

· Communicates easily with adults and other children

6-7 years

· Has a receptive vocabulary of approximately 20,000 words

· Uses passive voice appropriately

· Uses increasingly more complex descriptions

· Uses sentence length of approximately six words

Hart and Risley (1992) pointed out over 2 decades ago, delay in communication results in challenges in many areas in a lifetime. A more intelligent approach would involve individualizing specific empirically-validated diagnosis and interventions (either through group or single subject research designs) based on an infant or child’s unique behavioural, environmental, and family characteristics. There is broad agreement in the literature that early interventions provide modest positive effects on the developmental achievements of children with or at risk for developmental disability. Overall, structured, long duration, intensive, child-centered programs appear to optimize benefits. There is increasing recognition of the importance of family participation in maximizing the developmental potential of their disabled children.

Speech and language therapists assess and treat a person with specific speech, language and communication problems to enable them to communicate to the best of their ability. They work directly with people of all ages. They also provide screening, assessment, diagnosis, treatment, management and counselling services for children with special needs. Speech language pathologists work with children with mild, moderate or severe learning difficulties, physical disabilities, language delay, specific language impairment, specific difficulties in producing sounds, hearing impairment, cleft palate, stammering, autism/social interaction difficulties, dyslexia, voice disorders, selective mutism, swallowing difficulties. As allied health professionals, they also work closely with parents, careers and other professionals, including teachers, nurses and occupational therapists.

Many parents make the mistake of considering speech therapy as a miracle cure, the solution to get their children up to speed in terms of their expressive, linguistic skills. It is not a cure; it is just training them to be better and help them to cope up with the surroundings. Just sending the child to a speech therapist for a few hours is not enough for training. The activities need to be practiced at home. Results need time and patience. Parents need to replicate the plan explained by the therapist at home. Therapy must be a part of routine activity in such a way that the child is not even aware that he or she is undergoing a “therapy session”.

So, the parent/guardian should track the milestones and if they-have any doubts about possible delay in the child’s development, it is recommended that they consult a Speech language pathologist immediately. “Communication is the essence of human life”.