2. Speech and language: Treatment


Many normally developing children of two three and four say little and middle as LIKU and MIGU and yellow as LELO, and at five, six and seven hospital as HOSTIPU and spaghetti as BASKETI or PSKETI and magnet as MAGNIK. and at seven or eight, monopoly as MONOKOLI and hippopotamus as HITOPOTAMUS.

There is, I believe, a natural pathway here. But it is subtle. Why is monopoly so hard to say”? Or does it matter if a child can’t say one long and unusual word correctly? If an adult can never say any long words correctly, this does often get noticed. And even if no one is rude enough to point this out, speakers tend to become aware of the problem themselves.

People are entitled to decide, I believe, whether they want to be helped or not. When? To me, this depends on age, how obvious the issue is, the degree of immaturity or distance from the normal developmental pathway.

If a seven year old is still saying yellow as LELO, he or she probably does need help – and typically recognises this. But the problem is often not just in the individual speech sounds, the Y in yellow and the T in little and magnet. The sounds are surrounded by other sounds – four in yellow, six in magnet, and so on. And every word has a stress – if there are two syllables, usually on the first. And every word is always part of some larger structure, even if this is just the conversation. There is no reason for assuming that children are not listening in a careful, subtle way to what they hear.

But the data is complex, and easily misconstrued. For some children it is helpful to be able to hear the most relevant data in some sort of structured form. So I believe that the natural focus of treatment should be to guide the child’s discovery of whatever is missing for him or her on his or her journey.