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To intervene – or not?

Impairment is obvious enough. But when it occurs with a child, there is an obvious question: Will the child just grow oout of it? Children do grow out of most developmental immaturities. But not always. And many parents, quite reasonably, do not want to leave this to chance.

The commonest issues include what are known as ‘Speech Sound Disorders’, Childhkood Apraxia of Speech of CAS (previously known as verbal dyspraxia, Articulation disorders, Specific Language Impairment, stammering, Autistic Spectrum Disorder, and Central Auditory Processing Disorder. Sometimes they are grouped together under the heading of ‘psycholinguistic issues’. Some of them were once known as ‘dyslalia’. I personally think that there is a big problem of definition and terminology here. It seems to me that there is little point in arguing about the best treatment for a condition when the only real issue is what it should be called.

Issues that involve the clarity of speech often impact on literacy,

There is, I believe, a natural pathway from little, often hard to say even at four, to monopoly, often hard to say at seven or eight. If an adult can’t say any long words correctly, this gets noticed. Some people have problems here. Sometimes it’s screamingly obvious. Or it can pass unnoticed. 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. Does it matter if a child can’t say one or two long and unusual words? To me, this depends on age, how obvious the issue is, the degree of immaturity or distance from the normal developmental pathway, and in the case of children, the way the family takes decisions.

It is obvious that many, perhaps most, children go through a stage of saying little and middle with the L as something like OO and the T of little as K and the D of middle as G. But very few say hot as HOCK and mud as MUG. Somehow the L sound at the end of little and middle disrupts the previous sound, whether it is T or D. But it is not obvious what is going on here. Is this by mishearing the words? Or by getting the tongue in a wrong position for one or more of the sounds? Various analyses have been proposed.

In the speech of children of two, three and four, this does not generally, and should not, cause any anxiety about speech development, It is developmentally quite normal. But 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 an individual speech sound such as Y.

Every word is always part of some larger structure. 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 – particularly in some words like monopoly. 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 pathway.