Lily, a three-and-a-half-year-old in my preschool program, has a language delay. Both her understanding of language and her ability to express herself in words seem to be lagging. She's a warm child, eager to understand and be understood, and she communicates with gestures such as dragging me over to the easel if she wants to paint. Lily is also quite social-she smiles and frowns appropriately. I think she's bright. She just has a hard time making herself understood by the other children who have less patience with gesturing now that they are so verbal. How can I help her develop better language skills?
You have already begun an informal set of observations to discover Lily's underlying challenge, and so far you've found that Lily has a lot going for her. She's interested in others and interacts purposefully, as when she drags you over to the easel. She's a warm child, and she seems to do something else very important-combine many gestures in order to express intentions and feelings and to problem-solve-so she's a pretty good preverbal communicator and problem solver.
Observing further will help you to get a good sense of her other strengths and limitations. Ask yourself:
- Is her behavior inconsistent? For example, does she problem-solve sometimes, but other times exhibit an aimless or self-absorbed demeanor? That would tell you that you have to work on more than just the acquisition of words.
- To what degree is she using ideas despite her lack of words? A child who's not talking, but who is doing elaborate pretend play, shows good ability to use ideas.
- Does she have the ability to combine ideas? If, for instance, during pretend play Lily has two dolls fight and then make up, she is combining ideas. A child who is not yet readily combining ideas may do some fleeting pretend play-such as having one dolly hug another dolly-but she will not use elaborate sequences. However, the child who can follow only the simplest one- or two-word directions is different from one who's using lots of ideas but just can't find words.
Observations of these things can help you determine the extent of Lily's problem. In the scheme of things, if a child is fine at attending and engaging and purposeful in her play, if she is a problem solver and uses ideas creatively, her inability to either understand or express words is a somewhat narrower problem.
While you are still assessing all of this, there are many things you can do to help little Lily develop more language. The first method employs the floor-time philosophy: You get down on the floor with a child who's just beginning to use ideas and tune in to whatever she's doing. Let's say she's moving a car back and forth. Ask if she wants to take a little doll for a ride. Talk for the doll and say: "I want to go for a ride in a car!" But also gesture and motion toward the car, so Lily can understand even if she doesn't understand the words. If she takes the doll and puts it in the car and then begins moving the car, you might exclaim: "Where are we going?" Have a puzzled look on your face and point in two different directions-one toward the play school and another toward the play house. "Are we going to the school? Or the house?" The child who's communicating with gestures might move it more toward the house. You'll say: "Oh, we're going to the house!" Now begin to experiment, making the task more complicated. Lily will be getting a rich opportunity to hear words in meaningful ways and be motivated by the fun of doing it.
I like to call the second method "semi-structured problem solving." You create situations with a high degree of intrinsic motivation. For instance, you may take the child's favorite toy and put it outside the door. The child knocks on the door to open it. So you say: "Do you want to open the door? Can you say open?" The child says: "Ope." Then you help her open the door. This method sharply contrasts with just looking at a picture book and labeling pictures. The child who looks at a picture of juice won't learn the word juice as quickly as the child who uses the word juice to get it from the refrigerator and drink it! Highly motivated, semi-structured learning works much better than rote learning.
Handling More Complex Problems
The majority of children will start making progress when you use these methods. This signals that things are going well and that the child probably does not have a more complex problem. But some children may not make such ready progress. You may notice that a child has difficulties with motor activities (such as holding a pencil, catching a ball, or jumping) and doesn't seem to sequence four or five or six actions together. This child is showing you that the language problem may be related to a motor-planning problem. Then you may want to bring in an occupational therapist as well as a speech pathologist. On the other hand, some children appear to have more social or cognitive difficulties, in which case you'll want to bring in a psychologist, child psychiatrist, or a developmental pediatrician.
And, of course, whenever there are language problems, there is a question about what the child is able to hear. Carefully observe how quickly the child turns and alerts when you begin talking to her. Some children are only intermittent in their turning toward sounds, so you can't be sure how much they hear. If this is the case, you'll want to have an audiologist do a systematic evaluation to determine how well sound is getting into the child's ears and beyond the ears-into her brain so she can make sense of what she's hearing. Then, too, some children seem to be hearing, but they don't register sounds very well until you get on top of them and in their faces. It can be very helpful to have cases of over- or under-sensitivity to sound assessed by a pediatric audiologist.
Finally, if, for example, a four-year-old understands the direction "pick this up," but doesn't understand "that's not nice", which involves a little more complicated concept-there may be a cognitive problem. But be careful. Often people think that a child has an intellectual problem, but as the child's language improves, she seems more intelligent. So it's best not to jump to conclusions. Intelligence scores can go up as much as 20 points a year once language starts coming in. It's not that the child is becoming smarter; rather, the tests are language-mediated. So hold off on IQ tests.
Now after all this, I must say that most commonly there turns out to be no specific reason for language delay. Just as some children are slower to walk or to climb or to read than others, some are slower to talk. In the long run, a child who shows only verbal delays in the preschool years may go on to do quite well.