Non-speaking child. 2. Speech delay causes and what to do

Last Updated on November 26, 2024

Speech delay causes can be physiological, intellectual, psychological and social. The first part was about speech development and speech delay symptoms by age. Each of these symptoms means a specific disease or several diseases.

Speech delay by children. Part 1. Norm and problems
Where you can find help. Speech therapist in Germany
Special schools and inclusion for kids with speech delay in Germany
Bilingual children. 1
Bilingual child speech development
German primary school. Orientation. Must and can – school obligation
Deutsch in German primary schools. Grades 1-2

I combine speech delay causes in groups. In each part you will learn who to contact if your child has these symptoms. However, with a high probability you will need more than one doctor and most often a speech therapist. That is why it is important not to wait for the results of each appointment. Because the waiting time is 6 to 12 months. The record holders are child psychiatrists. Therefore, all appointments should be scheduled at the same time. If you do not need it, you can cancel it.

otolaryngologist (HNO) – 2-3 months waiting time (you can also find short-term appointments on Doctolib),
Pediatric audiology – 7-9 months waiting time,
SPZ – up to 9 months waiting time and 2 years for the entire examination – even without a diagnosis at the end,
Children’s center (Kinderzentrum) – 9 months
Speech therapy (Logopädie) – now up to 6-7 months
Child psychiatry – 1 year and more
Child psychology – 6-7 months

Unfortunately, I have to say that there are pediatricians who say, for example, that German speech therapists do not put the missing sounds in. Or that the child must first learn German in order to attend speech therapy. Sometimes the only thing that helps is changing doctor. Here are also a few more tips for successful battles.

Speech delay causes

1. Problems with hearing

absence, impaired hearing,
water in the ear,
internal noise that makes it difficult to understand words completely,
problems with distinguishing words by hearing

If the child doesn’t hear it is not that hard to notice or suspect. German pediatricians test hearing after birth and at regular check-ups, so this is likely to be noticed early enough.

The difficulty of recognizing words by hearing is more difficult to determine. But with the help of tests for distinguishing words that differ only in one letter, this can be suspected even by parents.

You should find the simple words, that differ only in one letter. Firstly you must be sure, that the child knows these words – ask to show in the picture. Now the word is pronounced in a whisper, the mouth is closed with a sheet of paper.

Your child does not react to noises / his speech does not develop well after a cold / he confuses similar-sounding words –> go to an HNO doctor / pediatric audiology

You can start with an ordinary city doctor. For him you need no recipe. The consequences of a cold, water in the ears, which often becomes the source of the problem, can be perfectly detected by an ordinary otolaryngologist.

It makes sense to wait 6-9 months for a term from an audiologist if some serious hearing problems are suspected or if the child confuses similar words (this requires diagnosis on special equipment). The same examination is sometimes also carried out by special needs schools with a focus on hearing.

The prognosis is often positive if detected early. If earlier children with hearing impairments had only one option – the sign language, now they walk with hearing aids and live normally in society. Sometimes they can sogar go to regular school.

2. Problems with jaw, mouth, larynx, vocal cords

Many of them are visible (or heard by ear – a strange voice) already at an early age. The dentist can also tell if there are any problems with the jaw. These children may also have problems with eating and drinking. But some decease are revealed only with a detailed examination of the phoniatrician. I know a boy, that received diagnosis only before the 1. grade of primary school (he has a problem with jaw).

–> Dentist / ENT doctor / Pediatric audiology – Phoniatrics

The prognosis depends on the size of the problem and how much surgery can correct it.

3. Problems with the mouth muscles

Your child speaks unclearly, but there are enough words and sentences for this age. You have already checked the ears.
The problem lies in the articulation of sounds. For example, the child pronounces w, s, sch, g, k and of course r poorly. The cause may be weakness of the mouth muscles, which is treated with training and massage.

Usually even the pediatrician hears it, and you calmly get a prescription after 4 years.
However, there are options. For example, one pediatrician told my sister that German speech therapists do not work on articulation so as not to give her a prescription. The children are now in speech therapy school.

4. Neurological, mental and intellectual speech delay causes

Down syndrome,
fragile chromosome syndrome

Down syndrome is detected early and there is a complex of other problems that parents face at an early age, that is, there is usually no problem with the diagnosis.

Fragile X syndrome can be overlooked, as it can be of varying severity. Typical signs: high forehead, elongated face, protruding ears, deep-set eyes. The syndrome is accompanied by problems of intelligence and speech (depending on the severity – and other problems). In a speech therapy kindergarten in each group every year there are at least two or three such children, they are easy to identify by their appearance.

Genetikum / SPZ / Kinderzentrum

If you suspect these problems, you can seek advice from the support department at a special school (Förderschule mit Förderschwerpunkt Lernen), get a recipe from a pediatrician for genetic counseling, or Kinderzentrum.

5. Psychological problems

Autism Spectrum Disorder (ASD) (Asperger’s syndrome etc.)
ADHS (attention deficit disorder),
stuttering (lack of coordination in the brain),
silence due to severe psychological trauma (mutism) and other problems,
selective mutism

Autism Spectrum Disorder

Autism can be two types: with a loss of intelligence or with normal intelligence. First type is quickly diagnosed. The degree of loss of socialization is also different. Severe degree, with the impossibility of contact, attacks of fear or aggression at the age of 1.5-3 years is also difficult to overlook.

All the many forms and degrees of milder variants are referred to as “autism spectrum disorders.” And these are not so easily diagnosed.

But ASD is quite strongly associated with speech problems. Some variants are possible:
– when a child is silent for a long time (up to about 3 years old) and then begins to speak like an adult,
– when even a 6-year-old child speaks little or not at all
– when he speaks poorly, confuses words, cannot speak in situations that are psychologically unpleasant for him (fear, insults, bullying, too many emotions, etc.).
The latter was previously called selective mutism. However, attempts are now being made to isolate selective mutism as a separate disorder.

More about:

Asperger’s syndrome without outdated clichés
Asperger Syndrome empathy, speech and emotions
Asperger autism symptoms by age. Aspies in Germany

However, there is a trap here: once doctors diagnose a child with ASD / suspected ASD, they immediately stop dealing with his speech delay problems. You have to make extra efforts to convince that you need a speech therapist. If a child has ASD, it does not mean that a psychologist/psychiatrist will solve his speech delay problems.

Your child does not make contact, cannot look directly in the eyes, he is aggressive or fearful –>
— >
Frühförderung (up to 3 years old),
SPZ (ask for feedback! It’s better to go to the SPZ that specializes in autists),
psychologist or child psychiater

Important – ask a local autism association for recommendations.

Just keep in mind: a child who does not own his mouth is likewise aggressive and has frustration. Put yourself in his shoes and see why (nobody understands you – what can you do as a child?). It can be also not ASD, but frustration.

Selective Mutism

Selective mutism means that a child cannot speak in situations that are emotionally difficult for him (mainly fear), but in other situations everything is fine. For example, he does not speak at school, but at home he talks as much as he wants.

Signs: frozen face and body, silence at school and with “toxic” people – and normal speech in a safe situation, problems with greetings, goodbyes, questions, speech about emotions etc.

In recent years, selective mutism has been separated as a separate disorder. I saw an application for a survey group with the request “not autistic”. The professional website also lists “differences from autism”. Here, it seems to me, they have again forgotten to talk to autistic people and have only difficult cases of autism in mind. The website distinguishes selective mutism from early childhood autism (complicated cases), and not from ASD.

As a difference, for example, it is pointed out that an autistic person has problems with communication with parents too. But children with milder forms of autism do not have this problem in their “safe” zone. I have met many autistic people with selective mutism and not a single person with “pure” selective mutism. I would also like to see the statistics – I suspect that the vast majority of those with this “pure” diagnosis will be girls and that it is actually a relatively mild ASD. Has anyone examined these children for ASD 10-15 years later?

I think this limitation is wrong because:

• a symptom has been brought into a separate disorder,

• therefore, children on the autism spectrum with this problem would be ignored. Then name somehow this condition of autistic people and treat it too. And I can tell you that these children do not get any help in Germany, because psychologists only treat the children who talk to them, and these children cannot talk about their feelings.

• and children who are diagnosed with this symptom as a “pure” disorder without autism are not further tested for ASD, that is, they do not receive help if they actually have it. I personally know an adult woman who had all the signs of “pure” selective mutism and who was not diagnosed with autism spectrum disorder as a child, but has it nonetheless.

ADHS

Children with attention deficit disorder are diagnosed due to the lack of this very attention – the inability to concentrate even on what they love (unlike Aspergers, who can be completely wild, naughty and hyperactive, but can focus on what they need).
Lack of attention also affects speech. They misunderstand, rearrange words, and have a limited vocabulary. And at an older age, it can be dysgraphia or dyslexia.

If you suspect ADHS (attention deficit hyperactivity disorder) by the child’s behavior — > then go to Frühförderung (under 3 years old), SPZ or a psychologist.

If the diagnosis is confirmed, then the speech therapist will also be necessary. But it will be much easier for him to work with the diagnosis than blindly.

Stuttering

Your child begins to draw initial consonants, insert letters in front of words (a, u, e), repeat the first syllables of words.
The child suddenly raises his voice, often falls silent, helps himself with movements of his head or hands, This can be a sign of an approaching stutter.

–> Ask for at least a recipe for diagnosis – if the child is stutter, you need to see a doctor as early as possible.

6. Speech disorders as a result of a disease – aphasia, dysarthria

Damage to the brain due to hemorrhage or other diseases, which leads to the loss of some of the speech abilities or damage to the facial nerves and impaired coordination of the mouth. It usually occurs in adults, in children – due to serious diseases, such as cerebral palsy.

7. Unknown (alleged) speech delay causes – Birth, genetics

Developmental Verbal Dyspraxia (Verbale Entwicklungsdyspraxie – VED)
Specific Language Impairment
and Cluttering (Poltern)

It is assumed that the cause is genetic (or during birth) damage to the speech area of ​​the brain – in dyspraxia. Or an abnormally small volume of this zone – in a specific disorder.

In the last year, the question arose about the stimulation of birth with pills. There is a significant group of parents who believe that their children have suffered from them, including myself. I am sure that a lack of oxygen because of overstimulation was the cause of dyspraxia of my son.
In fact, all the children with severe dyspraxia that I know had problems at birth – most were born with induced labor, the rest had to be pulled.

Dyspraxia (Verbale Entwicklungsdyspraxie)

If
– a child at 2 years old speaks only vowels, a certain number of syllables and no words and especially if the child remains in the same position even at three years old.
– or if the child randomly changes syllables, and most of the consonants are missing. The child has only one syllable of the word, for example second (pu – computer)
– or if the child replaces all inconvenient consonants with comfortable ones
so that it is almost impossible to understand him.

At the same time
– you do not suspect problems with autism (or admit that if there is autism, then a weak ASD)
– the child has no visible problems with intellect
– and you have checked the ears,
– but you think that the child cannot control his mouth (this can be seen – ask him to repeat a series of two movements with his lips or tongue).
The child eats for a long time, does not like hard food. There may be varying degrees of motor problems.

— > Well, you can be “congratulated”. Most likely, you will receive endless speech therapy work with a dyspraxia.

If we are talking about the age of two, go to Frühförderung, from there it will be easier for you to get to the Logo and Ergo. If you are lucky it was a another diagnosis and the problem will resolve up to 3 years.

If we are talking about the age of three years, the problem will not go away and recipes should be taken for everything (see below how to choose a specialist) and immediately, since in many places the wait is up to 9 months.

It can be:
Beratungsstelle at a speech therapy school – without recipe
Frühförderung – without recipe
HNO (ENT) in the city – without recipe
Pädaudiologie – with recipe (the same examination can sometimes be done at the school for the hearing impaired)
SPZ – abut only good one! Better Kinderzentrum – with recipe
Logopädie – with recipe

Ears must be checked quickly and in any case. You go to city HNO and take a term by Pädaudiologie. This will give you the opportunity to tell the pediatrician that everything is in order with child’s ears, but, of course, you will check them with an audiologist, but in the meantime, still give please a recipe to a speech therapist.

Ask for a recipe at least for diagnostics to a speech therapist specializing in toddlers (for three sessions). If the speech therapist suspects dyspraxia – hurry up, take a terms wherever you have not yet.

Many “specialists”, especially in the country, tend to write off everything to bilingualism. But no bilingualism can be reason the absence of recognizable (albeit without a couple of sounds) words in 2,5 to 3 years – in both languages.

The prognosis is not very happy: it is a lot, a lot, a lot, a lot of … work with hope for the best.

Specific Language Impairment (Spezifische Sprachentwicklungsstörung)

The child has limited vocabulary, has big problems in grammar in both languages. The pronunciation is normal, autism or other diseases are unlikely.

If at the same time there are also problems with concentration – this is a suspicion of ADHS.
If not, it looks like a Specific Language Impairment.

And in the first, and especially in the second case, you need a lot of speech therapist. The question comes up more likely by the years 4-5, so the problem with the recipe is unlikely to arise.

Poltern (Cluttering)

Your child speaks at a wrong pace, which makes it very difficult to understand. More often, he speaks too fast, trying to get out everything he has in his head, and there is too much in his head. Sometimes, on the contrary, it suddenly slows down a lot. He changes words order, rearranges syllables. It is characteristic that he himself believes that he speaks normally.

This problem is called Poltern. Therapists have not yet studied this phenomenon at all. They know no causes, no recommended method. Only the first conference on this disease has passed.

This is a very problematic diagnosis for you, because this problem becomes clear as the child get older. And the older the child, the more difficult it is to get a prescription for a speech therapist. There is a chance that you will either have to forget about therapy because you can’t get a prescription, or have to pay for it yourself.

8. Non-medical (social) speech delay causes

There is, of course, pedagogical neglect and families with social problems. But such parents do not search in the Internet what is wrong with the child. We are much more concerned with bilingualism as a cause of speech delay.

The main reason for the appearance of bilingual children in our speech therapy kindergarten is a mess in the speech of parents. If the mother says mixing mother language and German: “And she said: Ich hab schon Teig gekauft and then ran down the Straße to the nearest Laden to buy another Kiste of apples,” then the child does not have very many chances of a normal speech in either of the two languages.

If foreign parents separate the languages, then the child will most often have a normal development of the mother language and a deficit of German. This is not a problem of speech therapy, but of learning. Of course, it’s not bad to have a speech therapist: put the grammar in place or practice the sounds – but not necessarily.

Let’s look at a few options

1. The child is bilingual, purely foreign language at home. Foreign language (mother language) is correct (that is key point), German is behind. This is especially true of the volume of the dictionary.

–>
There is no need to fight for the recipe, rather to fight against a recipe for SPZ.
After 4 years, you can (don’t have to) ask for a recipe to a speech therapist for grammar problems. In most cases in the 1. Grade the child catches up with classmates.

2. The child is bilingual, languages are distributed by parents. The child’s languages ​​mix, they lag behind the age norm, especially in the vocabulary, but the basic skills and vocabulary are present. There are some correct words. Sounds are age appropriate (with a few exceptions). Sentences for the norm appear (it does not matter in what language or in what mixture).

–>
It is not necessary to fight for a recipe to a speech therapist, but it is not bad to have one (see below which speech therapist to choose) if you can convince the doctor to give it without sending the child to the SPZ.

It’s a good idea to visit the Beratungsstelle at a speech therapy school if you have one: they usually indicate that they are advising parents of bilingual children. You don’t need a recipe for that. But the most important thing is to think over the rules for the distribution of languages ​​in the family and strictly follow them.

But the most important thing is to rethink and strictly adhere to the rules for the distribution of languages ​​in the family.

All about bilingualism – part 1 (strategy and rules), part 2 (problems by age).

Speech delay treatment – what can you do yourself?

There are some things you can do before going to the doctor to better understand your child’s problems and explain them more clearly to your doctor.

• See how the child articulates: ask him to stretch his lips, stick out and raise his tongue, click, make a sequence of mouth movements (for example, lips forward-wide-forward-wide). Analyze what and how the child eats – whether there are problems with solid food (meat, for example). This information helps by therapist and doctors.

• Check your child for a vocabulary: for example point to objects in pictures, point to body parts.

• Test the child for understanding:
  – give him a task of several actions.
  – ask to show words in the pictures that differ by one letter (as toy-boy). Speak the words in a whisper. Before that, check if he knows these words at all.

The next two points are your help to the child. If you can do this, it will be a great help to your child while you wrestle for prescriptions and wait months for appointments.

• Listen to your child speak, take a week to write down everything he is trying to say. Write down all the sounds that are pronounced, and your assumptions – what this might mean. Ask all the family to do the same. Do such a list every 3 month.

• Repeat after him all the time the guessed “words”. He says “aa” – you repeat “Yes, car”. He says “ei” – you repeat “Play”. The children, if other people do not understand them, stop trying to say words correctly. The words lose their communicative function for them.

How to speak with a pediatrician?

Pediatricians don’t listen to parents. They especially don’t trust parents who don’t speak perfect German. This is typical, subconscious, intuitive: if you do not speak the language, you are an idiot. The exception will be native speakers of a highly respected language – for Germans, these will be native English speakers.

What can you do?

• Come to pediatricians together – mother and father of child. The pediatricians trust fathers more.
• Print the informations from speech therapists Websites. There are many such Websites, where they tell, that therapy should earlier begin.
  Tell about your family situation, your education, how you work with child. Take a list of child’s “words”. That is proove, that you are not the parents, which do not take care of the child and his speech.
• Ask for all possible doctor examinations at the same time, not one after another. Search for specialists carefully! And ask recipes (Überweisungen) not for nearest, but for best specialists, even they are far from your town. The more difficult the case, the more important this point is.
• Take a letter from kindergarten, that your child has problems and needs an examination and speech therapy.
• Visit the counseling center at the speech therapy school, if you have one, and get a letter there about your child’s problems. A letter like this works wonders.
• You must be well prepared and speak confidently. Sometimes it makes sense to argue! I hate it, but I had to learn – otherwise you are just kicked out with nothing.
• If possible, see a doctor early in the year. At this time, they have more quotas for recipes.

Otherwise, the years just fly away, and you only wait for six months or more for the next term. It is difficult even for German-speaking parents. One mother in the special kindergarden said: “I feel like a beggar at the doctor’s office”. But for us, expats, it requires even more struggle and strength, since pediatricians tend to write off everything for bilinguality.

Speech delay by children. Part 1. Norm and problems
Where you can find help. Speech therapist in Germany
Special schools and inclusion for kids with speech delay in Germany
Bilingual children. 1
Bilingual child speech development
German primary school. Orientation. Must and can – school obligation
Deutsch in German primary schools. Grades 1-2