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Speech and language delay for a two year old

Speechand language delay for a two year old

Speechand language delay for a two year old

Childdevelopment is a critical area which has attracted numerous theoristswho have postulated various theories, which explain the developmentof children (Smidt, 2013). It is imperative to point out that thedevelopment of a child is an all-round process, which occurs frominception to death (Keenanand Evans, 2009).Growth and development in children is a multi-dimensional processthat cannot be described by the growth or development of one singleaspect (Keenanand Evans, 2009).Growth and development comes in different dimensions, which comprisephysical, emotional, social, cognitive, as well as speech andlanguage. For the purposes of this paper, the topic of speech andlanguage development in two year old children will be explored.Research has indicated that children at the age of 2 years have theability to master approximately 50 words and can construct two wordsentences (Keenanand Evans, 2009).However, speech and language development for 2 year old childrendepends on various factors. These may include scientific factors,social factors and parenting (Barth, 2008). The environment in whicha child grows also determines the development of speech and language(Keenanand Evans, 2009).

Therefore,in instances where a child does not have any of the above factors atits disposal, the aspect of speech and language development may bedelayed (Smidt, 2013). Speech and language delay in children isregarded as an abnormal occurrence, which has attracted the attentionof theorists such as Piaget, Chomsky, as well as Bruner and Skinner(Smidt, 2013). This paper is based on a case study of a two year oldchild nicknamed Ben, whose language and speech development has beenextremely delayed.

Overviewof child development

Althoughthere are various definitions of the term child development fromvarious theorists, one generally accepted definition is that childdevelopment refers to the continuous physical, physiological,emotional and biological changes that are imminent in the body of achild from the time of birth till adolescence (Smidt, 2013). Childdevelopment takes a multidimensional approach and depends on variousfactors such as the environmental, parenting, child protection, aswell as biological factors (Keenanand Evans, 2009).Some of the theorists who have defined the term child developmentinclude Piaget, Chomsky, Vygotsky, Brunner and Skinner. According toPiaget, development of children occurs in four stages. That is thesensorimotor stage (0-2 years),preoperational stage which is between2 to 7 years, concrete operational stage, as well as the formaloperational stage which ends at the age of 15 years (Keenanand Evans, 2009).According to Piaget, the development of cognitive skills such asspeech and language develop in these stages. Piaget proposed twoconcepts through which children may acquire new skills such as speechand language (Smidt, 2013). He asserts that assimilation andaccommodation are the two concepts that explain acquisition of skillsin children (Keenanand Evans, 2009).

According to Chomsky on the other hand, language acquisitionand development in general is a complex process that takes a naturalcourse (Smidt, 2013). Chomsky asserts that the acquisition ofknowledge in a natural process that happens automatically and it isnot influenced by environmental factors or parenting. B. F Skinner,in his operant conditioning theory argues that the development ofspeech and language in children depends on whether the behavior isreinforced or punished (Keenanand Evans, 2009).In other words, according to Skinner, child development depends onreinforcing correct behaviors, which will develop, and punishingunwanted behaviors which will end (Keenanand Evans, 2009).Vygotsky’s developmental theory asserts that child cognitivedevelopment is influenced largely by factors such as the social,interpersonal experiences and linguistics (Smidt, 2013). According toVygotsky, young children will voice their frustrations out unlikeadults (Keenanand Evans, 2009).Although Bruner was heavily influenced by the works of Piaget andVygotsky, he came up with his own Learning theory of development.According to Bruner, child’s mental development occurs in stages(Smidt, 2013). Casestudy

Thenames in this case study are pseudonyms in accordance with the NMC(2008) guidelines on confidentiality. Ben is a 2 year old boy. Helives in a two bedroomed council flat with his mother Julia. Juliaseparated from Ben’s dad when Ben was 4 months old. Julia reportedthe time of her separation to have been “quite difficult” whereshe suffered severe postnatal depression citing that she feltsuicidal. She portrayed postnatal depression characteristics ofsadness, irritability and withdrawal. This meant that the baby boyhad no one to positively influence his speech and languagedevelopment. Julia further reported Ben’s dad to be of no use inBen’s life, citing that he had not pursued any contact since theirseparation. As well as being documented, Julia reported that throughtreatment she had recovered from the postnatal depression. Ben hasnot received the proper parenting that is essential in a child’sdevelopment.

Benwas not known to any agencies such as the child protection howeverthey were numerous entries in the notes detailing staff efforts toget Julia to attend clinic for Ben’s weight check andimmunizations. The immunization history was now up to date. Julia wasnow attempting to build a new social network for her and her son intheir new location. Julia remains unemployed and has hopes to achievean economic achievement later. She is currently content being onwelfare benefits. Ben has not developed his speech and languageskills as expected. He is only in a position to master two words,which is contrary to the expected 50 words at his age of 2 years. Itis apparent that child Ben is not achieving the expected milestone inhis speech and language development. The speech and languagedevelopment of the child in this case is viewed as abnormal.

Speechand Language delay of a two year old – scientific perspective

Speechand language development is a continuous process in children, whichconcurs with the progress of chronological age (Thomas, 2005). InBen’s case, a health visitor conducted a development reviewfollowing the Sheridan guidelines (2008). This review was conductedby the health visitor under the Healthy Child Program of thedepartment of health. It is vital to point out that this is a programthat seeks to identify children belonging to families that needadditional support. According to the Sheridan (2008) framework, thiswas an opportunity for the health visitor to assess the holisticdevelopment of Ben, i.e. physical, emotional, social, cognitive, aswell as speech and language development. In addition, Sheridan’sframework (2008) provides and avenue to determine normal or abnormaldevelopment of a child’s developmental areas. After the healthvisitor measured Ben’s height and weight, he asked him about hisbody parts, but Ben could not answer. It was also apparent that thechild could only pronounce the words “no” and “yes” as he didwhen his mother tried to pick one of his toys.

Itwas clear that Ben had only a mastery of two words, yes and no.However, according to Sheridan’s framework, a child of two yearsshould have in its possession a vocabulary of at least 50 words. Inaddition, two year children should be able to combine at least twowords to make simple sentences (Bee &amp Boyd, 2013). In otherwords, that is normal speech and language masterly of a two year oldchild such as Ben. However, in this case, Ben is way too much belowthe expected number of words that a two year old should possess. Itis clear in this case that the development of speech and language hasnot been achieved and does not concur with the chronological age ofthe child. Therefore, according to Sheridan’s framework (2008),this child has an abnormal speech and language development.Therefore, it is evident that Piaget concurs with Sheridan thatspeech and language development occurs in stages or according tochronological age (Bee &amp Boyd, 2013).

Thiscan be compared with Piaget’s cognitive development theory whichasserts that children’s cognitive development occurs in stages (Bee&amp Boyd, 2013). Piaget stipulates four stages through whichchildren develop cognitive skills such as speech and language(Thomas, 2005). Piaget’s developmental stages have largely beendescribed as the blueprint that stipulates the normal stages ofintellectual development from infancy to adulthood (Smidt, 2013). Thestages of development are the sensorimotor stage, which Piaget arguesthat it occurs within the first two years (Bee &amp Boyd, 2013).This is followed by the preoperational stage which takes placebetween the ages of 2 to 7 years. These stages are followed by theconcrete operational stage and finally the formal operational stagethat occurs at the age of 11 to 15 years (Thomas, 2005). According toPiaget, children should be able to develop language skills.

Piagetstates that the language development towards the end of thesensorimotor stage is major milestone in child development. Duringthis stage, children learn through experimenting with the environmentand the things around them (Thomas, 2005). In other words, duringthis stage which the boy in this case belongs, the environment andthe things around the child are critical in the development of speechand language. Piaget’s theory applies to Ben’s case in that he isat the sensorimotor stage where he should develop language skillsthrough coordinating sensory experience with physical action such asplaying with toys. In this case, the toys available were not matchingto the age of the child and therefore affected speech and languagedevelopment. Vygotsky agrees with Piaget that language and speechdevelopment in children occurs in stages. However, the stages thatVygotsky proposes do not match with those proposed by Piaget. Forinstance, Vygotsky asserts that children start with the trial anderror form of speech, which develops to egocentric speech, which asocial kind of talk, which occurs in the next stage (Bee &amp Boyd,2013).

Thedelay in the speech and language development for Ben in this casemight be associated with his lack of exposure and lack of aneffective environment to aid his development. It is clear from thecase that the mother was poor financial status and was thereforeunable to provide a variety of toys to the child. The health visitornoted that the few tots that were in Julia’s house were noteffective and appropriate for a two year old. In this light, thelanguage delay in the case of Ben can be associated with the lack ofproper coordination between sensory experiences and physical action(Keenanand Evans, 2009).This is a key factor in the delay of the speech and languagedevelopment to the child. The lack of physical equipment on which thechild could hold onto when trying to crawl or stand and walkinhibited the cognitive development of Ben (Smidt, 2013). As aconsequence, the development of Ben’s speech and language wasinhibited.

Chomsky(1965) disagrees with Piaget’s argument of development and assertsthat development of children is a complex process that is not solelyinfluenced by the environment. According to Chomsky (1965), childrenare born with an innate ability to realize the features of language.He argues that children are born with a language acquisition device(LAD), which enables them to develop speech and language naturally.He also believes that language and speech develops as one matures. In the case of Ben, Chomsky (1965) argues that the other areas ofdevelopment such as physical development are normal and it is onlythe language and speech development that is delayed. This is contraryto what Piaget argued that children at this age acquire speech andlanguage through interacting with physical things in theirenvironment.

Skinnerdeveloped the operant conditioning theory, which asserts that goodbehaviors should be rewarded while bad behaviors are punished. In thedevelopment of speech and language, Skinner asserts that childrenshould be rewarded for uttering words correctly and punished whenthey utter the words wrongly (Bee &amp Boyd, 2013). Skinner, inKeenan and Evans (2009) argues that the parents and relatives play acritical role ensuring that there is effective speech and languagedevelopment. Parents and relatives should praise and smile to thechild when it utters a word correctly. This ensures that the childdevelops language appropriately and according to age. In the case ofBen, Julia suffered a postnatal depression, which kept her aloof fromthe child. In her own words, Julia confessed of having been unable toeffectively communicate with Ben. Therefore, Skinners operantconditioning theory plays a critical role in explaining the languagedelay with Ben. The delay in the language development in the case ofBen was caused by lack of reinforcement from the mother. According toSkinner’s theory, if Ben had been reinforced appropriately any timehe uttered a correct word, his language development at the age of twoyears would have been normal. It is vital to point out that critiquessuch as Keenan and Evans (2008), disagree with Skinner, arguing thatthe time required to reinforce every word would take a lifetime. Thisis the reason that they put forward as deeming the theory impossibleto explain the acquisition of speech and language in children (Bee &ampBoyd, 2013). In addition, biologists have argued that Skinner ignoresthe role played by chromosomes and hormones in the acquisition ofspeech and language mastery in children (Bee &amp Boyd, 2013).

Bruner’swork has largely borrowed from Piaget and Vygotsky. Bruner assertsthat language development in children develops with age progression.In this regard, we see an agreement with what Piaget argues aboutspeech and language development. Bruner argues that the cognitivedevelopment of children is largely influenced by the environment. Heasserts that people view the world according to their experiences(Bee &amp Boyd, 2013). In this regard, children develop mentallyaccording to the experiences they perceive within their environment.In the case of Ben, his speech and language development delay waslargely influenced by lack environmental experience with the world.It is vital to note that Bruner discounted the relevance of thedevelopmental stages as stipulated by Piaget (Bee &amp Boyd, 2013).He however viewed mental development in children as a progressiveprocess which occurs with the continuous growth? Vygotsky broughtforth the social developmental emphasis to the debate of languagedevelopment in children. According to Vygotsky, the peers and olderpeople have a great influence in the speech and language developmentof children (Thomas, 2005). He asserts that the interaction betweenthe mature people or the caregivers and the child is vital in themental development of the child. Mature people or the caregiversprovide the child with an environment that is critical in thedevelopmental of mental skills in the child (Keenanand Evans, 2009).For instance, the mature people provide children with tasks, whichenhance language and speech development. It is evident that Vygotskyconcurs with Piaget’s sensorimotor stage where children learnthrough interacting with an effective environment (Gerhardt, 2004).Criticaldebate- The social perspective

Bronfenbrener’secological theory asserts that the environmental factors that affectthe development of a child are interrelated (Barth, 2008). Thistheory is an extension of the Vygotsky constructivist approach whichasserts that knowledge is constructed through social interaction(Gerhardt, 2004). The theory asserts that the child’s environmentcan be viewed in different dimensions. The microsystems are factorsthat affect the development of a child directly in its developmentsuch as the parents, relatives and early childhood setting (Maggi,2010). These factors influence the development of the childphysically, mentally, biologically and even speech and languagedevelopment. In this case, the parenting, which is a microsystemfactor in Bronfenbrener’s theory does not have a proper impact onthe child and affects the speech and language development negatively(Barth, 2008).

Thetheory also stipulates the effects of exosystems, which are factorsthat do not affect the child directly in terms of development, butaffect the microsystems (Maggi, 2010). Such factors may include theparents work, or the network of friends of the mother. The theoryalso points out that there are other factors called macrosystem,which comprise of the cultural or the subcultural setting in whichthe child develops (Gerhardt, 2004). This may include poverty levelsof the family, wealth, ethnic identity or the neighborhood. In thecase of Child Ben, it is evident that the environment is of povertyand they depend on social welfare for survival. This has a tremendousnegative effect on the cognitive development of the child. Povertymay result in poor parenting due to lack of resources and thereforeresulting in poor development of the child (Maggi, 2010).

Thespeech and language development in children requires a socioculturalapproach. It is critical to point out that children cannot learn ontheir own but require the interaction with both relatives and peers(Maggi, 2010). In this case, Ben lacked proper social environment,which would have aided his cognitive development, hence his speechand language development delay. It is also paramount to note thatparenting is critical in the development of children. In this case,Julia suffered from postnatal depression after breaking up with Ben’sfather. According to Sten etal,(2008), postnatal depression has symptoms such as sadness,withdrawal and irritability, which adversely affect the developmentof a child. Adults have the responsibility to provide an environment that willensure that children develop effectively (Maggi, 2010). Childrenlearn in the social perspective through interaction with theenvironment and with other people.

Thereare three phases of children, which comprise early childhood,childhood and adolescent (Maggi, 2010). Each of these stages requiresa child to conduct himself in a certain manner. It is therefore therole of the adults to provide activities to children that will ensurethey learn the required skills at each phase. Parenting is a criticalfactor in the speech and language development of the child (Maggi,2010). Parents must provide activities to children that ensure theirmental and cognitive development. The parents must interact with thechild in order to instruct, direct and correct the child when it iswrong. In this case, Ben lacked the proper social perspective in hislife, which can be attributed to his delay in speech and languagedevelopment.

Theparenting style that a parent adopts affects greatly on the mentaldevelopment of a child. There is a complex exchange between a parentand a child that has tremendous effects on the cognitive developmentof the child (Maggi, 2010). Julia had a style of parenting which hasbeen described as authoritative. This type of parenting is the onethat the parent is not concerned with the autonomous development ofthe child, give commands on what the child should do. Such kinds ofparents leave their children alone and have no influence in the dayto day life and development of the child. This is the type ofparenting that Ben was exposed to. It is critical to point out thatthis type authoritative parenting hinders the cognitive developmentof the child hence hampering speech and language development (Maggi,2010).

Thebasic unit of a family dictates that the two parents must be presentfor the child to cognitively develop effectively. Research hasindicated that children raised by single parents portray low levelsof cognitive and mental development. The family is a key socialfactor which affects the speech and language development of a child(Maggi, 2010). In this case, Ben is raised of a single mother and heis not an exception from the findings of parenting research. Hismental and cognitive development is hampered by the absence of afather. This can be categorized under the exosystem circle ofBronfenbrener’s ecological theory, which points out to people orfactors affecting the microsystems. His delay in language and speechdevelopment can be largely attributed to the lack of a father orotherwise his absence as a social factor. The element of divorceamongst the parents of Ben can also be a factor that affects hismental and cognitive development.

Playplays a critical part in the development of a child in all aspectssuch as the physical and mental development. In the early stages oflife of a child, play is the only main activity that a child uses tolearn (Maggi, 2010). Play stimulates development of various aspectsof children such as speech and language. The child needs to beprovided with toys which are commensurate with his or her age inorder to develop effectively. It is also critical for the adults toprovide children with opportunities for play such as letting thechild to play with other children (Maggi, 2010). It is during suchplay that the child gets an opportunity to experiment with variousactivities including speech and language acquisition (Thomas, 2005).It is also critical for the parent to play with the child and guideit in acquisition of various skills. It is during play that childrenare able to learn new ideas and concepts.

Childrenat a tender age have a huge capacity to learn new things than anyother age. Children learn what they see, hear or touch. It istherefore clear that play which presents such opportunities isparamount in the development of the child both physically, mentallyas well as in speech and language development (Maggi, 2010). It isevident that in the case above, Ben lacked the intended play bothfrom her mother and from peers. It is clear that the family of thesingle mother had just arrived in the new location and there waslittle interaction between the family and the neighbors. The motheralso portrayed an element of aloofness from the child and they hardlyplayed. This affected the speech and language development of thechild at his age of two years.

Criticaldebate on the role of the health visitor

Inthis case, the health visitor would seek to find out whether Juliaknew that Ben would be late for school which would have long termeffects. The child’s speech and language delay will affect hisinteraction with other children and this might deem him antisocial infuture. In addition, Ben will be slow in learning at school, whichwill make his time in school being prolonged. It is vital to pointout that children are ready for nursery school when they have awell-developed speech. In the case of Ben, he will need more time todevelop speech and language before joining school.

Thehealth visitor in Ben’s case needs to advice Julia on the need ofintroducing her son to stimulation activities which would facilitatehis language development. Stimulating activities such as play withpeers and playing with various physical objects which aid in speechand language development. Children watch and listen while playing. Itis also critical to note that children imitate what they see or hear.In this regard, Ben will watch and listen and also imitate. Forinstance, Ben may imitate sounds he hears, which will aid in hisspeech and language development. In addition, the health visitorwould advise Julia to apply for nursery benefits for Ben to help himinteract with his peers hence aid in his development. This would alsogive Julia time to establish social networks with her friends.

The work of the health visitors is guided by documents such as theworkingtogether to safeguard children 2010, which has by now been replacedby the 2013 version. The document asserts that health visitors havethe responsibility of ensuring that the welfare of the children isguarded. This is a document in law that safeguards the rights of thechildren. It is vital to point out that children are protected in lawand their development and needs are put first in law. The WorkingTogether To Safeguard Children 2010, stipulates clearly that theneeds of a child comes first and should be given priority to avertany possible harm or illness. The same document continues to assertthat all professionals in contact with a child must be alert to theneeds of the child and ensure that they are met. The health visitorsmust also communicate with each other in a bid to establish any needsof a child and provide the necessary help. Professional such asclinical officers or nurses with knowledge on child development canprovide steps to be taken in order to improve Ben’s speech andlanguage development. Such steps include introducing Ben to peers andengaging him in play.

Inthis case, it is clear that the development of the child has beenneglected by the mother hence the child’s right for protection hasbeen neglected. Although the mother suffered from postnataldepression, it is clear that the responsibility of ensuring properdevelopment of Ben remained with her and therefore the neglect wasdeliberate. It is also apparent that if the child was left out for alonger time, this delay in development would have had immense effectsin his adulthood. Ben’s case is that of neglect and emotionalabuse, which goes against children’s rights Act of 1989.Theprofessionals must also engage in regular review of the outcomes oftheir activities towards meeting the needs of the children (Barthet al, 2008).

Itis also imperative to point out that children are protectedextensively by the law. The children`s Act 1989 is one Act that wasestablished to ensure that parents, courts, local authorities andstakeholder agencies have the responsibility of ensuring the welfareof children. Although the Act places the care of the child at thefamily level, it is vital to note that it recognizes theresponsibilities of other stakeholders in the caring and protectionof the child (Barthet al, 2008).The Act asserts that the courts have the responsibility ofsafeguarding the welfare of the child. In addition, the Act pointsout that the parent(s) of a child have the responsibility of ensuringthe child’s welfare and development (Thomas, 2005). In addition,the Act states that the local authority has the responsibility ofcaring for the children who are deemed as needy. It is thereforeclear that the welfare and the development of children are wellguarded in the law.

Itis apparent that if the parents cannot provide for themselves, theywill definitely be unable to provide for the child (Barth, 2008). Asa consequence, the needs of the parent and those of the child go handin hand. Failure to provide for the child by the parents indicatesthat the parent has also got nothing for themselves. Health visitorsassess whether a family is capable of providing for the family atlarge and the child in question (Barthet al, 2008).The provisions can range from daily needs, adequate diet, socialinteraction opportunities, as well as toys for the child to playwith. A failure to provide for the child becomes a child protectionissue, where the health visitor provides practical help and advice tothe family.

InBen’s context, the health visitor has a right under the law toassess the development and growth problems affecting Ben. The healthvisitor will have an opportunity to identify and realize that thechild is having a language development problem. The health visitorwill go ahead and offer advice on the steps to be taken to enhancespeech and language development for Ben. The health visitor has theresponsibility of ensuring that the child’s welfare is met and thathe is set on the right path of growth and development.


Itis clear from the case study and the discussion in this paper thatthe development of a child is affected by various factors which mayinclude scientific, social and biological (Barth, 2008). However, themain point to note is that each of these factors works hand in handin ensuring a child’s holistic development. The development ofspeech and language is one part of child development that requiresclose attention and the contribution of parents, relatives andfriends in its acquisition (Barth, 2008). In the case of Ben, lack ofproper parenting and the social cultural setting have played acritical role in his failure to acquire speech and language skills ofan equivalent two year old. The postnatal depression that Juliasuffered had a tremendous effect on the development of Ben. Themother’s contact with the child and interaction was minimal hencehampering the child’s development. It is evident that the speechand language delay of Ben is abnormal and there is a huge problem inhis speech. The difference in the number of words he is supposed tomaster at the age of two years is huge. It is therefore the role ofthe parent to enhance the environment in which Ben develops and alsoimprove on her parenting styles in order to complement the growth gapthat exists.


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