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 that explain the development ofchildren (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 purpose 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 multi-dimensional 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 is 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, a 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” becauseshe 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, however,they 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 the child, Ben, is not achieving the expectedmilestone in his speech and language development. The speech andlanguage development 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 an 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 old children should be able to combine at leasttwo words to make simple sentences (Bee & Boyd, 2013). In otherwords, that is the normal speech and language mastery of a two yearold child such as Ben. However, in this case, Ben is way too muchbelow the expected number of words that a two year old shouldpossess. It is clear in this case that the development of speech andlanguage has not been achieved and does not concur with thechronological age of the child. Therefore, according to Sheridan’sframework (2008), this child has an abnormal speech and languagedevelopment. Therefore, it is evident that Piaget concurs withSheridan that speech and language development occurs in stages oraccording to chronological age (Bee & Boyd, 2013).
Thiscan be compared with Piaget’s cognitive development theory whichasserts that children’s cognitive development occurs in stages (Bee& 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 incudes the sensorimotor stage, which Piagetargues to occur within the first two years (Bee & 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 a 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, where 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 such a waythat he is at the sensorimotor stage where he should develop languageskills through coordinating sensory experience with physical actionsuch as playing with toys. In this case, the toys available were notmatching to the age of the child, and therefore, affect the speechand language development. Vygotsky agrees with Piaget that languageand speech development in children occurs in stages. However, thestages that Vygotsky proposes do not match with those proposed byPiaget. For instance, Vygotsky asserts that children start with thetrial and error form of speech, which develops to egocentric speech,a social kind of talk, which occurs in the next stage (Bee &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 in financial status and was, therefore,unable to provide a variety of toys to the child. The health visitornoted that the few toys 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 of 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 the development of children is a complex process that is notsolely influenced by the environment. According to Chomsky (1965),children are born with an innate ability to realize the features oflanguage. He argues that children are born with a languageacquisition device (LAD), which enables them to develop speech andlanguage naturally. He also believes that language and speechdevelops as one matures. In the case of Ben, Chomsky (1965) arguesthat the other areas of development such as physical development arenormal, and it is only the language and speech development that isdelayed. This is contrary to what Piaget argued that children at thisage acquire speech and language through interacting with physicalthings in their environment.
Skinnerdeveloped the operant conditioning theory, which asserts that goodbehaviors should be rewarded while bad behaviors should be punished.In the development of speech and language, Skinner asserts thatchildren should be rewarded for uttering words correctly and punishedwhen they utter the words wrongly (Bee & Boyd, 2013). Skinner, inKeenan and Evans (2009), argues that the parents and relatives play acritical role in 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 &Boyd, 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 & 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 & 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 the lack of environmental experience with theworld. It is vital to note that Bruner discounted the relevance ofthe developmental stages as stipulated by Piaget (Bee & Boyd,2013). He, however, viewed mental development in children as aprogressive process which occurs with the continuous growth? Vygotskybrought forth the social developmental emphasis to the debate oflanguage development in children. According to Vygotsky, the peersand older people have a great influence in the speech and languagedevelopment of children (Thomas, 2005). He asserts that theinteraction between the mature people or the caregivers and the childis vital in the mental development of the child. Mature people or thecaregivers provide the child with an environment that is critical inthe developmental 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 the speech and languagedevelopment. In this case, parenting, which is a microsystem factorin Bronfenbrener’s theory, does not have a proper impact on thechild 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 is comprised of the cultural or the subcultural setting inwhich the child develops (Gerhardt, 2004). This may include povertylevels of the family, wealth, ethnic identity, or the neighborhood.In the case of the child, Ben, it is evident that the environment isof poverty, and they depend on social welfare for survival. This hasa tremendous negative effect on the cognitive development of thechild. Poverty may result in poor parenting due to lack of resources,and therefore, resulting 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 a 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 are comprised of 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 to 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 greatly affects 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 onewhere the parent is not concerned with the autonomous development ofthe child and give commands on what the child should do. Such kindsof parents leave their children alone and have no influence in theday to 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 by 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 or,otherwise, 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 ofthe life of a child, play is the only main activity that a child usesto learn (Maggi, 2010). Play stimulates the development of variousaspects of children such as speech and language. The child needs tobe provided 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 is,therefore, clear that play, which presents such opportunities, isparamount in the development of the child both physically andmentally as well as in speech and language development (Maggi, 2010).It is evident that in the case above, Ben lacked the intended playboth from her mother and 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
Healthvisitors are nurses with post registration experience in publichealth, health promotion and child health. The initial work of healthvisitors is to conduct holistic assessment on the well-being anddevelopment of a child. Health visitors seek to provide advice andoffer practical help to children who are at risk of health problems.Their work involves the assessment of the health and well-being ofchildren, families, and the community at large. The main aim ofhealth visitors is to promote health in the community and preventillnesses (Barthet al, 2008).In addition, health visitors seek to find out whether parents orcaregivers have any information on the effects of abusing children’srights or neglecting their welfare. Inthis case, the health visitor would seek to find out whether Julia isaware that Ben’s condition of delayed speech and languagedevelopment would have long term effects on the child’s holisticdevelopment. According to the Learning Disabilities Association ofAmerica (2014), a delay or disorder in a child’s speech or languagedevelopment may significantly affect the child’s personal, social,academic, or vocational life, so it is important to identify suchconditions early on such as on the case of Ben.
Thehealth visitor in Ben’s case needs to advice Julia on the need ofintroducing her son to stimulation activities which would facilitatehis language development including play. As mentioned earlier, Bencan be exposed to different ways to playbecause playing presents opportunities that are paramount in thedevelopment of the child both physically and mentally, as well as inspeech and language development (Maggi, 2010).. In addition, the health visitor would advise Julia to apply fornursery benefits for Ben to help him interact with his peers, hence,aid in his development. This would also give Julia time to establishsocial networks with her friends, recover completely from postnataldepression, and perhaps, find a job that could sustain her and Ben’sneed.
The work of the health visitors is guided by documents such asWorkingTogether to Safeguard Children 2010, which has by now been replacedby the 2013 version. This is a document in law that safeguards therights of the children. In addition, thisdocument setsout some ways by which organizations, health workers like the healthvisitors, and individuals like mothers, could work together tosafeguard and promote the welfare of children and young people suchas Ben. Itis vital to point out that children are protected by the law, andtheir development and needs are put first by the law. The WorkingTogether to Safeguard Children 2010 stipulates clearly that the needsof a child should come first. This document asserts the sameprinciple mentioned by Barth et al, which states that the childshould be given priority to avert any possible harm or illness(2008).
Also,it continues to assert that all professionals in contact with a childmust be alert to the needs of the child and ensure that they are met(Barth, 2008). The professionals must also communicate with the eachother in a bid to establish any needs of a child and provide thenecessary help. These authorities that are children’s servicesauthorities in their locality may also be consulted since they arededicated to the duties such as organizing and planning communityservices that would safeguard and promote the welfare of childrenlike Ben.
Inthis case, it is clear that the development of the child has beenneglected by the mother, hence, the child’s right for protectionhas been neglected and lead to the child’s delayed speech andlanguage development. It is also apparent that if the child was leftout for a longer time, this delay in development would have hadimmense effects in his adulthood. Ben’s case is that of neglect andemotional abuse, which goes against children’s rights Act of 1989.
Asstated in the Working Together to Safeguard Children 2010, highquality professionals have the role to use their expert judgment tosafeguard the needs of the child and ensure they are protected intheir programs. As high quality professionals, health visitors mustalso engage in whatever actions that are deemed as meeting thechild’s needs. It is also a duty of professionals like them toengage in regular reviews of the outcomes of their activities towardsmeeting 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 of 1989 is one act thatwas established to ensure that parents, courts, local authorities,and stakeholder agencies have the responsibility of ensuring thewelfare of children. Although the Act places the care of the child atthe family 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 and that they canalso hire people on its behalf to provide for and care for the needychildren (Barthet al, 2008).It is, therefore, clear that the welfare and development of childrenare well guarded by 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 of the parents to provide the needs of the childindicates that the parent has also got nothing for themselves. Healthvisitors assess whether a family is capable of providing the needs ofthe whole family at large and the child in question (Barthet al, 2008).A failure to provide the needs of the child becomes a childprotection issue, where the health visitor provides practical helpand advice to the family.
InBen’s context, the health visitor has the right under the law toassess the development and growth problems affecting Ben thatcontribute to his delay in speech and language development. Thehealth visitor has the responsibility of ensuring that the child’swelfare is met and that he is set on the right path of growth anddevelopment not only physically and mentally, but also in his speechand language development as mandated by The Children`s Act of 1989.
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,the main point to note is that each of these factors works hand inhand in 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, thelack of proper parenting and the socio-cultural setting have played acritical role in his failure to acquire the proper speech andlanguage skills of an equivalent two year old. The postnataldepression that Julia had suffered from had a tremendous effect onthe development of Ben. The mother’s contact and interaction withthe child was minimal, hence, hampering the child’s development. Itis evident that the speech and language delay of Ben is abnormal, andthere is a huge problem in his speech. The difference in the numberof words he is supposed to master at the age of two years is huge. Itis, therefore, the role of the parent, Julia, to enhance theenvironment in which Ben develops, and also to improve on herparenting styles in order to complement the growth gap that exists onthe child’s development.
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