Speech, Language, and Communication in the Early Years – Interview with Dr. Krupa Murugesan.

Speech, language and communication in the early years

Speech, Language, and Communication in the Early Years

Today, we interview Dr. Krupa Murugesan, assistant professor at the Department of Speech-Language Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai.

In today’s episode, Dr. Krupa, talks about the difference between speech and language, the importance of developing communication skills in children, and the milestones in children’s speech development.

Good morning, Dr. Krupa! Can you tell us some background information on your qualifications and your work experience?

Nice to meet you, and glad to be a part of this!

I’m a speech language pathologist by profession and I have about fifteen years of experience working with children and families who have communication related issues. And I predominantly work with children and working with families on empowering them to be better facilitators of communication.

Qualification, as such, I did my Bachelor’s and Master’s in audiology and speech language pathology,and I’ve also done Bachelor’s and Master’s in psychology. Added: Subsequently, I completed my Ph. D in Speech, Language and Hearing Services.

I also have a couple of trainings like the Hanen’s More Than Words and It Takes Two To Talk, which empowers professionals to be better facilitators of communication, which coaches, and helps in coaching other parents.

And I’m there with Ramchandra as an assistant professor. And I do take classes for budding speech language pathologists and see children and families. Apart from that, I also work as a consultant speech-language pathologist at an NGO called Vasantham, which is a residential special school in Chennai run by my mother.

We hear two different titles: speech therapist and speech-language pathologists. Is there a difference between the two?

Technically speaking, actually no, because both are the same and…, but speech language pathologist is more apt because it doesn’t deal only with therapy. It works with identifying the cause whenever possible, assessing what could be the reason, what is the level of the communication of the child or the adult; and then treating them accordingly, modifying the environment as required, empowering the stakeholders like the family, the school and everything, the pathologist…, speech language pathologist is a more ideal term.

You’re right because there is a lot of…, evaluation and understanding what is causing… and how to address the needs. We get many questions from parents and other caregivers. We notice that there is a fair amount of confusion about speech and language. Their focus is mainly on the child’s ability to talk. Can you explain the difference between speech and language for our listeners?

So, this is one of the common questions many people have, right from being an SLP or even a parent, ‘What’s the difference between speech and language?’ I would like to introduce another term to it, and that’s communication.

So basically, among these three, the speech is whatever we produce verbally. And language is about the content, how we are communicating, and language need not necessarily be speaking. It could be through sign language ‘I wave bye.’ And all of us use it very commonly. Some of them have rules for sign language based on where they are. So that’s language and written mode is also language.

But speaking deals only with talking. And communication is when there is an interaction. But basically, to look at these two speaking is how I speak, how it is being delivered. Language is about the content and how it’s structured. It involves cognition as well, when we talk about language.

When I say speaking, somebody speaking well, and we only think about, ‘Oh, how is the voice? How fluent the person is and how clear the person’s speech is.

But when I talk about the person having good language, it’s more about the vocabulary, the different types of vocabulary the person uses, the complexity of sentences. So this is to deal with verbal language. But when it also comes about writing and other ways, language covers a large area of how a person is communicating through indirect ways… their body language.

There is a lot of information beyond speech when we talk about language. At the end of the day, all of this comes down to communication because we use any language – it’s more like a mode of communication – when we want to convey our thoughts and needs. We want to share. We want to ask for information. So that comes down to communication, finally.

So communication is critical, especially as children are developing their speech and language skills.

In fact, I would say the speech therapist, or speech-language pathologist, is mainly a communication therapist.

Parents come to us when their children struggle with reading. As we gather information, they tell us their kids were late talkers. When we ask parents if they did an evaluation for the speech delay, they often say ‘no!’ Friends and family, or total strangers on social media advised parents, “Oh, my child was like this, and now we can’t stop him from talking,” or “Oh, this is normal. Nothing to panic! You don’t have to see a therapist for this.”

 A lot of this misinformation comes from not knowing the range of typical speech and language development. Can you elaborate on what is typical or normal for children from birth to five years?

That’s an interesting question and much needed, too, because there’s a very close relationship between how somebody starts reading…, literacy development, and how the language and communication develops. But unfortunately, we do ignore or we don’t try to understand the relationship.

Basically, children as young as three months or four months…, they start making sounds. They start making brr sounds. They start playing with the articulators. And as they start growing, they start making more sounds like ga ga ga, bubu, mumu.

They start playing with the vowels and consonants, trying to produce different sounds and as they see an adult and the way their articulators are moving the mouth and the lips, they try to imitate them and that’s how they start communicating. And by one year we all know…, most of us are aware children start telling, ‘Amma, appa, paapaa, thatha,’ few words that they try to communicate or call people. And even before that, by ten months they do tell a few words. Some of them do continue, some of them…, it gets faded overtime.

But one year is the milestone what we must remember. Just like a child starts walking by one year, one year is a time when child also starts to talk. And by one and a half, some children do talk one- or two-word combinations. Their vocabulary size increases suddenly. They start talking about fifty words, eighty words. Again, all this depends on the exposure that the child has. How many people are at home? Do we keep talking to the child? What the child sees, what the child hears…, and by two years, children start talking in two-word combinations.

“Amma vaa.” “Thanni Thaa.” “Idhu vendaam.”

I need this.. that one.” “That socks.” “This chocolate.” “No bikki.”

So, they start using these combinations by two years, and by three years, they do three-word combinations. By four, definitely children start understanding indirect requests. “Can you do this for me?” They do have a peer group. They do have their own friends and they may have slang that they use with their friends. And these days the exposure is very high that…, media is there.

Children talk to their own circles. Their vocabulary is huge and they direct stories by 3-4 years; imaginary stories, stories that they were told to them by their parents, or they’ve read somewhere. And a lot of information or development that used to happen by seven to eight years happens for children even by three years these days because their exposure is very high. Again, there are developmental milestones, and children tend to understand or speak words with ‘r, l’ by six to seven years. So we don’t really need to worry about our three-year-old child not saying r, l.

But having said that, it’s important we do remember milestones like one year – one word, two years – two-word combination, three years – the child does three to four-word sentences, and by four years definitely they should be narrating, telling stories, asking questions.

“Why is this like this? Why are we going to this person’s house? Why can’t I play now? Why should I do this and only after?” The before and after relationships!

So, these are important. And where do these come into play? Children start seeing things that we buy at home. The labels on the products that we buy and use have names. And before they even start identifying alphabets, they know this is the so-and-so soap; this is that toothpaste. This is a…, a toffee that I like. And this is a cereal that I like to eat.

They start identifying alphabets, and when they start going to school or when they start looking at books, they start identifying and connecting the name with the word that they see, the picture that they see, the action or the function of it. Introducing books at three months definitely helps children.

There are a lot of books which can be used in the bathtub…, which are waterproof. It can be played and children start learning to turn. They know there is a picture, they know to touch, and gradually, words are introduced in books. There are books where they’ll have one picture and a word beneath, and they start scrolling from left to right. These are emergent literacy skills that help a lot when they go to school.

To track from left to right, turn the pages from right to left, you know which is straight and which is holding it upside down and…, those families where parents read books, parents read the newspaper, children start holding books very young. In families where they read a lot of books, their (children’s) vocabulary and the kind of sentences they use would be different. The earlier we introduce books, the earlier they start looking at things. It facilitates their communication and thereby also facilitates their literacy skills.

There’s a wrong notion that books have to be introduced after they go to school. And that’s when the struggle starts. So then, everything is new to them. They’ve the syllabus to finish, there are activities to complete, there are deadlines…, and then children do not have enough time to explore. So, they don’t really learn much, but it is formal and monotonous. And they stop enjoying the reading aspect. When it starts early, they start enjoying and they pick the book on their own.

Instead of giving screens, we can actually use a lot of books so that when we travel, children start looking at them. A lot of research and evidence shows that when we introduce books, very young children learn and read much more easily.

Yes, absolutely! When does children’s vocalization become intentional communication?

Around eight months or nine months, children start communicating, vocalizing intentionally because they want to grab our attention. But even before that, I personally would say it is intentional because when they are hungry and want a parent to come, they do start crying, and it’s still intentional. So from three and a half or four months onward, children’s cry…,  their differential cry, the way they vocalize it emerges to be intentional…, where they want to gain attention, or they want to call for something, or if they’re expressing pain.

More sounds start coming in by eight to nine months, and their communication becomes more intentional. And they also start imitating us. There’ll be the intonation that they copy. It may not be the words that …, that we speak, but when we are happy, when we communicate with them, and they reply back, they would use different sounds, but it will still have that intonation as an adult.

Slowly, as I said earlier, they start getting into words. It becomes more intentional when their needs are satisfied. When a parent is busy with something else, and it’s ignored, their intention gradually reduces. Even if they have the intent to communicate and there’s no reciprocation from our side, then gradually, even the intent might go down. So, it’s important we put our things aside sixty to seventy percent of the time, and when there is a call from them, attend to them…, and then expand that further to communicate.

That’s a very good point about responding to them, and how their intent can go down because that’s something that we hear a lot from children who are institutionalized. No one is responding to them, and so they’re passive. Young children who were adopted from institutions…, they learn intentional communication around two and three years when other children are starting to use language for processing and critical thinking, problem-solving, and critical thinking.

Parents play such a vital role in a child’s speech and language development. Is it just that parents must talk a lot, or does the quality also matter?

That’s a very valid question and much needed because a lot of parents do come to us when there’s a delay and the child is not talking. Sometimes the grandparents come and say they’re not spending time. Sometimes, there are parents where the mother is blamed or the father is blamed. ‘You’re not spending enough time. You quit the job!’

After seeing a lot of children, I see that it’s not really the quantity that matters, but the quality first!

There are parents who are there with the child the whole day, but they’re busy with their own daily work and not really having enough time to spend with the child. So, a working parent or a non-working parent really doesn’t matter. But with respect to the time that I spend with the child, quality time…when we go to home visits and observe children, we ask the parent, “Why don’t you sit and play with your child? We’ll observe and then give feedback,” and we see,

“Oh, I’ve have never played with him. I just give him the toys, and he plays!” There’s…, that’s one side. On the other hand, there are parents who say, “Oh, I’ll sit and play.”  They’re playing, and we see there’s a background…, TV that’s on through the day.

OK.

It could be this potential communication partner, that is the parent, who is also watching some serial. They are kind of distracted a bit, so their attention is divided between the child and the TV, or something else will be in the kitchen. So, there’s divided attention. So, we always suggest, even if it’s half an hour or one hour, when you spend time with the child, just play. Don’t worry about what’s there in the kitchen, switch off everything there!

Don’t have a background TV running. At least half an hour or one hour in a day, spend undivided attention…, give that undivided attention to the child. Play with them. Enjoy playing. Don’t have demands!

“I’m playing today. This is the game we have to finish. These three games!”

Just play with the child. My PhD. was on observing caregiver-child interaction in about 150 families, children with autism, and those who were typically developing.

OK.

Constantly, both with the parents of children with autism and with the typically developing, what we observed was that, as adults, we tend to ask a lot of questions. We tend to give them directions!

“Do this! Point out this! Show me this! Show me that! What is this?”

 Absolutely.

And this Hanen training actually helped me introspect myself, and I, well I realize that I’m equally bad. I was equally bad. When we talk to children, we think…, we take a dominant role, and we try to guide them, but ideally, we should just let them play; only do commenting!

We keep telling parents it’s like how it comes in cricket…there’s a running commentary. You keep talking about what the child sees. He sees a toy. “Ohh, that’s a red ball!” He switches to something. Talk about that next second. He switches to something. Talk about that. So, he knows whatever he sees, there is an object. He is seeing, and he’s getting the visual information; we are talking about that, he’s getting the auditory information; gets to touch, he gets tactile information. So, they get multi-modal input. And even if they miss out on something, there’s some mode that gives the information, and that helps a lot.

And we have done some studies here in Ramchandra and also found that coaching parents one-on-one has changed the way they communicate and thereby reflected in the children’s communication. Many children who are minimally verbal have started talking; have started communicating; even if not talking verbally, they’ve started communicating. They know that ‘My behavior is acknowledged by my parents, and I have a role in taking decisions. It’s not just my mother who’s taking the decision. It’s not just my father who’s deciding.’ It’s…that makes a lot of difference and.

So, since you talked about the mother making the decisions…, the family dynamics with…, a lot of them have extended family. Does that interfere with…?

Quite a lot, a lot, in fact, especially when grandparents are with them. When the parents come here, we talk to them, and they follow this procedure. Grandparents say, “No, no, the child is crying. Give it to him. Don’t, don’t! He’s….” They pamper. They say, “Ayyo paavam!”

“You started talking late. Your husband started talking late. Why are you trying to push the child?” Those things do come into play mostly, but there are a few families where grandparents do a wonderful job…, than the parents.

They are good at guiding the parents.

I would also say grandparents’ distraction with gadgets is minimal because they don’t look at the phone, but parents tend to. ‘There’s a message; there’s a pop-up that’s coming, there’s a notification! I have to go look at it.’ Then they get carried away. Sometimes there’s a call from the workplace or something else. ‘There’s something that I’ve got to attend to at the door; there’s a delivery!’

Then, the interaction that we are working on goes off. We say ‘you pick the time whenever you want, but let that be an interaction that you and your child have and that you enjoy doing!’ There are times when parents come and say, ‘I felt very good! Among all the stresses that I have, I enjoyed playing with my son!’

And we also suggest to parents, ‘the mother may have some set of games, the father may have some set of games, you don’t interfere in each other’s…, you don’t give directions.

You know, though, fathers spend less time; generally, in most families that we see, children have their own games with fathers. And it’s often not rule-driven, unlike with the mother. I’m not trying to be stereotypical, but we do see that in many families. Mothers tend to put rules around the game that they play, but fathers don’t have rules. They just play and there are children who pick up more words with the father.

Ah, OK.

Invariably, it’s about the quality of interaction. And we also suggest, ‘Have them involved in the daily activities. You buy groceries, and you have to put them back into the fridge or your containers, then take the child’s help. Let them do it, and they’ll learn the words. You have to go buy, take them along.

It’s not instruction time, it’s actually practical.

Yeah. ‘You’re cleaning up the house? Let them help in cleaning.’ It’s a win-win because if we tell them, ‘Spend half an hour or forty-five minutes with your child.‘ Before I was a parent, I used to insist that so much! And when parents come back and say, ‘No, I couldn’t do it today,’ I was wondering why parents can’t spend half an hour in twenty-four hours. Then, after I became a parent myself, I realized that it was very difficult.

Yes, I learned that, too.

We learned the hard way. It’s not easy! It’s easy to sit on this side in a chair and say, ‘You do this at home,’ but at home, sometimes they have to cook for multiple people. They’ve to take care of so many things, and it’s difficult. So, when we say, ‘Get them involved in the daily activities, they get one extra helping hand!’

So, the child helps, and the child also learns. The parents feel less stressed when their children are involved in daily activities, and communication happens as a part of it. We say speech therapy happens throughout the day, and as long as the child is awake through the day, it’s speech therapy. It’s not really half an hour or one forty-five minutes.

Exactly.

They talk about vegetables, fruits open, close. It’s over. It’s full. There are so many words that can come in with daily activities.

When boys show a speech delay past three years, their parents are told not to worry. Why? Because boys talk late. Can you clarify for our listeners whether boys do talk late or if their development falls towards the outer end of the range?

We do also see with our children around a lot of them who come to us, there is…, they are a little laid back, I would say; on the outer edge, not really a delay, but on the outer range when compared to girls.

Though boys explore a lot, they go around, they explore. They’re more physical than girls generally. But again, this is just one part, because a lot of other factors influence communication development like, how many people are at home? How many people are effectively talking to the child? What does the child see? How much of exposure that the child has to go out because a lot of children during this COVID time did not go out at all, and the screen time drastically increased!

And they picked up a lot of vocabulary from that, and it went on from there. But gender differences between boys and girls it’s more equivocal. We do see boys talk a little late. But still within the range within the range, yeah.

Within the range, that’s key! So, it’s not like they…, you can just sit back and not do anything.

No, definitely not! Definitely not! Female children start talking by ten months, one year. The first one. Boys may do it by one year or one year, two months, definitely before one year, three months. Not later than that, and we can wait for a maximum of three months. Not more than that. For all the milestones, we can wait for three months maximum – the speech related. If not, then it’s important that adequate intervention and counseling, and support system is taken care.

And even that three months is if the other parameters are fine; if the child is understanding well, if the child is at least trying to communicate gesturally, if there are other delays, and if the child is also not understanding adequately and there is a delay, that’s…, we don’t need to wait even for those three months.

Right. OK. What is your advice for parents who are concerned about their child’s speech delay?

Parents who are concerned about their speech delay…, there are two things.

First thing I would say is don’t be too anxious that, “Ayyo, there’s a delay! There’s a delay!” On the other hand, I think it’s important to know the milestones: one year, one word; two years toward combinations; three years, three to four words, and they ask questions, answer to questions; and by four, definitely they should be narrating something that’s imaginary, able to converse with a person for about a topic for some time, talk about something, ask questions, give indirect comments.

All these are important. And if the child is not doing this, especially that one-year milestone, even by one year, three months or one year, six months, the child has not spoken a word or doesn’t speak 4-5 words, it’s important that we start taking help from another person.

As parents, and as families, sometimes we tend to console ourselves. ‘Oh, it’s fine. I started talking late.‘ It’s important we see…, it may not necessarily be therapy always. It may be some simple advice or strategies that we can follow at home. So, it’s better to consult a professional, get the child observed for a play visit, and then take a call.

Generally, we would suggest…, what we recommend to parents is ‘play a lot with the child, play, play, play,‘ and don’t expect the child to do anything. When we say play, they say, ‘I played today but the child was not talking,’ and this adds some stress. ‘Oh, yesterday I did, he didn’t! Today also I did.

No, the play doesn’t come with an expectation. Just play, enjoy playing. Show the child what can be done, not what he should do. We should not decide what a child should do. Just show. Model the child what he can talk. When he asks for something, we just say, when he comes and pulls, ‘Mama, come! Mamma, come!‘ When we open some box, ‘Open. Open!‘ Just tell that several times. ‘See, I’m opening the box,’ we don’t need to say. ‘What I’ll open, it’ll open!‘ That also is not required. Just say ‘open, open,’ and do it.

‘I’m going to the washroom. I’m going to the kitchen,’ this commenting on whatever we do on a daily basis, getting the child involved in daily activities, making them responsible for the morning to evening activities, engaging them, talking about it, and giving them choices. “Do you want a red dress or a blue dress?” Make them feel responsible, don’t just decide what they have to wear. We should be their friend and supporter, not like the person who decides what they should do.

And start introducing books as early as possible. Three months is the right age to start. It may sound, ‘Three months. What book do we get?’ There are enough number of books, and I would always suggest going to the bookstore in person and choosing. Let the child choose.

Doing this online is very easy, but going to the store, letting the child turn, choose the book, and when we let them choose, they will start taking it again and again instead of pushing them.

And whatever rule holds good for the child holds good for the adult at home. It can’t be child does this, but I will do something. ‘You play with this toy. You fix this. I will sit and do something on my phone till you finish it.’ You’re setting the wrong example. If we say no screen time in this activity, it’s no screen time for the adult too.

And watch out for the words that we speak at home and what we watch on TV. We may watch a movie together as a family, but what words come in that? Because children pick up words very easily.

Screen time. How much time are we getting exposed to, not feeding them with screens, letting them explore the food, at least one or two meals in a day.

For one meal, sometimes we are in a hurry, and they are in a hurry, you need to use screen is fine but not through the day or for every meal that day. Talk about things that they are seeing. The photograph that we take on the phone. It would be nice if we could also print a few and keep it so they get to turn and see. We take the children to the zoo. We click so many photos, but it’s always in the gallery. At least three or four can be printed. Just put it into a folder, and as they keep turning, they keep talking about it.

So these are some ways that will help communication, and this definitely facilitates their play, cognition, their thinking, their imaginary skills. Communication is the key to everything. And all development happens hand in hand, they’re all interlinked. So, these strategies will help parents to be better facilitators of communication.

Next week Doctor Krupa answers questions from parents and touches upon how child-directed play develops language skills.

Read in detail:

The Speech and Language Developmental Milestones

Read other interviews here:

Mental Health Counselling in India

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