Speech issues in young 4 year old

[carriede]

My 4 year old shows no signs of Autism or other related issues. But he does not say his words properly.

He speaks in complete, complex sentences. He'll look at you when he talks. He knows all the basic letter sounds and can say them as accurately as a 4yo should (from observing big brother's lessons). He hears fine.

But he does not pronounce words properly in everyday speech. He's mostly missing consonants. If asked to say it intentionally, he can, when he wants to.

I've searched on the internet for therapy type suggestions, but I cant find anything geared toward this particular problem. At this moment he's playing a kids monopoly game with DD8. He understands the rules and flow of the game , can make change with the bank, he can even strategize a bit.

I'm just really confused about why this is an issue. I expected that as a 3 yo his speech would develop, and it has overall, but all my other kids were understandable by others by 4. And without any other developmental issues, I'm not sure how to approach this.

Any ideas as to the source of the problem or possible fixes?

 

Some examples: "this" sounds like "di"; "sit" is "i" with no s or t; "look" is "uh" with no l or k

 

[PeterPan]

Have you started by getting an SLP eval? If you want to find someone trained to eval apraxia (motor planning of speech), you could look for a certified PROMPT therapist. https://promptinstitute.com/default.aspx  And yes, that's how a motor planning of speech problem could present, with a dc who can say sounds in isolation but struggles to motor plan them in the whole. 

You're NOT being worriesome or over worried to want this eval'ed. My ds was diagnosed at newly 2. I would go to the apraxia specialist because they can *discriminate* it from other disorders more accurately. 

 

[Aura]

I recommend getting him evaluated by a speech therapist with possible speech therapy.

Your ds sounds like my youngest, who is now 9 and in speech therapy. I always thought he'd outgrow it, but he didn't, and I wish I'd addressed it when was 4 instead of waiting.

Edited March 10, 2020 by Aura
Typos

[PeterPan]

47 minutes ago, carriede said:

My 4 year old shows no signs of Autism or other related issues. But he does not say his words properly.

He speaks in complete, complex sentences. He'll look at you when he talks

Does he have a sibling on the spectrum? Why is this on your mind? Just wondering.

So, fwiw, eye contact issues are going to be more apparent with strangers than they are in the home with people he's familiar with. I would watch what he does at the grocery store when people interact with him. Also look at pointing, reciprocity, and repetitive behaviors.

My ds has a IQ, like it sounds like your ds has, and his issues weren't completely apparent or easy to discriminate at that age. They were but they weren't, if that makes sense. Like I can see it in the pictures, and it was obvious in the way he interacted with strangers. But in our home, our interaction level was so high and the support so high that he was doing REALLY WELL. And that was what the psych who diagnosed him said, that we had done REALLY WELL with him.

So I don't know why ASD is on the table as a worry, but you should keep up the high level of interaction and get evals on the speech, sure. It could be motor planning and not a developmental delay, and that's why it's not coming in. I would also take him in for a hearing eval, JUST TO BE SURE. Did I say that emphatically enough? You should. Our university will see people for free and we've had other boardies say the same thing, that they got hearing evals through their univ at low cost. And our univ has top notch APD booths too, so they can do some screening and observation. Sometimes, just getting them in that fresh environment and getting more eyes on him, some things become apparent. 

So the hearing would be an eval to exclude things, but I would still do it. The SLP might even request it. But if you can get it for free/low cost, I would, just to exclude. We knew my ds had motor planning problems, but you can have layers of issues. The APD question they won't really diagnose till later, but still it's laying the ground work for that discussion too.

Does he have any sensory issues or behavioral issues? Unexpected wetting, discomfort with sitting, unusually high level of motion, sensory seeking or avoiding? I'm asking, because sometimes there are retained primitive/neonatal reflexes that, when integrated, result in a language jump. 

Also, how is his phonological processing? Is he discriminating sounds and developing phonological processing age-appropriately? Can he rhyme, clap syllables, indicate the first sound of a word if you say it, etc? 

[PeterPan]

2 minutes ago, Aura said:

I wish I'd addressed it when was 4 instead of waiting.

Bingo. This sounds like it's setting off Mama's mother gut in a way that goes beyond oh he needs some help with his th or r. And those deeper issues take a lot more work, more than you can do googling the internet. My ds has gotten very specialized speech therapy since he was 2 and he's now 11 1/2. We're STILL doing speech therapy. He's considered to have severe apraxia, but our therapy has WORKED. He sounds great, it's just that it takes a lot of therapy to get him from finally able to say a sound with supports to able to say it independently, comfortably, automatically in speech.

And not to scare the op, but yeah the stories I had boardies telling me, when I was deciding how to handle this with my ds, were basically of people, ADULTS, wishing they had had speech therapy earlier and more aggressively. The difference in outcome, even when the speech comes in, can be how easy and automatic their speech is.

You will not regret going for good speech therapy. You will not regret driving as far as it takes for a good, accurate eval. I was driving 2 1/2 hours when we started. Then they finally moved closer so it was only 2 hours, lol. But to get a good eval with someone who is certified so you can discriminate praxis vs. something else, that would be worth the drive. Then decide how to handle therapy when you have an accurate diagnosis. 

[Rachel]

As the other recommended, I suggest getting a speech evaluation. Call today, in many areas in can take awhile to get in. It took 6 months to get a call back from two different places in my area and I’m not in a rural area. 
 

My then 5.5 year old was having difficulty pronouncing certain sounds, it is common to have  difficulty with the particular sounds he struggled with, but he was correcting in an unusual way. Most people told me he would grow out of it, I trusted my gut and got him evaluated. Speech therapy made an incredible difference. Just getting the evaluation gave me comfort. 

[Junie]

1 hour ago, carriede said:

My 4 year old shows no signs of Autism or other related issues. But he does not say his words properly.

He speaks in complete, complex sentences. He'll look at you when he talks. He knows all the basic letter sounds and can say them as accurately as a 4yo should (from observing big brother's lessons). He hears fine.

But he does not pronounce words properly in everyday speech. He's mostly missing consonants. If asked to say it intentionally, he can, when he wants to.

I've searched on the internet for therapy type suggestions, but I cant find anything geared toward this particular problem. At this moment he's playing a kids monopoly game with DD8. He understands the rules and flow of the game , can make change with the bank, he can even strategize a bit.

I'm just really confused about why this is an issue. I expected that as a 3 yo his speech would develop, and it has overall, but all my other kids were understandable by others by 4. And without any other developmental issues, I'm not sure how to approach this.

Any ideas as to the source of the problem or possible fixes?

 

Some examples: "this" sounds like "di"; "sit" is "i" with no s or t; "look" is "uh" with no l or k

 

There are lots of reasons for speech issues, not just autism.

Two of my girls have gone through some speech therapy.

We started with a referral for speech therapy from a children's hospital.  I think therapy associated with a children's hospital is definitely the way to go.  I'm sure there are independent therapy centers that are of good quality, but I would go with a children's hospital if possible.

And, yes, getting an evaluation can often take months.  I would start now.

[Farrar]

It sounds like it could be within the range of normal, but I agree with the above to just get the SLP eval. I don't think you'll regret it.

[sweet2ndchance]

The fact that you can elicit the sound from him when you get him to focus is a good sign. It could be just a habit or it could be something more. As others have said, speech issues have nothing to do with autism or overall intelligence. Very smart kids can have speech issues too. Given his age and the nature of his errors, I would get him evaluated by the school district if nothing else.

I know it might be harder in some districts than others but he should still fall under your states "Birth to Five" initiative. Depending on your family's financial situation, you might be able to get greatly reduced or even free speech session until he is five years old. Our local Headstart program runs the "Birth to Five" program in my area (don't know if they do in all areas) and they actually had special services for homeschooled children! It's worth checking and seeing if you qualify. You don't necessarily have to be below poverty level to get access to services.

[PeterPan]

1 hour ago, Junie said:

I think therapy associated with a children's hospital is definitely the way to go. 

Around here the children's hospital (very big, exceptionally well known) does *not* have people trained in the best techniques for apraxia. So if that's what your dc has and you use them, you're not getting the best therapy. And the cost can be 3X private centers. I've met kids with apraxia who are largely unintelligible and had children's hospital services. It has to be the right therapy and paying more doesn't guarantee that unfortunately. People always assume I drive 2 hours to get to another big children's hospital in our state, and nope because they aren't trained either. It's really astonishing.

 

[PeterPan]

1 hour ago, Farrar said:

It sounds like it could be within the range of normal

For a 4 year old??? 

http://www.ldonline.org/article/6313  This chart hits all the areas of language development, so you can not only be looking at articulation but narrative language, receptive, etc.

I'm especially concerned that he can say sounds in isolation (the thing you worked on) but not get them into words. That's what you want the explanation on, to know whether it's a hearing issue (specific sounds correlate to specific ranges of hearing, so they can be very targeted) or phonological/auditory processing (not discriminating to include them) or motor planning (can say in isolation but not motor plan for complete words/phrases/sentences).

The other thing we look at, when a question like ASD is on the table, is joint attention. With my ds it was immediately obvious when we put him in swim lessons, because he was like a little man on an island, all by himself, not looking to me or the teachers or anyone for comfort. Experienced teachers saw it immediately.

There are also some lists you'll find of oral motor planning red flags. Things like can he blow bubbles, does he fatigue with chewing, did he babble, etc.

Anyways, keep us posted on how it goes! You should definitely be pursuing this. 

[maize]

Have you had his hearing checked yet?

[Junie]

11 minutes ago, PeterPan said:

Around here the children's hospital (very big, exceptionally well known) does *not* have people trained in the best techniques for apraxia. So if that's what your dc has and you use them, you're not getting the best therapy. And the cost can be 3X private centers. I've met kids with apraxia who are largely unintelligible and had children's hospital services. It has to be the right therapy and paying more doesn't guarantee that unfortunately. People always assume I drive 2 hours to get to another big children's hospital in our state, and nope because they aren't trained either. It's really astonishing.

 

Good to know.  Only one of mine had apraxia issues.  She had a very good therapist, imo, so maybe we got lucky.

Her speech issues are related to a genetic birth defect, so it was mostly covered by our medical insurance.  I didn't check to see if a private center would take our insurance.  We just went with the hospital as it was recommended, fairly convenient, and mostly covered.

At age 4 her speech was virtually unintelligible.  Only immediate family could understand her.  When we went for the evaluation, they kept checking more and more sounds that she was unable to make.  There were a lot!

Her speech issues are still not perfect, so we may end up going back.  We quit therapy because it was getting cumbersome with our schedule and she was making good progress.  She was given probably at least a hundred words to practice and she has conquered most of them just working with me at home.  She still hasn't mastered r's yet, though, so if she doesn't get those by summer we will probably be going back.

[PeterPan]

22 minutes ago, Junie said:

She still hasn't mastered r's yet,

Yup, Rs are the long slog, so many positions, sigh. We're in our 2nd or 3rd year, I forget. We lost vocalic Rs during a therapy break, so we had to go back. Now he has them, so we just have to keep working till they're automatic and easy. But he's far enough along that they have some wiggle room to work on other things as well. And yeah, it's a huge sacrifice. A whole day for the trip and then the day after to recover. And wearing out a car. But my kid is intelligible and that was the point. He had no speech at all and wouldn't have if we hadn't. He couldn't even pick up his jaw.

[Ottakee]

Agreeing with the speech eval.  It could be just a simple articulation issue.  A hearing test might be in order to make sure hearing is perfect.  A tongue tie and overly large tonsils can also affect articulation.

[Farrar]

1 hour ago, PeterPan said:

For a 4 year old??? 

 

Yes. I have no clue from the OP how often he's doing this. Or how pervasive it is. Some young 4 yos do have these little hiccups in their speech, including leaving off some sounds, and still have some very minor speech issues that can clear up with a little bit of intervention at home and aren't a big deal.

She should get him tested, like I said. And if it's pervasive and really is all the time, then yeah, that's not within the range of normal.

[carriede]

Wow, thanks for the support, everyone!

In regards to ASD, the only reason I mention it is because I have two brothers on the spectrum, so that's my experience with these sorts of issues. Both of them had/have speech problems and both had therapy for it (and their other issues). I also know that communication problems are a hallmark indicator for ASD, but I don't think my son exhibits any of the other indicators.

No, I have not had his hearing checked. I don't feel like this is an issue - he never seems to have a problem understanding us. But yes, if were going to pursue other therapies/diagnoses, I know I should have him tested.

Thank you all for the advice to schedule this sooner rather than later. He keeps making slow but steady progress, but I do feel he's outside of the normal range. I didn't know it could take so long to get an appointment time.

Looks like there's a lot of work to do. Time to explore our options!

[Farrar]

Since you haven't had his hearing tested... I do know a family who was sure their older toddler could hear fine and that she was facing developmental delays because she seemed to understand them but her speech (and some behaviors) were so off. Nope. Turned out she was nearly deaf and just really good at compensating. The good news is that fast forward and she's fine today, but they spent several years remediating. So yeah... start with the hearing test.

[sweet2ndchance]

And just to reinforce that hearing test even more, my oldest could pass the tone test in the pediatrician's office with flying colors but he still couldn't hear properly. When I finally got the referral to take him to an audiologist. The audiologist told us within the first 5 minutes of the testing what was affecting his hearing, his ears were full of clear, uninfected fluid. So he wasn't getting ear infections for some reason, but he couldn't hear clearly. He was hearing everything underwater essentially. So, I would recommend an audiologist's hearing test, not just a tone test. A tone test is an easy way to detect deafness but not a very good way to decipher if a child is hearing speech clearly.

Edited March 10, 2020 by sweet2ndchance

[PeterPan]

26 minutes ago, carriede said:

if were going to pursue other

Not to be rude, but if??? Please at least talk with your dc's pediatrician. I suggested the hearing eval because you probably can get it for low cost/free. But not doing ANYTHING at this point would be inappropriate. I gave you that link with developmental milestones, and not only is he behind on articulation, but he may be behind on other aspects of language development. It would be very sad at this point not to be getting evals, when you suspect something is going on and know.

Here's the thing. Technically the autism and the speech issues could have been different genes. So the total package in how it presented in your siblings was called autism, but if there was a distinct gene causing their speech issues, you could have carried that. For instance, one gene they look at is FOXP2. Yes it's correlated (loosely) with autism, but it's very *strongly* correlated with apraxia and speech problems. So you can have that gene going on, have speech problems, and maybe or maybe not get a broader diagnosis.

You should trust your mother gut here and get evals and intervention. Waiting does not make it go away. What can happen is that kids who don't get the early intervention then have other issues down the road, issues with narrative language, writing, phonological processing, comfort getting their thoughts out, etc. Getting a speech eval is a win-win here. And yes, at the very least he qualifies for identification and services through your ps. At least get him that. 

[sweet2ndchance]

I didn't read that "if" as she may or may not get him evaluations and services.... I read it as if she is going to get him evals, she understands that she needs to get his hearing tested too. I could be the one in the wrong here but I don't think she is considering not doing anything.

[Tanaqui]

Quote

 

No, I have not had his hearing checked. I don't feel like this is an issue - he never seems to have a problem understanding us. But yes, if were going to pursue other therapies/diagnoses, I know I should have him tested.

 

 

If he's as bright as it sounds he could just be lipreading and compensating really, really well for his inability to hear. Definitely do get his hearing checked and, especially as you have a history of autism in the family, also have him checked for an auditory processing disorder.

[carriede]

1 hour ago, sweet2ndchance said:

I didn't read that "if" as she may or may not get him evaluations and services.... I read it as if she is going to get him evals, she understands that she needs to get his hearing tested too. I could be the one in the wrong here but I don't think she is considering not doing anything.

Yeah, this is my sentiment!

[Clemsondana]

Depending on where you go for the eval, a hearing test may be part of it.  Our testing was at a university that trains speech pathologists, after testing at a private clinic a year earlier said that it was in the range of normal.  It sounds similar to the apraxia that we dealt with.  I would recommend earlier because they said that kids with apraxia often struggle to learn to read because the sounds that they say don't match the phonemes that they're being taught.  My apraxia didn't have this issue, but kiddo was atypical in lots of ways (and, alternatively, I've seen this be a big deal in some of the kids that I tutor who speak non-standard English - a kid who exclusively said 'dis' for 'this' as a dialect issue struggled to read the word 'this' because he didn't recognize the word).  

[HollyDay]

Sorry, I did not read all the posts.  Have you had a hearing test yet?  Dental or Orthodontic evaluation?  Vision test? 

[carriede]

2 hours ago, HollyDay said:

Sorry, I did not read all the posts.  Have you had a hearing test yet?  Dental or Orthodontic evaluation?  Vision test? 

None of the above. 🤔

[Tanaqui]

While I doubt that vision problems are likely to cause speech problems, you should get his eyes checked anyway. All kids should have their eyes checked yearly starting by kindergarten even if you don't think you see any signs of something wrong - and honestly, I only tell people "kindy" because people don't listen when you say "preschool or even sooner". Since you'll be calling within the next few days to start setting up appointments with an SLP and so on, you might as well get the yearly eye exam scheduled at the same time. (For all your kids if you aren't in the habit of taking them!)

[maize]

1 hour ago, carriede said:

None of the above. 🤔

I'm assuming you would have noticed if there were significant dental decay but difficulty with consonants is occasionally caused by tooth pain.

[maize]

6 minutes ago, Tanaqui said:

While I doubt that vision problems are likely to cause speech problems, you should get his eyes checked anyway. All kids should have their eyes checked yearly starting by kindergarten even if you don't think you see any signs of something wrong - and honestly, I only tell people "kindy" because people don't listen when you say "preschool or even sooner". Since you'll be calling within the next few days to start setting up appointments with an SLP and so on, you might as well get the yearly eye exam scheduled at the same time. (For all your kids if you aren't in the habit of taking them!)

I agree!

My husband was extremely nearsighted as small kid but no one caught it until he was in school--he would have benefited from glasses much sooner!

They took even longer to catch his hearing impairment in spite of complete deafness in one ear and moderate impairment in the other. It still boggles my mind that even though he was in speech therapy no one thought to get his hearing checked.

These things are just not always as obvious as you might think.

 

[Ottakee]

13 minutes ago, maize said:

I agree!

My husband was extremely nearsighted as small kid but no one caught it until he was in school--he would have benefited from glasses much sooner!

They took even longer to catch his hearing impairment in spite of complete deafness in one ear and moderate impairment in the other. It still boggles my mind that even though he was in speech therapy no one thought to get his hearing checked.

These things are just not always as obvious as you might think.

 

Yep.  I had a student this year that I was sure had a hearing issues.  No one had checked his hearing in 10+ years (he had had ear surgery then).  Tested out as profound loss in one ear and moderate to severe loss in the other.  

Sometimes a tongue tie can be missed as well.   For my son (adopted at 7) we saw an ENT for speech and his tonsils were so large as well as adenoids that they interfered with his articulation.  It improved greatly after surgery.

Lots of possible causes but certainly worth a hearing test, vision test (just because) and speech eval.  So much easier to address issues at 4 vs 10.

[Tanaqui]

If he'd had ear surgery then should it not have been obvious they should double check? Oh, I can't even.

[maize]

1 hour ago, Ottakee said:

Yep.  I had a student this year that I was sure had a hearing issues.  No one had checked his hearing in 10+ years (he had had ear surgery then).  Tested out as profound loss in one ear and moderate to severe loss in the other.  

Sometimes a tongue tie can be missed as well.   For my son (adopted at 7) we saw an ENT for speech and his tonsils were so large as well as adenoids that they interfered with his articulation.  It improved greatly after surgery.

Lots of possible causes but certainly worth a hearing test, vision test (just because) and speech eval.  So much easier to address issues at 4 vs 10.

Enlarged adenoids can interfere with hearing as well. 

[Lecka]

Repeat silent ear infections can also be a concern.  
 

Kids can “compensate” a ton by following visual cues and copying others.  

[Ottakee]

7 hours ago, Tanaqui said:

If he'd had ear surgery then should it not have been obvious they should double check? Oh, I can't even.

One would think........

Just this week it started raining and he suddenly said, "I can hear the rain".  He was so excited.  His hearing is not perfect but is greatly improved with his hearing aides 

[HollyDay]

On 3/10/2020 at 8:36 PM, maize said:

I'm assuming you would have noticed if there were significant dental decay but difficulty with consonants is occasionally caused by tooth pain.

Oral exams can sometimes tell if the teeth are growing in properly or if there is any other issue such as tongue thrust, lisp, etc.

[HollyDay]

22 hours ago, HollyDay said:

Oral exams can sometimes tell if the teeth are growing in properly or if there is any other issue such as tongue thrust, lisp, etc.

Also tongue tie, palate issues.  Sorry it took me multiple posts to get what I wanted to say out. 

[Sweets]

My now 22 y/o son had severe speech deficits as a child. He made no babbling sounds as a baby, and by 18 months we started with speech therapy. He was evaluated for everything, and we even took him to be evaluated at Vanderbilt in Nashville. They were no help. He didn't fit any parameters of autism. His hearing tests were normal. Tongue structure normal. He just could not talk beyond grunting, although at age 4 he could say Mama. We continued with speech therapy through age 14. It was a long process of basically teaching him to talk - how to place his tongue, how to make sounds, how to be aware of his speech so he talked slowly and clearly. He is now in graduate school and has normal speech. There were many times i would get very discouraged when he was younger. We homeschooled him because of his speech issues all through high school. I am not sure that your child’s issues are the same, but I wish someone had been able to be more encouraging to us years ago. If there are no underlying issues for speech impedients, it might be that your child just needs help in learning how to talk. Not all kids learn speech in the normal manner. From what I experienced also, this speech delay seems more common in boys.