When Sooriyakanthy Gnanasooriyar’s son, Ajethan, turned two years old and could not yet speak, she knew something was wrong.
“He was not yet talking. He could only say ‘Mom’ and ‘Dad’. If he wanted to tell me something, he could only point. After his second birthday, I could really see that something was wrong,” explained the Scarborough resident. Her eldest son, who is just a year and a half older than Ajethan, had started talking when he was just a year old. She also noticed that other children Ajethan’s age were already talking.
Something wasn’t right, and her paediatrician agreed. He provided her with a pamphlet from the province of Ontario’s Preschool Speech and Language Program, which outlined developmental milestones that toddlers Ajethan’s age should be achieving, in terms of speech and language development. Gnanasooriyar could see that her son wasn’t meeting them. She became very concerned, but soon a vital source of support would provide both she and her son with the tools they needed.
After discussing her concerns with Ajethan’s paediatrician, she contacted the Toronto Preschool Speech and Languages Services (TPSLS), at the Rouge Valley Centenary (RVC) location in east Toronto. The clinic is located in RVC’s Shoniker Building. There, Ajethan was assessed by Janine Heath, speech-language pathologist, who confirmed that the toddler was not meeting the speech and language milestones expected for his age. He began speech and language therapy soon after the assessment.
“This wasn’t a straight forward case, which is not unusual for our clients. When I re-assessed him after his first speech and language intervention, I could tell that he wasn’t making the progress that we had hoped for and wondered if he was hearing properly,” remembers Heath. One of the recommendations made was to have Ajethan’s hearing assessed, to see if this was contributing to his ability to hear words, and to learn how to speak.
Ajethan’s paediatrician referred him to an ear nose and throat (ENT) specialist. Upon examination, the ENT discovered fluid in the toddler’s ears, which was affecting his hearing. Ajethan’s ears were fitted with tubes to help drain the fluid.
Ajethan’s story is one of many seen at the TPSLS. The program, offered through Toronto Public Health, has locations across the city. In east Toronto, the main TPSLS office is based at RVC, and oversees four satellite locations found throughout the east end of the city. Each site has its own team of speech pathologists, communicative disorder assistants, and early childhood educators. While the average age of the children seen at the clinic is 26 months, infants and children up to age five are seen there.
Last year, close to 800 children were treated at the RVC location for a number of issues, including: children with speech and language delays/disorders, autism, stuttering, cleft palates, and Down Syndrome. Speech refers to how sounds are pronounced. Language includes: knowledge of words; comprehension; the ability to produce sentences; and the social use of language. Language also includes learning letters and numbers, and eventually, reading and writing.
TPSLS also offers the Infant Hearing Program, and the Blind-Low Vision Early Intervention Program, two other community-based programs for children. This free service is available to qualifying infants, toddlers, preschool children and their families living in the City of Toronto experiencing challenges with communication development, hearing loss, and visual impairment.
Early intervention is key
“Research suggests that early intervention is extremely important. The critical period for language development is birth to three years of age,” explains Nancy Chisholm, manager of the TPSLS East Quadrant at RVC.
The long-term effects for children with speech and language issues can be significant, with many later facing academic and social challenges. So, early intervention is key. “We want parents to know that if they notice that their child has speech or language difficulties, that they shouldn’t take the ‘wait and see’ approach in getting it assessed. A child is never too young, and it’s never too early to start intervention,” adds Chisholm.
Assessment and treatment
Before treatment begins, the child is first assessed to determine their strengths and weaknesses. Goals are then chosen based on this, and recommendations for referrals to other services as needed. The speech-language pathologist will recommend a treatment plan for the child, which may be delivered in ‘blocks’ – or chunks of time. Parents are then given time between ‘blocks’ to practice the skills with their child, to support speech and language development. For Ajethan’s treatment, the initial goals were to improve his interactive and play skills; to follow simple directions; and to get him to become more imitative of actions, gestures, sounds and words.
Parents play a critical role in their child’s treatment, as the bulk of the child’s time is spent with the parent. At TPSLS, the speech-language pathologist will discuss different strategies to help the child meet their goals. The parents are active participants in the intervention, both at TPSLS and at home. “Parental involvement is the biggest part. We’re giving parents the tools they need to create a language-rich environment throughout their daily interactions with their child. They can then apply these tools and strategies in natural settings,” explains Heath.
An important strategy is to involve the parent in the child’s play, and to add language to the interaction. Face to face communication during conversations, and the use of short, complete sentences that describe what the child is seeing and experiencing, are other strategies often used.
Each therapy session builds on the strategies that have been practiced. In each session, it’s not unusual to see the speech-language pathologist, parent, and the child, playing together on the floor, putting the tools into practice.
Ajethan’s treatment sessions involved his mother describing everything he was doing and experiencing, to help him learn and better understand language, so that he could use it on his own. She learned to use short, descriptive sentences when they were playing with a toy, or reading a book, or during everyday activities, like meal or bath time.
“They taught my son, but they taught me as well,” explains Gnanasooriyar.
Ajethan has come a long way since his first visit to TPSLS. He is now five years old, and talking up a storm. Recently, the junior kindergarten student won the Co-Operation Award in his class. He can pronounce most words, although there are still some sounds that he struggles with. He’s on his final block of speech and language therapy, and will be transferred to the school board speech and language services for consultation in senior kindergarten.
“He talks so much now, I can’t even believe it,” says Gnanasooriyar. “I’m very thankful for Janine. Now, I tell anyone who I see that has a child with a speech problem to go and do speech therapy.”
How to access services
Anyone can access TPSLS’ free services, and a doctor’s referral is not needed. Parents can contact the Toronto Preschool Speech and Language Services directly at 416-338-8255, or visit www.tpsls.on.ca. They can be reached by email at firstname.lastname@example.org.
According to the province of Ontario’s Preschool Speech and Language Program, these are just a few of the developmental milestones that show some of the skills that mark the progress of young children as they learn to communicate.
By six months, babies should be turning to the source of sounds. They should also smile and laugh in response to the smiles and laughs of others.
By 9 months, babies should be responding to their own name, and should be able to get what they want through sounds and gestures. For example, reaching to be picked up.
At this age, your baby should be using three or more words, and tries to get your attention by using sounds, gestures, and pointing while looking at your eyes.
By 18 months, babies should be using at least 20 words. They should be responding with words or gestures to simple questions, like “where’s teddy?” and “what’s that?”
By this stage, most babies can follow two-step directions (ex. “Go find your teddy and show it to Grandma”). They can also use 100 or more words, and consistently combine two or more words in short phrases.
At 30 months, your baby should be using more than 350 words. They should also be able to remember and understand familiar stories.
By age three, your child should be able to create long sentences, using five or more words. They should also be telling simple stories.
By this age, your child should be able to follow directions involving three or more steps. For example: “First get some paper, then draw a picture, and last, give it to Mommy”. They’re able to talk to try and solve problems with adults and other children.
By age five, children are able to follow group directions. They can also describe past, present and future events in detail.
Ontario Speech and Language Program: www.children.gov.on.ca/htdocs/English/topics/earlychildhood/speechlanguage/index.aspx
To order copies of the Ontario Preschool Speech and Language Program developmental milestones pamphlet, visit www.serviceontario.ca/publications, or call 1-800-668-9983.