Researchers develop tool to guide speech therapy referrals in children

Melbourne researchers have developed a new tool designed to help identify children at risk of speech disorders, with the aim of reducing unnecessary treatment for speech errors that often resolve on their own.

For many parents, the preschool years can be filled with quiet questions. Is this just a phase? Should we wait? Or is it time to ask for help? The new research, led by the Murdoch Children’s Research Institute and published in the Archives of Disease in Childhood, seeks to bring clearer guidance to those moments.

The study identifies “red flags” to guide referrals for speech therapy and confirms for the first time in more than two decades that speech errors are common and vary widely up to six years of age.

Researchers recruited 1,179 children aged two to 12 from schools, childcare centres and kindergartens across Victoria and New South Wales. Trained speech and language therapists assessed the children using a picture naming task.

The findings are likely to reassure many families. Developmental speech errors were common in children aged two to six. By the age of seven, 90% of children could form all sounds. Between eight and 12 years, only minor differences in speech were observed.

Some speech patterns were less typical. Disordered speech errors, seen in fewer than 10% of children, included vowel errors, transpositions such as “efelant” for elephant, and mixing up sounds such as “glack” for black.

When compared with data from 20 years ago, some sounds were acquired more slowly and some common errors took longer to resolve. However, the researchers found no evidence that children’s speech had become more disordered overall.

Prof Angela Morgan of MCRI said that although speech disorders present an increasing challenge for paediatricians, there has been limited evidence to guide which children should be referred for further support.

“The lack of research forces a trial-and-error approach, which can result in critical resources being wrongly directed,” she said. “This is compounded by the absence of any official English speech data being published for over two decades. New data is also needed to find out how new technologies, like phones and devices, are changing children’s speech.”

Dr Daisy Shepherd of MCRI said the large, representative study offered a much-needed updated picture of children’s speech performance.

Morgan said the new assessment tool identifies the lowest-performing children within their age group using speech tasks. In practice, she said, it would support healthcare professionals to improve detection and make more targeted referrals, ensuring fewer children are incorrectly placed on wait lists and reducing resources spent treating speech patterns likely to resolve with time.

“We found lots of young children can struggle to pick up speech correctly, which may explain why so many families seek support for speech development in the preschool years,” she said. “Furthermore, our data suggests speech is mastered more slowly and common errors are taking longer to outgrow compared with previous generations.

“Our tool identifies the children experiencing the most difficulty within their age group using speech tasks and will support healthcare professionals to improve detection and referral for disordered speech errors.”

For some families, early support can be critical. Isla, nine, has childhood apraxia of speech, a rare disorder that affects the brain’s ability to plan and co-ordinate the muscle movements needed for clear speech.

Her mother, Sheree, said Isla was referred to speech therapy at about two years of age after she did not meet early developmental milestones.

“Isla’s speech was delayed, she wasn’t babbling like babies do and had difficulty starting or transitioning between sounds or words,” she said. “Luckily at the time, Isla was already seeing a pediatrician who was able to refer us to a speech clinic. Despite acting on it quickly, we still had to wait another four months to see a therapist.”

She said therapy had made a significant difference, particularly to Isla’s confidence.

“Her speech difficulty has a huge effect on her confidence. When she was younger, Isla often gave up on talking and relied on non-verbal communication including gestures so others could understand her.

“But with the help of therapy Isla is now better understood, and family and friends have noticed the huge progress in her speech, she has come a long way.

“Isla knows what she wants to say in her head, but sometimes her mouth has trouble saying the words clearly and consistently.”

Sheree said the tool developed by MCRI researchers would help families and healthcare workers alike.

“We know so many families with children who have apraxia of speech who weren’t able to access early support,” she said. “Their GPs didn’t refer them to a speech therapist when symptoms first appeared, thinking the child would eventually catch up with their peers.

“On top of that, long wait lists and finding the right therapist fit for your family only adds to the delays. Children with speech disorders have to be incredibly resilient but they need early intervention to make sure they can thrive.”

Researchers from the University of Melbourne and Redenlab also contributed to the study. The research was supported by grants from the National Health and Medical Research Council and other funding bodies.