Cynthia Miller-Lautman

Hi, I’m Cynthia Miller-Lautman, an Occupational Therapist.

Dana Lawlor

I’m Dana Lawlor, a Speech Language Pathologist.

Cynthia Miller-Lautman

In today’s episode, we talk about how language develops in young children. We share some signs that could let you know when your child or another child might need extra help in learning language. As well, we talk about developmental language disorder or DLD for short. We give you some signs of struggle to look out for as your child begins their language journey.
Please do not use the information in this podcast to replace the professional services from a speech language pathologist. But also don’t forget to listen to part two where we talk about some simple ideas that can be used to help children learn language. Before we can get into talking about DLD or developmental language disorder. Dana, I feel it’s really important to talk a little bit about how we see language develop in early life.

Dana, can we start with an introduction about how babies and children learn language, how they actually learn to talk?

Dana Lawlor

Yeah. So yeah, I think it’s a great place to start. So language is learned from birth and babies learn about the world around them and they share messages in many different ways. They express themselves in many different ways. They cry to tell us many things. I’m hungry. I’m thirsty. I need my diaper changed. They express themselves through their facial expressions.
Maybe you’ll see a smile or a frown when you give a new food. Or if you take away their favorite toy. Maybe you’ll see their face light up when their brother or sister walks into the room.

Cynthia Miller-Lautman

So, Dana, are they actually talking with their face before they actually start to talk?

Dana Lawlor

They’re communicating with their faces for sure. Yeah. Before they’re able to talk. And you might see, you know, their eyes twinkle and open wide as a way of asking you for more tickles.

Cynthia Miller-Lautman

So you mean when I was tickling my baby and they smiled and laughed, that was their way of talking.

Dana Lawlor

Exactly. Yeah. Because if they can’t talk yet, their faces can share many messages and express feelings, but actually so can their whole body. And these are all ways that they can communicate before they’re even able to talk. So most very young children can express themselves through their bodies, through their gestures. For example, before my son could talk, he would reach up to me when he wanted to be picked up. And then he started saying “upie, upie, upie” which was his way of saying, “Up, please”. So you’ll see that most children learn to kind of do this to communicate because they’re not able to talk yet. And you’ll also see that most children learn to point to the things that they want before they have the words to ask. So here is an image that can help to explain language acquisition.

Typical language acquisition. It’s an image of an iceberg. And if you know an iceberg, there’s a peak on the top above the water, and there’s a huge part underneath the water. And we’ve just talked about what it looks like at the top of the iceberg, and that’s a child’s expression. So if you look here above the water, we see all the ways that children express or communicate what we’ve just mentioned.

So using their faces, gestures, sounds and words or talking and talking is just one way of how children communicate. But yet this is often the main thing we tend to focus on when a child is learning language. But all of these other ways are super important too.

Cynthia Miller-Lautman

Dana, I’ve often heard parents say, “I want my child to talk”, but what we are saying here is there is a lot more to talking. All the other things on that iceberg photo are also communication and they are all important for learning to talk.

Dana Lawlor

Yes. Yes. There’s a lot of different ways that children express themselves and talking is just one. Exactly. But before we can even get to talking and expressing, we need to look under the water. This is the biggest part of the iceberg. This is where we find a child’s comprehension or we say their understanding. So when I work with parents, I really try to explain the importance of building a child’s understanding as it’s the foundation of language learning. So a child needs to understand before they can express themselves. And we play a huge part in helping that understanding grow.

Cynthia Miller-Lautman

Wait, stop right here. You need to repeat that before a child can talk, they have to understand language.

Dana Lawlor

This is how language develops typically. They need to understand before they can learn to talk. Building that understanding comes from being exposed. We say exposed to language, which simply means giving children a chance to hear and be around language. So exposure to language can look like many things, Cynthia. Its like adding language into daily activities reading, singing, telling stories. And we’re going to talk more about this in part two of our podcast, which focuses on stimulating early language skills.

Cynthia Miller-Lautman

Okay, let’s stop again. So what we can do as parents and family is expose our children to language, surround them so they can learn to talk with language.

Dana Lawlor

Exactly. Exactly. It’s like a blanket, a blanket of language around them. So please be sure to listen in because we’ll get into how we can do that in part two. So then let’s go back to how language develops in children typically. So then as children grow, most will understand more and more words and then start to use those words to communicate. And in Cree, we would see words that would tend to get longer, and most children will start to have more words available to them.

Cynthia Miller-Lautman

Can you explain this a little more? So a baby’s first word might be no, but then other words will kind of start to pop in like dog or mommy, daddy.

Dana Lawlor

Exactly. Yeah. So you’ll start to hear longer words, maybe like banana, but you’ll also hear new words being used by your child. Like eat, more, want, mine, ball, up. Okay. So longer words and more words. And then in early school, like kindergarten or grade one, most children will be able to tell you a simple story or tell you something that happened during their day.And they’re really going to start to sound a lot more like an adult even at that age. So when language is not developing like other children, when it’s not developing typically, this lets us know that learning acquisition might be harder and help might be needed.

Cynthia Miller-Lautman

Hmm. This makes me think of a story when my son was in daycare. I mean, he was about four. I think most kids at four years old in his daycare, they were all talking in sentences. But I still remember there was one boy that was talking in simple words, not sentences. And he was frustrated. And I remember he was the one that was hitting other kids. I was always worried about him. Was I right? Should I been worried?

Dana Lawlor

Yeah, you were absolutely right to be worried. Some of the red flags would be that the hitting and the frustration and it could have been a sign that that young boy might have needed some extra help because he didn’t sound like the other kids around him. And that’s what we really want to pay attention to. Some children have a much harder time understanding what is being said, and they may have difficulty learning to express themselves like other children their age.

This is what the focus of today’s podcast is on. It’s children who do not understand and talk the same way as other children their age. There could be other things going on with the child’s development that might impact how the child communicates. But some of these children might have a language disorder which could lead into having difficulties learning in school.

Cynthia Miller-Lautman

Dana, so thank you for this first part, really explaining how kids learn language and how they learn to express themselves and the real importance of building language, understanding or comprehension, as you said, the part of the iceberg under the water. But now I really need you to tell me what is a language disorder?

Dana Lawlor

So the language disorder that we’re talking about today, the official term is DLD, developmental language disorder. A language disorder means that the child’s language understanding. So that’s the part underneath the water and their expression, the part above the water is not developing as we would expect. It would be slower and more effortful than other kids of the same age. Now, this is really important, for it to be a language disorder, these difficulties need to be ongoing and be big enough to get in the way of a child’s daily life, like playing with other kids, like interacting with their family, learning at home, or learning and participating at daycare.

Cynthia Miller-Lautman

So, Dana, if I understand correctly, DLD is a disorder. It doesn’t go away and it can cause a lot of problems later on or early on in the child’s life.

Dana Lawlor

Yeah, you’re right. If it is a disorder, it doesn’t go away when we are talking about DLD. It’s a disorder that impacts many aspects of life and it doesn’t go away. But it may change with time. It may look different with time. It’s there when a baby is born, Cynthia. But it can be very hard to see. It’s an invisible disability, which means that a child with a language disorder will really look no different than any other child.

Cynthia Miller-Lautman

So go back for a minute.

Dana Lawlor

Okay?

Cynthia Miller-Lautman

You said that a disorder can be hard to see?

Dana Lawlor

Mm hmm.

Cynthia Miller-Lautman

But then, really, how do I know it’s a disorder?

Dana Lawlor

So you can only really know by going to see a Speech Language Pathologist. And we won’t be going into the details of the disorder today, but a Speech Language Pathologist can figure out what’s going on. If it’s a disorder and what exactly to do to help, The child, with help from their parents or caregivers would go through a testing or assessment process.

Cynthia Miller-Lautman

So even though it’s only a Speech Language Pathologist who can decide if it’s a language disorder, are there any signs that we can look for? Are there signs that a child may be having trouble understanding that parents and educators can pick up on?

Dana Lawlor

Yeah. Yes. There definitely are things that, you know, we don’t want to just depend on whether or not we can see a speech language pathologist. There are things that you can pay attention to. So the child may struggle to use a variety of words or have a hard time finding their words. The child may struggle to make longer sentences, so their sentences might be quite short.
The child may struggle to tell a story. The child may struggle to follow a conversation. The child may struggle to follow instructions. So wait. I know you’re going to ask me. You’re going to ask me to dig in like, well, “what does it all mean?” Yeah. Right.

Cynthia Miller-Lautman

Yep. 100%.

Dana Lawlor

Okay. I just rattled those all off. Let’s go back for a second. First one. The child may struggle to use a variety of words or have a hard time finding words so they may only use the same limited number of words over and over again, or they may seem to have a hard time pulling the words out from their head.

Cynthia Miller-Lautman

Hmm. So, for example, if I hurt myself. If I had trouble with words, I might just say ouch. And if I could speak better and more. I might be able to expand. Instead, I might say something like, “Ow, Dana, I really hurt my leg. It hurts here, look at my knee. It’s all bleeding.”

Dana Lawlor

Exactly. Exactly. Exactly. So if you are really limited in your words, you might say ouch and you might be holding your leg. Right. You might be using gestures as well to supplement. But a child who doesn’t have limited words might be able to say, “I hurt my leg. Ow.” Right. Second one, the child may struggle to make longer sentences, so their messages might be quite short when other kids are able to talk longer and say more.

Cynthia Miller-Lautman

So if I get this right, it could be something like “I want the big red ball with sparkles on it” compared to “want ball.”

Dana Lawlor

Perfect. You got it. You’re a good learner. Number three, the child may struggle to tell a story. So, for example, the child may want to tell you something that happened at daycare, but they really can’t give you all the pieces so that you can understand.

Cynthia Miller-Lautman

Makes me think of when my son came home one time and he was going “school teacher hit ouch.” Compared to him later on at four years old, he would be able to say,” today, Bobby hit me and I told the teacher.”

Dana Lawlor

Right. Yeah. Perfect. Exactly. So parents, then, you know, if you’re not given all the pieces, parents need to fill in the gaps because the child can’t paint the full picture and it can lead to a lot of frustration and confusion. Number four, the child may struggle to follow a conversation. So if the child is listening to a conversation, they may not be able to put the pieces together and make sense of it, or they may not be able to have a back and forth conversation themselves with someone like we’re doing right now.

Cynthia. Number five, the child may struggle to follow instructions. So if you ask the child to do something, can they follow? Do they need to watch others around them to be able to follow? Do they need help many times before they can follow on their own? And if you ask them to do something they aren’t used to.
Can they follow that? So, for example, I’ll give you an example. If you always ask the child to hang up their hat and their mitts so that they can dry, but then one day you ask the child to bring their hat and their mitts and put them in the clothes dryer. Can they follow your instructions?

So remember, language difficulties and their impact on everyday life differs from one person to another. You may see struggle in some of these tasks that we’ve talked about, and maybe not as much in others. And also, there’s an important part. We also know that DLD runs in families. So if another person in the family has a language disorder, trouble with learning language, the child is then more at risk of having a disorder as well.We know that there’s a genetic link.

Cynthia Miller-Lautman

Wow. Okay. But then again, I have another question. How do I know if a child is having a hard time making longer sentences or telling the story? Like, how do I know what to expect from a three or four or five year old? My gut told me that that little boy in my son’s daycare had some trouble with language.
But how do I know?

00:18:14:03 – 00:18:38:07
Dana Lawlor
That’s a really, really good question. So a good way to see if the child is having trouble and may need help is to look at other children around the same age. So is the child able to understand and say things like other kids around them? And the other kids could be cousins, siblings or other kids at daycare and ask the educators at the daycare to see if they notice differences.

Dana Lawlor

You were a good observer, Cynthia. You notice the difference between that little boy and all the other kids in the classroom.

Cynthia Miller-Lautman

Hmm. Okay. So my next question is really, can a child have a language disorder in only one language? For example, they might be okay speaking Cree, but disordered in English.

Dana Lawlor

No, no. Now a child with a language disorder will struggle in all languages they speak. So if a child has a language disorder and speaks English in Cree, you’ll see signs of struggle in both those languages.

Cynthia Miller-Lautman

Wow. So this might answer a long term question for me. So my French is not as good as my English, but that doesn’t mean that I have a language disorder. I learn French later in life.

Dana Lawlor

Right. Right. You’re bilingual. You speak two languages, you’re dominant, or your first language is English, and you’re very proficient in English.

Cynthia Miller-Lautman

Thank you.

Dana Lawlor

If you had a disorder, Cynthia, then you’d have much more difficulty acquiring language or learning English. And you would probably not be able to use English the way that you do right now.

Cynthia Miller-Lautman

So, okay, that’s clear to me. But then how many people then do have a language disorder?

Dana Lawlor

Hmm. So DLD affects about 7.5% of the general population. So it’s much more common than people know. We see it in about one out of 14 people.

Cynthia Miller-Lautman

Hold on. One in 14 people. That is a lot. That could be two kids in every classroom of, like, a 30 kid classroom.

Dana Lawlor

Yep. It’s kind of staggering actually because DLD is one of the most common neurodevelopmental disorders, more than autism spectrum disorder, which is one in 66. So this is this is why we’re talking about this today. We want to bring more awareness to this. It’s big. It’s big. It’s more prominent than we know. So another thing that is important to know as a parent or as an educator is that developmental language disorder is also frequently associated with other difficulties, such as it can be linked with attention deficit disorder or attention deficit hyperactivity disorder.

And you can hear our podcast about ADHD as well. We have a nice podcast on that. It can be linked with motor coordination disorder or difficulties. So that’s difficulty coordinating your body, your hand or your mouth movements. And it can also be linked with behavioral issues. So difficulties controlling your emotions.

Cynthia Miller-Lautman

So these other disorders, attention deficit, motor coordination, behavioral issues, they don’t cause a language disorder. But if my child has ADHD, for example, I would want to keep an eye on their language skills.

Dana Lawlor

Exactly. So if you’re seeing behavioral challenges, attention difficulties, motor coordination difficulties with your child, you’ll also want to keep an eye on their language skills, because we often see that these challenges go together.

Cynthia Miller-Lautman

Wow. Okay. So if ADHD doesn’t cause language disorder and autism doesn’t cause that, what does cause language disorder?

Dana Lawlor

Well, we don’t know what causes DLD, so it’s tricky. But I can tell you what doesn’t cause DLD and it’s often a myth. Is being bilingual talking more than one language to your child will not cause your child to have DLD.

Cynthia Miller-Lautman

Okay, stop. I need to ask another question. So being bilingual does not cause DLD. Okay. But if I do speak English and French in my house, will my child be confused and could they maybe end up with a language disorder?

Dana Lawlor

Hmm. Well, there’s a few things to answer that question. When learning two languages, you may find that your child gets confused or they get mixed up, and that’s normal. And in time, it will likely become easier for your child and they will be less confused. If a child has a language disorder, they were born with it. It’s not because you’re speaking more than one language. And the research shows that children with a language disorder can learn more than one language. So a big message here that I really want to stress, Cynthia, is that it’s great to speak to your child in the language that is most comfortable for you. What is your strongest and your most comfortable language? Then go ahead and speak that language to your child.

Cynthia Miller-Lautman

So if my child is learning two languages, they might mix their languages together. Like, I want biscuit. I want a cookie. But they would say I want biscuit.

Dana Lawlor

Yep. Yeah. So, yes, if your child is developing, as we expect with time and practice, the two languages will become clearer for them. Their will become more separate, more distinct.

Cynthia Miller-Lautman

So eventually, then they won’t say, I want biscuit. As they get older, they’ll understand it’s “I want a Cookie” in English an “Je veux un biscuit” in French.

Dana Lawlor

You got it. Exactly.

Cynthia Miller-Lautman

Okay. Well, I have another one for you. So I have a colleague who recently asked me what to do. She speaks English really well, and she speaks some Cree, but she really wants her son to learn Cree. What language should she speak to her child in?

Dana Lawlor

Hmm. So I’m going to assume that her son is young. And that he’s just learning to talk. So then it might be best for her to speak in the language she’s most comfortable speaking. So in your example, she would speak English.

Cynthia Miller-Lautman

Really? But she has some Cree, and I know it’s so important to her. How will she teach her child Cree?

Dana Lawlor

Yes. And Cree is super important. And it’s important to her and it’s important to her family. You said she has some Cree, but that she’s more comfortable in English. So when your friend speaks to her son in her strongest and most comfortable language, she’s giving a solid foundation in that language. That is the foundation where other languages can be built.

What would be the most helpful is if she provided lots of exposure to English, where she is strongest and then I would encourage her to find ways to expose her child to lots of good language models in Cree. And so this can come from other people who are more comfortable than her speaking Cree. It may be a daycare. It may be through community activities. It may be through other family members. So maybe she can ask them to give her son lots of exposure to Cree, as she can also give exposure to carry through music, through the radio, by reading Cree books. And wait, if you know someone, Cynthia, who is the opposite, who speaks most comfortably in Cree but wants their child to learn English, then it might be best to give lots of exposure to Cree and ask others around to give exposure in English.

And sometimes we see it’s not uncommon to see that one parent is most comfortable in Cree. So they speak Cree to the children, while the other parent is more comfortable in English. So they speak English to their children. It’s really what’s important to the family. And, you know, learning languages is a gift. And all children can learn more than one language, even if it’s hard, even if they are found by a speech language pathologist to have a disorder.

What’s super important to remember is to give exposure to language. Lots of chances to hear and build the child’s understanding. So, Cynthia, invite your colleague to listen to part two. So she might just get some ideas, you know, that she hasn’t tried yet. On how to stimulate her son’s language skills.

Cynthia Miller-Lautman

Dana, I so enjoyed speaking to you today. And over the years, I’ve spoken to other wonderful Speech Language Pathologists who have taught me so much. And I think, again, my reminder is the biggest take home message here is to watch what’s happening under the water as your child starts their language journey. We often want a child to talk, but if we don’t give them lots of exposure to language to build that understanding, then it will be harder for them. It’s really important, though, to be aware of the signs of struggle that a child may have and learning language that we talked about today.

Dana Lawlor

Thank you, Cynthia. That’s an amazing summary and thank you for showing so much interest in DLD. It’s really important to try to get this information out to people. So even though, you know, a Speech Language Pathologist is who needs to be involved to identify a disorder, it’s really tricky right now. Right. Because at the time of this recording, the situation on territories is hard. We don’t have any Cree Health Board Speech Language Pathologist providing services in communities. But if you have concerns and want to look into getting services for your child, please talk to your case manager or your doctor. There are creative ways that people are finding to reach services.

Cynthia Miller-Lautman

I know that giving help to the kids that need it as early as possible. Super important. And it’s the way we can help.

Dana Lawlor

Mm hmm.

Cynthia Miller-Lautman

So I’m really excited for part two, because that’s how we’ll learn and teach others to help stimulate language in children.

Dana Lawlor

Yeah, we’re going to roll into the fun part, so let’s do it.