Young People Part 2 Language Development

Following my brief look at the changing pattern of family life in Britain, I'd like to turn my attention to children's language development, since the two are inextricably linked.

Human babies are amazing creatures: given normal hearing and average cognitive ability, they progress from 'mewling and puking' to being masters of their mother tongue(s) in less than four years. After infancy, new language is learned in a different way, which most of us find quite difficult. Whether we subscribe to the Chomsky or the Bruner theory of first language acquisition, or think, as I do, that the truth lies in a combination of the two, there is no questioning the fact that all over the world, in primitive tribes and civilised societies, babies acquire speech and language in a seemingly effortless way.

So why is delayed language development among children of school-entry age the major concern of those involved in Early Years education in Britain today? Communication difficulties affect social and educational progress and are frequently associated with behavioural difficulties in children of secondary school age. The usual suspects of television, working mothers or simply being a boy have been blamed and in Australia the answer has been discovered in middle ear infections. In fact all of these issues can be seen to be inter-related.

I spent the last twenty years advising parents and teachers on language development in children with impaired hearing and the twenty years prior to that teaching deaf children. Only 1 per 1000 babies is born with severe sensorineural deafness but as many as 1 in 4 children suffer some degree of temporary hearing loss due to otitis media with effusion (OME), commonly known as 'glue ear.' While the children with permanent deafness were my main concern, I was involved in the assessment of children with glue ear and in advising their parents and teachers on how to minimise the impact of the hearing loss on their educational development. Between 1990 and 2006, the number of referrals I received to assess children with conductive hearing loss caused by glue ear increased from an average of 30 per year to 30 per month. Working with audiologists and paediatricians to discover the reasons for this increase, I concluded that the actual incidence of episodes of glue ear had not increased but the impact on the development of speech and language was greater than in the past.

Having to devise a new way of working in order to cope with the numbers of children being referred from 67 schools scattered over a large rural area, I produced information leaflets for parents, presentations for health and education professionals and a guide on language development for teachers in Early Years settings. Within months, I was overwhelmed by requests to attend meetings and address conferences; sadly, this was not a tribute to my wit and charm but an indication of the level of concern among a range of professionals dealing with ever-rising numbers of children with poor speech and language skills.

Otitis media with effusion, OME or glue ear, is usually a minor medical condition and doctors are right to resist pressure to rush to surgical solutions. It is a condition that requires good management rather than intervention. It is an educational rather than a medical issue. The behavioural and cognitive sequelae of OME were established many years ago by the Dunedin Project and confirmed in many later studies. What has changed in the 33 years since the Dunedin study began is the scale of the problem. As I said earlier, the incidence has not increased but the impact has.

Language development and hearing

(For any outraged scientists who might be reading, this is the Audiology for Dummies version)

This illustration gives an indication of the relative pitch (frequency measured in Hertz) and intensity ('loudness' measured in decibels) of common sounds.

You can see the all-important 'speech banana' which shows the range of speech sounds in the average adult voice.

The white section indicates what would be considered the 'normal' range of hearing responses, with the heavy line representing a typical audiogram for a young child i.e. a similar response to all frequencies at minimal levels.

Responses mainly in the yellow section would indicate a mild hearing loss, the green section a moderate loss and so on. A typical audiogram of a 4 year old with glue ear would show a fairly straight line around 40-45 dBHL. The child would have difficulty in hearing any of the sounds above the line showing his 'threshold of hearing'. (Surgical intervention - myringotomy and insertion of ventilation tubes, 'grommets' - would normally be considered appropriate if the hearing loss was greater than this and persisted for more than 6 months)

The speech banana shows that vowel sounds and the voiced consonants b, m, n, l, g, ng, r, and j are clustered together in the lower frequency and the higher intensity range of the banana. Therefore they are the easiest sounds to hear and those are the first sounds that babies produce in their babbling. It is no mere chance that parents are called dada and mama! You will also see that f, th and s are the highest pitched and the softest sounds; these are the last speech sounds to appear in a child's repertoire and cause difficulties for many children.

In order to learn spoken language, an infant needs to hear clearly articulated speech at a level at least 15 decibels above his threshold of hearing. Imagine you enter a room where the radio is on at a barely perceptible level; if the programme is a discussion of your favourite topic, you will recognise some of the words and begin to make sense of what you hear. On the other hand, if it is in a foreign language or full of technical jargon from a subject you know nothing about, you will pay no attention because it will be a meaningless background noise; if you want to understand, you will turn up the volume. So it is with young children acquiring speech, a very mild hearing loss during the critical period for speech acquisition will disrupt that development.

The impact of modern lifestyles on language acquisition

This is an oversimplified comparison between what I will call 'traditional' childrearing methods and modern lifestyles, most real people are somewhere in the middle:

Babies are prone to brief episodes of very mild hearing loss; their eustachian tubes are narrow and easily blocked by mucus during a cold or when teething. In traditional situations, babies were carried around for most of the time, close to the mother, grandmother or older sibling and the proximity to the speaker compensated for the mild hearing loss. Most modern babies spend a lot of time in carry cots or bouncers at a distance from adult voices so their speech is not heard clearly.

Traditionally, infants spent most of their time in an intimate family setting, hearing and interacting with the same person or small group of people who would adapt their speech to evoke responses from the baby - what is termed 'motherese'. While not correcting the infant's utterances, the mother would automatically model the correct language, we call this the 'maternal reflective' input to language development. Infants in day care, whether nurseries or with childminders, do not get this intimate, individual nurturing treatment.

Modern homes are filled with sound from washing machines and vacuum cleaners to day long television or music in the background. Nurseries are filled with the noise of many children talking, singing and playing. Infants cannot discriminate new speech sounds from background noise, even when their hearing is normal. Glue ear usually has no symptoms other than mild hearing loss and this can easily go undetected because the child responds to the loud noises around it.

Traditionally, children learned a lot of the features of language incidentally e.g. anticipation, turn-taking and rhyming through shared activities like peek-a-boo and nursery rhymes. During my home visits in the last twenty years, I found 7 out of 10 mothers did not know any language games or nursery rhymes and I had to teach them some to use with their toddlers. While Sesame Street, Teletubbies and other children's programmes may be entertaining and can be useful for reinforcing already acquired skills, they are no substitute for child-carer activities.

Another startling change I noticed in modern homes was the lack of a family dining table. Children learn a great deal about how to behave and how to converse during family meals. Adults and older siblings are the role models for language and behaviour and this feature of development is being lost because of poorly designed modern starter homes and TV dinners on trays. It has been interesting to watch the recent spate of reality programmes on television, dealing with 'problem children' or 'problem families'. In every case, the turning point in the programme was when the family started to eat at least one meal a day together at a table.

Managing change

We don't want to go back to the days when women stayed at home, keeping house with washtub, mangle and broom. But we need to look at what else was thrown out when the new labour-saving appliances were introduced. The most obvious change is that women have time to develop interests outside of the home, and some have no choice but to work to pay for all those new appliances. I don't want to pile guilt on mothers who choose or are forced to put their babies into daycare, but I want them to appreciate what has been lost and look at ways of compensating for that loss.

In terms of language acquisition, the main loss has been intimacy. It is in a close, quiet, physical relationship with a carer that babies learn to understand and use spoken language. If possible, therefore, a nanny or childminder with a very small number of children will be a better choice than a nursery with lots of children and many different adults.

Children, especially boys, are prone to develop glue ear between the ages of 18 and 24 months and again around 5 years of age. The symptoms may not be startlingly obvious, look out for lack of response to quiet sounds, and a decrease in vocalisation in younger infants, and for older children turning up the volume on the television, misunderstanding or apparently ignoring instructions, lack of attention or daydreaming, lots of 'what' or pardon?' Often children with glue ear are mistakenly labelled unco-operative or slow learners.

Temporary episodes of hearing loss can be managed by letting everyone who deals with the child know about it. Always get the child's attention before giving an instruction or information e.g. 'Johnny, it's time for bed. Go and brush your teeth.' is more likely to get the desired response than 'Off you go to bed now and remember to brush your teeth, Johnny.' When nursery teachers adopt this way of speaking to all the children in their care, they find a noticeable improvement in behaviour; in fact, it is an improvement in communication. Get close to the child when speaking, to compensate for the reduced hearing level. Check that information has been received correctly. Make allowance for the fact that a child with even a mild hearing loss has to concentrate harder and so will tire easily.

Those children who are arriving at school at age 5 with delayed language need lots of activities that they missed out on in early infancy to encourage language development. There are lots of books available (including mine!) with ideas for parents, carers and teachers to help them do what our grandparents did as a matter of course.