我最近遇到一对夫妇，他们有一个 2 岁半的儿子，他们向我表达了对儿子还不会说话的担忧。他没有说过一句能听懂的话，只会用手指和手势与人交流。除此之外，他的出生史并不顺利，是一个非常活泼好动的幼儿，身体发育正常，也没有任何症状表明他有任何潜在疾病。
在我们开始讨论这种情况的可能性之前，我想说的是，儿童是按照自己的时间表逐步发展的。大约有 10% 到 20% 的两岁儿童（大多数是男孩）在言语和语言方面发育较晚。如果假以时日，他们中的大多数会在三岁前赶上。如果一个孩子因为 "大器晚成 "而开始说话的时间比其他人晚一些，这不一定是个严重的问题。不过，大多数孩子在某一年龄段都会做一些典型的事情。例如，一个典型的两岁儿童能用两三个词的句子说出多达 50 个单词。三岁幼儿的词汇量当然要高得多，可达 1000 个单词。他们甚至还能讲小故事。了解哪些是正常的，有助于发现哪些是不正常的。以下是常见的儿童语言发育里程碑：
- 出生到五个月 咕咕叫/笑/哭/咯咯笑/说话时发出声音
- 6 到 11 个月： 咿呀学语/说出第一个单词/"妈-妈 "或 "爸-爸"/重复发音
- 12 到 17 个月： 词汇量约为 5 个单词/能模仿简单的单词
- 18 到 23 个月： 使用两个单词的句子/词汇量为 50 个单词/发音不清晰
- Two to three years: Uses three-word sentences / Answers simple questions / Uses pronouns like ‘you’, ‘I’, ‘me’ / Uses descriptive words such as ‘happy’, ‘big’ / Strangers may not understand speech
- 三至四岁 辨别颜色/描述物体的用途/表达感受和情绪/陌生人可能听得懂他说的话
如果孩子无法适应常见的里程碑，就可能有语言发育迟缓。大多数情况下，他们会在以后的年龄赶上，但重要的是不要错过导致言语和语言发育迟缓的实际问题。这些问题包括
- 听力损失
- 早产和发育迟缓
- 自闭症谱系障碍
- 学习障碍
- 神经系统疾病 - 脑瘫/肌肉萎缩症/脑外伤
- 舌畸形或舌系带
- 父母忽视或缺乏刺激
A suspected child with speech delay will be assessed for risk factors of having the conditions above. Questions will be asked on birth history, family history, speech and language capabilities, and developmental milestones. The child’s ears, mouth, palate, tongue, and the neurological system will also be examined. Depending on this initial screening, the child can be further subjected to audiological tests, referred to as an ear, nose & throat surgeon, speech-language pathologist, or a pediatric neurologist.
Audiological tests to assess the child’s hearing include Otoacoustic emissions (OAE), tympanometry, and brain stem evoked audiometry (BSER). If a child is found to have hearing loss, this is further categorized to type; conductive hearing loss or sensorineural hearing loss and severity of the hearing loss; mild to profound.
Treatment of speech delay will depend on the cause. If the developmental delay is merely speech with no other associated conditions, speech and language therapy may be the only treatment needed. It offers a good outcome especially when initiated early. Even when speech delay is caused by other additional factors, speech and language therapy by a trained therapist helps as part of an overall effective treatment plan.
When the speech delay is associated with other disorders as mentioned above, it is important to address those issues as well, in addition to speech and language therapy. These include treating the hearing loss, correcting mouth or tongue abnormalities, physical or occupational therapy, behavioral therapy and also treating underlying neurological disorders.
作为父母，注意观察孩子的能力和发展里程碑是一种很好的做法。同样值得称赞的是，通过以下方法鼓励和培养孩子的语言表达能力：
- 与孩子交谈。使用恰当的词语，与孩子保持良好的眼神交流。全神贯注。
- Point or gesture to the objects as you describe or narrate.
- 与孩子一起阅读。讲浅显易懂的故事。
- 与他们交谈时要有耐心。用简单的语言仔细解释。
- Sing together simple songs or nursery rhymes.
- 让他们回答其他人提出的问题，而不是代替他们回答。
- 向他们提出有多种答案的问题，并给他们足够的时间回答。
- 让孩子与语言表达能力强的孩子互动和玩耍。
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