A Neurodevelopmental Approach
to Speech and Language Problems
by Kay Ness
Children with Down syndrome often have speech and language problems. Neurodevelopmentalists are trained to look at the steps for normal human development, from birth to the level of mature excellence. A developmental evaluation will look at underlying causes of problems. By addressing causes and by fixing the sources of problems, much progress can be made. This is quite different from the normal therapeutic approach, which gives a child tools to cope with disabilities. A better approach is to find the cause of a problem and treat it at the source. The neurodevelopmental approach does this.
Several pieces are necessary for good speech and language. These include hearing and mouth tactility (input), the ability to hold pieces of information in short-term memory (auditory processing), the ability to recall things that have been learned (long-term memory), and lung capacity, articulation with good oral motor skills and the ability to speak in sentences (output). These pieces are put together as any child develops.
We will not go into all of these pieces in this article. But they must all be addressed to properly deal with causes of speech and language problems. This article will focus on the problem of distorted hearing, and describe a solution to that problem.
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A newborn baby has to learn to hear, just like that baby has to learn to see and learn to creep, crawl and walk. Normal environmental stimulation—listening to normal sounds and language—usually “wires” up the auditory system to the brain and the child puts together the pieces to develop normal language. If during this developmental process the ears are full of fluid, then this “wiring” takes place in a distorted fashion. Congestion, ear infections and chronic fluid in the ear are a major source of problems with developing good speech and language. A child must be able to hear well in order to develop good speech. This is not unique to children with Down syndrome. It is present in many, many children with a variety of disabilities.
In distorted hearing, a child may not be able to hear certain frequencies appropriately or may be too sensitive to certain frequencies and not sensitive to other frequencies. Certain sounds may be painful to the child. The brain has a very sophisticated feedback mechanism to shut out painful sounds so that they are not heard. Some children whose hearing tests very well on an audiogram still cannot shut out extraneous sounds to concentrate on the sound of interest. This is like trying to listen to three radio stations superimposed on one another. These children hear everything, but generally sounds are a roar to them. Hence, they essentially shut down to almost all sounds. For some, sounds are so threatening that they do not develop expressive language. Language problems in a number of learning disorders and delays (Autistic or Central Auditory Processing Disorder, Pervasive Developmental Delay, Attention Deficit Disorder, etc.) are often caused by distorted hearing.
Some children whose hearing tests “normal” on an audiogram have hearing that is so distorted, they do not develop good auditory processing and hence good speech. Auditory processing is the ability to hold pieces of auditory information in short term memory. The level of auditory processing will be reflected in the length of sentences that a child can use or the number of sequential steps a child can remember and follow when given directions. An audiogram does not test the quality of hearing. Experience has shown that good auditory processing is a major component in developing social maturity and good reading skills.
Parents of children with Down syndrome should aggressively treat fluid in the ears. A child cannot hear normally if fluid is present. This alone is enough to cause major developmental delays. Regular tympanograms and tubes, if necessary to keep the ears clear, are recommended. Families can purchase an Ear Check Monitor at most drug stores that performs this test. The cost is around $100.
The sense of hearing is the first to develop in the uterus. At 135 days of gestation, a full sized cochlea has already developed in the baby. The first part of that hearing system to develop is the part that senses high frequencies. Thus, we can see that hearing is very primary to brain development, especially the part that hears high frequency sounds—which is often the first to be lost when there are hearing problems.
The dynamic range of hearing is broader than any other sensory input. We can hear over ten octaves. If we translated vision to the same scale, we can only see over one “octave.” Another part of the auditory system is the vestibular system. It is responsible for balance and for knowing the body’s position in space. So we have a very sensitive system to detect sounds and provide spatial information to the brain.
Because hearing provides so much information such as language with tone, frequency, emotional content, spatial information (where things are located in space and the nature of the space in which we are listening) and because the vestibular system is also involved, treating hearing problems is critically important. It must be noted also that the auditory nerve is in close conjunction with other parts of the central nervous system and auditory system that functions well affects an individuals overall sense of wellbeing.
Identifying an area of distorted sensory input provides an opportunity to normalize it through appropriate stimulation. For instance, if a child has low muscle tone and low pain sensation, direct stimulation of the sensors involved in these areas can normalize this function. The same is true with vision. If a child has a problem with his eyes working together, then direct stimulation with eye exercises can help the brain learn to control vision.
Treating distorted hearing is of primary importance. But, we cannot go in and directly stimulate the auditory system as we do touch and vision because the brain will simply block out sounds that it anticipates will be painful. We have to “trick” the brain to listen to sounds. With electronics, we can introduce a sound to the auditory system in a step function, without the brain having a chance to anticipate it. If, when this new sound is introduced, it is gentle and non-threatening, the system won’t shut it out and we then have the opportunity then to provide stimulation to the auditory system that was previously blocked. This is the theory of sound therapy.
The German scientist and musician Ingo Steinbach developed SAMONAS Sound Therapy. From his background in the physics of sound and music theory, he developed ways to record music that preserves the special spatial qualities of music and nature sounds that are usually lost in the recording process. Given the breakthroughs in recording and reproduction technology with the advent of CD’s, these qualities can now be reproduced and made generally available. Given the importance of high frequencies to the brain, there was a need to enhance these high frequencies (the overtones) in a natural way. Though it is technically complex, essentially what is done with SAMONAS recordings is to boost the high frequencies of the recordings, lowering the base frequencies in a way that maintains the same energy for the whole base tone with its overtones. The result is beautiful music and nature sounds with enhanced high frequencies.
SAMONAS Sound Therapy is administered by a trained Samonas therapist. Once a child is evaluated, a program can often be designed to administer at home. It must be done gently and appropriately to the individual. Great care has been taken to select or make recordings that meet different needs. The music and the qualities of the sounds of that music must be matched to the needs of the individual and monitored closely. It is important that the sounds used for sound therapy are natural sounds. Unnatural or harsh sounds could have a negative effect. By gently exposing the hearing to beautiful, natural sounds and music, the auditory system can be opened up to hearing in a more appropriate way, without distortions and sensitivity.
Given the wonderful tool of SAMONAS Sound Therapy, a major component of speech and language is now accessible for treatment with great success. We have seen hypersensitivity to sounds reduced, tonal processing improve, auditory processing improve, even recovery of some hearing loss. With this tool and by addressing all of the other pieces of good speech and language, normal speech and language can become a reality for many more individuals.
Kay Ness is a certified neuro-developmentalist who writes individual, home-based educational programs for parents to do with their children. She is a founding member of ICAN, an association of neuro-developmentalists, and through ICAN can refer parents to a neurodevelopmental practice near their home.