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Detecting speech disorders in Malay-speaking children

To hear a normal young child (without any speech disorders) speak is often endearing, even if the child is not related to the listener. Many people think speech disorders are not a big deal since they are not dangerous.

There are many studies that linked children with communication difficulties with low self-esteem, and if left unchecked, these children would face barriers in education, employment, and recreation.

A normal speech and language development for a child of two years old is that he would master at least 50 words and by three-years of age, he would master a full-sentence consisting of three to four words. By five years of age, the child would have mastered adult-like speech and language. (source: Ministry of Health Malaysia (MOH)).

For parents whose child might be facing some speech delay, this typically leads them to seek professional and medical help. The medical professional, in this case, is the Speech & Language Therapist (SLT) who would be able to assess the child’s problem. Speech & Language Therapist work either in government hospitals or in private practice.

The Role of a Speech & Language Therapist

A speech & Language Therapist is crucial in assessing and providing treatment related to speech, language and communication disorders.

Children with communication disorders may be due to autism, Down syndrome, hearing impairment, attention deficit disorder (ADD), attention deficit hyperactivity disorer (ADHD), stuttering, and others (source: MOH).

This is an early prevention method – where children are taught to overcome their language disorders. For example, for children with dyslexia, there are some ways and strategies of reading. In the case of autism and down syndrome, the speech & language therapist would mitigate and facilitate them in their language development.

Why Communication is Important

Halalop editor, Shahfizal Musa, spoke with Dr. Rogayah A. Razak, who is a clinical linguist, PhD, and director of LangIT Education & Consultancy. She is also a retired associate professor at the Centre of Rehabilitation & Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM) (the National University of Malaysia).

“According to the theory of language acquisition among children, children are born with the ability to acquire language. When the child is exposed to the language environment, he will intuitively pick up the language. Based on the theory, by the age of five, the child would have completed his language acquisition, which is then followed by language enrichment.”

“What happens if you identify the child [with a speech or language disorder] at three years old? Maybe he has a hearing impairment, and the parents only just realize this. A person must hear before he can speak a language. When you identify a child by the age of three, that child has about two years to catch up to complete his language acquisition.”

“However, it is usually the case that the child with a speech disorder is only detected at the age of seven when he or she enters primary school.”

“However, if a child is identified with a disorder at seven years, old, he is past the five-year-old mark. If the child lacks oral language and enters primary school where the emphasis is on academics, the child will be lost.”

“Research has shown that children that have oral language — they are speaking, interacting, telling stories, — are precursors to success in academics. Almost all subjects taught in schools are language-based. “

“In addition, if a child can’t convey his desire, or is unable to communicate, he will get isolated, and socially alienated.”

Inventing a Standardized Test in Malay to Detect Speech Disorders

Malaysia is diverse on many levels – ethnic, cultural, religious as well as languages. Bahasa Malayu (Malay) is the national language of the country, as well as the main language spoken by the main ethnic group while English is the second national language. As Malaysia consists of a mixed pot of various ethnicities, other ethnic languages such as Mandarin (and other Chinese dialects), Tamil (and other Indian dialects), as well as indigenous languages are also used.

This makes the task harder for Malaysia-based speech & language therapists to conduct their work. In addition to the multi-lingual challenge, these speech therapists would have imported English-language tests from the UK, US or Australia and translated and adapted them to the local languages. Such practice posed their own additional challenges.

According to Dr. Rogayah, “This is important in speech-language therapists and speech pathologists rely on test kits. When the therapists conduct the test, they are able to compare the child against other normal children. Once the speech therapist applies this test on the child, the therapist can determine how far impaired the child is in terms of language development, when compared to other normal children.”

However, when imported test kits are used, they lacked the data of a normal distribution in the local language, as the imported kits are from monolingual, English as a first language, countries. In addition, there are translation difficulties and cultural differences – English relies heavily on tenses, whereas Malay uses fewer tenses, and are manifested differently.

Hence, Dr. Rogayah created a standardized language assessment test for Malay preschool children. It is the first test in the local language, which is called the Malay Preschool Language Assessment Tool (MPLAT) (Alat Ujian Kanak-kanak pra-sekolah Melayu

). It took eleven years to build this test.

“Unlike imported English diagnostic tools, where the test is then translated into Malay, this tool is suitable for Malay children whose mother tongue is Malay.”

“With this test, it gives the speech therapist a way to determine the extent of the child’s speech deficit, and secondly, it is based on the local language, Malay, and local culture.”

How The MPLAT Test Was Developed

Dr. Rogayah explained, “in a clinical setting, a standardized test is to determine if a child is away from the norm with the aim to bring nearer to his typical developing peers, in terms of child development. If the therapist doesn’t know where the child is at, the therapist can do a lot of activities with the child although the therapist’s target is not clear.”

“We started with a pilot study is on normal children. We tested about 500 Malay children in the Klang Valley, in Kota Bahru, Kelantan, and in Grik, Kelantan, as my students were located in these areas. We tested normal kids, to get the bell-shaped curve of the normal distribution scores. “

“According to the theory of [language disorders], when you test a child with a disorder, there is a mean, and a standard deviation, if a child scores 1.5 standard deviations below the mean [-1.5 standard deviation], it means he has a slight language disorder. However, if the child scores two standard deviations or more below the mean [-2 standard deviation] , it means that the child has a language disorder.”

“This makes the local test needful, as it can promote early identification of the problem. When you are able to identify a child [with a speech problem] at an early stage, you can give early intervention.”

The MPLAT tool is now used in Malaysian government hospitals, private hospitals and speech clinics. Developmental paediatricians, psychologists and researchers are also interested to use this tool.

The tool is in Malay and if tweaked, it can be used for children who speak Malay as a second language. Right now, the tool is being used in Brunei. There is a current collaboration to adapt the tool to standard Bahasa Indonesia.

Detecting Developmental Language Disorder (DLD) Early

“There are many communication disorders. There is a disorder called developmental language delay (or Developmental Language Disorder (DLD)). This is when a child is of normal hearing, normal cognition, normal IQ, but have a language disorder. For this type of condition, if you are able to identify and help him, the child will be as good as his peers.”

“However, it is harder to identify him because he lacks showing symptoms of the disorder, and appears normal. With his limited vocabulary and limited language skills, after a while, the child will become disruptive in class. In this case, if we can identify them early, we can help.”

“I believe that the education sector would really benefit from using this tool. Teachers, at preschools, are normally able to intuitively identify which children are normal, and which have a language disorder. However, most don’t know how to identify them, and where to refer the child to for help.”

Impact of Undetected Developmental Language Disorder (DLD)

According to studies in the US and the UK, DLDs are prevalent in children, in as many as one in twelve children would have the disorder. When compared to autism, in the US where only one in 54 children with autism, in Malaysia only one in 625 children with autism, and worldwide only one in 160 with autism.

In children, if DLDs remain undetected, it could be misinterpreted as children with ADD or just lazy, and the children’s academic performance would deteriorate. In adolescents and youths, the problem becomes more severe:

The UK and US statistics have shown that youths with DLDs have higher rates of arrests and convictions with as many as 47% of convicted youths, and they have been identified as those who have not worked with speech & language therapists.

The Greater Need For Screening Children

In Malaysia, newborns and babies are screened for hearing and sight, whereas there is none for language screening for preschoolers. In the US, there is a campaign to make language screening for preschoolers into universal screening as the impact of undetected DLDs can be severe.

“The MPLAT test has two versions – the diagnostic test and the screening test. The diagnostic test is used in hospitals, whereas the screening test is suitable for use in schools. The screening test is only based on a pass or fail outcome. If your child, based on an age-range, fails the test, then the child should be referred to a speech therapist. The speech therapist will then do an in-depth analysis and give the help needed to the child needs.”

She also runs reading clinics where she does case by case coaching of reading, and some kids become motivated to learn and overcome their problems.

“All I wanted, back in 2004 when I applied to be a Fullbright scholar. But then, as I go along, things evolved. Now, I am happy that there is a tool for speech therapists to diagnose Malay-language speakers in Malaysia.”

Halalop Editorial Notes –

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