Why is my 8 year old son still not speaking.

[Crystal]

My son was hurt in an accident at 16months of age, where his oxygen supply was severely cut off.  He had a MRI performed shortly after the accident that did not show any brain abnormalities.  My son is now 8 years old and in good physical health.  His gross motor skills are on 6-8 years and his fine motor skills are about 5-7 years.  He has been diagnosed with moderate learning disablity.  My concern is that he is still not able to speak.  He does make sound and there are some words that he can pronounce.  He has not been diagnosed with any brain damage.  Should I have my son retested?  Why is he unable to speak?

Thank you,

Crystal

[CCF Neuro[P] MD, RPS]

Dear Crystal:

Sorry to hear about your son's accident and the subsequent problems.  Your son should have been speaking prior to the accident, at 16 months of age he should have had a couple of dozen or so words.  It is about this time that children begin to put words together into sentences.  I gather from what you didn't say that he probably did speak but since the accident he has not spoken words.  Was your son in a coma after the accident?  Can he write his name or other words?  Does he draw things?  Although he has some motor delay, what other delays does he have?  Is he toilet trained?  What is his behavior like?  Does he point to things he wants and can he convey his wants and needs to you?  Does he follow any simple commands?  What have your pediatric neurologist and pediatrician told you why your son hasn't spoken since the accident?  

It is difficult to tell you why without having seen, examined, and known the entire medical history of your son.  If a workup is warranted, then you might begin with a MRI to see what his brain looks like now.  There are non-verbal intelligence tests that could be tried.  Depending on the length of time your son was anoxic it may be that the brain damage was severe, especially to the language areas of the brain.  An EEG would show severe slowing over the temporal leads.  I would talk over the situation with your pediatric neurologist and see if a medical and neurological workup is warranted.

Sorry, I couldn't be more definitive.

Sincerely,

CCF Neuro MD

[charleen]

Sorry to butt in here, but your letter caught my eye.  I am an occupational therapist, retired due to my own medical predicaments.  I wanted to ask you a couple of questions.

1. You say he was diagnosed with a moderate learning disability, but where does the disability lay in?  Motor skills? Math? Reading? Dyslexia which would fall within visual motor/perception and reading?, a broad based disability could also lay within all these disabilities as well with no specific LD listed?, or any specific disability such as pervasive developmental disorder or autism which would attribute to his difficulties with communication?, There are many other types of medical disablities that atrribute to lack of verbal skills including mental health issues...not saying that your son is mentally disturbed here, but here are mental health issues within the realm of medical issues that can attribute to speech as well.

2. Has your son been tested by a speech language pathologist? Has your son been tested for any hearing difficulties which can include auditory processing difficulties where the child has difficulty perceiving what is being said to him...sort of the opposite of dyslexia or dyslexia of the ears as one of my past parents stated?

3. I assume he has had occupational therapy testing since you are able to detail his fine and gross motor skills, but has he been tested for sensory defensiveness difficulties?  This could explain a "shut down" scenario in busy environments or environment that are too stimulating including bright lights, music running, cluttered rooms, too many kids in one room, loud verbal noises, distractions in the hallways etc.

I hope I did not overstep my bounds, but once an OT always an OT.....Charleen

[CCF Neuro[P] MD, RPS]

Charleen:

Thanks for your comments.

CCF Neuro MD