When acting Child Development Programme language supervisor, Aprille Choudhury-DeShield worked with one little boy this week, he turned his head curiously when he heard the sound of a truck in the yard.It sounds like a minor thing, except that the little boy had just been fitted with a hearing aid and was hearing many sounds for the first time. Mrs Choudhury-DeShield was happy to take him out and show him the truck making the noise. The experience left her saying on Friday, “that's why I do this job”.The child's mother originally brought him to the Child Development Programme because of concerns about his speech.“When we first started working with him we didn't realise he had a hearing impairment,” said Mrs Choudhury-DeShield.“He wouldn't talk in the sessions with us. He would do whatever we asked but he didn't say anything. His mother would make him say a word every now and again. She took him away for tests in January and found that he had a hearing loss.“We were like ‘oh, my gosh, thank goodness, that is why'. Now that he has his hearing aid it is like day and night. He kept turning around to listen to different sounds. He is a pleasure.”She said she always wanted to work with children, but originally wanted to be a dentist. Unfortunately, in university she struggled with the biology side of things. “One day my mother rigged this meeting between us and a speech language pathologist. She started talking about her job and how she loved it. It sounded like my kind of work. I always loved children, but I couldn't see myself as a teacher. I went back and switched majors. I love what I do now.”The little boy with the hearing problem is just one of many children that Mrs Choudhury-DeShield sees every week for speech and language assessment and intervention. Speech and language problems are sometimes picked up at the two-year-old developmental screening that is offered to every child on the Island by the Child Development Programme. Other times, parents call the Child Development Programme with their concerns.“Sometimes the child was just really shy with the screener, and when they get to us, they warm up and their speech is fine,” she said. “But we also see three-year-olds with no language. With most of our children who are nonverbal, it could be because of some kind of syndrome such as autism, or they may have an undiagnosed hearing disorder.”Mrs Choudhury-DeShield said parents should be concerned if their child reaches the age of three and isn't talking yet, or the child doesn't respond when called, or startled by loud noises.“You can do a small test with babies,” she said. “You can take a rattle and shake it by the ear and see if the head turns or their eyes move towards the sound. If there is a loud noise behind the child, do they startle? Sometimes children won't be fazed by certain sounds because they have heard them in the womb, but startling sounds should get a reaction. Some red flags might be if you have a child that doesn't seem to need anyone's attention or they don't come to you or make eye contact. A red flag might be if they are content always playing alone. It might be a problem if your child's speech is so unclear that even you can't understand it most of the time and they are age three or four years old. That would be reason to seek a speech language pathologist.”One early indicator of an oral motor weakness might be if your baby does not latch on to the breast or bottle and doesn't seem to be thriving. However, if you toddler stutters a little, or says “yamb” instead of “lamb” or “wellow” instead of “yellow”, it is not necessarily cause for concern. Mrs Choudhury-DeShield said it takes children a little bit of time to physically be able to move their mouth in the right way to pronounce certain sounds.“A lot of children do outgrow certain speech impediments,” she said. “At two or three what they are saying sounds like baby talk because they are not wired yet to formulate a lot of the sounds that you can make as an adult. I have a lot of parents saying ‘my child can't make the S sound'. We don't expect that to be mastered before age eight, although a lot of children do get it before then. Mixing ‘L' and ‘Y' is very common, or ‘W' for ‘L' is very common.”She said when people call the Child Development Programme with concerns about their child's speech, they first try to filter out what is developmentally normal speech, and what are real issues.“Most children naturally learn to make the sounds without speech therapy,” she said. “They do it by hearing others talk and watching people's mouths. Children seem to learn very quickly from being around other children. But then there are those children who have all of that in place and they still can't make these sounds. They might have age-appropriate errors, but there are so many that their speech is a mess and you can't understand what they are saying.”Mrs Choudhury-DeShield said they also sometimes see speech problems with children who are growing up in bilingual households.“We do have a lot of children going through here who are learning two and sometimes three languages,” she said. “That is fine, but some of our children are struggling in all of the languages. That is when it is a problem. That is when we would go in and see them and say to the parent, you will have to pick a language for right now, so that the child has enough time to master that language before you add on another language. Sometimes when children are bilingual and they are learning two languages at the same time, it may appear they have a delay. Other children may have 100 words, but the bilingual child might have 50 words in one language and 50 in the other. That is fine. They usually catch up.”But she said if you as a parent, speak another language it is better to speak to your child in the language you are proficient in, rather than to speak broken English to the child.“Let someone else deal with the other language,” she said.Mrs Choudhury-DeShield sees about 25 to 27 children a week, almost all of them on a one-on-one basis. Sometimes they come to the Child Development Programme, but often speech language pathologists go out to the home or nursery school.“We want the general public to know that we are here,” she said. “We do free assessments. We provide therapy and workshops. We can go into the nurseries to provide workshops to the teachers or they can come here. We provide parent language learning workshops. It is all for free.”She said their biggest issue was manpower, as they have three speech language pathologists to service the entire Island.“We have just got another speech language pathologist, Daryl Masters,” said Mrs Choudbury-DeShield. “She was the first recipient of the Dr Barbara Ball Public Health Scholarship in 2008.”