Priya Koul, 37, a mother of two, travels 60 kilometres from Udhampur, thrice a week, for her daughter’s speech therapy lessons in Jammu. The centre is one of the few available in the region. Her six-year-old daughter has been undergoing speech therapy for the past year.
Priya, who didn’t want her real name to be shared, said that her daughter started uttering the words 'mamma' and 'papa’ when she turned two. Her speech ceased over time but it wasn’t much of a concern until she turned five. "That's when we realised there might be a problem and took her to a doctor, who recommended speech therapy,” she said.
“She still struggles to form complete sentences,” Priya told Decode.
Various studies from across the world have demonstrated a clear correlation between speech delay and screen time. Priyank Bhutani, a research scholar at Tezpur University and a practising speech therapist, spearheaded a comprehensive review of numerous studies. Their scoping review revealed that 95.2% of children over the age of two were exposed to video content nearly every day, with 60.2% watching videos for more than 2 hours daily. For children under two years old, video exposure ranged from 57% to 96.7%.
Specialists dealing with speech delays believe that excessive screen time is a major reason behind increased speech delay cases among children.
“In recent years, there has been a notable increase in speech delays attributed to excessive screen time,” said Iqra Bashir, a speech therapist based in Jammu. Bashir, who has been providing speech therapy for the last eight years says she has been observing a ‘concerning trend’.
“Many of these children, particularly those under the age of three, have had significant exposure to smartphones during critical developmental periods. The lack of environmental stimulation hampers speech development and can lead to symptoms resembling autism, often referred to as virtual autism,” she said.
Iqra Bashir, a J&K based Speech Therapist at her clinic. Photo: Aatif Ammad
Numerous studies indicate, (here and here) that screen time has significant impact on speech delays, especially in children under three years. Dr. Sangeetha Mahesh, a doctor in Child Language Disorders from the All India Institute of Speech and Hearing (AIISH) in Mysore, explained how screen time contributes to speech delay.
“For a child's development, it's crucial that all sensory aspects are engaged and utilised. This can only occur in a natural environment. However, as children spend more time in front of screens, their development primarily focuses on visual sensations, often overshadowing the development of other sensory experiences such as auditory and kinesthetic sensations. Consequently, issues like speech delays may emerge due to these masked sensory concerns,” said the doctor.
Dr. Sangeetha revealed that she has seen a concerning trend of increased speech delays post COVID due to increased screen time.
Riddhi Doshi, a renowned Mumbai-based parenting counsellor and child psychologist said, “To mitigate the impact of screen time on speech development, parents can implement strategies such as setting limits and parental controls on screen time, promoting interactive screen activities that involve verbal communication (e.g., educational apps with interactive features or video calls with family members), and providing opportunities for off-screen activities that support language development, such as reading together, engaging in imaginative play, and participating in social interactions.”
“What is important here is that you replace the screen with yourself or something more productive - like sharing some general knowledge while eating instead of watching YouTube. Additionally, parents can model positive screen behaviours by being mindful of their own screen use and prioritising face-to-face interactions with their children,” added Doshi.
Speech Delays And Psychology
Experts believe that speech delays among children can cause serious psychological and behavioural issues like low confidence and anger issues.
Dr. Gulzar Ahmed, a child psychologist based in Patna, said, "We often observe behavioural challenges in children experiencing delays in speech. These children tend to display heightened levels of anger and exhibit behavioural patterns such as low self-confidence and difficulties in academic performance."
To exemplify the anger-related problems, Ahmed presents a scenario, “imagine a situation where a child wants to play with a toy that a friend is using. The child lacks the vocabulary or ability to articulate their desire to play, leading to frustration. Instead of saying "Can I have a turn, please?" the child might resort to yelling, pushing, or other disruptive behaviours to express their frustration and desire for the toy.”
Ashwini, a 37-year-old journalist based in Mumbai, shared the story of his son, Adarsh, who experienced speech delay due to excessive screen time. Adarsh’s parents often relied on dropping him off at his grandmother's home for care. "My mother used to give him a phone whenever he made noise or became difficult to handle as it was hard for an aged woman to deal with a toddler. Adarsh became so dependent on the phone that he was unaware of the world outside. He would spend 7 hours a day on the phone. He didn't speak basic words, but we hoped he would eventually start speaking. Adarsh reached 4 without speaking and began exhibiting anger issues. He would throw toys and even harm himself at times."
Recognising the seriousness of the situation, a paediatrician suggested starting speech therapy for Adarsh, highlighting that his anger issues may stem from his inability to communicate effectively. Ashwini expresses gratitude towards the speech therapist, stating, "After 6 months of therapy, Adarsh can now speak in full sentences. We owe a lot to our speech therapist."
The Covid Impact
Several linguists and speech therapists argue that there has been a hike in speech delays among children after covid primarily due to screen time.
“Prior to the COVID pandemic, cases of speech delays linked to screen time were not as prevalent. However, there has been a significant rise in such cases. Nowadays, when I encounter developmental delays, they are more likely to be associated with screen time rather than genetic disorders. In particular, speech delays are frequently attributed to excessive screen exposure,” said speech therapist Iqra.
Last year, a U.S based health platform Komodo revealed that paediatric speech disorders for children aged 0 to 12 years more than doubled amid the COVID-19 pandemic, with infants aged 0 to 2 years most affected, according to a research brief from Komodo Health.
Shreya, 34, a corporate lawyer from Delhi, reflects on her son Ritesh's phone addiction during the COVID-19 pandemic. With the transition to remote work, Shreya found herself busier than ever, leaving her 18-month-old son Ritesh in the care of their help, who had to return to her village due to the pandemic. This left Shreya with limited options to keep Ritesh occupied while she managed her professional responsibilities.
Shreya remembers, "In order to keep Ritesh quiet, I turned to giving him my phone or allowing him to watch TV, mostly cartoons, all day for about 8 months until our help returned. Ritesh became reliant on screens as a way to cope. Whenever he woke up, he would frequently cry and only calm down when given a phone or positioned in front of the TV with cartoons on."
As Ritesh grew older, Shreya noticed concerning signs regarding his speech development. He remained non-verbal even after crossing his third birthday, and used to do some unusual actions prompting a teacher at the kindergarten where they intended to enrol him to suggest seeking advice from a paediatrician. Following a medical evaluation, it was revealed that Ritesh's speech delay was attributed to excessive screen time, which had led to his addiction to screens.
Determined to address Ritesh's challenges, Shreya took a four-month leave from work to dedicate time to her son's development. They embarked on a journey of therapy, with a focus on reducing screen time and fostering speech development. Despite progress being made, Ritesh's speech remains less developed than his peers, and his confidence has suffered as a result.
"We took him for therapies for a year. Though the journey to recovery was tough, I stayed dedicated to ensuring my son gets the help he needs to overcome the impacts of his early screen addiction and speech delay," Shreya explained.
“The COVID pandemic has significantly contributed to speech delays in children aged 0-3, a crucial period for brain development. Reduced social interaction and increased screen time during lockdowns have hindered children's ability to learn from their environment and imitate adults, impacting their overall development, especially speech,” said Dr. Ajay Kumar, a paediatric neurologist from Patna.
Lack of Data and Resources
Although there is ample data on speech delays among children, most of it focuses on Western populations, leaving India with a lack of authentic data on the subject. The limited research conducted on speech delay in India often consists of small sample sizes or relies on compiled information from Western perspectives rather than being specifically tailored to Indian demographics.
Priyank Bhutani, one of the pioneering PhD scholars, is conducting research on speech delay data among children in India. According to Bhutani, “India lacks comprehensive data on speech delays because it is a relatively new concept in the country. Parents became aware of these delays only after the onset of the COVID-19 pandemic, although they were present before. It was only during the pandemic that widespread awareness about speech delays emerged in India.”
Bhutani said, "We are currently undertaking comprehensive research on speech delays among children in India. While I cannot provide exact figures on the prevalence of speech delays in children as our research is still in its final stages and yet to be published, I believe that India has a higher incidence of speech delays among children aged 0-3 than previously thought."
India's major challenge concerning speech delays is the insufficient resources available to address them. With only 5000 Speech-Language Pathology Assistants (SLPAs) in the country, and a growing number of over 50 million speech-related cases, the situation is expected to worsen over time.
Experts believe that there is huge demand for paediatric SLPAs and India is lacking resources to tackle that with the situation worst in rural areas where hardly any speech therapy centres are present.
Bhutani remarked, “While the shortage of speech therapists is widespread, the situation is particularly dire in rural areas, where speech therapy centres are rare to come by.”
Ashraf Lone, 42, and hailing from a remote village in the Anantnag district, recounts the journey of his 5-year-old son's newfound ability to speak after undergoing therapy at a speech therapy centre in Srinagar. Despite the distance of 85 kilometres, Lone makes the journey three times a week to ensure his son receives the necessary therapy.
"I would have taken him to the therapy centre much earlier," Lone shares, "but as a small shopkeeper, closing my shop for an entire day to accompany him was a significant sacrifice. I hoped he would begin speaking naturally over time, but with no progress in sight, I've had to shut down my shop for at least three days a week. This has greatly impacted my earnings." Lone emphasises the need for such therapy centres to be established in every district, making them accessible to all, as speech delays affect children from all regions.
It is noteworthy that while speech-related issues are on the rise globally and numerous research institutions have been established worldwide, India, which faces over 50 million cases of speech-related challenges, is relatively lacking in dedicated research facilities. Only a handful of institutes such as AIISH Mysore and the Dr. S.R. Chandrasekhar Institute of Speech, Bengaluru and Hearing are focused on researching speech and hearing disorders in India.
"We're facing a critical shortage of institutions focusing on speech-related research. It's imperative to establish additional institutes in India to address the rising issue of speech-related problems. Research remains the sole path to resolving these challenges," stated Bhutani.
While the global speech therapy market size was valued at $9.9 billion in 2021, and is projected to reach $17 billion by 2031, growing at a CAGR of 5.6% from 2022 to 2031 with paediatric segment accounting the largest revenue in 2021, the market size of India is yet to be known.
“There is an urgent requirement for speech therapists in India, with a significant demand that far exceeds the current supply. India lags considerably in meeting this demand. The field of speech therapy is poised to become increasingly compelling in the years ahead, attracting more individuals to pursue it as a profession. The key solution lies in establishing more colleges to provide training for these professionals,” said Dr. Reuben Thomson, Scientist at AIISH mysore.
Names of all the children and their parents have been changed to protect privacy.