Ashley Breese started worrying about her son Vinnie's speech before he turned two. He was clearly learning to understand language, she said, but he had a hard time making words.

But he was a boy, and boys often develop speech later than girls. Breese and her husband just had to keep working with him, the family's pediatrician insisted.

By three, Vinnie was talking a little, but something clearly wasn't right. He spoke like a minion from the Despicable Me movies, a gibberish only his family understood.

When he started kindergarten, Vinnie's voice was high-pitched and nasally, and he spoke with his tongue in the back of his mouth. His teachers often didn't know what he was saying.

In December 2019, the Collegeville, Pa., kindergartner was finally diagnosed with a cleft-palate disorder. A membrane on the top of his mouth was shifted. Air that should come out of his mouth when he spoke was instead moving sideways and coming out his nose.

He was scheduled for a surgery that April. After that, the family hoped, he would receive regular speech therapy at school and get back on track, just like his older sister, whose own cleft palate was detected at birth, and who had finished speech lessons by the second grade.

Those plans were sidetracked by the Covid-19 pandemic. Vinnie's surgery was delayed two months. After that the family struggled to get him the regular in-person and un-masked speech therapy they believe he needs. He's now fallen behind his peers, not only in his ability to speak, but also to spell and read, a domino effect that worries his parents.

"It's been frustrating. We've gone through so many different doctors," Breese said. "It's kind of heartbreaking when you're watching your child try to communicate with other people, and kids his age, and then they don't."

Ashley and John Breese, with their children Gracelynn, Gianna, and Vinnie.

Since early in the pandemic, speech and hearing experts have worried about the potential impacts of the pandemic and pandemic-related restrictions on children's language skills. With schools closed and kids forced to stay home in quarantine, they had fewer social interactions, the day-to-day experiences that provide input to their fast-developing brains. The masks everyone wore degrade speech signals and take away important visual cues for new language learners, a particular hardship for kids with hearing loss who often depend on lip-reading. And it has all driven a huge surge in demand and competition for scarce speech-therapy resources.

The extent of the pandemic's impact on speech development isn't yet clear. Data showing how the pandemic affected language and communication skills nationally doesn't exist yet.

"We don't have data that lets us be able to go, 'Oh my gosh, the pandemic has caused a huge, or any, speech delay in development,'" said Donna Smiley, the chief staff officer for audiology with the American Speech-Language-Hearing Association, or ASHA. "We are at the beginning of trying to figure that out."

In December, the U.S. Centers for Disease Control and Prevention reported that the limited available data indicates "no clear evidence that masking impairs emotional or language development in children." That was echoed by the Washington Post, which reported in March that "the few studies that do exist suggest masks do not inhibit child language development."

That very well may be true for most normally developing young children. But parents of children with documented speech-development issues told National Review that pandemic-related restrictions — masks, virtual school, teletherapy — along with less access to speech-language services generally, have clearly set their kids back.

Many professional speech pathologists worry there could be lasting ramifications for kids who have fallen behind and never catch up academically or socially.

"I have some major concerns about the long-term impact of all of this, most definitely. Especially with the babies, early intervention is so important," said Jaclyn Theeck, a speech pathologist and owner of the Speech and Learning Institute in Palm Beach, Fla. "Children have not received the therapy they've needed, because they've been afraid of the pandemic. 'Let's just wait.' Well, they've lost valuable time when the brain is developing the most."

Compounding Delays

Breese said the trouble getting services for her son Vinnie started shortly after his cleft-palate surgery in June of 2020. Believing it was important that Vinnie not attend school in a masked environment, Breese decided to homeschool her kids that year.

"The problem with the masking issue is, because he was older by the time [his cleft palate] was detected, he had formed habits. So now you're correcting a speech impediment, and you're also correcting habits," Breese said. "And the only way to correct a habit is for consistent modeling, and for consistent correction. Which means you would have to see the way he's saying things. And he would need to see the way you're saying things."

Breese worked that year with a cyber charter school, which provided virtual speech therapy for Vinnie three times a week for 20 minutes per session — but he made little progress.

Concluding that Vinnie needed in-person attention, she and her husband tried sending the kids back to public schools last fall. She said she set up a meeting with Vinnie's school to discuss his individualized education program (IEP), "and they were all in masks, including the therapist."

At the start of the school year, Vinnie was only getting therapy twice a week — less than he was getting virtually, and less than his IEP called for. If Vinnie and his therapist did take off their masks, there was a plexiglass divider between them, Breese said. It was better than wearing masks, she conceded, but still not ideal. "When you're speaking through plastic, there's vibration. And he's still not going to hear correctly," Breese said.

After a couple of weeks, Breese and her husband pulled their kids from the public schools and enrolled them in a private school, where Vinnie is getting three 20-minute, in-person and un-masked therapy sessions each week. "He's progressing. He's making strides," she said.

But the delays over the last two years have left Vinnie behind, she said.

Kids like Vinnie who struggle with speech often also struggle with spelling, because they don't sound out words properly. Struggles with spelling typically mean struggles with reading, which can lead to struggles with comprehension, and an academic and social domino effect.

"The delays, they compound on top of each other," said Smiley, the ASHA audiologist.

Breese also was frustrated earlier this year when the local Perkiomen Valley School District was sued after it finally went mask-optional. The lawsuit, one of at least nine nearly identical suits filed across Pennsylvania, accused the district of discriminating against medically fragile students and violating the Americans with Disabilities Act. Breese said it was hard to watch the ADA, which should also protect kids like Vinnie who struggle with speech and masks, being used as part of a statewide legal strategy to force everyone to cover their faces again.

Last week, the judge in the Perkiomen Valley case dissolved a previous injunction against the district, so public school students and district employees no longer are required to wear masks.

Dr. Stephen Camarata, a speech pathologist and professor of hearing and speech sciences at the Vanderbilt University School of Medicine, said masks clearly reduce short-term learning in kids. Because of that, schools that are forcing kids with speech and hearing issues to wear masks should have to provide clear evidence that they are effectively reducing transmission of Covid-19, and are reducing hospitalizations and deaths among students and staff.

"I'm sorry, from my perspective they haven't done that," Camarata said.

Working with kids, Camarata said he's seen that they don't typically wear their masks properly, and most aren't wearing properly fitted N-95s to school.

"I'm not seeing the benefit to masking kids from a public health standpoint," he said. "You've got to come to me with evidence that you're giving a benefit by wearing that mask."

Camarata said he suspects that for the general population of kids, the learning delays caused by pandemic restrictions are "probably not going to be long-term."

But he does worry about kids with speech and hearing issues who may have fallen behind, and could lose confidence in their academic abilities. And he worries about kids whose social development has been derailed, and the kids who didn't get the therapy they needed.

"I will tell you, the demand for services has just gone through the roof," he said.

The question is, why? Is there just a huge backlog of therapy services that didn't get delivered at the beginning of the pandemic, or are there really more kids than normal needing therapy?

Vinnie has been on a waiting list to receive private therapy for six months, Breese said.

Theeck, the Florida-based speech pathologist, said that since the beginning of the pandemic she's seen a "very significant" increase in the number of parents with referrals from their pediatricians bringing in young children with speech and language delays.

She said the surge in demand has made getting services at her clinic more difficult. Theeck told a local TV station last year that the percentage of her clients who are babies and toddlers increased from about 5 percent pre-pandemic to about 20 percent. She told National Review that has only increased over the last half year. "We have a waiting list," she said. "My colleagues that have clinics as well, everyone has a waiting list."

'It's Covid. It's masking. It's all of this.'

Katherine Hart, a New Jersey mother of two with a third on the way, said she struggled to get her oldest son evaluated during the pandemic, and then struggled to get him services he needs.

Her son was 18 months old when the pandemic hit, she said, and it was that summer that she began to notice that speech "wasn't really clicking on for him." She wasn't surprised, because speech delays run on her husband's side of the family.

Hart said it typically takes months to get appointments with the neurologists and developmental pediatricians she needed to see to get her son's speech delay diagnosed, and it took even longer during the pandemic. She said she asked a therapist why, "and she was like, 'It's Covid. It's the masking. It's all of this.'"

At three, her son's large motor skills are well developed, she said, but he still only uses three words — "mom," "no," and "that." She held her son out of a public preschool because they would have required him to wear a mask, even with two doctor's notes. Her son doesn't understand a lot of what people tell him, she said. Trying to force him to wear a mask "was going to do way more harm to him than good," Hart said.

"I know that would just traumatize him at that point, and it would just frustrate him even more," Hart said. If not for the pandemic and the school's mask mandate for her son, "he would have been in school. I think he would be a lot more vocal than he is now. He would have been able to be socialized a lot more. I think it held him back in that sense."

Hart was able to enroll her son in private speech therapy in September, but only once a week for a half hour. Another day opened up late last year, so her son is now going to speech therapy twice a week. But her family's health insurance only covers 30 sessions, and at $85 a session, "it's like a $600 bill a month as soon as that runs out," she said.

Her son finally started school in March. Hart believes he eventually will catch up, but she suspects that won't be the case for all kids who have fallen behind with language.

"I definitely think that there are kids that, yeah, ten years from now we're going to be like, why did we do this to kids? What was the point of this?" she said. "We took kids out of school. We hurt them emotionally. We hurt them socially. We hurt them physically. All because everybody was scared of a virus."

A Potential Public-Health Crisis

While data spelling out exactly what impacts the pandemic has had on speech and language development isn't available yet, some studies are emerging showing a real impact on reading fluency and early childhood development generally.

Researchers from Brown University conducting a large, ongoing longitudinal study of child development in Rhode Island found that children born during the pandemic "have significantly reduced verbal, motor, and overall cognitive performance compared to children born pre-pandemic." Male babies from less affluent families have been most affected, the research showed. The researchers found that "environmental changes" associated with the pandemic "significantly and negatively" affected infant and child development.

Another study published in January in the Journal of the American Medical Association that looked at 255 babies born between March and December of 2020 similarly found babies born during that period, regardless of whether they had been exposed to Covid-19, "had significantly lower scores on gross motor, fine motor, and personal-social subdomains compared with a historical cohort of infants born before the onset of the Covid-19 pandemic."

The researchers suggested that Covid-related stress — job and housing losses, food insecurity, loneliness — could be to blame. The findings "suggest the potential for a significant public health crisis for the generation born during the Covid-19 pandemic," the study said.

A study out of Stanford found that students in the second and third grades are about 30 percent behind in reading fluency because of pandemic restrictions.

Smiley said that one of the lessons during the course of the pandemic is that there has to be a balance between public health and accommodating children with specialized issues, including speech delays and hearing loss. She's most worried about "the kids on the cusp," the kids whose speech and hearing issues were identified at the outset of the pandemic, who may have started ramping up therapy services, and who were then cut off because of the pandemic.

"It's time to start to get a fresh assessment of where our students are, really pinpointing where are there deficits, where are the holes, what are they not doing," Smiley said.

Camarata said there has been a positive from the pandemic in terms of education — parents are more in tune with their children, and seem to be more invested in their kids' education.

"That's a very positive thing," he said, "so let's not lose that."