I see many children as a Speech Therapist, and often the parents want to hear my advice. Should they be worried? Is there something wrong with their child? Maybe he is a late talker? Or maybe there is something else that is impacting his ability to communicate and use language?
I see the children I work with in 3 groups (excluding kids with a medically obvious reason for a delay, such as Down Syndrome, Cerebral Palsy, Cleft Lip/Palate, Tongue Tie, etc). This information is for your typical toddler ages 16-36 months.
1. Late Talker
Understands everything but does not speak
These children have good receptive language skills, but they are not using their words yet to communicate. You can call the child’s name and they will respond, and you can give them instructions and they will demonstrate understanding (even if they do not always comply and follow the instruction!). They may prefer to grab items on their own and have autonomy in their household. They look you in the eyes and may ‘manipulate’ you with pouts or cry only when you are watching. They will use gestures such as an index-finger-point to communicate.
These kids TYPICALLY need a few strategies to get started, and then their language and speech will progress in no time! Having a Speech Therapist may be helpful to get them past their first speech ‘bump’, and a Speech Therapist can offer you continuing strategies. However, as long as your child can understand speech and tries to communicate in their own way, there typically is not a great need for concern.
Here are some reasons why your child may be a late talker:
Does not have a reason to speak:
This can be the easiest group to help! Families can use simple strategies and see HUGE progress.
There has been a large increase in the number of children I see who have a speech delay because of over-dependence on entertainment from electronics.
Children typically learn to talk through social interactions and when requesting for their wants and needs. Children learn to make comments (doggy!), negations (no!), exclamations (wow!, uh oh!), and requests (my!, milk). In order to comment or request, the child needs to be interactive with an adult.
So what is so bad about electronics…? Electronics are the never-ending one-sided entertainers. No interaction or speaking on the child’s side is necessary.
And what about TV shows that ‘teach’ words? Maybe you are thinking, ‘but my child learned how to say ‘red’ and ‘123’ from watching tv!!’ While this can be supplemental education, learning language from the tv is never as good of an investment as learning from social interactions, because there is so much MORE than labeling ‘red’ to verbal communication!
The rule is to encourage social-verbal routines and to change the environment so that initial request for wants and needs have an opportunity to occur. Let’s put their favorite snack on the top shelf J
For most kids, getting the first sounds or words out is the hardest part because the whole concept of speaking is entirely ‘unknown’ and even ‘scary’ to that child. Additionally, children typically avoid trying something they are likely to ‘get wrong’. Please see my post about ‘selective mutism’ for ideas on how to help your child!
Motor Speech Delay (With potential Phonological Delay)
For these children, a simple word like “doggy” seems just as difficult to say as desafortunadamente (Spanish for: unfortunately). These children have trouble coordinating their sounds, and likely did not babble much as an infant. They will likely open their mouth and try to say some words, but will overuse simple patterns such as ‘da’ or ‘ma’.
Sometimes these children also struggle with the psychological aspect and may elect not to talk, since they know that coordinating and producing sounds is difficult for them. They may need Speech Therapy to help guide them through sound patterns that move from simple to complex, or they may be able to work through a period of being ‘unintelligible’ and progress on their own! Stamina and confidence are essential to helping these kiddos progress; see my post about Speech Sound Disorders for information on strategies.
*A true disorder in the area of motor planning is called Apraxia of Speech. This disorder is rare with an incidence rate of about 2/1000. Most children will simply have a delay and require more practice to develop their verbalizations of words and sentences.
2. Language and Social Delay
Sometimes understands but does not speak
These children understand contextual information, such as when parents turn off the light and tell the child ‘time to come up for bed’ or grab a towel and say: ‘time for bath!’ They will sometimes respond to their name, but it is inconsistent. You would not say that they ‘understand everything’ but you can make it through your daily routine with verbal and gestural communication. They may hum or speak a little, but they are not using functional communication, such as pointing or requesting with words. They will look at items they want and reach towards them, but they will not look at you to see if you also see what they are reaching for (joint attention).
I would suggest that you find a Speech Therapist that works well with you and your family. Be selective! You will want someone who prioritizes social language learning instead of drills. Drills and flash-card practice is fine for the ‘late talkers’ if it gets them past the initial ‘bump’, but if your child has a receptive language and social delay, it is vital that you don’t forgo social development for teaching a few words. Remember that ‘communication’ is more important than ‘speech’; it is more important that your child can point and use gestures, and understand words and gestures, than it for him or her to say ‘cookie’.
These children may be later diagnosed with: ADHD, Deaf/Hard of Hearing, Auditory Processing Disorder, Anxiety, or Autism… or nothing. However, the earlier you start with this group of kids, the more and faster progress you will see! Your toddler should be able to understand familiar instructions and participate in communication non-verbally, so please don’t confuse these children with typical ‘late talkers’.
*Make socialization a priority! If you are waiting for Speech Therapy to begin, you can make IMMENSE differences by putting aside your worries about verbal speech and focusing entirely on social interaction and togetherness.
3. Severe Global Delay
Does not understand and does not speak
These children seem to be in their own world. They don’t respond to much of anything and you may wonder if they are deaf. They don’t make eye contact and may not even communicate for necessary items or help. If they do communicate, they will typically push you or move your hand, but will rarely look at you. They do not seem to anticipate what will come next and may become upset as you are trying to give them what they want: (Cry when you put them down to grab the cookies, or cry while you are filling their bottle/cup with milk. Crying stops only once they have the item in their hands). When they cry, your presence will not make a difference (they never cry ‘crocodile tears’ or ‘manipulate’ with their crying).
Schedule an Appointment with your Developmental Pediatrician:
The waiting list may take months, so try to be proactive even if you are uncertain. Having a diagnosis of Autism will get your child access to more therapies and resources.
Take a Deep Breath:
If you are embarking on the ‘Autism” journey, be prepared for a LOT of information and specialists with different opinions. Please know that NO ONE knows your child more than you do. There are different types of therapy out there and it is up to you to find your best fit.
Educate and Take Care of Yourself:
Even before starting Speech Therapy, I would suggest that you educate yourself. You can read my posts about Autism for more information. Be picky about your team of therapists and DON’T forget about your needs. In an airplane, you are told to put the oxygen mask on yourself first before helping your child. Remember to take care of yourself first in order to be the best available resource for your child.
*Please note that MOST of the time your child is struggling with a DELAY instead of an IMPAIRMENT. The definition of these terms is often misleading, and I have seen too much advancement and success in my time to ever pigeonhole a child with the expectation that they will never improve. ALL KIDS, no matter how severe, can improve with the right support!