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?
If your child is not meeting their milestones, there are 3 possible groups that they can fall into. This information is for your typical toddler ages 16-36 months.
(*These groups exclude kids with a medically obvious reason for a delay, such as Down Syndrome, Cerebral Palsy, Cleft Lip/Palate, Tongue Tie, etc.)
1. Late Talker
Understands everything but does not speak
These children have good receptive language skills (understanding) 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 want to follow the instruction. We don’t say terrible 2s for nothing!) 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. In general, you feel that they understand almost everything, and you can move through your daily routines easily. You know what your child is trying to tell you.
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.
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 and/or older child.
There has been an increase in the number of children I see who have a speech delay because of over-dependence on entertainment from electronics. Marketers use words like ‘educational’ for toys that speak 100 words in 3 different languages and tv shows that teach colors and shapes.
Don’t get me wrong – I have seen children learn from these gadgets, shows, and devices. A parent last week told me, “My son just learned to say ‘red’ with Sesame Street.”
BUT… here are two things to consider.
- Electronics are the never-ending one-sided entertainers. No conversation back and forth is happening between the child and an older partner.
- There is much more than labeling ‘red’ to verbal communication!
- What word would you rather your child say? ‘Green’ or ‘ball’? (When your child wants a ball). ‘Red’ or ‘Car’? (When your child sees a car). ‘Yellow’ or ‘open’? (When your child wants you to open a yellow box).
- Colors, numbers, shapes, and letters are ‘B’ words. They are not helpful words for early communicators. They are helpful once children are speaking in 2-3 word phrases. (1 word phrase = car. 2 word phrase = go car or yellow car. 3 word phrase = go yellow car).
So what can you do?
- Encourage social-verbal routines with face-to-face interaction and conversation!
- Almost any toy with a battery, tablets, and the tv can be used as ‘independent’ time. This is helpful when parents need to cook or clean. However, your child should have at least 3 hours of interactive play a day (routines count if it is interactive!) If your child is in daycare, then try for at least 30 minutes a day with each parent.
- Be a little less helpful
- Doesn’t it feel like your child was a baby just yesterday? It is shocking how fast children grow at this stage! It takes conscious effort to NOT anticipate your child’s needs and give them space to communicate. For example, instead of automatically getting their morning drink, wait for them to communicate. Instead of giving an entire meal or snack, give them just a partial portion so that they can ask for more. Instead of having all toys within reach, have a few items in sight but out of reach (A tall shelf works well!)
Coordinating speech sounds is HARD and overwhelming:
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’.
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 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. Finding the ‘just-right’ targets and increasing confidence is essential to helping these kiddos progress.
*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.
What can you do?
- Reduce pressure; your child probably knows that you want them to speak. Avoid saying, “Say…”, and instead model model model the words.
- I like to chant a word 3 times. I may say, “Let’s pop the bubbles. Pop pop pop!”. “We need to open the bag. Open open open!”
- Pair gestures and words as much as possible.
- Songs: Wheels on the bus, head shoulder knees toes, open shut it.
- Uh oh! Wow! Cool! Weee! What??, Eww! Yuck! Yum!
- Animal sounds
- Mooo, neigh, baaa
- Song: Old Mcdonald. Book: Moo, Baa, La La La (Sandra Bouton).
- Mooo, neigh, baaa
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 focus on your child’s social-communication development. Remember that ‘communication’ is more important than ‘speech’; it is more important that your child can point and use 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, Autism… or nothing. However, the earlier you start with this group of kids, the more and faster progress you will see!
*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 don’t 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. I have worked with parents who have absolutely no energy left for their child because they are running from therapy appointment to appointment. One mom shared with me that she “just wants to be a good mom”, so she is trying to follow all of the doctor-recommended therapies and schedules. However, the most important person that your child will have in their life is YOU. If you are able, I see home routines as the greatest investment for building foundational skills that will help your child grow.
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.
*Most of the time your child is struggling with a delay or difference in learning-style instead of an impairment. I have seen that all kids, no matter how severe, can improve with the right support!