Tuesday, March 8, 2011

Should I be worried about my late-talker?

I recently received the following question from one of my readers: 
 

I have a question about my just about 22 month old. He is very active and smart. He can figure out how to take anything apart and put it back together. He loves to be busy. A few people have commented he should be "saying more." I don't agree, but then again I'm no expert. He can talk and has always been vocal. He will bring things to me (or bring me to things!) point and say help and nod. He will ask for his needs. He asks me for his water, snack, relax (when he's sleepy.) He can communicate what he wants very well. He doesn't have melt downs, because he knows how to tell me what he wants. With all that said, he says only a handful of words. Snack, water, help, dog, go play, home, yes, no. He has started to make noises when he's playing...quacking like his ducks and making a car sound with his trucks. I have heard he's not saying enough often enough, to become a bit concerned. I was never concerned before, because he really communicates awesomely and comprehends what we ask him and does it right away. My question, is should I be worried? He has his 2 year check up in a couple months.

It can be disconcerting and a bit confusing when well-meaning family members and friends bring up concerns about your child that you don't share. What's more, young children are highly varied in all areas of development and so it can be hard to know exactly what your child should be really be doing and when you should be worried enough to talk to your pediatrician. Although I obviously can't evaluate a child without seeing him in person, I can certainly provide some guidance about when I would typically suggest a referral for an evaluation and how I would help parents of toddlers determine if speech and language intervention was needed.

First, the easy answer: if a child reaches 24 months and isn't yet using 50 words and/or isn't yet putting two words together into short phrases (e.g., more juice, bye mama), we do typically recommend that they talk to their pediatrician about an evaluation by a speech-language pathologist.

That, however, isn't the full answer (life is never that easy, right?). When I evaluate young toddlers who aren't yet speaking as much as we'd expect, I don't just look at how many words they are saying. While that is an important piece of the puzzle, there are many more pieces to the full picture. I also look at what that child understands, how he is communicating with gestures and facial expressions, how he is using the words he does have, what kinds of sounds he is using, and how he is playing. Looking at each of these areas helps me to determine if a child is "just" a late talker or if there are bigger concerns that need to be addressed.

What would I look for in each of those areas? While I can't detail every skill that I would look at in an actual evaluation, I can certainly paint a broad picture of what we would hope to see in a young toddler.

At 24 months, I'd want to ensure that the child could follow a wide variety of directions, find objects when mom and dad ask him to do so, point to pictures in a book, show off some body parts when they were named, and follow silly directions like "put a cup on your head."

I'd also look to make sure that the child was using gestures; by 24 months I'd expect to see him nodding and shaking his head no, pointing at things that he wants, waving "hi" and "goodbye", and clapping with delight. Very importantly, I'd also want to make sure that he is pointing at things that are interesting to him, just to get his mom and dad to look at those things (not just to ask for those things). This is a skill that emerges around 12-18 months, and it's important to ensure that a child is using it. I also like to see that children are showing objects of interest to their parents on a regular basis. And I'd ask the child's parents if he enjoyed playing simple games like "Pat-a-cake" or "Peek-a-boo" with them.

Then I'd take a peek at what the child was doing in play. At 24 months, we like to see children starting to use pretend play in some very simple ways. They might, for example, give a bottle to a baby. Or they might feed a stuffed bear with a spoon. Kids this age also play simple rolling or fetching games with balls with their mom and dad and should be starting to imitate housework (my 19 month old daughter, for example, is currently enthralled with wiping up the floor with paper towel. Who needs toys when you've got paper towel?). I'd also want to see that the child was imitating actions: Will he clap when an adult does? Does he imitate stacking blocks? Will he imitate his parents if they do something silly and unexpected, like place a block on top of their head?

Then I'd listen to the sounds the child was making. At 24 months, I like to see children using a variety of sounds such as p,b,m,n,t,d,h, and w, and I hope to see that child using those sounds in a variety of words. I'd also want to know that the child uses his voice to get attention, that he vocalizes often throughout the day, that he babbled often as a baby, and that he uses his voice in a way that sounds like he's having a conversation, even if there are no real words involved in that conversation.

Finally, I'd talk to the parents about hearing. I'd ask if they had any concerns with hearing and might also encourage them to talk to their pediatrician about doing a hearing test to rule out a hearing loss. Some kids can hear some sounds but not others. If a child has a language delay, we usually recommend a hearing evaluation just to make sure the child is really hearing everything.

What if the child was doing all those things I just described but still wasn't talking as much as we'd expect? Then he'd be what we call a "late talker" (such a professional term, eh?). The benefit of getting an evaluation for a "late talker" is that parents get to have a professional speech-language therapist look specifically at all those areas and help them to figure out what's really going on. If nothing else, this can ease a parent's mind. The speech-language therapist can also give parents some simple suggestions that can be woven into their day to increase the odds that their child will start using more words. A really good speech-language therapist will shed light on what comes next in child development and help parents figure out how they can get their child to that next level.

Having said all this, though, opinions are mixed about whether or not speech therapy is truly needed for children who are just late talkers. Some studies seem to indicate that as long as late talkers are in supportive, nurturing, and responsive families, they will catch up on their own. Other studies suggest that late talkers can potentially have lingering difficulty with reading and spelling when they enter elementary school.

My advice for parents of late talkers? Have a good conversation with your pediatrician about your concerns and ask your pediatrician to help you weigh your options. Then, listen to your own inner parenting voice to make the final call about what to do. You know your child best. Trust yourself.

The other piece of good news is that there are lots and lots of strategies that all parents can use in the context of their typical day to help their children develop language, whether or not their child is a late talker. Check out these to get you started:



 
And find an updated list of all strategies here

You might also want to check out this post:
  
Should Your Late Talker Get Speech Therapy?

22 comments:

  1. This is excellent advice :) My son had 50 words by 27 months, but was only labeling nouns. So many people said he was "talking fine" but yet he couldn't do ANYTHING else that you had just talked about. I trusted my gut and put him in Speech Therapy :)

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  2. @Jess, thanks for the note... and yes, sometimes we focus too much on the words and too little on everything else that surrounds those words. Glad you trusted your gut. :)

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  3. Excellent advice!!! I had just posted a comment on Blog Frog about this. There is an excellent book "Late Talking Children". I had my son seen by specialists and he was deemed "late talker". He had absolutely NO problem communicating. He had a very small base vocabulary then he would animate everything. (like charades, including perfect sound effects). Since he could communicate so well (actually advanced) they didn't worry about his speech, although I was still concerned. btw, he started talking more about a month or so before his 4th bday.

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  4. I will definitely be following this blog! I had my son evaluated at 20 months because he was only saying a few words and could't pronouce any consonants. He was using sign language and was far ahead in all other developemental areas and therefore didn't qualify for speech therapy. It's now been a year and he is saying a ton of single words and some 2-word sentences, but his articulation is so poor that only my husband and I can understand the majority of what he's saying and have to interpret all the time to others. He also can't pronouce a lot of his letters. Should I get him another evaluation?

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  5. @Home2home....it's great that he's using more words and I'm glad to hear he's using some two word phrases. That's certainly good news! Having said that, we'd expect the following for the following ages:

    At 24 months, we expect kids to be 50% or more intelligible (understood at least 50% of the time or more).

    At 36 months, we expect kids to be at least 80% or more intelligible (understood at least 80% of the time or more).

    And, we'd hope that, at 27-30 months, children would be using two word phrases most of the time and three word phrases regularly.

    The benefit of an evaluation would be that you'd be able to have an SLP listen to what he's doing with his words and help you to figure out if it's typical or not.

    So, while I can't really give you specific recommendations about your son without seeing him, that information should help you to decide what to do.

    Hope that helps! :)

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  6. Great advice and a great idea for a blog! So many new parents have speech questions...it's hard to navigate the first couple of years!

    Katie
    Practical Parenting
    www.practicalkatie.com

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  7. New parent here with a not-so-talkative 2 year old. Our ped wasn't too concerned at his check-up, and at 26 months he is adding a new word a day :)

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  8. What a great post! I'm a new follower to your site; I have twin 3-year-old boys who were born at 31 weeks. I worried constantly about their development, their speech development in particular. My baby girl turned one (today, in fact!), so your blog will be a great resource over the next year or so.
    Thank you!

    I stumbled ya! I'd love it if you could stumble me back at ..

    http://booksatthepaperhouse.blogspot.com/p/other-paperhouse-products.html

    ~ Devon
    Reading with Joey

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  9. This sounds exactly like my daughter! She barely said 10 words when she was 2 but she understood everything you said to her and communicated very well through other means.

    We did have her evaluated and started speech therapy and I'm really glad we did. Now at 29 months, she is using great sentences and has expanded her vocabulary to well over 60 words. There still seem to be specific sounds and sound combinations she has difficulty with and we need to clean up some of her words but overall the speech therapy has been a very positive experience.

    I Stumbled this post, mine is at http://librarygirlreads.blogspot.com/2011/03/absolutely-positively-by-heather-webber.html

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  10. Great article!

    I stumbled this. My post is http://booksyourkidswilllove.blogspot.com/2011/03/harry-potter-is-not-childrens-book.html

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  11. Hello! I stumbled you, here's my post: http://luxuryreading.com/sarahbower/

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  12. This is a great post and very helpful! I know a lot of parents will be reassured by reading this post and know that not speaking doesn't automatically mean something is wrong.

    I stumbled your post and would love if you'd stumble mine!
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    ReplyDelete
  13. New GFC follower and stumbled your post from Stumble Tumble Tuesday.

    http://www.simplewyrdings.com/2011/03/earthquake-and-disaster-preparedness.html

    ReplyDelete
  14. Great post! My daughter is 19 months old and doesn't always use her words, but she communicates very clearly in other ways. I'm not worried at this point because I know she understands and that when she's ready she'll explode with tons of new words. :)

    I stumbled your post, mine is http://tofa.ca/2011/03/my-boobs-my-business/

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  15. Great post!

    I stumbled you. Here's my post - http://www.mapleleafmommy.com/2011/02/water-tank-heater-question-by-numbers.html

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    Stumnbled you, please stumble me. I had early talkers!

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  17. Thank you for the tidbit in Blog Frog leading me here...
    And thanks for the post. My daughter was an early talker, so I've often wondered about our son... He got stuck on the word "car" and at 22 months hardly says much else. But everything else you list, he does. And, this week, he has picked up a few more things to say, finally. :)

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  18. Great info - I stumbled.

    Here's mine http://kellysluckyyou.com/2011/03/coming-soon-build-a-beautiful-blog-week-blog-design-tips-and-giveaways/

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  19. My sister was a very early talker, and I was a late one. At just short of 3 years, I spoke little but "gibberish", such as "Ya" for water, and yes and no. I said no very well. One day we were coming home from somewhere, and I said, "Are we getting ice cream?", none of that barely understandable talk that most little kids do, I talked like I was 10 years old. I could read too.
    My only problem with school was that it was boring beyond belief. My only real "oddness" is from day one, I wanted to sleep in the daytime and be up all night. Between keeping my mom up, and her worrying about me not talking, it's no wonder that when I was about 2 my mom had a meltdown from lack of sleep, saying, "Oh god, I think I'm going to die!". The doctor came over and gave her a shot and grandma stayed with us for about a week. She was convinced that my clock could be reset. She was wrong. At age 56, I sleep days, and am up all night. I stopped fighting it long ago.

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  20. My son is 14months old. Am a new mom and his not saying "mama" but saying "dada" when prompted. He follows directions like waving, clapping, etc. But his speech is slower and his grunting more. Should I be concern?

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