Help! My toddler isn't talking

Your son is 2 years old and still isn’t talking. He says a few words, but compared with his peers you think he’s way behind.

What should you do if those first words don’t come or if your child’s speech is difficult to understand?

Should you take the “wait and see” approach, or seek advice? Many parents turn to the Internet to try to find information about their concerns and land up feeling overwhelmed and panic stricken.

This is a common scenario among parents of kids who are slow to talk. Unless they observe other areas of “slowness” during early development, parents may hesitate to seek advice. Some may excuse the lack of talking by reassuring themselves that “he’ll outgrow it” or “she’s just more interested in physical things.” After all, wasn’t Einstein a late talker?

This can be a very confusing situation for parents who want to do the best for their child.

Late talker

It is important to recognize that every child is unique and develops at his/her own pace. Knowing what’s “normal” and what’s not in speech and language development will assist you in making a decision regarding referral to a speech and language therapist. Below is a chart of “typical” language development in children.

LANGUAGE DEVELOPMENT CHART

AGE OF CHILD	TYPICAL LANGUAGE DEVELOPMENT
6 – 12 months	Vocalization with intonation Responds to human voices without visual cues by turning his head and eyes Responds appropriately to friendly and angry tones Enjoys social games like peek- a- boo Shouts or vocalises to gain attention Babbling sounds include p, b, m Waves “bye-bye”
12 – 18 months	Uses one or more words with meaning (this may be a fragment of a word) Understands simple instructions, especially if vocal or physical cues are given Practices inflection Is aware of the social value of speech Responds to name Imitates new words Indicates wants and needs primarily by pointing or grunting, but words are emerging May leave off the final sounds of words (says “ca” for “cat”) Points to about 3 body parts on self Understands about 50 words
18 – 24 months	Has a vocabulary of 5- 15 words. Produces more than 5 consonant sounds, like m, w, n, p, and b. Imitates new words May begin to use two words together (“mommy shoe” meaning “mommy’s shoe”). Speech is about 60% intelligible Points to some body parts Follows simple commands (“Give me the ball”). Pretend play beginning.
2 years (24 months) -2,6 years (30 months)	Approximately 70% of what child says should be intelligible Says about 50 words Understands 300 words Names pictures in books Rhythm and fluency often poor Volume and pitch of voice not yet well-controlled Can use two pronouns correctly: I, me, you, although me and I are often confused My and mine are beginning to emerge Responds to such commands as “show me your eyes (nose, mouth, hair)” Puts many actions together during play like stirring, pouring, scooping, and feeding a doll.
2,6 – 3 years (36 months)	Use pronouns I, you, me correctly Is using some plurals and past tenses Knows at least three prepositions, usually in, on, under Knows chief parts of body and should be able to indicate these if not name Handles three word sentences easily Says 500 words by age 3 Understands approximately 900 words About 80% of what child says should be intelligible Verbs begin to predominate Begins to use negative words – no, can’t don’t Asks and answers simple “wh” questions dealing with his environment and activities Relates his experiences so that they can be followed with reason Able to reason out such questions as “what must you do when you are sleepy, hungry, cool, or thirsty?” Should be able to give his sex, name, age Can count to 3
4 years	Asks lots of questions. Most regular and irregular past tense verbs are used correctly. Understands most questions but has difficulty answering “how” and “why.” Can retell stories and recent past events. Uses the pronouns: they, us, hers, his, them, her, its, our, him, myself, ours, their, theirs, herself, himself, itself, ourselves, yourselves, themselves. Knows names of familiar animals Can use at least four prepositions or can demonstrate his understanding of their meaning when given commands Knows one or more colors Can repeat 4 digits when they are given slowly Can usually repeat words of four syllables Demonstrates understanding of over and under Has most vowels and diphthongs and the consonants p, b, m, w, n well established Often indulges in make-believe Extensive verbalization as he carries out activities Understands such concepts as longer, larger, when a contrast is presented

Many late talkers do “grow out of it,” but many do not.

Some strategies to stimulate language can be found here, here and here

It can be difficult to predict which children will not catch up to their peers. However, a list of risk factors has been identified, which suggest that a child is more likely to have continuing language difficulties. These include:

• No back and forth sharing of sounds and smiles by 6 months of age

• No babbling by 9 months of age

• Limited eye contact at any age

• No pointing to request something or identify things of interest by 15 months of age

• Does not follow simple one-step commands by 18 months of age

• Does not verbally imitate the names of familiar objects by 18 months of age

• Uses mostly vowel sounds and very few consonant sounds after 18 months of age

• Relies primarily on gestures and grunting to communicate after 18 months of age

• Does not use gesture to communicate.

• Leaves off many sounds at the beginnings or ends of words after age 3

• Not using three-word phrases by age 3

• Does not ask or answer “wh” questions by age 4

• Not using complete sentences by age 4

• Difficulty playing with peers (poor social skills)

• Consistently sounds as if talking through the nose (hyper-nasal)

• Child is frustrated, embarrassed, or disturbed by own speech at any age

What about the group of late talkers who seem to catch up on their own without intervention?

Even though a large percentage of these children appear to catch up to their peers by the time they enter school, studies are showing that this group of children do not perform as well as their peers. These children may experience difficulty with language complexity and grammar.

Many young children have difficulty pronouncing words and you might have to try and guess at what they are saying. Children are constantly receiving new language information and adjusting their use of previously-acquired language in order to communicate more clearly. If a child is missing one or two skills in an age range, it does not necessarily indicate a delay. If a child’s communication growth is limited or absent a speech and language assessment may be indicated.

Help! My toddler isn’t talking!

LANGUAGE DEVELOPMENT CHART

What about the group of late talkers who seem to catch up on their own without intervention?

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