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. You remember that his sister could put whole sentences
together at the same age. Hoping he will catch up, you postpone
seeking professional advice. Some kids are early walkers and some
are early talkers, you tell yourself. Nothing to worry about...
This scenario is common among parents of kids who are slow to
speak. 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."
Knowing what's "normal" and what's not in
speech and language development can help you figure out if you
should be concerned or if your child is right on schedule.
Understanding Normal Speech and Language Development
It's important to discuss early speech and language
development, as well as other developmental concerns, with your
doctor at every routine well-child visit. It can be difficult to
tell whether a child is just immature in his or her ability to
communicate or has a problem that requires professional attention.
These developmental norms may provide clues:
Before 12 Months
It's important for kids this age to be watched for signs
that they're using their voices to relate to their environment.
Cooing and babbling are early stages of speech development. As
babies get older (often around 9 months), they begin to string
sounds together, incorporate the different tones of speech, and say
words like "mama" and "dada" (without really
understanding what those words mean). Before 12 months, children
should also be attentive to sound. Babies who watch intently but
don't react to sound may be showing signs of
hearing loss
.
By 12 to 15 Months
Kids this age should have a wide range of speech sounds in their
babbling and at least one or more true words (not including
"mama" and "dada"). Nouns usually come first,
like "baby" and "ball." Your child should also
be able to understand and follow single directions ("Please
give me the toy," for example).
From 18 to 24 Months
Kids should have a vocabulary of about 20 words by 18 months and
50 or more partial words by the time they turn 2. By age 2, kids
should be learning to combine two words, such as "baby
crying" or "Daddy big." A 2-year-old should also be
able to follow two-step commands (such as "Please pick up the
toy and bring me your cup").
From 2 to 3 Years
Parents often witness an "explosion" in their
child's speech. Your toddler's vocabulary should increase
(to too many words to count) and he or she should routinely combine
three or more words into sentences.
Comprehension also should increase - by 3 years of age, a
child should begin to understand what it means to "put it
on the table" or "put it under the bed." Your child
also should begin to identify colors and comprehend descriptive
concepts (big versus little, for example).
The Difference Between Speech and Language
Speech and language are often confused, but there is a
distinction between the two:
- Speech is the verbal expression of language and includes
articulation, which is the way words are formed.
- Language is much broader and refers to the entire system of
expressing and receiving information in a way that's
meaningful. It's understanding and being understood through
communication - verbal, nonverbal, and written.
Although problems in speech and language differ, they frequently
overlap. A child with a language problem may be able to pronounce
words well but be unable to put more than two words together.
Another child's speech may be difficult to understand, but he
or she may use words and phrases to express ideas. And another
child may speak well but have difficulty following directions.
Warning Signs of a Possible Problem
If you're concerned about your child's speech and
language development, there are some things to watch for.
An infant who isn't responding to sound or who isn't
vocalizing is of particular concern. Between 12 and 24 months,
reasons for concern include a child who:
- isn't using gestures, such as pointing or waving bye-bye
by 12 months
- prefers gestures over vocalizations to communicate by 18
months
- has trouble imitating sounds by 18 months
- has difficulty understanding simple verbal requests
Seek an evaluation if a child over 2 years old:
- can only imitate speech or actions and doesn't produce
words or phrases spontaneously
- says only certain sounds or words repeatedly and can't
use oral language to communicate more than his or her immediate
needs
- can't follow simple directions
- has an unusual tone of voice (such as raspy or nasal
sounding)
- is more difficult to understand than expected for his or her
age. Parents and regular caregivers should understand about half
of a child's speech at 2 years and about three quarters at 3
years. By 4 years old, a child should be mostly understood, even
by people who don't know the child.
Causes of Delayed Speech or Language
Many things can cause delays in speech and language development.
Speech delays in an otherwise normally developing child can
sometimes be caused by oral impairments, like problems with
the tongue or palate (the roof of the mouth). A short frenulum (the
fold beneath the tongue) can limit tongue movement for speech
production.
Many kids with speech delays have oral-motor problems, meaning
there's inefficient communication in the areas of the brain
responsible for speech production. The child encounters difficulty
using the lips, tongue, and jaw to produce speech sounds. Speech
may be the only problem or may be accompanied by other oral-motor
problems such as feeding difficulties. A speech delay may also
indicate a more "global" (or general) developmental
delay.
Hearing problems are also commonly related to delayed speech,
which is why a child's hearing should be tested by an
audiologist whenever there's a speech concern. A child who has
trouble hearing may have trouble understanding, imitating, and
using language.
Ear infections
, especially chronic infections, can affect hearing ability. Simple
ear infections that have been adequately treated, though, should
have no effect on speech.
What Speech-Language Pathologists Do
If you or your doctor suspect that your child has a problem,
early evaluation by a
speech-language pathologist
is crucial. Of course, if there turns out to be no problem after
all, an evaluation can ease your fears.
Although you can seek out a speech-language pathologist on your
own, your primary care doctor can refer you to one.
In conducting an evaluation, a speech-language pathologist will
look at a child's speech and language skills within the context
of total development. Besides observing your child, the
speech-language pathologist will conduct standardized tests and
scales, and look for milestones in speech and language
development.
The speech-language pathologist will also assess:
- what your child understands (called receptive language)
- what your child can say (called expressive language)
- if your child is attempting to communicate in other ways,
such as pointing, head shaking, gesturing, etc.
- sound development and clarity of speech.
- your child's oral-motor status (how a child's mouth,
tongue, palate, etc., work together for speech as well as eating
and swallowing)
If the speech-language pathologist finds that your child needs
speech therapy, your involvement will be very important. You can
observe therapy sessions and learn to participate in the process.
The speech therapist will show you how you can work with your child
at home to improve speech and language skills.
Evaluation by a speech-language pathologist may find that your
expectations are simply too high. Educational materials that
outline developmental stages and milestones may help you look at
your child more realistically.
What Parents Can Do
Like so many other things, speech development is a mixture of
nature and nurture. Genetic makeup will, in part, determine
intelligence and speech and language development. However, a lot of
it depends on environment. Is a child adequately stimulated at home
or at child care? Are there opportunities for communication
exchange and participation? What kind of feedback does the child
get?
When speech, language, hearing, or developmental problems do
exist, early intervention can provide the help a child needs. And
when you have a better understanding of why your child isn't
talking, you can learn ways to encourage speech development.
Here are a few general tips you can employ at home:
- Spend a lot of time communicating with your
child
, even during infancy - talk, sing, and encourage imitation of
sounds and gestures.
- Read to your child
, starting as early as 6 months. You don't have to finish a
whole book, but look for age-appropriate soft or board books or
picture books that encourage kids to look while you name the
pictures. Try starting with a classic book such as
Pat the Bunny
, in which the child imitates the patting motion, or books with
textures that kids can touch. Later, let your child point to
recognizable pictures and try to name them. Then move on to
nursery rhymes, which have rhythmic appeal. Progress to
predictable books, such as Eric Carle's
Brown Bear, Brown Bear,
in which your child can anticipate what happens. Your little one
may even start to memorize favorite stories.
- Use everyday situations
to reinforce your child's speech and language. In other
words, talk your way through the day. For example, name foods at
the grocery store, explain what you're doing as you cook a
meal or clean a room, point out objects around the house, and as
you drive, point out sounds you hear. Ask questions and
acknowledge your child's responses (even when they're
hard to understand). Keep things simple, but never use "baby
talk."
Whatever your child's age, recognizing and treating problems
early on is the best approach to help with speech and language
delays. With proper therapy and time, your child will likely be
better able to communicate with you and the rest of the world.
Reviewed by:
Amy Nelson, MA, CCC-SLP
Date reviewed: October 2008