My child isn't talking, should I be concerned?

After nearly 3 months off from posting on my speech pathology blog I am finally back.  The official website is till underway, and by underway I really mean it's an item on my very long to do list.  We will get there eventually.  For now I will provide all my language development posts on my personal blog.  As for the long blog absence... Well our little family is growing from 3 to 4.  We are expecting a beautiful baby girl in May.  Some how napping, or cleaning my messy house has taken precedence over blogging lately, but now that I'm well into my second trimester the energy and motivation is slowly returning.

I have had a lot of time to ponder over this post, and am really excited to be sharing it with you.  I have had quite a few friends come to me with this question, so I hope this will be helpful to all my fellow mommies out there with toddlers. This post will answer the question...

"My child isn't talking, should I be concerned?" 

Brief overview

This post is specifically for children 1-2 years old.  For some parents this can be a scary topic, and you may begin to worry about your child's development.  Other parents may assume he/she will grow out of it, and start talking on their own time. Let's hit this question full force...  "why isn't my child talking, and should I be concerned?" As a parent I know it's easy to worry, to over analyze things, and to also (here's the biggie...) compare you child with his or her peers. So before you start panicking let's go over some quick yes or no questions to evaluate your child's current language development, and some developmental norms.   I will then briefly discus the difference between delayed language development, and language difference among children.  Following this entry I will make a post covering "what to do if my child isn't talking: strategies to use at home," so stay tunes. In the future I will also be providing more in depth developmental milestones for ages 0-4 years old.

girls, girls, girls 

Things to keep in mind

Please keep in mind that each child is different, and since I am not able to personally assess your child, the information I have provided is generalized based on normative data for typically developing toddlers.  With that being said If you are still concerned after reading this post I encourage you to seek out additional resources and speak with your pediatrician, or even go the extra step and make an appointment with a speech pathologist in your area.  For toddlers who have delays in cognition, motor and other areas besides language, and/or any identified syndromes, it is also suggested that you speak with your health care professional.   Please feel free to leave a comment, and I will try to address some of your concerns in my following post. 

• Hearing loss and Otitis Media (chronic ear infections) 
• If your child has a history of ear infections, and/or has had tubes put in, and appears to have a delay in their language development I would suggest speaking with your pediatrician, or seeking an evaluation from a speech pathologist.  It is common (however not always the case) for children with chronic ear infections (otitis media), to miss out on language stimulation so it is a good idea to address this with your health care professional.     

Language development questions: 

•  Did your child babble as a baby? (eg baba, mama, dada) (eg ma-moo-me, ba-do)
•  Does your child use gestures and/or any type of non verbal communication (eg point at something, use sign language, pull on your clothes to get attention, reach for items and make vocalizations, shake head for no etc)?
• Does your child make eye contact?
• Does your child look at an item if you point at it?
• Does your child mimic (facial expressions, actions, sounds, or words)?
• Does your child participate in interactive play that requires turn taking (such as peek a boo or taking turns rolling a ball back and forth)?  
• Does your child babble, make a facial expression, and/or do an action, then look for your response?
• Does your child laugh and smile during social interaction? 
• Does your child respond to their name?
• Does your child look at objects mentioned?

Developmental norms

• At 1 year old
•  have a handful of words (these are typically familiar words such as "mama," "dada," "blankie," "baba"-bottle etc).
• At 18 months old
• have around 10-50 words 
• make requests- eg"more", protests-"no"
• mimc/imitate words spoken to him/her
• follow one step instructions (eg give mommy the cup)
• able to point to body parts and familiar items when named (eg where is your nose)
• At 2 years old
• have around 200-300 words, and use new words regularly (their vocabulary should be expanding rapidly at this stage).
• use two word phrases (eg "more milk"), and occasionally 3 word phrases ("daddy throw ball") 
• beginning to ask questions  
• follow more complex instructions
• At 2 1/2 years old
• use 3-4 word phrases regularly using simple noun verb phrases
• vocabulary is around 200-600 words, average of 450 words
• responds to simple questions (yes/no, who, what, why, how many)
• able to describe items (color, size, category)
• understands prepositions (in, on, under, next to, behind, in front of)

Language delay and language differences

If you answered yes to the majority of the questions listed above, and your child seems to be following the developmental norms provided for his/her age, then it is likely your child's language is developing right in the middle of the pack.  Now, what if there were some areas you felt your child was behind in?  Let's discuss the difference between language differences and language delay.

Ella and her buddy Olivia 

Language differences
Since there are no two children in the world that develop and perform exactly the same, no not even twins (and I can safely say this since I am one).  There are going to be what we call "language differences" among children.  These are based on many factors such as a child's:

• Environment
• Home life
• Exposure to different experiences
• Personality
• Interests 

As mentioned in earlier posts a huge factor in language development is experience and exposure.  The variety of experiences they have, and the level of exposure to different experiences will greatly impact a child's language.  We must first "learn" something before we are able to "demonstrate" it.  For example, I have a daughter that is 18 months old and she loves animals.  She loves to name all the different animals and tell me the sounds they make.  We read book and watch movies about animals, we visit the zoo, and we play with toy animals.  Her experience and exposure to animals is quite high.  This is likely due to the fact that a) she is interested in animals and b) we just so happen to do lots of activities involving animals.  You may take another category for instance, types of transportation.  My daughters experience and exposure level to types of transportation is probably quite low, therefore her comprehension and vocabulary for types of transportation is also quite low.  I have met children her age that can tell you the different types of cars (ie tractor, dump truck, bus, train, plane etc).

Another thing to consider is personality.  Is your child a social butterfly, or more reserved and quiet?  Some children may get overwhelmed in large groups, and prefer to sit and observe.  What type of communication style does your child have?  You have some toddlers that are the "labelers" and some toddlers that are "social talkers."  The "labelers" motivation for communicating is to tell you about their surroundings.  These toddlers like to point and name items.  They can go around the house pointing and saying "dog" "plant" "cup" to their hearts content.  Then there are the "social talkers" where it may sound like 90% jibber jabber and 10% words.  Their main motivation for communicating is to be social.  They see people talk on the phone and family members talking at the dinner table, and they want to join in.  Then there are children that are a mixture of both.  One communication style is not necessarily better than the other.  They are simply different ways of interacting and making sense of the word around them.  

My daughter the little introvert.  In new environments and large social groups she likes to sit and observe.  

A couple other things to keep in mind.  It is completely normal for child to mispronounce words.  Their speech should be no where near perfect, in fact even at 2 1/2 years old your child should only be 65% intelligible to an unfamiliar listener.  This means that a person who has never met the child should only be able to understand about 65% of what the child is saying.  So go easy on your child.  They are still trying to figure out the motor control and coordination required for speech, and a good portion of their sounds are still developing.  In fact you may be surprised to learn that some sounds in the English language aren't even mastered until 7 years old!   You may find that a variety of words sound similar, and that is perfectly fine.  So if your child says "tat" for "cat," that still means cat, and is considered a word. Also it is normal for children under 2 years old to use overextension and underextension. For example all animals with four legs and a tail are "dogs" (overextenion), or the child only identifies "dog" as his/her dog rather than other dogs he/she encounters.   Go easy on your child, and remember that they are learning everything for the first time.  There is going to be a learning curve, and at this stage we are striving for practice not perfection.
 
Language delay
Most professionals will refrain from "diagnosing" a child with a language delay until two years or older.  This is because often there is some variability among language development up until 2 years old.  Some children may be slow talkers at the beginning, but then catch up with their peers.  This variability can be due to factors such as:

• Word retention (some children retain words at a slower rate, so it takes longer for them to use words expressively)
• Personality (child is shy/reserved)
• Motivation (child is not motivated to communicate)
• Opportunity (child is not given enough opportunities to communicate)
• Gender (language development in boys tends to be slower than in girls)

Once the child reaches two years old you will start to notice a burst of language.  The child should have a large vocabulary, communicate using two word phrases, be able to follow more complex instructions and identify objects.  There is a possibility of a language delay if your child's vocabulary is less than 50 words, and they are not using two word phrases (eg phrases containing two words- "bath hot", "mommy more") by the age of two.  In some cases a child may have normal comprehension (ie is able to follow instructions, and understands a large variety of words), but has difficulty "using" words expressively. Again, since I am not able to personally asses your child I will not be able to tell you specifically if a language delay is present or not.  A good portion of children will actually catch up without requiring intervention, they just need a little push to get the language flowing. The great news is a lot of the language therapy you would receive from early intervention you can actually do at home.... and that's where I come in.  :)    

Summary

I hope this has answered some of your questions, and that you now have a better understanding of language differences and language delay.  Keep in mind that your child is not going to walk, talk, and think the same as the child next door, so moms stop comparing!  This is why we have normative data based on children all over the world.  These norms are based on the average performance, keeping in mind that their are plenty of children above and below what is considered "average."  Although it is important to consider normative data, please do not be consumed by it.  If you're still concerned and/or there is a possibility of a language delay, don't hesitate to get more information.  There is plenty of resources, and guidance out there to give you the support you need.
My next post will be on ways to encourage your child to start talking, and techniques you can do at home during your day to day life.  These tips are beneficial for children on all ends of the scale, so even if your child is talking these tips will still help to expand their language. Before my next post I encourage all you parents out there to really hone in on and evaluate your child's personality, what motivates them, as well as their interests and communication style.  Rather than taking your child and trying to shove them into a predesignated box of language perfection, let's focus on each child's own personal attributes to help their language blossom.

X Lisa, your SLP go to mom. It's good to be back! :)