“My 2 year old doesn’t talk! What can I do doctor?”
A recent day in my clinic revealed why speech and language are the source of much anxiety for the parents of toddlers.
My first patient of the day was a very cute 17-month-old girl. As I walked in the room she demanded to “Color! Color! Color!” This budding artist was also investigating her body parts, as well as those of others. After I examined her abdomen she pointed to her umbilicus and proudly proclaimed “Beeeyyeee Buuuooon”.
Then she toddled over to me happily. She wanted, apparently, to see my beeeyyeee buuuuoon (belly button) and was determined in this pursuit. I am accustomed to being caressed/attacked by an explorative toddler but her mother was quite embarrassed by her groping. I reassured her mother that her socially-engaged use of language was not only age-appropriate, but actually quite precocious.
According to her mother, this 17 month old has more than 50 words in her active vocabulary, and will mimic many more words that she hears from her parents. Her receptive language—the words she can understand—is also excellent, and she will easily follow her parents’ commands (if she wants to.)
The next patient of the day was a charming 27-month-old boy who was equally keen in his desire to communicate. All of his “words,” however, had to be translated by his mother: to me they sounded like a big mash up of muddled sound. This cutest-of-boys has approximately 50 words, though a much smaller number of these would be understandable to an outside observer. And he has not yet starting putting words together into sentences. He points to pictures readily, though, and will follow two-step commands perfectly every time: though his expressive language (the words that he uses) is behind that of his younger peer, his receptive language is excellent.
You can see the predicament of kid #2’s parents: how can you fail to compare your jabberwocky-speaking toddler to your friend’s child who orders independently in restaurants by 17 months, or the girl in music class who is reciting Shakespeare at 20 months?
Between 15 months and 2 ½ years of age, children exhibit extremely wide variation in speech and language abilities. The good news is that either end of the spectrum can be completely normal. And a toddler’s place on this spectrum does not necessarily correlate to future success in communication, social interactions, education or career. But it is not easy, however, to feel convinced as a parent.
Most toddlers who develop expressive language more slowly have a period of rapid language development somewhere between 2- and 3-years old. These kids go from saying 5 to saying 500 words overnight. This is also a time, however, when significant language and developmental disorders emerge. In the case of a true language delay, early interventions like speech therapy can help children catch up to their peers so that they are prepared to start school.
So how do you know when to worry, and when to reassure yourself?
In assessing your child’s language development, pay close attention to their receptive language skills. What can your toddler understand? (Please do not pull that glass vase down on your head dear sweet Johnny.) Do they follow simple commands? (Baby, bring me my slippers.) Two step commands? (Please make your father a martini and I’ll take a gin and tonic, darling.)
Here are some very straightforward rules of thumb that will help you decide when you should wait patiently for the jabberwocky to turn to words, and when your little one may need further evaluation. (A colleague compiled this chart from four sources of normal development of language skills: Denver Developmental Screening Test II, the Rossetti Infant-Toddler Language Scale, and schedules of language development from the American Speech-Language-Hearing Association and the Child Development Institute. Some experts may have slightly different opinions about when children should be referred.)
Children should be referred for a speech and language evaluation if:
At Age 15 months:
- Receptive Language: They do not look or point at 5-10 objects or people named by their parents.
- Expressive Language: They are not using 3 words.
At age 18 months:
- Receptive Language: They do not follow simple directions (“Get your shoes”).
- Expressive Language: They are not using Mama, Dada or other names to refer to specific people.
At age 24 months:
- Receptive Language: They do not point to pictures or body parts when they are named.
- Expressive Language: They are not using 25 words.
At age 30 months:
- Receptive Language: They do not verbally respond or nod/shake their head to questions.
- Expressive Language: They are not using unique two-word phrases, including noun-verb combinations. (No, “uh-oh” does not count as a two-word phrase).
At age 36 months:
- Receptive Language: They do not understand prepositions or action words. They do not follow two-step directions.
- Expressive Language: They do not have a vocabulary of more than 200 words. They do not ask for things by name. They exhibit echolalia to questions (i.e. they repeat the question back to you rather than respond to it). They have a regression of language after acquiring two-word phrases.
These simple rules of thumb are a starting point. If you have further concerns, please talk to your child’s pediatrician.
As for the 17 month old who wanted to see my belly button, she was unsuccessful in her pursuit. What is it with the belly button anyway? Another mom told me the story of her 22 month old who, on a plane flight, would make eye contact with unsuspecting fellow passengers and (coyly) pull up her shirt to show them her belly button.
Tips for Parents:
When the jabberwocky continues, where can you go for help if you suspect that your child has a speech or language delay or disorder?
- Visit or call your pediatrician, who can help you determine the next steps in evaluating this situation.
- Your child should get a hearing test to make sure that a subtle hearing defect is not part of the problem.
- They should also be referred for an evaluation by a speech-language pathologist, who has special training in assessing communication difficulties. They can make recommendations regarding treatment and intervention.
- Early intervention with speech and language therapy can be incredibly effective in helping to improve a child’s communication. Services are available in most states through the state education system. Private therapy services are also available.
- For some practical ideas on using toys and books to stimulate communication with your children check out: The New Language of Toys.
- For more information on the different speech and communication problems and advice on how to find resources for your child try: Childhood Speech, Language, and Listening Problems.