Teaching Your Toddler to Answer Questions - Receptive and Expressive Language Delay Issues
Many toddlers with language delays have difficulty learning to answer questions. Common problems include:
- Repeating or the last few words of the question rather than answering
- Answering incorrectly such as shaking their heads “yes” when you ask them a question with 2 choices
- Giving an off-target response such as answering, “Two,” when you ask, “What’s your name?”
- Not responding or ignoring questions
By 30 months of age, most toddlers with typically developing language skills are consistently answering yes/no questions, choosing between 2 options (”Do you want your Dora shirt or flower shirt?”) and answering simple “What” and “Where” questions (”What do you want to eat?” or “Where did Daddy go?”).
By age 3 most children with typically developing language skills correctly answer common questions related to themselves such as, “What’s your name,” “How old are you,” and ”Are you a boy or a girl?”
Listed below are the tried and true ways I recommend that parents work on answering questions with their children at home.
Basic Questions
Children learn to answer, “What’s that?” questions to label items before they begin to answer other kinds of questions. If your child is not consistently answering this question, practice often with words you know he can say across different contexts. For example, if says, “Shoe,” ask him, “What’s that,” while pointing to his shoes, while looking at pictures of shoes in catalogues, while reading books, and while playing with a doll or toy characters.
Toddlers also begin to answer questions by making verbal choices. Offer choices for everything throughout the day. ”Do you want milk or juice? Which one should we play - blocks or cars? Should we read Good Night Moon or the Elmo book? Do you want a hug or a kiss? Does the cow want to eat or sleep?” If he is not yet using words, he can respond with a gesture such as pointing, looking, or even grabbing the one he wants. When he is talking or signing, you should wait him out for a verbal response, especially for words you know he can say or sign.
One way to make sure that your toddler understands choosing is to offer a non-preferred item as a choice. This is an especially effective technique for children who only “echo” the last words they hear. For example, ask if he wants to play with bubbles or a sock. If he repeats “sock,” make him take the sock. You can also use this with favorite snacks and a not-so-desirable option. If he echoes and says the wrong item, make an effort to have him take the item he doesn’t want, even if he’s initially upset or confused. Give him a second chance by saying, ”You said, ____. What do you want, ______ or _____?” Sometimes I hold the “correct” choice forward or shake it to call attention to it. I also the exaggerate the ”preferred” item as I say the word and whisper the non-preferred choice.
Ask early “where” questions that she can ”answer” with a point, look, or by retrieving an item. For example, hide a ball in your hand and ask her where it is. Ask her where common objects are in your home so that she can go get them. Ask her to locate family members by pointing or looking as you are seated around the table during meals. Have Dad or an older child model the correct answers as you ask your child. Practice these kinds of tasks often knowing that you are building a foundation for verbal responses.
When your child correctly ”answers” with a non-verbal response, use words to describe what he did. As he’s pointing to family members when you’re asking, “Where’s _______,” say the family member’s name or a response such as, “Right there.” When he’s answering a location questions, use the correct words. “Yes! It’s in the box.”
Moving On
Work on yes/no questions by giving them as “choices.” For example, “Do you want cookies - yes or no?” Shake or nod your head to cue your child as you say the words “yes” and “no” so that he can associate those gestures with words and use them if he can’t or won’t say the words just yet.
When he’s answering “where” questions accurately without words, begin to model verbal responses by giving two choices for more complex questions. Say, “Is your hat on your head or on your feet?” ”Is the ball on the couch or the floor?” “Is the dog eating or sleeping?” Again, use visual cues to help him. I use an exaggerated point to help cue the correct answer.
Higher Level Questions
For answering questions about recent experiences, use the choice method or the review method. Ask her, “What did you do at school today?”
Use the choice method to help generate an answer if she doesn’t respond to your first attempts. Try, ”Did you paint or play in sand?” Again try to vary the order of your choices so she is listening for the “correct” answer. (A little foreknowledge of what she actually did is required for this to be effective!)
Practice the review method in daily routines and especially at the ends of specific play times. Narrate what you did and then ask questions. For example, “Today we played with the farm, ate Oreos, and blew whistles.” Then ask her what you did giving visual cues (pointing or holding up the objects) as she answers.
When you come in from playing outside, have her tell Dad what she did. Start with a review of activities by saying, “We played on the slide and then on the swings.” Then have Dad ask, “What did you play?” Model what she should answer if she can’t do it.
Another great time to practice is at meals. Review what she ate for dinner by saying, “You ate chicken, macaroni, and peas.” Then ask, “What did you eat for dinner?” Point to her foods as a cue of what to respond. Fade the review and pointing when she begins to answer on her own.
A very effective way to cue answers to questions is to have one adult “ask” the child questions and have another adult “whisper” the answers if he needs help. Fade the coaching as he becomes better.
For children with better language comprehension skills who understand humor, try using a ridiculous choice to entice her to respond without echoing. You might say, “Do want to eat ice cream or poop?” Exaggerate the silliness of your offer so she knows you’re kidding and gets the “humor” in this question. (Beware the “poop” jokes. This may catch on and be a loooong phase at your house!)
For learning to answer the familiar name/age/gender questions, practice, practice, practice. A good way to begin working on this is to ask older children first so that your child can hear a model and it becomes a game. I also ask these questions with ”yes/no” choices too. “Is your name Daddy/sibling’s name/pet name/character name?” Model an exaggerated, “Noooooo” with a big head shake and grin. Ask a couple of “no” responses, then ask the correct version.
To help children learn gender, label “boy/girl” everywhere you go. I also use children’s clothing magazines with stereotypical pictures such as girls in dresses and with long hair and boys in pants since there are lots of pictures for practice. Be sure to ”teach” this concept for a long time before you begin “testing” by asking, ”Is he a boy or a girl?” You don’t want to let a child repeatedly make a mistake in answering since he then “over-learns” the incorrect response. Gender is often a difficult concept for children with language delays.
If you have any other “tricks” for teaching your child to answer questions, please feel free to share them with us by leaving a comment! Laura
Comment by Shaffon on 6 July 2008:
Wow!! So i guess my husband and i have been doing something right, because everything you mentioned we have done or are starting to do it. I think our son will make great progress especially with the advice and information on this site. Thanks again Laura you have no idea how this site has opened my eyes and rested my worrying mind. Your’e Great!!
Comment by niyati on 17 July 2008:
Hi! Laura . I have been writing to you regarding both expressive and receptive speech delay for my 33 month old son. He goes to school and the teacher was complaining that he only follows limited instructions , and based on her feed back, these were instructions that we use at home with him (like sit down , come back etc). Beyond that he is only imitating what other kids are doing after an instruction is given. Just wanted to know is this the normal way for an improvement in the receptive language? He is also on Spoeech therapy and does a lot of echolalia
Also I have been wanting to order your DVD and am based in India. Is is possible to place an order as I am geting a message that service is not available in India from your site
Comment by Laura on 17 July 2008:
Niyati - Keep reading the articles in the receptive language section for ideas on targeting these things at home. Don’t give up on helping him learn to follow directions. It takes a lot of work and follow-thru on a parent’s part!
As you probably know, DVD players for televisions operate using different systems around the world. Teach Me To Talk The DVD will only work in DVD players in North America. However, if your computer has a DVD drive, you should be able to view the DVD using your computer. Check it out with any other DVD you have at home before you place an order. If that works for you, then you can order the DVD.
All international orders also should send an e-mail to Johnny@teachmetotalk.com with your address so we can calculate shipping BEFORE you place the order thru Google checkout. Thanks! Laura
Comment by Ramya's mom on 30 August 2008:
My daugher Ramya is 3 years and 3 months old. She has:
- very good memory
- very good pretend play
- intelligent and sharp
- can count upto 20, recite and recognize alphabets (also in long format ‘a for apple’, ‘b for ball type’), days of the week
- remember and recite stories and poems
but in the following areas she does not meet the milestones:
1) She does not answer when called. There is absolutely no response from her. (Let me specify that her hearing has been tested by a specialist and is perfect. She can hear and recognise the smallest of sounds)..To come back to t he problem, Even though she knows her name is Ramya. And she uses both I and Ramya while speaking about herself.,she does not answer if we call her…Everytime she has to be reminded to say ‘yes mom’ when called.
2) If asked what she ate for breakfast, or what she did in school, etc she does not know how to answer. She simply repeats the question oin
response. For eg. I ask: “Ramya did you finish your lunch?” Ramya replies: Did you finish your lunch?….If I ask: Did George come to school? Ramya
replies: Did George come to school? …If I ask: Do you like Icecream? Ramya replies: Do you like Icecream? ….
However, of her own accord, she is able to say things like, “I dont want banana; I want icecram; I dont want more of this biscuit, I shall eat the chocos; I want my pink frock; I dont want to wear tshirt, I want to wear dresses; i hurt my finger; I want to go to the park; ” etc. But asked as a question, she does not know how to respond. At 3 year 3 months, is this normal?
3) Though she is a hyperactive child and is unable to stand still most of the time, when given a book to read or puzzles to do, she sits down and completes the task with great focus, concentration and wihout any fuss. At other times, she is hopping, jumping up and down the furniture and hugging and climbing all over us. Her Emotional Quotient is very high. She has been tested for autism and pronounced fine and fit by an eminently qualified doctor.
In short, we have got all the medical tests done and doctors say she is ok. But I worry about points 1) and 2) above. Also, it is difficult to make her look at us when we speak to her though when she chooses to talk to us and demand our attention, her eye contact is perfect. Can it be plain disobedience? How can we explain her refusal to look us in the eye when we want to tell her somehing strongly? Is it becaue she does not chose to do what we want her to do? She is a strongwilled and stubborn child and seems to be extremely intelligent. Please advise at the earliest…we are very worried! Thanks a trillion!
Comment by Laura on 31 August 2008:
Ramya’s Mom - It is not normal for her to continue to repeat questions at her age. You have had her evaluated by doctors, but I am wondering if you have had her language skills assessed by a speech-language pathologist. Even though she is a handful behaviorally from what you’ve described, I don’t think “stubborn” or “disobedient” is the real reason she’s not answering questions or responding to you when you call her name. From what you’ve said, it sounds to me like she might have auditory processing issues. Simplistically this means she understands the single words/concepts per se, but she can’t synchronize or fully process all the incoming information she hears enough to forumulate an answer. Some professionals might still also call this “echolalia,” and some might label it a receptive language issue, but I think (again just from what you’ve said since I haven’t actually SEEN her) that her ability to fully integrate and process incoming language is the problem.
So many children with these issues are initially suspected to be on the autistic spectrum, but because they lack the core qualities of autism, they end up being not “diagnosed” at all. However, it DOESN’T mean that there’s not a problem, and a huge one at that. I would search high and low for a speech-language pathologist who is willing to treat her and help you tease out these issues BEFORE she goes to kindergarten. She needs to learn how to understand and appropriately answer questions. Even if she can talk, she’s still not communicating at an age appropriate level since she can’t truly participate in conversations with you. Find someone who can help her and help you learn how to carry over strategies to help her at home. Responding and answering are essential skills, and the sooner you can find ways to help her consistently do these things, the better.
Keep reading the articles here for ideas while you are looking for someone to assess her and help you in person! Laura
Comment by Ramya's mom on 31 August 2008:
Dear Laura,
My very sincere thanks for your immediate response. I am grateful for your in-depth assessment of the problem and intend to work on your advice. However, I want to clarify one matter- the child seems to understand and assimilate full information/situation when we narrate stories to her. Even when we talk among ourselves, she seems to listen and take stock of the situation. For eg: when I talk to my mother about packing clothes, she at once understands that a train journey is in the offing and starts talking about it. When I tell that I have a headache, she hands over the pain balm to me. On her own accord, she narrates stories and copies all the actions of the cartoon characters. For eg. she would come home and talk to herself : “Rita caught hold of me and ramya cried and then the teacher came and took hold of ramya’s arm and said, never mind, don’t cry, daddy will come and fetch you in the afternoon and then I did not cry anymore and i smiled and became a good girl.” Listening to her soliloquy, if we ask her questions about what Rita did to her or if she cried in school or what the teacher said to her, we can not elicit the proper reply from her. But judging from her sololoquy, it is apparent that she has understood and grasped the whole incident and whatever her teacher has told her. Would you very kindly let me know if it does not prove that she is able to fully process all the incoming information?
To give you more insight on the problem - Her paediatrician had suspected Attention Defecit Disorder and slight hyperacivity and told us to put her in a playschool when we frequently expressed our concern for her refusal to respond to her name. She said that mingling with other children might improve her communicating skills as she seems medically fit otherwise. As for ADD and hyperactivity, when the doctor ran a few tests with some montessory apparatus (when ramya was around 2 years old), she snatched the toys and all the apparatus and wanted to play with them in her own way..but when the doctor told her that she can play with them if she first does as she is told, she grabbed the toys again, did all that she was told in a jiffy and proceeded to play again. The focus and attentiveness with which she completed her task made the doctor wonder about the presence of ADD and the double-quick way she finished it made her wonder if she was hyperactive or overbright.. However, she asked me to put her in a playschool early which we did.
Normally when we ask ‘what have you eaten?’ she repeats the question. However, while writing this reply, I was discussing with my mother her inability to answer simple queries like ‘what have you eaten’ and ‘what are you doing’. Although she was engrossed in another activity, we found her saying to herself “Ramya ate rice and butter while watching Tom & Jerry.” Which was exactly what she had done. Does this rule out auditory processing issues?
Are there any specific tests that I can ask doctors for? (since despite giving these symptoms, the doctors here seem to think I am over-reacting).
Sorry to take up so much of your time… Thank You!
Comment by Laura on 1 September 2008:
Ramya’s Mom - Ramya is an interesting child, isn’t she? Just when you think you might have an answer for her - BOOM! She goes and bursts the bubble of your theory! I would so love to work with Ramya because it would be so exciting to peel back her layers to get to the root of her issues.
But I can’t do that from afar, so you are going to have to find a great SLP who can actually SEE the both of you and observe her and talk with you and try different things. She would be so fun to work with, so I hope you will give some lucky SLP this great learning opportunity!
I will also caution you with one other point. You may NEVER find a good “diagnositic” fit for her. You may NEVER know one “reason” she’s the way she is. She is very complex in that she has her deficits and struggles while all the while, she’s excelling in other areas. She sounds like a wonderful little girl with lots of strengths mixed in with those weaknesses too!
Just so you know how I have come to think about this - being able to spit back a story is not the same as formulating an answer to a novel here-and-now, on-the-spot question. It still could be processing the question, as well as her ability to generate a novel answer. Actually, it’s probably both.
What I would do if I were her SLP (or her mother for that matter) is figure out a way to help her do the things she can’t do, as well as continue to support her with her strengths. Start with answering those basic questions using the suggestions I posed in the articles in the receptive language section. Give her choices, use the review method, have someone “whisper” coach her with the answer. These things really do work, AND it lets you channel your energies where they need to be - helping her excel rather than wondering what the exact problem could be. Again, you may never know!
Take care! And let me know what the SLP you find thinks! Laura
Comment by Ramya's mom on 1 September 2008:
Dear Laura,
I cannot thank you enough. Your comments have really helped me understand my child’s status. I intend to follow your advice word by word. I am based in south of India and finding an SLP with as much knowledge and experience looks like a remote possiility. However I have already started enquiring. If only me and ramya could come and see you. Meanwhile me and my family are going to study your website for more information and knowledge. We will keep you posted for any developments. Ramya is a wonderful child and I feel blessed to have her in my life. Thank you once again for everything. Your advice and assessment meant a lot to us. God bless you!
Comment by Mason's Mommy on 20 September 2009:
My son Mason will be turning 3 on Sept. 26th. He’s doing a few things that worry me. When you ask him a question he repeats it back to you, so then I’ll tell him “Mason, say “yes”. He says “say yes”.
He repeats dialogue from his cartoons, and can sing whole songs. But when I ask him which snack he wants, or which show or book he wants he can tell me. He knows how to ask for things he wants. He also ignores us a lot. He hits other kids, and prefers to play by himself, but loves to be around other children. Please help me figure out what I need to do to help him.
Mason’s Mommy
Comment by Laura on 20 September 2009:
Mason’s Mommy - It sounds like he just needs some additional help learning to understand and answer questions. Read the article above for ideas. Laura
Comment by Mason's Mommy on 21 September 2009:
Thank you Laura for your rapid response to our concerns. I was doing a lot of research online yesterday, and kept coming upon the definition of “echolalia”, and how its almost always connected to autism. Just wondering what you thought about that in Mason’s case, because he definitely does a lot of reciting and repeating.
Thanks Mason’t Mommy
Comment by Laura on 21 September 2009:
Mason’s Mommy - Echolalia was my initial thought based on your report, BUT it doesn’t matter if it is or isn’t associated with autism since we work to treat the deficits, not the diagnosis.
Sometimes when Moms are scared, I really ask them to shift the focus and work on what he needs help with rather than worrying about WHY he might need help for right now.
You also indicated that he CAN ask for what he wants and ALL of his speech isn’t echolalic, so he definitely has some strengths to work with. If he’s mostly having difficulty answering questions, use the ideas above.
One other idea for you - since he CAN initiate and tell you what when he’s asked for something, turn that into a question - “Do you want some milk?” and use the tag “Yes or No?” rather than immediately giving him the direct cue, “Say yes Mason.”
Or ask, “What do you want?” like you didn’t quite hear him after he asks for something since he clearly knows what he wants at that point. Bear in mind, turning this into a question for him to answer trips up lots of kids, so keep working at it!!
Now on to the more delicate question - have you thought of having him formally evaluated? I know that probably scares you to death, but since you’re so worried, an evaluation usually results in helping parents calm down at least a little bit, especially if the news isn’t totally unexpected. If he’s truly on track with language, he won’t get services since most good SLPs are so busy we wouldn’t dare qualify a kid who didn’t need therapy!
On the other hand, if he does need some speech therapy to catch up, wouldn’t you rather it be sooner than later? The BEST part about speech therapy is that YOU will get specific ideas about how to help him at home, and from the sounds of things, you’re the kind of mom that could take a few good strategies and really run with them! Try to think about the outcome of an assessment as Mason getting whatever help he needs, rather than a specific diagnosis.
I know it’s scary, but I hope this helps!! Laura
Comment by Laura on 21 September 2009:
LISA BEALE - I have tried to email you 3 times, but it keeps coming back as “undeliverable” so there’s some kind of glitch in how your email address was entered or reads. Please tell me what you coupon you tried to enter so I can see what the problem is. I will also credit your order. Thanks so much!!
Comment by Mason's Mommy on 21 September 2009:
Laura thank you so much for being honest and up fromt with me. Of course these concerns scare me to death, but like you said I would much rather he get the help he needs than just ignore them and hope they go away. Mason has his 3rd year check-up with his pediatrician on Oct. 15th, and
I’m going to request that he have an evaluation. I’m eager to get started on working through this. I will keep you posted as to his progress as he is definitely making some. Thanks again for valuable knowledge and you generosity in sharing it. I so appreciate it and you will be blessed for helping all the people you do. Mason’s Mommy
Comment by Laura on 22 September 2009:
Mason’s Mommy - I’m so glad you’re pursuing the eval. Let me know how he progresses. AND, just for the record, I am blessed beyond belief every single day of my life and never cease being grateful for the wonderful people who cross my path! Laura
Comment by Lorelei on 17 October 2009:
thanks again for such a really wonderful website. I got great use out of your first teachmetotalk video, by the way. If you have time to answer this (no offense if you don’t), I wonder what you think about something. My son wound up dx’ed with an autism spectrum disorder at 23 mos., although I am not 100% confident it was the right dx personally. But although he often uses complex phrases (but rarely with a subject) now (e.g., often he says things like “mommy to go” but more often “climbing on the table” and when requesting, telegraphic commands “water, water, water!”) … and he’s great at “where” and “what” questions and even sometimes complex things like “what do you do with the cookie?” “eat it” … “yes” and “no” is still a struggle. after months of working on this, i could get a head shake sometimes but yesses not forthcoming. in desperation, I started offering ice cream one bite at a time … “do you want another bite?” … and made him nod or say yes before he could get one … but now he’s learned to say “please” instead which is sweet, but he will not answer yes or no. then I made up a story which has led to a script: “mommy said, “Bobby, do you want a cookie? and Bobby said, “__________” and I wait for him to fill it in. if he doesn’t, I ask “what did Bobby say?” over and over until he answers. guess what? this always works. although … it’s obvious that he struggles to spit out the word. (he does have some oral issues by the way). If I just ask him “bobby, do you want a cookie?” I wait all day with no response. Oh, he’ll lunge for it, he’ll point at it, and he might even say “please” and “cookie!” but he will never ever say yes, without the script. and by the way, he REALLY won’t say no. I have to be majorly pushy with something majorly gross just to get half a head shake. As I type this I feel a little crazy obsessing over this because he has come SO far (he is now 32 months but at 23 months he had no spoken words and about 10 signs), but it feels significant to me. Am I wrong to be worried about this? thx for listening.
Comment by TL on 29 December 2009:
I am concerned about my daughter who will turn 4 next month. Currently, she attends 1/2 day pre-school and her teacher asked that she be evaluated for speech and then recanted that statement once she heard my child speak. Let me explain, she was in school for 2.5 months before she spoke audibly. She would just whisper her request. Now she is speaking above a whisper but sometimes I still have trouble with her answering yes and no questions and all other questions where there are two options. Some times she repeats the last thing that I said or sometimes, if I say do you want juice, she will respond with “I do not want juice.” Then there are other times she is very clear with saying no! For example, do you want to go to bed, her response NO. She knows where and what. She is excellent at expressing her feelings and she often tells me about her day. I just do not know what to do in regards to the yes or no. Her teacher says she is doing well in school. There are somethings we have to work on but nothing of concern. Should I just push for the speech therapist?
Comment by Laura on 29 December 2009:
TL - I’d go ahead and have her evaluated to rule out any underlying speech-language concerns. You want to have these things identified and taken care of before she starts kindergarten so that she’s ready to learn to read and write and not still struggling with understanding language or expressing herself. You can start with your local public school system to see if she qualifies for services, or if you’d like, you can have her evaluated by a private clinic or children’s hospital. If she’s developing normally, the SLP will tell you so and not see her for speech. There are too many kids who do need special help to take up a slot for ones who don’t need therapy!
About the yes/no questions- is she just confused with choices that could go either way? How does she answer when it’s a concrete yes/no question - Is this a car? Is your name ____? Are those your shoes? Is she just indecisive and shy, or is a real comprehension issue? If it’s a real comprehension issue, there would likely be other things she doesn’t understand. Can she follow mutliple step directions? It sounds like, from how you’ve described her, that this is situational difficulty when she’s feeling under pressure and this is more likely related to her temperament and personality rather than a true language delay. You’ll feel better if you have it formally rule out. You’re a good mom for being so concerned about her and not just blowing it off. Laura
Comment by Emily on 19 January 2010:
Hello! Love this website. Can PDD-NOS that takes the form of echolalia and perseverative speech (in a kid that does not ONLY speak that way) interfere with potty training? If so, how? Tips? Thanks!
Comment by Laura on 19 January 2010:
Emily - I think ANYTHING can interfere with potty training!! It’s so hard!!!
One thing I make sure I recommend to moms with kids who learn in this way is to model exactly what you need him to say when he has to go. You say, “I need to potty” or whatever you call it, rather than asking him, “Do you need to potty?” Or you can use the yes/no method - “Do you need to pee pee, yes or no?”
If I’m not on the right track with what you’re asking, send me another comment! Laura
Comment by Emily on 20 January 2010:
No, that is great advice. I just wonder if he TRULY understands that he is supposed to pee in the potty when he needs to pee! There’s been PLENTY of explaining. My gut tells me know knows. He has peed in the potty many times, but only with prompting. NEVER on his own accord (well, it happened randomly ONCE one day when he was naked anyway! But never on his own accord again. Very random), and he never, ever tells us he needs to go. He can definitely hold it (never pees on the floor or in the tub) but will gladly pee in underwear. For me, it’s the whole concept of, “Do you GET what you are supposed to do, my sweet boy?” Given that, again, he has gone many times when his dad or I bring him to the potty, how can he NOT understand?
As for poop, when he is going he tells us to go away or he hides, etc. Good signs, I GUESS. (shrug).
BTW, he sees an SPL once a week and will be evaluated next week by our school district, for possible Pre-K. It’s odd: when the SPL evaluated him she said verbally that she saw stong signs of PDD-NOS in my son, Will. Okay, was devastated but am moving on, taking action. He was VERY VERY upset at that session (with perseverative speech, also), so much so that after his first “real” session (I chose not to go to that one because I believe I make him anxious) she sent me a report raving about how different he was and all the good and “correct” things he said (not that there isn’t a problem. There is. Esp. with echolalia and “I”/”you” mixups). Turns out, her official diagnosis on her clinical, written report is “mixed language disorder” and “pragmatic language disorder.” Are these old-fashioned terms? Google is very scant on them. I won’t bug you after this…thank you so much for all you do!
And yes, this process is SO HARD, it’s unreal.
Comment by Laura on 20 January 2010:
Emily - My only advice is to keep at the potty training. I think it’s great that he goes when you take him.
Let me explain pragmatic language disorder. The official definition of pragmatic language is language use. Some kids know lots of words, but they don’t USE them appropriately. For example, they may label “milk” correctly when they see you pour it in a cup, but they don’t ask for milk using that word. They don’t understand the “rules” of language - that you greet others, respond to questions, ask for help when you need it, etc… Children on the spectrum have LOTS of difficulty with this area of language. Check out a related article here on the website with ways to help work on pragmatic language at:
http://teachmetotalk.com/2008/03/01/teaching-toddlers-to-use-the-words-they-know-to-change-their-worlds/
Mixed language disorder means that you have delays in both receptive (comprehension) and expression (speaking) skills.
This means that he may not be understanding things even if he’s saying them. My advice to any parent of a child with language comprehension delays is to make helping him understand language even more of a priority than what working on what he can say. This may be why potty training is so hard for him (and you). He may not really get it yet.
I’m so glad the second session went better for him, and I’m glad your SLP recognized success for him!!
Feel free to keep your questions coming here on the site! You are not “bugging” me at all. I love what I do
Laura
Comment by Emily on 21 January 2010:
Thank you so much; I have printed and will read the article.
You re DEAD ON with what you are saying, and you made perfect sense.
“Would you like some milk?” when HE wants milk is also a problem. The whole use of “You” when it should be “I” is really stronlg in my Will. A slight smile and a raised eyebrow from me typically elicits a self correction and then he says, “I would like some milk, please.” But I worry that his little neurons/synapses will never “change” so that he says “I” automatically. SOMETHING must change with intervention, as I have never met an ADULT who speaks that way.
Well, thank you again, SO MUCH. Yes, you clearly love what you do and are good at it! I will read the article.
Comment by Sharon on 18 March 2010:
Hi Laura,
My daughter who is 25 months old really picked up her speech around 19 months. She started a few words around 10 months but due to recurring ear infections and subsequent ear tubes procedure at 15 months potentially delayed things. My question is, is it too early to detect echolalia? While she is not consistent in repeating everything we say but she does quite often just repeats the question we ask her. She initiates speech and lets us know most of the time what she wants. Still does not say “I” or “me”. She refers to herself as “baby”. She has a lot of repetitive speech. For example, every evening when I come home she would go on non nonstop: “Hi Mama, how are you?” I would answer her “I am good Sophie”, “Hello Mama, how are you?” I would answer “I am good, how are you Sophie?” “Hi Mama”, “Hello Mama”, “Hi Mama”….she would go on until I remind her to ask once only. If she wants something she does the same thing: “More Cheese mama” “more cheese” I would say “please wait” but she goes on and on. Sometimes she gets the concept of waiting but it is inconsistent.
We have a Speech evaluation appointment next month but I am skeptical on how that would go as she gets extremely anxious in new surroundings (partly bad experience from recurring ear infections). I don’t think she would cooperate and hence would get the wrong diagnosis.
Due to her anxiety around new surroundings, people (peers and adults) and speech concerns, I suspect that she may have an underlying issue. Here is a list of her milestones:
- Walked at 9 months
- First words around 10 months then slowed down
- By 15 months could count to 5, identify the numbers 1 - 5 and could also count objects 1 to 5. By 28 months could count to 20
- Same with Alphabets. Can now spell and read some of the words like “STOP”, “NEMO”, ELMO”, “MAMA”. Not sure if she is memorizing them. But she knows the sounds phonetically
- know lots of colors including the difficult ones like grey, purple, turquoise by 18 months.
- same with shapes - trapezoid, octogon, pentagon, etc
- can do puzzles for hours - 36 pieces
- makes good eye contact, has joint attention, very alert
- Toe walks every now and then
- very very anxious around new people. Her nervousness pours out in her speech. She would go on nonstop with a frown. “bye bye lets go mama”, “bye bye, all done”, “Lets go mama”
- Hates crowds, does not like being touched by other children
- repetitive speech
I would really appreciate it if you could offer some advice on what you think of her repetitive speech.
Thanks!
Comment by Laura on 18 March 2010:
Sharon - I’m so glad you’re getting an assessment for her so they can see these things she’s doing and balance that with your concerns about her. I love how you’ve listed them out here, and I’d share that list with the SLP if I were you since it’s very detailed and may help to provide a clearer picture of her strengths and weakness as well as a diagnosis for her.
Since I can’t SEE her, I can’t say for sure what’s going on. Based on the list you provided, she is exhibiting lots of red flags I’d be concerned about as well as sensory issues too (hates being touched, is anxious in new surroundings, toe walking), so I’d look at an Occupational Therapy eval as well. The very best way to test her might be through a facility that offers team assessments. Another option might be through your state early intervention program which may provide services in your home vs. an office setting.
To answer your specific question about repetitive speech, imitation for children with typically developing language usually peaks around 19 months then decreases as they expand their spontaneous vocabularies. Echolalia is the term used to describe “scripts” that children repeat, and as I’m sure you know, is typically associated with children who go on to be diagnosed with autism spectrum disorders. It doesn’t sound exactly like she’s using those phrases she repeats in this way based on how you’ve described her, BUT I do think it’s a red flag, and I’m glad you’re pursuing a professional opinion.
And since you’re asking what I think, I’d also lay off the focus on the pre-academic concepts - numbers, letters, shapes, colors, etc… Many parents get so excited about early success with these kinds of concepts that they hyperfocus on teaching these kinds of things and miss out on all of the other more important language skills that really do matter at 2. Instead, focus on developing her back and forth conversational skills, pretend play, and expanding her vocabulary with words that she needs for everyday life. Although she seems to have real visual strengths for recognizing numbers and letters and even reading, and she may really enjoy these activites, I would not focus on these skills right now. As her mom you want to make sure her world is full of all kinds of new real-life experiences at 2 and not so “academic.” There’s plenty of time for that later, after she masters foundational social and language milestones that are important right now.
Thanks for your questions. Let me know how the eval goes. Laura
Comment by Sharon on 19 March 2010:
Hi Laura,
Thanks so much for putting things in perspective for me. You are absolutely right about focusing on developing her conversational skills and other areas that she needs help with . The reason for mentioning Numbers and letters were to indicate that she perhaps indicate signs of Hyperlexia.
For the SPL evaluation, I will take your advise and highlight just concerning areas so not to confuse things.
I haven’t looked at getting her services in home setting. I didn’t think that was an option. I will look it up right away. We did take her to the OT once as it is very obvious to me she has sensory issues, however, she was so anxious that the therapist decided to stay out and talk with me in private while her dad played with her alone. After that, I have to be honest, I haven’t had the courage to take her back again. Although since then, I have read up a lot of books on SPD and we are engaging her in various experiences. It is helping a little bit. But professional help would definitely be better.
Thanks again for your input. I really appreciate it. Sophie is set to see the speech pathologist early April. I will definitely post the outcome of the visit. S.
Comment by Laura on 25 March 2010:
Sharon - Keep us updated! You’re exactly right about the hyperlexia too. I didn’t mention that initially, but that’s exactly what that is. Let us know what the SLP says and what she recommends. Hopefully you can follow-up for OT too! Good luck!! Laura
Comment by Michelle on 28 March 2010:
Hi Laura,
I recieved a copy of your article “Helping Your Toddler Listen and Obey” from my sons’ speech therapist. I visited the website with plans to order a DVD and found so much more in these posts.
My son Anthony is older than the children I have read about here; he is 4 yrs old. By the time he was 9 months old he literally had already had 8 ear infections and recieved his first set of tubes. He then recieved his second set of tubes (after the first ones fell out)at age 2. As far as milestones he was right on schedule and potty-trained at age 2 1/2. We were told early on that he would more than likely have some speech delay because of his hearing problems.
Hearing this, I was not alarmed that his vocabulary was limited but I began noticing echolalia and even reciting parts of stories and movies he had heard or seen. I started asking other parents who I knew with children with ET tubes and inquired about any speech delay problems. I became worriedthat something was really wrong and took him in for a speech evaluation.
He answers “yes” when he is called, and can follow instructions, “throw this in the trash”, “get your coat”, “time for bed”,can articulate very well what he does and does not want, can recognize the alphabet in and out of sequence as well as numbers up to 20, can spell his name, and tell you his address. He is very social with other children and does well in large play groups. However, like I have noticed in some of the other posts, if I ask ‘what did you do at school today?” he will echo and repeat the question.
He was diagnosed with severe expressive and receptive speech delay and has been in speech therapy for 2 months now. A lot of the echoing has decreased, but he still gets that blank look with questions about what he has done during the day.
I feel so bad that I didn’t notice there was a problem sooner…he is currently in Montessori for preschool but we have decided to send him to another school in the fall that provides speech therapy in the ciriculum. I know it will take time and committment and possibly even holding him in preschool another year, but can you offer any other advice?
Thank you for this forum
Michelle
Comment by Laura on 29 March 2010:
Michelle - I’m so glad you’re being so proactive with him now by having him in speech and in preschool. Try not to beat yourself up too much. You’re doing the right things now. I would highly recommend that you work with him as often as possible at home. Children with the best outcomes have parents who are absolutely committed to working with them at home. Even though he’s older than the children in the DVDs, if his language is delayed, the techniques are still applicable. You may change the toys since he’s a little older (like using Batman toys rather than Fisher Price Little People), but you’re still going to concentrate on building his vocabulary and helping him understand a variety of words. Remember that if he’s repeating you, he still may not necessarily understand what he’s saying, so work to give him enough cues to help him. In my Teach Me To Listen and Obey DVDs I stress the cues, “Tell him, show him, them help him” so that parents remember to say what you want him to do, give him visual cues by pointing or demonstrating what you want him to do, then lastly, by providing physical help if he can’t follow through with your request. Understanding language is the foundation for being able to functionally USE language, so keep at it. Use the strategies your SLP gives you in therapy too since she actually knows your son and what he needs to work on. Thanks for your comment. Laura
Comment by Candace on 16 April 2010:
Hi Laura,
My son just turned 4 years old and went through a really rough time with ear infections starting when he was 20 months old. There was a lot of middle ear fluid that persisted, and I immediately enrolled him in a state-provided speech therapy program for children under 3. I am home with him, and we spent a lot of time with the pediatrician, ENT and SLPs. He tested out with a receptive language level of 14 months, expressive language of 16 months, social and emotional at 33 months (!), gross motor at age-appropriate, plus a slight fine motor skills delay. A team of SLPs and OT’s also evaluated him as “no way” autistic (they commented specifically on his empathy, nurturing and warm behavior and his terrific sense of humor) and also noted his ability to be quite willful (he refused to participate in some parts of the tests).
Well, he tested out of fine motor skills OT in less than a month! And when his ears finally cleared on their own (we barely avoided ear tube surgery), he began talking in one weekend. He continued speech therapy for 9 months, until he was released (4 months before turning 3) as being at “age-appropriate” levels, and his SLP indicated that he was very unlikely to qualify for school district services. We were all thrilled, and I was very happy that I had learned so many things that as a stay-at-home mom, I could continue to model for him and coach as his language continued to blossom.
I won’t go into all the fabulous things my son can now do (ride a tricycle and a scooter, read board books (sounding out words!), play hide and seek with other kids, play Candyland with his family, do puzzles meant for 5-year-olds, play pretend like being a rescue superhero all over the house), but what I am writing to ask about is some continued delays I am seeing with asking and answering questions. I was fascinated by your page on teaching your toddler to ask and answer questions — he was doing a lot of those “top four common problems”! At age 3, his doctor asked him at his checkup what his name was and his age and gender (we had been practicing), but he wouldn’t answer her. Then I was strapping him into his car seat 15 minutes later and he mischievously said, “Hi, my name’s Jeremy and I’m fwee (3) and I’m a boy!” Um, did I mention my son hates being put on the spot!
Anyway, sometimes (and even his SLP commented on this) my son just doesn’t want to speak because he feels like he’s being tested. And this is where we are having issues with questions (which I know can even make non-speech-delayed kids clam up). He has been asking “what” and “where” questions for some time (“What’s that?” “What’s wrong, Daddy?” “What are you doing?” “Where did it go? Where’s Mommy?), and we have been working on when and why and how. A year ago, we were having a lot of trouble getting him to answer yes or no questions, but because of his SLP I used a lot of the techniques you used here, and now he is a pro at it. I hardly ever have to prompt with him with “Yes or no?” anymore. And he can answer lots of other choices questions (“Smoothie or juice?” But I can tell that the more abstract questions are causing him trouble – I can see the gears grinding, but he’s not sure how to respond to “why do you want the red car?” when we’re playing or whatever or even “Why do you want to go outside?” His cause-and-effect understanding has also gotten a lot better in the last year, “Put on seatbelts, so we can be safe!” and “No, I don’t want to go – I’m still playing with trains!” He can also understand three-step instructions at this point. But there are some questions where I can tell he is just not sure how to respond, and that is the one and only time he will repeat things back to me – when I ask him a question and he’s buying time to try to answer it. Do you have any advice as to how I might work on the more difficult abstract questions? And is this delay with these sorts of questions still part of the original speech delay (could he still be catching up?)? By the way, I love the trick about using one parent to whisper the answer while the other parent asks the questions! Can’t wait to try it! I feel like my son has come so far in the last 2 years, but I am not sure if what I’m seeing is continued “catch-up” or a sign of overall auditory processing disorder.
Thanks so much for your advice!
Candace
Comment by Candace on 16 April 2010:
Sorry Laura,
But I also forgot to add that the whole reason I decided to ask this question in the first place is because sometimes I feel like my son is the only 4 year old in the world not bombarding me with “Why?” all the time. And I’m guessing he’s not asking why questions yet, because he’s still trying to figure out what why means when we ask him!
Sorry to add to an already long post, but I thought it was important to point out.
Candace
Comment by Laura on 18 April 2010:
Candace - First of all congratuations on his progress! That’s super! I do think he’s still in the process of catching up, and it sounds like he still needs some help filling in the gaps. The best way to do that is to do exactly what you’re doing. When you see “the gears turning,” step in and help him fill in those gaps. Keep explaining things so that you are constantly helping him link meanings with those difficult abstractions. Give him some choices even with those kinds of “why” questions. When he’s told you “No” to something ask, “Why?” If he’s not wanted a certain snack, say, “Why not? Would you rather have something else? Are you not hungry right now?” GIVE him those answers when he’s not answering readily. It sounds like you’ve both come so far, so just keep going! If he DOES end up diagnosed with an overall processing disorder, you’ll deal with that too, just like you have this initial language delay. You sound like a great mom, and if it happens, it happens. You can do this regardless! Thanks for your email. Laura
Comment by lori on 13 July 2010:
Hi Laura - do you have any specific advice on how to get my almost 3 year old to stop repeating questions rather than answering them? he will answer some questions but he still mostly repeats what we say to him. any help would be appreciated. thank you!
Comment by Laura on 20 July 2010:
Lori - Repeating means that he doesn’t understand what you’re asking him, so keep building his receptive language skills. You can find specific ways to do this on my DVD Teach Me To Listen and Obey 2 AND by looking at the articles here onb the site regarding echolalia. Giving visual cues and choices is usually is the best way to target this, but read the ideas in the articles about echolalia. Laura
Comment by Nadim on 1 August 2010:
Hey laura,
I have a baby girl 2yrs 8 monhts… when she was 18 months old.. she started learning a few words etc.. here and there and could answer us back also eg: if we asked what sound a cat makes.. she would go “MEOW”.. likewise.. but since then she has dropped on most of the talking.
Now she does not use words.. but just points fingers and cries if she needs something, when we sit with her to try to talk to her it is impossible as she just wants to jump and run and play all tshe time… so it is difficult for us to sit with her and talk to her.. although she understands us very very well and is very sharp at catching on to movements and can imitate you only after being shown once.
I am very concerned about her not speaking any words almost at all… me and my wife speak different languages..however with the baby we speak only english.. she watches a lot of Tom and Jerry..and also imitates them in many ways.. and i think this could be a reason why she thinks its perfectly normal not to talk??..
I am in UAE.. Dubai/ can i buy your CD here.. if yes are there any authorized dealers?
thanks and regards
Nadim