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March 03, 2008 | Laura | Comments 67

Making the Leap from Words to Phrases…. Tips for Helping Your Toddler Learn to Combine Words

Research tells us that toddlers with typically developing language possess a single word spontaneous vocabulary of 35-50 words before they begin to combine words into two-word phrases.  We should use this same guideline when deciding when to target phrases with children who are late talkers,  those with language disorders, and especially in children with apraxia, or motor planning difficulties.    

There are many things that you can do at home to work on the prerequisite skills necessary for spontaneous phrase production.

1.  Before you begin working on two-word combinations, be sure that your toddler is saying at least 35 words on his own (meaning without imitating you) in daily routines.  (This point is so important I’m repeating it in case you didn’t process it the first time.)

In my experience, many late talking children, especially those with apraxia, or motor planning issues, have single word vocabularies well in excess of 50 words before they can begin to consistently imitate two-word phrases, much less say novel ones on their own. 

If your child’s vocabulary is not this size, continue to work on adding new single words.

Some children can imitate phrases before they are truly using 50 words on their own.  In many cases, they are learning the phrase “holistically” or as one unit.  In other words, the entire phrase is just one long word to them.  Children with difficulty processing and understanding language often learn phrases in this way.      

The only way to know if your child’s vocabulary is at this level is to keep a list of all of the words he says on his own (not imitated) over 2 or 3 days.  I routinely ask the parents of children on my caseload to do this.  Most parents have good luck keeping a running list on the refrigerator or in the den.  Sometimes parents are surprised at the results.  Some parents underestimate their child’s vocabulary and are excited when they realize just how much he/she is saying.  Some are disappointed when they realize their child might be using a core set of words over and over.  If you’re not sure how your child is doing, I definitely recommend this exercise.       

2.  Your child needs to have a variety of words in his vocabulary from different grammatical categories before he can sensibly combine words into phrases. 

When analyzing the early vocabularies of toddlers, most of the words they use are nouns/names for people and objects.  This is the case in typical language development too.  But if you’ll think about it, a child needs more words than nouns, or names for things.  It’s hard to make a sensible phrase using two nouns.  (Other than those for agent + object such as “Daddy shoe.”) 

Children also need:

  • Social words (such as bye-bye, hi)
  • Requesting words (such as please, more, again)
  • Verbs/action words (such as go, eat, sleep, drink, jump, open, push)
  • Early pronouns (such as me, mine, my, I, you)
  • Prepositions/location words (such as in, out, off, on, up, down, here, there)
  • Negation (such as no and then later contractions including don’t, can’t)
  • Adjectives & adverbs/descriptive words (such as big, hot, fast, yucky)

Be sure you are introducing and teaching words from these different categories so that your child has broad vocabulary base in order to make phrases.    

3.  Your child needs to be able to sequence two syllables together. 

If your child routinely reduces multisyllabic words to one syllable, such as “ma” for Mama, “bu” for bubble, “Mo” for Elmo, he needs more practice with sequencing syllables first before trying to learn phrases. 

Work on this by practicing words with reduplicated or repetitive patterns since this is the easiest and earliest form noted in typically developing language.  For example, all the “early” words - Mama, Dada, bye-bye, baba (for bottle), and night-night.  Try to target words with sounds he already tries to say. 

Don’t forget animal sounds since these are more fun to practice such as moo-moo, baa-baa, neigh-neigh, quack-quack, woof-woof, etc…

Use clapping or patting the floor to help him “feel” both parts of the word.  You can model this and wait for him to imitate, or use hand-over-hand assistance to make him do this.  This technique is very helpful for children with motor planning problems (apraxia).  The motor movements actually help them produce the word.  (That’s why signing is so effective too!)

4.  Your child needs to be able to say several different types of syllable structures.        

This is going to be a little technical to explain, so hang in there with me.  Toddlers with typically developing speech and language skills usually learn to say words with various patterns and syllable structures.  For example, a toddler who can say Mama, up, no, hot, and open is using 5 different kinds of consonant (C) and vowel (V) combinations.

“Mama” is CVCV.

“Up” is VC.

“No” is CV.

“Hot” is CVC.

“Open” is VCVC if he says “open” or VCV if he says “opu” (a typical way babies say “open.)

If your child can only use one or two syllable types, he is not going to be able to say lots of different phrases.  Even if he tries, you may not be able to understand him because it will be “off-target.”

Analyze the kinds of syllable structures your child says by carefully listening to how he says the words.  (A word of caution here - new talkers do not need to be constantly corrected for their first word attempts.  Do not take this as a license to overcorrect.  This should be a process of analysis, not an opportunity to prematurely begin work on articulation!)

Note if most of his words are the same patterns.  This is common for children who are late talkers and especially those with apraxia, phonological disorders, dysarthria, or whatever else you want to call it.      

If most words are the same pattern, you’re going to have to work on introducing new syllable structures.  This requires some thought and careful planning.  If you’re not naturally good at it, call in a speech-language pathologist to give you some assistance.  (Another word of caution - Your child may not be able to do this without special coaching, and you may not be able to teach him.  Don’t despair if you can’t get him to pronounce a new pattern.  I had to go to college for 6 years to learn how to do it!)

For children who did not babble or produce jargon (saying short syllable strings with inflection similar to adult speech), this step may be unrealistic for a while, since difficulties with verbal sequencing is likely the reason he is talking late.  Some therapists try to teach kids to babble or jargon by modeling this for them.  I must confess that I am horrible at this! 

Instead, I sing to them using very familiar songs.  Singing is the best way to practice sequencing because we get help from the melodic (The technical term is “prosodic”) qualities of speech.  Remember all the advice about using a “sing-song” kind of voice from the What Works article?    It’s the same idea.  I encourage kids to sing by “bouncing” or dancing during singing.  Sometimes I just hum the song to get them going.  Or you could use a single syllable he can say and repeat it to the tune of a familiar song.  There’s more about the benefits of singing later in this article.                  

5Your child needs to hear a variety of two-word phrases before he is able to imitate them.   

What can you do to work on this at home?  Frequently model short two-word phrases during the day.  Try to vary your categories too.  (See #2 above if you’ve forgotten this already!)  Don’t get stuck always modeling, “Noun + Verb.”  “Mommy sees.”  “Blocks fall.”  “(Name) eats.”     

Vary the way you model phrases. 

  • Verb + Noun - “Read book,” or “Eat cookie.”
  • Pronoun + Verb - “I run.”
  • Pronoun + Noun - “My shoe,” or “You(r) turn.”
  • Adjective + Noun - “Yucky milk.”
  • Noun + Preposition - “Arm in.”

Expand his single words to phrases and repeat these to him. 

  • When he says, “Car” to ask for a car, model, “Want car.”
  • When he sees a car and is labeling “car,” model, “There’s car.”
  • When he’s making the car move, model, “Go car.”
  • When you are playing cars with him, take it from him and teasingly model, “My car.”

Remember that lots of the language directed to a late-talking toddler should be at or just above his expressive language level.  For new talkers, you should be using mostly single words and short, two-word phrase utterances when you’re talking directly to them in play and in daily routines.     

6.  Your child should be able to imitate two-word phrases before he can consistently produce them on his own.

(Okay - here’s another disclaimer.  Sometimes kids with apraxia can say phrases on their own initially better than they can imitate them due to the difficulty with imitating anything, especially a challenging sound sequence, which usually includes phrases.) 

Teach phrase patterns so he has a model of what words to combine.  Use predictable patterns for extra practice since motor planning will be easier if one word is changed. 

The ones I start with first are:

More + (Noun he says frequently)         (Noun he says frequently) + please

More  + please                                      Bye-bye + (Name/noun he says frequently)

           

If your child has used sign language, it may be helpful to model the sign as you are saying the word. 

Even if your child has “dropped” signs in lieu of words, you may want to pull them out again as a strategy to help him “motor plan” for phrases.

Another way I use signs at this level is for me to sign the word, but not say it, as a cue to help the child know what to say.  If he can’t do it with this no verbal cue, I mouth or even whisper the word.  Sometimes kids can even say a phrase in unison with me, but not repeat it.  If your child is interrupting you while you are modeling, he’s indicating that this technique will work for him, especially if he’s doesn’t “finish” the phrase without you.          

One mistake many people (including therapists) make when practicing phrases is to break up the phrase into single words.  For example, they have the child repeat, “more,” then “milk.”  This is okay for one time or perhaps two, but please resist the urge to split up phrases every time you practice!  This defeats your purpose!  Model the phrase with the words together.  You already know he can say single words.  You’re working on phrases!

If a child keeps repeating the first or second word as the phrase, such as “ball ball” for cheese ball, he is having difficulty with motor planning.  Keep using these strategies.  He needs them!   

Another thing I do is to model the phrase using a sing-song tone of voice.  Again, this helps with motor planning/programming because of the rhythm and prosodic (melodic) qualities.  Your kid won’t sound like this forever, but doing this now may give him a shot at being able to produce phrases sooner.

When he’s imitating those well, move on to other patterns including: 

            Hi + Name/Noun                       Night-night + Name/Noun  

                                                                  (For you purists out there, “good night” is usually too hard!)

When he’s doing these well, I listen for words he says frequently to model and prompt as phrases.     

If he says, “go” and “choo-choo,” I model the phrase both ways to see what’s easier for him to imitate, “Go choo-choo,” or “Choo-choo go.”  I always keep these kinds of “probes” in context too.  Don’t sit down with your word list while he’s having a snack and try to see what he can imitate.  Keep it real!   

7.   Some kids need an “in-between” step when making the leap from single words to two-word phrases. 

 

Some kids need that extra practice with sequencing before they are able to try phrases.  I like to use the same word for this kind of practice.  Use words in a repetitive pattern like “up, up, up.”  Location words/prepositions and verbs/action words usually lend themselves better to this kind of practice.  Try, “Walk, walk, walk,” as you’re walking or making an animal walk in play.  Try, “Down, down, down” when you’re going doing the stairs.    

Another way I practice is to label pictures in a book or toys placed in a line on the floor sequentially.  (This is a great way to work in a language focus for kids who line up all their toys!)  Start with all of the same kinds of objects.  For example, if he’s lined up all his trains, point to each one and say, “Choo-choo, choo-choo, choo-choo.” 

Instead of counting objects or pictures of like items, I practice labeling them.  For example, in a counting book with a picture of a group of dogs, I point to each one and say, “Dog, dog, dog.”   

I also practice with different pictures or objects in play when a child’s sequencing is better.  Try to stick with words she can already say.  For example, when playing with dolls, place a few items in a row and label, “Baby, milk, sock.”  Pause between words, but not for too long or you’ll defeat the purpose of practicing to improve sequencing.   

8.  Take advantage of “automatic” speech.  

When something is familiar to us, it becomes “automatic.”  When you’ve heard something over and over again, your brain “recognizes” and “predicts” the next part.  Use this with your child.   

One way to practice this is with books with repetitive themes.  Look for ones with a tag line that’s repeated over and over.  Again, make sure this makes sense to your toddler.

Another way to practice this is by singing familiar songs.  When your child has heard a song many times, his brain begins to expect what comes next.  You can use this to get new words by singing a line from the song and pausing for him to complete the next word.  Toddlers usually do this best when you leave the blank at the end of the phrase.  For example, sing, “Row, row, row your” and wait for your child to sing, “Boat.”  This works best when it’s an age-appropriate word.  The next line in this song illustrates my point.  “Gently down the _______.”  I don’t know a two-year old with typically developing language skills who says, “Stream” in everyday conversation.  Be sure you’re using common sense in choosing which words you expect him to say.           

When you’re singing, be sure to slow down the rate so he has time to catch up.  This is the main reason you should sing, and not rely on CDs.  You can control the speed!  Some children’s CDs and toys sing so fast that I can’t even keep up.

Don’t forget to try other familiar sequential phrases such as, “Ready,” and pause for him to say,

“Set - Go.” Or “1″ and wait for him to say, “2 - 3.”  Make up your own cute phrases at home during daily routines and say them over and over so your toddler expects what’s coming next.  We had lots of these in our house (and still do!)       

9.  Try wholistic phrases if your toddler is really struggling.

 

As a rule, I don’t model lots of these unless I don’t think I can get phrases any other way.  Sometimes children with apraxia can imitate or “pop out” a holistic phrase and then it becomes part of their core vocabulary.  Good ones to try are:

I did it             I got it             There it is        Here you go      See ya              Where (did it) go?

Right there      Right here        That one         This one           No way!                        Oh man!

Gimme 5          

I also try funny, novel sequences such as, “Oooh - Yuck,” “Uh-oh Spaghettios,” or “Oopsy daisy” to help move sequencing along if I’m not having any luck with more traditional combinations.  

10.  Listen for any “pop out” phrases and try to elicit them again in similar situations. 

 

Pay attention to any “accidental” phrase he might use and try to get your little guy to say it again.  You may have to set up the same situation later to see if lightning will strike twice.  Remember that repetition is what increases the strength of your child’s brain’s motor pathways or connections for speech.  Do all you can to help your child be able to say the phrase again, without lots of obvious pressure.  Sometimes the more you push, the harder it is for him!  Set up the situation and wait (and hope and pray!)    

Hope these ideas help at home!  If you need clarification, please feel free to leave a question or comment!  I love to hear from you!  Laura 

EDIT TO ADD -

11.  Try carrier phrases.

Use simple phrases with the same words at the beginning so that your toddler only has to “plan” to change one word at a time.  For example,

There’s a ___________.

That’s a ____________.

I see a _____________.

I want _____________.

I like ______________.

Give me ____________.

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There Are 67 Responses So Far. »

  1. Is the 35-50+ word minimum supposed to include only words a child can say completely correctly, or can this minimum vocab include close approximations? For example, my son says “peas” (please), “beebee” (baby), “anan” (banana). Of course for him (and for us), they are REAL WORDS. Just want to make sure I’m doing things correctly. I’m pretty sure his spontaneous vocab is in this range, but we are making the list just to be sure. We model correct pronunciations for him, but try not to overcorrect, as you have suggeted.

    Thank you!

  2. Karen - You’re exactly right! Approximations of words that you recognize and understand certainly count! You’re also doing the perfect thing by modeling and not overcorrecting his articulation. Good job! Laura

  3. I have a 20 month old who has a single word vocabulary of over 50 words, but is not yet producing two word phrases. Is is too early to expect this? I don’t want to pressure him, but want to be sure he is where he needs to be.
    Thanks so much,
    Lori

  4. Two-word phrases usually emerge when a child is between 15 and 21 months and after a child has 50 words. It sounds like your little guy is in PRIME TIME for learning phrases. Model phrases frequently for him using words he can already say on his own. Try the other tips listed in the post as well. With a little work on your part, these should appear in no time at all! Keep us posted! Laura

  5. Are thg\ere any DVD’s you recommend to help reinforce phrases? A lot of the educational DVD’s I have seen are alphabet, numbers and single words. Thanks! Robin

  6. Actually Robin, we are working on a series of DVDs to teach parents techniques to work on language at home, and this would include targeting phrases. We’re still hoping to begin to have these available around June 1. Please keep checking back since they will be available on this site. Laura

  7. [...] Making the Leap from Words to Phrases…. Tips for Helping Your … [...]

  8. Laura,
    I posted in April about my little boy not combining words. He is 21 months old now. We started working on the things you suggested and now he is making 3 and 4 word sentences! Thank you for your help!

    Lori

  9. Lori - HOORAY!!! Congratulations! That’s why I started this site! Thanks so much for the feedback! Laura

  10. Hi! Laura

    I was looking at the point you made on “AUtomatic Speech”. I notice that my son ( about 34 months old) says a lot of words correctly when under stress. For Eg. For a long time I have been teaching him to say “Its Mine” with his favorite toys, books and other items , but only ( about a few months back), when I was trying to grab something from his hand did I hear him shout “Mine”. The same thing was repeated a couple of times when his friend was trying to take his tricycle from him and the speech therapist was again grabbing something from his hand. SImilarly I was trying to force him to eat some thing and he just looked at me and said’Finished’ !! once . Thats it - cant hear it again! My point is how do I make him use the words and repeating them without always adding a pressure situation.

    He plays a lot ( run and catch ) with me. I try to include words during the play but he is only having fun ( laughing and enjoying himself - does nt say anything execpt ‘Mummy’) or during sleep time/ feeding time. Has nt helped much. I hear him babble a lot - which is absoluetly meaningless, also has some repetition of words now ( if i said”uh-oh” he would also say “uh-oh” and later that would be play for us) and if I am teaching him the alphabet and I say ‘A’ he will say ‘B’

    Can you pl guide me on this please?

    Thanks once again

  11. Niyati - Play is the best time to introduce words, but you need to do it in a way that encourages him to respond using playfulness, modeling, choices, and withholding. If you’re not sure about how to use these techniques, keep reading articles on this site. I also have some clips under the DVD release article so that you can SEE how I work with children in this way. Set up situations so that he HAS to communicate. Again - the DVD may help you see how to do it if you’ve not gotten help from an SLP yet. Laura

  12. Laura-

    First let me thank you for taking the time to put all of your great advice and treatment strategies into an easy to read format!!! I work in early intervention and I already use many of your techniques - the kids truly respond to adult enthusiasm, high affect praise and silly play!!! I have been desperately looking for good hand-outs for parents (for homework and as reinforcers) to highlight what it is that I do and HOW I do it. Just today, I found your website and I ordered your DVD (which I can’t wait to view); I look forward to sharing your site and video with my families.

    I wanted to share a strategy that I use with some of my clients when working on 2 word phrases. For children who recognize pictures, I use individual photos to represent the 2 different words: e.g. a picture symbol for MORE + picture of desired object/activity (COOKIE, BALL, TICKLES, etc) and point/cue the child to use words. This also works with photos of the child paired with action pictures - children love seeing themselves as the agent!!

    Thanks again for supporting all of our early childhood intervention efforts - I appreciate all of your hard work and can’t wait to read future comments and articles.

    Karen

  13. Karen - Thanks so much for your comment and for ordering the DVD! It will ship tomorrow! I hope you enjoy it and can share it with the families you serve. You didn’t say if you’re an SLP or developmental interventionist (or whatever the equivalent is in your state!) Let me know, and drop me a line after you’ve watched the DVD to let me know what you think! Laura

  14. My son is 24 months and has been refered to a speech pathologist because he has expressive speech disorder. I am pretty sure it is apraxia. He only grunts and says Ema(mother) Aba ( father) and he and I are trying to work on some animal sounds, baa, moo and neigh. He said yuk the other day. I have learned a lot since going on line but I find that most of it does not deal with the very intial stage where he is at. He is very communicative and has developed his own sign language. He communicates with everyone. He is also physcally a very talented child. He loves books, songs, dancing and games. He tries anything I give him instructions to do but sounds just dont seem to come out. Do you have any suggestions

  15. Debbie - You’ve come to the right place! Read the all the articles in the expressive language section including “Help! My Child Won’t Imitate Words” and “Successful Strategies …..” These should give you additional ideas. Might I also suggest the DVD because it SHOWS you how to cue him which might make it easier for him to learn to imitate. Laura

  16. I guess the important thing is for all of us to be aware of our kids preparedenss when it comes to language development. There is a wide rage of ages in which toddlers start putting 2-word phrases togehter and we need to make sure our little ones are not too late (way over this parameter) but i most cases they will eventually speak. I was pretty impressed when my 16-month old started putting 2-word phrases toghter. At 20-months she went to 3-word phrases and now at 22 months she does 4-word phrases. The point is, once they start nobody can stop them :-)

  17. Vanessa - My own children also combined words very early, but the difference is, they were not language delayed. The OUTER age limit for typical language development is imitating these by 21 months and using these frequently and spontaneously by 24 months. As you’ve noted, there is a wide variation in “normal” from 14 months to 24 months, but beyond this, and a child is considered to be delayed. Laura

  18. What i feel is important is spending time with our toddlers atleast an hour everyday on teaching the phrases. My daughter, she is now 23 months started saying a full phrases like “Oh my God” when she finds something goes wrong. When she finds something very exciting on TV or books she says “Mama look this” and now she knows where to use all the magic words like “Please”,”Sorry” ,” Thankyou” etc,etc…. But i dont want to stop with this. I need more ideas how to teach her with more good words and phrases. Suggestions on DVDs or books would be appreciated. Beena

  19. Beena - It sounds like your daughter is on the right track! Take a look at the ideas listed in this article “Making the Leap from Words to Phrases.”

    During the day keep trying to model (or say) short 2 word phrases when you are playing with her. Use them during daily routines so she can repeat you and ask for things she needs. Vary the kinds of phrases you use so she can hear and imitate all kinds of patterns throughout the day.

    Teach Me To Talk the DVD includes lots of ideas on teaching new words and then shows you how to expand those words to phrases during play with your child.

    If your daughter likes to listen to books, try to read repetitive children’s books like Brown Bear or Good Night Moon or any of the Sandra Boynton books. Toddlers can learn what comes next and then fill in the last word or phrase of the line. You can also do this while singing familiar songs as suggested in the article.

    Good luck teaching her! It sounds like you’re both doing a good job so far! Laura

  20. I feel a little confused because if a child is not putting words together by 21 months are they label delay. my 22 months is to me slow in learning 2 words and putting them together and I read so much and all give different time frames. as a first time mom anytime my daughter is not doing something like is said I automatically freak out. I just don’t know what to think anymore is she ok is she behind will she catch up I don’t want to take her to therapy just yet I am just getting frustrated

  21. Jenny - Many children do start using 2 word phrases long before the developmental charts tell you, but the language mielstone charts say that by 21 months a child should be beginning to imitate 2 word phrases and then use phrases frequently on their own by 24 months. Hope this clarifies the information for you! Again - there are lots of things you can do at home to help her. Keep reading the articles I mentioned before! Laura

  22. Laura,

    My son is 26 months and can say well over 200 words on his own (I made a list), and in the correct context. He was a late talker to begin with (which apparently runs in my husbands side of the family), and now will not combine words. He’ll say the same word over and over, and I try so hard to get him to say “more please” (or things like that) and he’ll say “please”, or just “more”. There I times I see him struggling really hard to try to repeat what I just said, but he can’t. He says “Thank you” and “Bless you” on his own, but he thinks it’s one word.
    I have heard him on his own trying to practice two words and then he’ll come running in the room and go “juice please”. Very rare though. He’ll say Baba (dad), truck, go. Which means Baba’s truck is going. But he doesn’t say it as one sentence, he pauses between each word. Is this reason for concern, or am I driving myself crazy for no reason?

  23. Christina - Thanks for your question. It does sound like he’s having some difficulty sequencing two words, and on some level, he knows it, since he is beginning to “practice” and is so proud of himself when he can successfully do it. I have had this happen with children on my caseload, and here’s what I do and then more importantly, have moms practice thru the week at home.

    Practice the same word in a sequence in your daily routines and in play. As you are going up stairs say, “Up-up-up-up.” If you’re playing with a toy character or animal, have him practice “Walk-walk-walk.” When you’re looking at pictures in a book, say a counting book, don’t “count” the pictures, but label them like “duck - duck - duck - duck.”

    When he’s been successful for a few days with those activities, up the ante a little. Organize a row of toys in sequence and have him label them - car truck car truck car truck. Try alternating what’s worked in the last few days by changing it just a little. Instead of up-up-up on the stairs, add, “Up stairs up stairs.”

    If you’ve used signs in the past, or even if you haven’t, you may try doing the signs with the words “more please.”

    The other thing I try is to get a kid to say the phrase WITH me - not just imitating me.

    Try these ideas, and hopefully you’ll see some improvements! Let me know! Laura

  24. Again thank you so much for this article. My 23 month old is not saying phrases at all. He has been diagnosed with mild hearing loss which Iknow is behind his speech delay but while we wait for the doctors to figure out whether to do tubes or not, I want to start working with him on his speech. We read and spend tons of time together-I’m a nanny so he comes to work with me- but your article has really helped me figure out some techniques to use in our play and in the one hour each day I plan to set aside to work on his speech issues with him through play. thank you so much.

  25. Hi, my son is almost 14 months and he’s only using one syllable word sounds right now and occasionally two will come out but very rarely. Is this normal? I am always worried about his development….is there anything more I can do to help him with this? Thank you very much.

  26. Heather - He’s pretty young, so at this point I wouldn’t be overly concerned. Try to elicit words with duplicated syllables like Mama, Dada, bye-bye, etc.. since these will be the easiest for him to combine. Try to get him to try to sing along with you too, although he won’t be saying the real words yet, since with this he’ll practice sequencing syllables. Even if he’s singing “Da-da da-da da-da da” for Twinkle, Twinkle, Little Star, he’ll be working on getting those sounds into syllables. Hope these ideas help! Laura

  27. Hi Laura,
    I appreciate all of the information. My son is 23 months, says between 40-50 words, although not all spontaneously. He has a few 2-word phrases, such as: love you, man roar (uncle taught him!), trot ol joe (song), whoa joe (song). He moves his mouth a lot when he is trying to come up with a word. He tends to grunt or make noises when he wants something, rather then say the word. Sometimes I will ask him to say a word, but it sounds nothing like it. Would you recommend I get him tested, or is it too early?

  28. Diane - I would go ahead and have him evaluated by a speech-language pathologist who specializes in working with very young children. 23 months is an ideal age to be assessed. Some of the things you’re reporting might possibly be signs and symptoms of childhood apraxia of speech - namely off target imitations and “oral groping” or moving his mouth when he’s trying to say a word. However, many clinicians will not formally diagnose this in children under 3, BUT you can still do speech therapy and see how he comes along even without a formal diagnosis.

    The other thing I’d HIGHLY recommend that you do is to re-phrase how you are presenting his communication skills. Without careful listening or questioning, I think a busy SLP could overlook what he’s really struggling with, based on how you’re reporting his skills. You should begin your discussion by saying he’s able to imitate words, but he doesn’t use them to get what he wants and over-relies on grunting. I’d only “count” the words he says consistently and spontaneously as part of his true “vocabulary” and report that number rather than saying 40-50 words. If you’ve only heard him repeat a word or even say it on his own once or twice, then it shouldn’t be counted at all. When I give these same recommendations to parents I see, they are often disappointed to learn that their child’s true vocabulary is much less than what they thought.

    All of the phrases you’ve indicated he uses are really “holistic” phrases and not true two-word phrases. He’s likely learned each of the ones you reported as one long word. Examples of what SLPs consider two-word phrases are words he says on his own purposefully as single words and then combines them into novel phrases such as, “Hi Mama,” “More cookie,” or “Go car.” The names of songs aren’t counted as a phrase unless he routinely and meaningfully understands and uses each word. I don’t count things like “all done” or even “thank you” as a real two-word phrase until a child is using “all” or “you” in another context such as “want all trucks” or “You do it.” Does that make sense? Do you understand why changing how you talk about him would be important in helping someone determine if he needs services or not?

    You can go through your state’s early intervention program to get a speech-language evaluation, or you can see someone in private practice. Know that all children with delays may not qualify for since children have to be significantly delayed to be eligible to receive services through this kind of state-funded program. Some children who are a little behind fall through the crack of not being age-appropriate, but not delayed enough to qualify. Based on what you’ve said, I certainly think he could benefit from a jump start to help get his speech and language going, but it sounds like he could also fall into this in-between area. In that case, if insurance would cover it, or if you can afford to pay out of pocket, I’d pursue a private evaluation with an SLP who specializes in treating very young children. He/she can tell you for sure if there’s a problem and more importantly, give you very specific ways to work with him at home to help him learn to initiate and use words purposefully to get his needs met, continue to build his vocabulary, combine words into real two-word phrases, and then produce more on-target word attempts.

    Hope this info helped! Laura

  29. Hi Laura
    I loved reading through your website and got a lot of ideas how to help my daughter combine words. She’s 26 months old and is saying about 40 words (possibly more that I can’t think of at the moment). We’re raising her bilangual since I’m from Denmark and she’s able to say words in both English and Danish. She’ll imitate a two word phrase as long as it starts with “bye” or “hi”, but she is not combining words on her own. It makes me worried, especially since other girls I know her age says three of four word phrases and some can even carry on a converstaion. I just wondered if you have any advise for her particular situation(being bilangual) and if I need to worry. I really appriciate all the effort you’ve put into putting this website togther to help us moms out there, thank you.
    Xenia

  30. Xenia - Research tells us that children raised in bilingual homes frequently take a little longer to meet their expressive language milestones. As long as she’s not having any difficult UNDERSTANDING language, I’d not be too concerned about her. If she’s following directions, pointing to pictures named, and understanding daily routines, there’s probably nothing to worry about. Keep pumping language into her and use the tips outlined in this article to help her learn to combine words into phrases. If she’s not doing this in a couple more months, (and it sounds like she will be based on the info you’ve provided), then you may want to have her evaluated and get someone to help the both of you get over that huge hump! Phrases are so hard for some children!! Hope they start to emerge soon in your daughter’s language! Laura

  31. Hi Laura,
    I have written to you before. I have twin boys who are 26 months. They have a vocabulary of 35-50 words or more. A lot of them have the consonant dropped off the end of the word and they don’t use all 50 everyday. We are working with them continuously with an SLP 2x a week. I have noticed though with 2 word phrases that they can repeat them if I say one word at a time. For example, if I say baby and then say sleep, they can repeat it. But if I say baby sleep they say “ah sleep”. So the addition of two words in fast sequence is giving them trouble. They will only either say the last or first word in the phrase or shorten the first word to be something like ah or da. Once again, I know this is an indication of a speech disorder but I was wondering if it also could be kind of normal in speech delayed children without a disorder. My kids are too young for an apraxia diagnosis and especially since they are only using single words - this is what my SLP has been telling us. I am not rushing for a diagnosis either but I do want to know if my boys are still within the range of normal speech development (just on a delayed basis).

    However, on the bright side, they learned their alphabet at 22 months and can say every letter perfectly. They also know the sounds that each letter makes. They can count to twenty and know all colors and shapes. They say them pretty well but articulation is an issue.
    Any thoughts you can give are greatly appreciated, Thanks for your input.

    Cara

  32. Cara - Keep working to build their vocabularies so that their words are very spontaneous and consistent, then the phrases should come. IF they are still struggling to combine words once their vocabularies are well past say 50-75 words, then you can start to think sequencing may be a problem, but I’d not worry about that just yet.

    What you may want to try are some easier patterns. Kids I see rarely use a phrase like “baby sleep” first. Try “Bye bye Mama or Dada” or “more ______” or other very familiar and well-rehearsed words from their vocabularies. Try other things that naturally go together too like “choo choo train” or even holistic phrases you’re using all of the time such as, “I got it,” or “I did it.” These usually do come a little easier to our kids with delays.

    Since they are counting, are they doing this sequentially like, “One two three four five….” with barely a pause between. If so, then sequencing is likely not the problem - they’re just not ready yet, as your SLP suspects.

    It sounds like they are making good progress now, so keep doing what you’re doing. It will work! Laura

  33. Thanks for your quick response Laura! Yes, they can say their alphabet and numbers quickly without much pause in between or at all. The number don’t always come out articulately but the more they practice the better they get.

    My older twin can say “all Done” and “no way” and “up down” quickly as if they were one word. Holistically I guess as you put it.

    I will work on the easy phrases and hopefully they will come. I am not worrying too much about articulation because I see how they perfect it over time. When they first learned their alphabet they couldn’t say the letter C (I guess its phoenetically wierd). But over time they finally got it.

    Right now their number 1 is said backwards like “noe”. Its kind of odd but when I think about it, they are pronouncing it phoenetically in reverse. One sounds like WON and they are saying NOW with a long O. Funny huh? And they both do it. I think Cole is copying his brother.

    They spend a lot of time communicating with eachother and do have their own language (although they are not identicial). But I will do the exercises you talk about in this article and do a lot of praying.

    Thanks again for your help and advice, you are awesome!

    Cara

  34. Hi Laura,

    It’s me. Again. We have been working on Jakob with some of the things on the video. And I have a few questions….shocked aren’t you?

    First. Jakob IS picking up new words…..verrrrrrrrry slowly, but he is. But here’s the thing. They don’t have to do with what we are working on. Like we have been working on ‘weeeeeeee’ like Kate suggested on the podcast. And he has finally picked up a ‘yeeeeeeeee’ Ok, that was a bad example. And now I think he is calling me ‘meemee’ instead of mama…..do you think he is fixing to morph the new with the old into ‘mommy’?

    More often than not he just ‘comes out’ with a random word.

    Second, I know that typically kids need to have a vocabulary of 35 words minimum to start forming phrases. I made a list of all of jakob’s words and signs, and he has 24 signs and 21 words. But he IS saying-on his own- some two word phrases. “Mo woo woo” for when he wants to watch another train video, and I think one other “more” request that I can’t think of right now. Do you combine the word lists and give him a vocab of 40 or so words, and that is why he can combine words?

    I had him reevaluated by another ECI therapist and he was still put at a 15 month level with his expressive language. (This was before he started combining words into two word phrases.)

    That therapist swore to me that once we got rid of his paci his vocabulary would skyrocket and I know that isn’t true but i am so darn tired of everyone telling me they are worried about his paci that i got rid of it.

    Let’s move past the paci, folks and focus on his talking.

    (He added two word phrases before i got rid of the paci, btw.)

    He also has added words with ’s’ on the end. He is having a hard time perfecting them, but he is trying and I can say, “Say ‘fish’ ” And he will start with his default ‘pah pah’ and if i keep asking him, he will keep trying and eventually come out with a word that sounds pretty close…. Kind of like ‘chush’ or something, he keeps his teeth closed the whole time….he always has the ’s’ on the end, but something unidentifiable before the s sound.

    Also I have noticed him leaving the first m off of mama….

    Now that I have written a book….

  35. Hi friends! I’ve been on a whirlwind trip this weekend and have approved several recent comments that were submitted from March 19 to 21, but I am simply too tired from the trip to give you the thoughtful responses you deserve! Promise I’ll get these answered as soon as I can! Thanks for your patience - Laura

  36. I have 2 ,5 year old daughter who does not make sentences yet. She knows many words, but it is frustratiing at this point that she does not communicating with us at all. she will say fish, mia sleep, swim, etc. but nothing else. I cannot make her repeat anything after me, when I say” mia say I love you” she doesn’t want. I think that she is being lazy, but I wanted to check with you. we are trilingual family, my husband speaks german, i speak croatin, and mia get exposure to english through media…she is about to start preschool now.
    please help. is this reason for concern?

  37. Tamara - Your THREE languages at home are likely the problem she’s having with expressive language development. If possible, try to stick to the language she needs for school at home too to see if this will give her the jump start she needs. Model lots of simple 2 word phrases with vocabulary she already uses as single words to see if she’ll start to spontaneously imitate those. Try the ideas in the above article too since those tips really work. Laura

  38. Hi,

    I have a 22.5 month old who says about 75-100 words (some clearer and more complete than others but definitely a wide vocabulary between nounds, pronouns, actions, descriptive, etc).

    On any phrasing, however, he struggles and it is limited, at best. “I do” is very clear (and often :)) but not sure he sees it as a phrase as much as another word. On other phrases (that also could be just another word) are blurred. For example, “all done”, “no more”, etc are blurry- “all done” sounds like “awe da” whereas “done” alone is clearly “done” as a stand alone - “help” and “me” are clear but “help me” is a blurred combination of the two. “give me” is a fast “gibe” and so on. Should I be concerned or is this how it progresses? He also does not seem ready to put together a description with a noun, although he loves to evaluate big, little, colors, etc., just not tying it to the noun.

    He was a bit late getting to his words so he went from a few words to his current state in just the last 3-4 months. We have bought your DVD and the expansion part is a great help but I’d like to know what you think on getting evaluated or other steps or this sounds pretty normal in terms of getting to next step of phrasing. It’s hard to tell when you read so many different opinions out there on the web. Thanks for all your tips!!

  39. Carol - I like your question so much that Kate and I are going to discuss it today on the podcast at 5 pm eastern time. Listen in, or better yet, call yourself and discuss it with us! The call in # is 1-718-766-4332. If you can’t call or listen today, you can still hear us discuss this later on show #83. Thanks so much! Laura

  40. Hi Laura,

    Thanks…I couldn’t listen live but just listened and your tips are great! In fact, I think buidling phrasing with words he is really comfortable with is a great idea and honestly, we hadn’t been doing that much (in fact, we had been focusing on some phrases that were far less common words for him, although common to us adults :). In fact, I could have sworn I heard a “I do truck” today now that you mention such examples and will build on that type of approach. Thanks so much! - Carol

  41. Hi Laura, I am so greatful to find your site and I have started listening to your podcasts - you are wonderful.

    I have three sons and my youngest is 25 months and is seeing an SLP weekly. My son has similar struggles to many others who have made comments on your site. He can say many sounds in isolation but when combining sounds into words he struggles unless it is a word he can use without having to think about it. He tries to say many phrases - usually “more______” or “no______” or “hi or bye,bye _____” but most times when combining any two words both words get messed up even if he can both words by themselevs well. He has about 10 clear words but over 40 words that we can understand - it is just that they are really hard to understand.

    Anyway, our SLP is great and she keeps saying that my son is having sequencing problems. Is this the same as motor planning or apraxia?

    My son struggles with imitation of non verbal things like facial expressions, sticking out his tongue etc. He can do these things reflextively but not when asked (although he tries - moves his tongue around etc. but can’t get it out of his mouth).

    I think he has Apraxia and has many of the typical signs (quiet baby, didn’t bable until 12 months, said “da” for everythings until about 18 months, now says words but usually makes lots of vowel sounds - “booboo for baby, boba for ball, Deeda for Dora etc., and if combining words usually both words become unreconizable.

    I am just wondering if our SLP’s thoughts on him having sequencing issues is the same as Apraxia or another concern completely?

    Thanks for any advice you can offer - I love your site and easy to understand information you provide.

    Angela

  42. Hi Laura and parents, My daughter Nadia is 4 and half years old i suspected she had a language disorder since she was about 2. Only this month was she properly diagnosed with receptive expressive language disorder although she has a vast vocabulary and does speak and answer most questions. her disorder was not obvious to many pshycs and professionals but with age and her complete lack of understanding abstract concepts and my realization that she does’t understand or respond to instructions and also repeats most of what is said to her and asks “why” and “what” when it is not the correct way to address or respond in a conversation. Now we do structured play and use toys and games that will expand her receptive and expressive language but i wanted you to share with me if any of you have a similar experience and how can i make Nadia understand things that are frankly unexplainable at least for her age?? and do kids with her disorder actually improve to be able to fit socially and academically with their peers?? or is this forever?? I am doing all the work with Nadia myself so i would appreciate it if you can help me with activities to do and with books or websites to allow me to track Nadia’s progress and to be sure am going in the right direction. I am not able to get help where i live and was lucky enough to travel to get her diagnosed.

    Thank you, your site is a life saver.

    Masha

  43. im not sure how to post a comment on here so maybe this is. ive been wondering for a year now about my son if he may have sutism or something in that area but ive becom really concerned now , hes three and he has some symptome ive read above most of them. hes very independent he gets things without asking he ignores you it seems he lines things up and stacks things up he doesnt listen he has unusualt attachments to objects when he runs his eye cut to the side he knows so many lines of movies and songs of his but doesnt communicate with tohers very well compared to other three year olds his speech is delayed only his father and i can really understand what hes saying when he talks and sometimes its still hard he repeats almost everything he hears he has a big interest in numbers and letters he doesnt interact with other children very well he seems to act like they arent there.he gets violent sometimes like he will come up to me and just start slapping my leg and shaking his head he squealls alot and you can tell him repeatedly dont do that thats a nono that wil hurt you and he will still wind up doing it. he likes to talk in this almost hatefull voice its like his voice gets deep and raspy kinda like if someone was trying to talk scary. he has other symptoms from that list above too. im all new to this this is my first time really researching in to it and im very scared honestly i dont know how to go about anything i just dont know what to do. im really worried. does anyone have any advice?

  44. Hi Lisa. I moderate/approve all comments before they appear on the site, otherwise we’d be overrun with ads and porn! I would be very concerned about your little boy. Based on what you’ve said, he is exhibiting many red flags, and I’d highly recommend that you get him evaluated. At the very lease, his communication skills are not where they should be for a 3 year old. By this age, he should be conversational and using novel language that he generates - not just repeating what he hears. He should be using sentences consistently and be understood 90% of the time by you.

    I totally understand how scared you are right now, but there’s help for your little boy and for you. I’d begin by talking with your pediatrician about your concerns. You can also contact your local public school program which provides free therapy assessments to children over 3 who have delays. It’s very important that you seek help now and not wait. Communication delays are often the first sign that a child will struggle in school, and you want to have him as ready for kindergarten as possible. Thanks for your questions, and good luck to all of you. Laura

  45. Hi Masha. Thanks so much for your questions. Every child with language issues is different in how they progress and catch up to what would be expected, and since I can’t see your little girl, I have no idea of what her prognosis would be. However, parents who are committed to working with their children, as you have told me, generally see better results than those children whose parents don’t work with them or who only leave it up to therapists. As for ideas for working with her, I’d highly recommend my DVDs so that you can SEE the strategies in action. It sounds like you might live outside the USA. Email me what DVDs you’d like, and I will email you an invoice through PayPal. In the meantime, keep reading the articles in the receptive and expressive sections for ideas. The older articles contain most of the detailed information. Let me know if you have specific questions. Good luck to you, and I congratulate your commitment to helping her! Laura

  46. Hello Laura, I am concerned about my 23 month old. She is very bubbly and happy and has about 100-150 words in her volcabulary. However, She is unable to string 2 words together. For the 1st time about 2 days ago, she pointed to my husband’s elbow and said “daddy elbow”. She hasn’t done this since then. I do encourage her to say 2 words together, like when she says “cookie”, I tell her to say “want cookie” or “I want cookie”. It usually comes out sounding like something totally different like “cu-cu-cookie”. I hope that gives you an understanding of what I mean. Another concern is that when I ask her a yes/no question, she just repeats the latter part of the question. I.E. Mommy; “Do you want juice?” Jadyn; “Juice?” I have been trying to help her learn how to answer yes/no questions but nothing is helping. I met w/ EI in my county and am waiting for an appt. to see a ST. I know you can’t diagnose a problem w/o seeing her but any idea as to what is wrong and how I can help her. Thank you for your time :)

  47. Hi Laura,
    I have boy/girl twins who are 3 years old. They started preschool for speech delayed children. They both had early intervention but it wasn’t consistent. I don’t have them in speech therapy anymore because my insurance doesn’t pay for it and so now the only help they are getting is through their school. According to the SLP my twins are expressive and receptive delayed. They both are social, loving, know there ABC’s, 123’s, colors and shapes. My daughter is ahead of her twin brother when it comes to requesting things. Just recently my daughter can string along 2 to 3 word phrases but my son has 2 word phrases but very slowly…He has lots of words but doesn’t use them consistently. My daughter never pointed at pictures in books until she was 2.5 but my son just started pointing a little before 3 years old. Is that something to worry about? I have seen some improvement with my son but its not in leaps and bounds like my daughter. My daughter started really talking in sentences a little before 3 years old whereas my son’s language is much slower. When my daughter talks it seems more clear and my son talk is not as clear..sometimes..lol…He never says the word “no” unless I give him food he doesn’t like…Should I be worried?

  48. Hi laura,

    I have twins , one of my twins has a cleft lip and palte and got operated. she is 2.8 yrs , she is not able to speak only hardy 10 words , that alos very less one word, she gets violent if she i swith me notgoing away from me as i have to leave office. but when i anm not there she is o.k.she poins to things and understand all the things, not able to speak out.other one is very bubbly and happy and is a chatter box, but still she is not picking up.
    she holds things not the same way like other, laughes also stangerly, please help.

  49. Hello Laura,
    My daughter is 31 months old and has a vocabulary of about 55-60 words. She puts some words together like Bye bye baby, Hi da da, baby cold, outside etc. but, I know that she should be doing more than this. She is getting speech therapy through early intervention a couple times a month. Is there anything else I should be doing?

  50. Hi Naomi. It does sound like she’s still struggling with language and she should be doing more by now. What recommendations did your SLP make for you at home? I would recommend to keep building that vocabulary so she has a larger word bank to pull from. From the examples you gave, she is learning words from different categories - “cold” is an adjective/descriptive - and this is a HUGE part of language development. Expansion is also an important strategy for increasing utterance length. Have you seen my DVD Teach Me To Talk? There’s a section on there demonstrating how to use expansion during play. Take a look at that for more specific help. Laura

  51. Laura,

    This is the best website i have ever seen. Congratulations!!!

    I need some guidence from you. I have a 20 month old ( will be 20 month old in next 15 days. She is much ahead in Physical/ motor skills development area, i don’t think have any problem in being social but i am little worried about language development part. We are a bilingual family ( sometimes speak more than 2 languages i.e. 3-4) but mainly 2 one of which is English. My daughter was saying only bye bye and Baba around age of 11 months-13 months. she was still on only 3-5 words till 15 months which were sort of clear. She did jump to 30-35 clear words and about 30 half words (i.e. ba for bath) by her 18 month appointment. Yday when i found your website i counted her words again. she can say 140 words on her own ( spontanously and when i ask whats this in book), repeats about 50 ( different than above 140) when i say it and has spontanuous vocab of about 50 half words (i.e. Choc for chocolate) so i guess she has pretty impressive vocab of around 250 words but still she is not joining/nor showing much interest in joining words together. she does say few two words together but i think that is not joining she is saying it as one holistic word as you mentioned. She answers most whats this and where questions correctly to us but when someone stranger asks her questions she kind of repeats word from it instead of answering yes/no. i.e. if someone asks did you take bubble bath she will say bubble bath. If question is did you drink milk , she says milk. Should i be concern? What i can do to help her out? Am i missing on something?

  52. Thank you Sonia! She’s still very, very young and sounds like she’s coming right along. Model familiar patterns as noted above and you should start to hear some imitations. Those holistic phrases are sometimes a precursor to “real” phrases, so again, it sounds to me like she’s right on the verge. Keep at it! Expansion may also really help her. This means taking a word she says as a single word, adding a word to it, and saying it to her as a phrase. I believe the technique is described above. If you need more help, take a look at my DVD Teach Me To Talk, but again, I think it sounds like you’re on the right track. You’ll also want to be sure she’s USING her words on her own to request and comment, not just to label or answer, “What’s that?” Hope this makes sense! I’m on the way out the door, but wanted to get to your question! Laura

  53. This was a fascinating article! My daughter just turned 23 months and still is not saying 2 word phrases. However, her single word vocabulary is incredibly large (I will attempt to count starting tomorrow, but I’m pretty sure it is above 100). She knows the entire alphabet, many colors, many numbers, every body part I can think of, many shapes (although has trouble pronouncing them), emotions, etc… she also knows several verbs and can say 2 syllable words. Finally, she enjoys pointing to things & demanding that I count them… the closest she comes to 2-word phrases is when she tries to count to 3 (for some reason she says “hi, see, hi, see, do” instead of 1, 2, 3, go). Do you have any suggestions for encouraging 2 word phrases with her? Maybe we need to start speaking in 2 word phrases more ourselves instead of speaking normally?

  54. One other thing: some of her words sound nothing like the real word (lotion & ocean are “ee-yo”), while other words are pronounced perfectly with ease (ex: can say octopus, airplane= “airbee”).

  55. Melanie - Yes you should model LOTS of two word phrases for her to imitate. My guess is that if you work on them, it will improve. My DVD Teach Me To Talk can help you with this as well. Check that out! I’d also stop the focus on academic words like letters, colors, and numbers opting for words she can use in her everyday routines. The phrase examples listed above are what you should model for her to repeat. Again - the DVD will also help you since you can SEE how to work with her at home. Laura

  56. Laura, you have one of the best websites on helping toddlers to talk.
    I had a 2 year 5 month son who is delayed in his speech. At last count, he has about 40 - 50 words in his vocabulary but not all of them are spontaneous yet.
    I give you an example on this. If he sees me holding some sweets, he would run to me, pointing at the sweets I am holding on to and says “Want”. I would then ask him, “What do you want?” He would say “Eat”. So again, I would ask him, “What do you want to eat”? And he would say “Sweet”.
    I like to know if i am right in doing these in order to encourage him to speak up more on his own? And is this the right way for him to learn to speak in sentences?

  57. Thank you Tan! The best way to teach phrases is to model phrases - not one word at a time as you are doing. So… when he says, “Want,” you say, “Want eat” or “Want sweet” so that he can imitate two words together. You’re still having him repeat only one word at a time which is virtually no help to a child who needs to learn to combine words.

    If you need more direction with helping him move to phrases, watch the section on Expansion in my DVD Teach Me To Talk or in my books Teach Me To Talk: The Therapy Manual and the section on phrases in Building Verbal Imitation in Toddlers.

    Good luck to you!! Laura

  58. My son is 26 months and diagnosed with a speech delay. He says about 40 words. He has a mild metopic ridge, but the doctors say this is not affecting his speech.
    I was wondering when he was 18 months he was saying about 15 words. He was saying apple as papple and lizard as izard. He is now saying aaa for apple and zard for lizard is this normal?
    He was not saying much from 19 mths to 24mths and then started talking again. His sister was born when he was 21 months. He has been in speech therapy for 2 months.
    He does not imitate too well. He still does not say baby or his sisters(shes 5 mths.) name even tho his cousin is already saying her name.
    He has started to say door open when he wants us to open the door and shorts off once.
    The speech therapist says he has attention and concentration issues cause he does not always respond to his name or directions.
    When he wants to know what an object is called he points and calls it dada and then looks at us for a response. He calls his nose mama too. But when he wants me I will hear him call my name out.
    I am very concerned and wondering what your thoughts are based on this information and any suggestions would be appreciated.

  59. Dear Laura, I am an ophthalmologist from India. My baby girl had cleft palate which we got operated at 11 months of age. The surgery was uneventful. She started walking at 18 months of age. She was uttering only one meaningful word (dad) at 21 months of age. We then consulted a developmental pediatrician who diagnosed her as having language delay. She told us that her comprehension was at 15 months and speech at 12 months. She advised us to do intensive stimulation to improve comprehension and enroll her into playschool to increase contact with other kids. We also consulted a speech language pathologist around the same time. She did audiometry which was normal. She also told us to increase stimulation. With stimulation, her comprehension got improved and she started to point fingers at objects at 21 months.
    We again consulted both pediatrician and SLP at 24 months and were told to continue the same. My baby has started vocalizing and babbling. Now, my baby is around 26 months old and still not speaking much. She just says dad and papa. Otherwise, she is just babbling aa aa, ba ba, da da pa pa and similar sounds. She understands things in surrounding, goes to playschool, watches TV, runs, and explores the things. She points at common objects (dad, mom, grandmother, fan, tv, cycle, car) when asked. Can you suggest tentative cause of language delay in her? Is it because of cleft palate or some other reason? What should be further course of action? What dvds from your store may be helpful to her? The pediatrician tells me that there are no other issues apart from language delay although I feel that she is behind her peers. Please help me.

  60. Hello Laura,

    I’m Tania, mother of Milena, 24 month old loving, playful, very social, with gifted motor skills little girl, excellent climber and painter.

    I know that she understands most of what I say, since she can imitate me (cooking, cleaning, makeup). We manage to play and house for example, she cooks and feeds me, then cleans my face… super cute!

    We have three languages at home, Finnish from her father, Spanish from me and English between us. Milena goes to a Finnish daycare and she doesn’t say even 10 words spontaneously all together.

    I’ve purchased your DVD and now implementing the techniques. She learned 3 words in a couple of days in the park and now repeats them spontaneously. She ‘imitates’ speech constantly and almost seems like she’s speaking sentences! But really doesn’t say anything I can understand.

    I’m on a summer holiday and I’ve taken this the time to work with Milena on her speech intesively. I’m not a fluent Finnish speaker so I cannot teach her that, I focus on Spanish, but I’m afraid that we won’t have that much time to practice once I’m back at work.

    She will go the daycare in Finnish and probably nobody will take care to teach her like I’m doing now. Can she fall back again? Any suggestions on how to manage with so many languages?

    Thank you for sharing your work and knowledge!

    Best,
    Tania

  61. Mirya - Since I can’t see him, I can’t know for sure what’s going on with him. I’m glad he’s in speech therapy so that you’re getting specific help.

    Almost anytime a toddler has “attention” problems, there are very likely receptive language problems too. How is he following directions for you? Can he locate familiar objects on request? Is he pointing to body parts when you say, “Where’s your hair?” Does he point to pictures in books when you ask, “Find the car.” Unless he’s doing LOTS of those things consistently, he’s not linking meaning to words and that’s why you’re not hearing more word attempts. When attention/sensory processing are at the root of a child’s language delays, then you have to make sure that what you say to him is very, very simple so he begins to make clear associations with words and that you’re FUN enough for him to want to be with you to learn from you.

    I wouldn’t worry too much about how he sounds just yet, but instead be focused on how well he understands language and attemtps to imitate you.

    If imitation is a key skill he’s missing, I highly recommend my new book Building Verbal Imitation in Toddlers. It lays out a step by step therapy plan for you to follow to teach him HOW to imitate.

    If he’s not consistently following directions, then I’d also recommend Teach Me To Listen and Obey 1 & 2. Children must UNDERSTAND words before they use them to talk.

    My first DVD Teach Me To Talk also outlines the basic play-based approach and is what gets most parents working on the right things in order to move a child forward with language.

    I hope those product ideas help you! Laura

  62. Dr. Shrikant - Without seeing her I have no way of knowing what’s going on with her. Since she walked a little later, I’d suspect that her delays are more global in nature as you think too which probably explains why she looks more delayed than her little peers. What do her teachers at nursery school say about her? They are probably a good judge because they see the full range of children and are usually pretty aware of typical development. They will likely let you know if there are more global issues than the developmental pediatrician originally thought.

    It does sound like she’s making progress with additional focus on language from you and that’s great news. I’d continue to concentrate on what she understands and building her receptive language and cognitive skills. Children learn those things (and everything else!) better from adults and not other kids, so please don’t depend on interaction with peers to make those issues better. You’ll need to be sure she’s receiving quality (and quantity!) time with adults who go out of their way to teach her to understand new words.

    The products I’d recommend for you to work with her are the 3 DVD set which includes the first DVD Teach Me To Talk which shows you how to use play-based activities to target language. The other 2 DVDs, Teach Me To Listen and Obey 1 & 2 are focused on receptive language. Again, I think an emphasis in this area is critical for her.

    The other product I’d suggest is my new book Building Verbal Imitation in Toddler since it outlines a step by step therapy approach to help her learn to imitate. If your’e doign the bulk of her therapy at home, this book can serve as your guide for that.

    The other book that might be a great help to you is Teach Me To Talk: The Therapy Manual since it lists goals and gives TONS of directions for working on those with her. It is written specifically for therapists, but many parents have told me it helped shaped their work and provided more structure for focus on language at home.

    I hope these ideas help! I’ve gotten lots of emails and comments from India in the last several months and we’re shipping more and more products there! Good luck to you - Laura

  63. Tania - I’m glad she’s making some progress since you’re implementing the techniques from the DVD. That’s always great to hear!

    The research tells us that language disorders are usually consistent across languages and that if there’s a delay in one, there’s a delay in all of them. The research does not suggest limiting exposure to one language. Typically developing children do not have difficulty learning multiple languages.

    HOWEVER, I have found in my practice that when you simplify your language (no matter how many you’re using!), children do begin to respond because they understand more. When they understand more, they say more.

    Since you’re on a break from work, keep doing everything you can to work with her to teach her new words. When you do go back to work, it will be more difficult of course, but you’ll have to find ways to work on language in the midst of your daily routines. You can target new words, from both a receptive and expressive language focus, with bath time, during meals, while dressing, etc… but you’ll have to really stay on your toes and think about what you’re saying to her and how you can make sure she’s learning to understand and use her new words. My new book Building Verbal Imitation in Toddlers gives some GREAT examples of how you can work language into daily routines like this. Be sure to check that out for some new ideas. Laura

  64. Hi Laura, thanks for your prompt response. It is so good to hear back from you and get your opinion on some of the issues he is having. I do think he has some sensory issues since he will sometimes rub his head and likes to rub my hair at night and grab it at other times. The speech therapist does not seem concerned about these issues.

    Do your videos show how to correct when a word is being used incorrectly? he will use more to mean want and come and a lot of other things. Also, he uses dada a lot.
    How do I purchase more than one item at a time?

  65. Mirya - Use this link http://shop.teachmetotalk.com/ for our store and you can order more than one thing at a time.

    Usually when a child is using a word incorrectly, there’s a receptive language component meaning that he doesn’t really understand what word he should use. Keep repeating the word he intended to elicit an imitation of the correct word.

    Laura

  66. Hello Laura!

    I want to thank you so much for all of the information on this site and answering so many questions from all these concerned moms. You are so generous! Im going to continue to search out info on this site and see all the resources you have available, but I would love to ask you about my daughter specifically and see if you have any thoughts.

    My daughter is 27 months and she has many single words in her volcabulary, though the overwhelming majority of them are nouns/ words for concrete things she interacts with in real life or has seen in a book/on a video. She loves to speak and talks all the time, repeating favoritre words, animal sounds, phrases from songs, etc. Shfie can count to 20 easily, knows her numbers to 20 on sight, can say her alphabet and knows all the lettes, and even at least one word that the letters stand for. She can go through a whole children’s pictionary book with probably 200 pictures in it and tell you the name of every picture.

    BUT- she does not use pronounes at all, almost never says names (not even mom or dad or her own name), does not use words to express feelings (like sad, happy, tired, want, dont want), does not say yes or no when asked a question (she will sometimes now say “OK”, though, in stead of “yes” when asked), only just recently started saying “hi” and “bye bye” but has to be prompted to do so, does not ask any questions at all, and does not use any true two word phrases as you have described them above (in other words, she will say thank you or “orange duck” from a line in a book or other phrases like that but she has not ever put two words together on her own). I have been trying to teach her phrases and the use of pronouns like “I want food”, etc, and if I say it enough she will eventually repeat it, but I can tell she has no idea what shes saying or how it is connectd to meaning. She just repeats it and smiles like its a game. For instance usually at night I we do an “I Love You” phrase game where I say the first word, she repeats, etc, but tonight becuase I had been teaching her “I want food” earlier in the day at mealtime, when I went to do the “I Love You” game, instead she finished the stentence as “want food”. Also I have noticed that she will repeat things but its all about context. For instance if I say I love you in a certain way, no matter what time of day it is, she will say “night night”, becuase that is the way I usually say it at night before bed.

    I should also add that she is not yet showing any imaginitive play with her toys, and she rarely points at anything that is not up close like in a book, etc. She has never been one to point across the room or point at something that she wants. We have had her vision checked, however, and it is just fine.

    So… all of this to say… do you think that I should have her checked out by our doctor or get a referal to a child developmet professional? Its strange because she does talk so much but she doesnt meet these milestones that so many of the charts say she should be meeting by 2. We want to get her the help she needs if she needs any, and I am certainly going to put all of this great advice you have given above. God bless you for your generosity on this site and I so appreciate any help you can give me.

    Nicole Mueller

  67. Hi Nicole - What a great question. You’re so perceptive to note that she’s just labeling and not really using language spontaneously and isn’t following the typical sequence of development since she’s not yet combining words. The way you’re describing her phrase use sounds a little echolalic. If that’s a new term for you, it’s most often seen in children who go on to be diagnosed with autism spectrum disorders BUT is also seen in children with other developmental delays including difficulty with processing language. She is obviously having at least a little of this kind of difficulty since her responses to some questions are off target.

    That being said…. she may not qualify for speech therapy from a state early intervention program because she’s already talking. IF you have insurance or can afford it, I’d pursue services from an SLP in private practice who can help you learn how to communicate - which includes learning to understand and use words beyond nouns, learn how to combine words into phrases, learn how to answer and ask questions and truly use her language, not just label pictures or objects with words.

    She is still pretty young and has some great strengths to build on in therapy. I hope that you can find an SLP who can look at both her strengths and weaknesses and provide great ideas for you to work with her at home.

    Regardless, you’ll need to work HARD on the comprehension/processing piece with her at home so that her expressive language will follow. The 2 products that I always recommend for parents working on these kinds of goals are Teach Me To Listen and Obey 2 and Teach Me To Talk: The Therapy Manual. In the DVD you’ll see great examples of teaching words beyond nouns and in the book, you’ll get structured therapy goals/activities. The manual is really written for therapists, but committed moms usually do well with it and it provides a written plan for exactly what/how you should be working with her at home.

    Thanks so much for your questions. Feel free to post any time! You’re the kind of mom who makes me want to do this!

    Laura

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