Guidelines for Referral for a Speech-Language Assessment for Toddlers
I recently found a great article written by Marilyn Agin, M.D., and author of The Late Talker. It was written for a pediatrics journal, but it also has great information for parents who might be on the fence wondering if their child will catch up on his own, or if they should go ahead and be referred for a speech-language evaluation.
I love the beginning quote so much that I’d like to share it here:
“Not all children with delayed speech are “little Einsteins” or garden variety “late bloomers.” Some have a speech-language disorder that will persist unless warning signs are recognized and intervention comes early.”
She also includes a set of risk factors for pediatricians (and parents) to look for which might also inhibit language development:
- Family history, such as a strong heritability factor. There’s a higher risk of continued delay if one of a toddler’s parents or siblings had long-term language and learning difficulties.
- Otitis media with effusion causing a fluctuating hearing loss during the period of speech development. (This means frequent ear infections. If your child has had several, and especially if he’s had to have tubes during infancy or toddlerhood, this could be a major contributing factor to his speech-language delay.)
- Low socioeconomic status and educational level. These families are more likely to have a child with a poor outcome.
- Parental characteristics that may inhibit speech, including the way parents interact with the child. Parents need to follow a child’s lead and provide a language model using simplified speech. Use of “parentese,” the way that many parents instinctively talk to infants in a high-pitched, sing-song voice, actually fosters language development by attracting the infant’s attention and resembling the pitch of the sounds he makes.
- Missed language explosion. Most children experience a vocabulary spurt around the age of 18 months, but late talkers don’t. Some late talkers have an “explosion” of speech later—between 24 and 30 months. If a child has not had a vocabulary spurt by 30 months, he is at considerable risk of continued language delay.
She also includes information I’ve cited in other places on the site with the signs that a child should get an early speech-language assessment including:
One major review in the speech pathology literature paints a profile of toddlers 18 to 24 months old who are at risk of persistence of language impairment at 36 to 48 months and who should receive early intervention.6 The greater the number of warning signs a child exhibits (especially the closer he gets to 3 years of age), the greater the need for early assessment. Those signs include6:
- little sound play or babbling as an infant, with limited number of consonant sounds and, possibly, vowel distortions as a toddler
- poor verbal imitation skills; reliance on direct model and prompting
- immature play skills; little pretend play
- interactions with adults more than peers
- few communicative gestures (the late bloomer who caught up with his peers within a year used significantly more gestures than the child who had persistent delay)
- impaired social skills or behavior problems
- small vocabulary for age; less diverse verb repertoires
- comprehension delay of six months or greater relative to chronologic age
This might also be a great resource for your pediatrician, especially if he or she is of the “wait and see” variety. Printing this article and taking it with you to an appointment might be a great way to start (or re-start) a conversation about your concern with your child’s language skills.
You can read the full article at this link.
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Comment by niyati on 1 July 2008:
Hi! Laura
Wanted your feed back on my 33 month old son who has a speech delay. He still uses a lot of words but is not able to join words to form sentences. He only responds to questions once in a while (not always). For Eg. If I ask him do you want food? He would reply with 1 word:’No’. ( He learnt to say ‘no’ when he was about 22 months old). But the response will not come everytime even for the same question. I heard him say’Yeah’ a couple of times recently. He is also of late repeatying a lot of words we say. ( I said’Its raining today” and he would say “today”). He has a vocab of over 50 words for sure.
I have an 8 month old daughter after him and he is quite friendly with her. I have seen him go and hug her a few times, look her in the eyes and smile and keeps calling her’baby’. However, he is not very comfortable with his peer group. ( He was an only child and was under the care of a nanny till he was 2 years old without much interaction with other kids as we were both working). Whenver I take him to the park, I initiate play with his peer group which he seems to enjoy but needs an asurance that I am around ( come and hugs me in the middle of the play). Also, without my initiation does not show much interest in the other kids even if they come to play with him. Is more comfortable with’parralel play’ even now. He is otherwise a very active child , very close to all the people in the family incl his grand parents. Can ask for his needs ( he wants water, will say’water’ and go and take the glass from the dining table and drink himself, wants TV will hit on the TV screen and call for me, wants to be held, will say’Hold’ and raise both his hands and stuff like that), will show with gestures when I sing’Twinkle Twinkle Little Star’ or ‘Clap your hands’). Otherwise loves to go out ( I take him shopping with me / friends places etc)
He is of late started repeating words . Wanted your advise on how to help him improve his speech and improve intearction with his peers
Thanks a lot for your help
Comment by Laura on 1 July 2008:
Niyati - You don’t say if he’s in speech therapy or not. I would start with this if you’re not doing this already. Based on what you’ve said, he is not meeting the language milestones for his chronological age. Although it sounds like he is improving, I think his delay is great enough to warrant an assessment by a speech-language pathologist.
As far as ideas to improve his speech-language at home, you’ve come to the right place! Read the expressive language and receptive language articles for more specfic info. Not answering questions is really a receptive language too. I’d also read the article on Making The Leap from Words to Phrases since his vocabulary sounds large enough for him to begin to imitate simple phrases.
You’re doing the right thing by including him in social outings and being his “bridge” with other children by helping him initiate. He may continue to parallel play until his language improves. Most 3 year olds are pretty conversational, and since this is hard for him, he may have a hard time wanting to “stick it out” with a peer. Things that usually bring kids into early social games involve gross motor actions - everyone runs or jumps or crawls or building then knocking over blocks, etc… Start this kind of game with him and other kids then bow out, but stay near to reassure him that you’re there. You could also use bubbles with everyone popping bubbles you blow then give the wand to someone else to try. Him needing you there is not unusual.
It sounds like overall he’s functioning, even socially, more near his language age-equivalency (my guess would be near the 18-21 month level based on what you’ve said) more so than his chronological age of 33 months. This is important to remember as you set expectations for him.
I wish you all the best as you work to help him! Let me know if you need additional information! Laura
Comment by niyati on 2 July 2008:
Thanks Laura! That was very helpful. I have put him on Speech therapy. Will also try the other techniques in your site for improvement of receptive & expressive language.
Thanks again!
Comment by Ashi on 5 July 2008:
Hi Laura!,
I need your help for my 5 yrs old son, who has recently diagonosed as having mild autism. I am really worried, especially about his speech. He got bilingual environment, but the primary language was hindi, has exposure to english in his kindy. First I thought he is confused between 2 languages and as he was dominating hindi i continued with that but then he had started having problems in kindy. I consulted some coordinator at kindy she said ok if he is picking up hindi then you go ahead with that. Now as because of othe issues he has found out to have mild autism, I am more worried about language development. He has problem both in receptive and expressive languages. but he prefer to talk in hindi, understands it better than english. But paediatric told me to now only talk to him in English, my problem is that he is going much better in hindi now, has echolalia problem also. But at the same time tried to talk spontaneously in hindi, not in English. understands hindi better than English.
Now you pls advise me what technique I should use as I fear If i concentrate or start in English he might go back to zero in both or so. I am very very stressed and worried, pls help me.
Comment by Laura on 6 July 2008:
Ashi - First of all, he really needs to be seeing a speech-language pathologist to help you tease out all of his issues. You didn’t mention if he’s done this yet.
You also didn’t say what the primary language for his school is and for what his peers use. I would think you’d want to focus primarily on that language since he’ll need this for academics and to communicate with his friends. I hope that it’s Hindi since this is what he’s understanding better than English, but if you’re in the USA, that’s not likely to be the case.
Like most SLPs, I believe that if a child is struggling to learn language, it’s best to reduce the complexity so that he has a better chance of becoming a proficient communicator. If his best language is Hindi, I’d stick to this at home, but again, if you’re in the USA, this is going to be difficult to accomplish.
His language problems are compounded because he’s also demonstrating charactistics of mild autism. Again, I hope that you’re seeing a speech-language pathologist so she can advise you after meeting you, hearing your concerns, and more importantly, evaluating your son. Her advice would be better than any I could give you because of the complexity of your situation. She will be able to help you determine priorities for your son, including which language he really NEEDS to be able to function at home and at school.
I hope this helps! Laura
Comment by Ashi on 6 July 2008:
Thanks Laura,
I am in Australia and the primary language is English here. yes i am going to slp soon, but I have already started to talk to him in English hope it helps!
thanks
Comment by Ally on 11 July 2008:
Hi! Laura,
i have a 5yrs old son, he was born with cleft lip and palate but surgery repaired when 10 mths old.. suddenly around 2.5yrs old..his hearing was progressively lossed.. ( he can hear at birth.. and picked up some languange at those time )..
since then.. he had language delayed..as he couldn’t hear.. he’s fitted with hearing aids now.. at the beginning when we took him to see ENT .. the doctor said he’s fine… (he’s an active boy so, the doc assumed he’s having ADDH.. and not focus on what we’re saying ).. , not only 1 doc.. we’re seeing 4 docs..
and some people said boys are late talkers.. that’s why it’s really late till we really stand on our point to let him to do another hearing test..
he had seen SLP for 1.5 year.. but it’s not helping..
we’re in Malaysia.. and here at least people must learn 3 languanges: chinese,english, and b.malaysia..
he’s raised using chinese.. but i teach him english as well..I’D read ur article which said we should minimise to 1 languange.. now i’m homeschooling him as even kiddy didn’t want to accept him..
after 3 mths from homeschooled, he’s improving.. in reading (he loves to read..but pronounciation isn’t cleared yet)..the matter is.. he still couldn’t do phonics.. so, he used his memory to remember the words i taught him.. and he’s really struggling..
he also didn’t understand question.. whatever we ask..he’ll repeat it back.. hope u have a good advice to teach my son..
thanks a lot…
PS: u really have a great website..keep it up !!
Comment by Laura on 11 July 2008:
Ally - I am a firm believer in using one primary language if a kid is struggling to learn to talk. What does your SLP say about this? She may have different advice since most people in your country are multilingual, but again, if he is struggling, I still believe you should minimize the complexity for him. I would recommend that you read all of the articles in the receptive language category since he seems to be struggling with understanding language too. Good luck to you! Laura
Comment by Ally on 14 July 2008:
thanks a lot Laura for ur advice..,
i’m thinking of that too..but he used to understand more of Chinese sentences (instructions,explanation).. English in words..(numbers, color, shape)..
however he’ll enter primary school in the next 1.5yr.. and bahasa malaysia is compulsory subject in school here (plus chinese and english as well).. no matter in normal or special school(either bahasa in government school or eng in private).. and he totally didn’t get into it..
it’s really hard to choose what language to teach..as he understand better in chinese.. (but other people didn’t understand what he’s talking except his near family).. then he can do maths well in English (he knows number in Eng)…
i still use visual in most of my teaching..as i find out he gets understand better.. but then will it minimise his hearing capability if he didn’t want to focus on his hearing but visual clue?
i’d thought to let him learn cued speech for a few words which he can hear well..but my SLP against it..
again..thanks a lot…
Comment by Janet on 15 July 2008:
Hi Laura,
I have an 18 month old that I am concerned about. She has only 2 spontaneous words (ma for “more” and “uh oh”),frequently uses “ba”, “da”, and “ga” when she attempts to communicate, often leaves endings off of words, at times, there are no audible sounds when tring to imitate words with initial consonants /p/ and /b/. She will imitate words; some words are close approximations while others are not. She imitated “bye-bye” perfect not to long ago; however, has not said it since. She had tubes placed 3 months ago with no significant changes in expressive language. I had Early Intervention come out to the house a few weeks ago, however, she scored quite well with no delays noted and therefore, did not qualify for services. I am still concerned, however, I feel that she is still so young and I might be too aggressive. I will add that I was a late talker too. I would appreciate any advice that you have.
Comment by Jason on 15 July 2008:
Janet you should buy the DVD it’s AWESOME!
Comment by Laura on 15 July 2008:
Janet - I’d recommend that you read the articles in the expressive language section. It’s not too early to be “aggressive” with language - just make sure you’re doing it in a playful way.
If you try the advice in the articles and don’t see much change, or you’re not sure exactly how to carry out the techniques, then I’d agree with Jason’s advice to buy the DVD because then you can see the techniques in action. Sometimes it’s not WHAT you’re doing, it’s HOW you’re doing it, and the DVD will show you exactly HOW to do it to make your efforts more successful.
Whichever way you choose - good luck! I applaud your efforts for being so concerned about her now and not adapting the usual “wait and see” approach! She’s lucky to have such a go-getter Mommy! Laura
Comment by Laura on 15 July 2008:
THANKS TO ALL OUR READERS WHO ARE BUYING THE DVD!
Let us know how you like it and especially how the ideas are working for you at home or in your sessions with clients. You can send us an e-mail at laura@teachmetotalk.com or post a comment here on the site. We love to hear from you! Laura
Comment by Jewels on 22 July 2008:
Our son will be 9 months in 2 days and is not babbling. We’ve heard a couple “ma-ma-ma”s, “na-na-na”s, “gla”s, and “bla”s but they are very few and far between. He smiles and laughs a lot and responds to us socially. He passed his newborn hearing screening but has another hearing test scheduled for next week, at our request. In addition, we have made a referral for early intervention assessment and are wondering if you can give us information on what to expect from the evaluation. In the event he does qualify for speech services, how are services delivered for an infant this age?
Thanks in advance for your help.
Comment by moonz on 22 July 2008:
Hi Laura,
I have recently read ur post,which I really find beneficial for my 2.8 year old daughter who is speech delayed.Now after following ur advice given in ur post,it had really helped her to start speaking one syllwrds. She still has problem with “t”,”d”&”l” sounds.She only speaks words with “sh”&”ch” sounds,that too are one syllable.But there has been remarkable improvement in her,going from crying for every thing to be able to point or say monosyllabacally for what she wants.I am patiently waiting for her to say complete words and sentences.
I am hoping to learn more from ur site.
Comment by Laura on 22 July 2008:
Jewels - The early intervention assessment usually consists of an overall developmental evaluation of his skills in each of the 5 developmental domains including motor, social, cognitive, adaptive (self-help skills) and communication skills. It’s completed using a standardized tool so that his skills can be measured against other babies his age. With an infant this age, examiners most often rely on parental report, so be sure you are answering objectively since they will likely not be able to “see” him do every one of the skills they need to evaluate. Your evaluator will likely be a speech-language pathologist, a early developmental specialist, an occupational therapist, or a physical therapist. He or she will ask you LOTS of questions about his history and your concerns, so be very specific. He or she SHOULD also play and interact directly with your child, and be leery if the person doesn’t do this.
I will tell you that I think it’s very difficult for a baby this age to qualify for services. For a child to get speech this young, there is usually an established risk diagnosis such as Down Syndrome, cerebral palsy, hearing loss, or another known condition which is likely to result in a communication delay. I also don’t think many SLPs in private practice would want to see him yet, especially since he is social and his hearing is okay.
However, I am so happy that you are concerned even at his young age. There are things you can do at home to help him learn to communicate. Check out the other articles on this site, and you may want to consider the DVD. It’s loaded with ways to facilitate early language and first words at home! Thanks - Laura
Comment by Laura on 22 July 2008:
Moonz - I’m so glad you’re enjoying our site! Good luck to you and your daughter! There is a link to an article with ways to work on /t/ and /d/ at home. It’s okay that she doesn’t use a correct /l/ sound yet since that’s a later developing consonant sound. Many children don’t master this sound until closer to age 4 1/2 to 5. The thing all of these sounds have in common is the ability to elevate your tongue. You can help her practice this skill by having her imitate a clicking sound or “feel her bumps” on the roof of her mouth behind her teeth with her tongue. There are other great ideas in the article I mentioned. Look for it on our home page. Thanks! Laura
Comment by Jewels on 22 July 2008:
Thanks for your response. We’ve received so many mixed messages on whether we should be concerned or not at this time (since he is still quite young). We decided to make a referral based on the information we’ve received that suggested not babbling by 9 months could indicate a problem. Our pediatrician suggested we wait to refer until closer to 18 months. What are your thoughts on this?
Comment by Kathy on 22 July 2008:
Hi Laura,
This website has been extremely helpful to our family. Thank you for all of your wonderful advice and insight. Our daughter is 2.4 years old and speech delayed. She has been evaluated by both EI services and a SLP and it was determined that her expressive language is severely delayed (4th%)and her language comprehension is age appropriate. Her strengths are her social skills and cognitive abilites. My concern is that a cause has not been determined and I feel uneasy with this. She does not exhibit any autistic traits but I am not sure if there are other syndromes I should be aware of. The SLP said she would be concerned if our daughter was also delayed in receptive language but that is not the case. Since she appears to be in good health, we are just focusing on improvement. Just some history, our daughter was born with largnomalacia (unformed cartilage in the airway) and we struggled with feedings throughout infancy and it was noted that she had mild low tone. I wonder if there is a connection with the speech delay now. She has a lot of words (100-200) but I am tallying how many of those are spontanius (up to about 25). Still no real 2 word combos but recently I thought I heard a few. I was a late talking child (approx 2.5) and how do I know if this is also a late bloomer case?
Comment by Laura on 22 July 2008:
Kathy - You may not know for a while if this is a case of late talking or something else. If things move along beautifully and she’s completely caught up by 3, it was likely just an expressive language delay. If she’s still struggling at 3, then it’s likely something else.
I have had one other client with largnomalacia who was also language delayed. We treated her issues like a motor planning/apraxia difficulty and used signs to help her sequence words to phrases. She ended up doing very well, but that’s not to say that it worked because she was apraxic AND had largnomalacia.
Try the ideas in the article “Making the Leap from Words to Phrases,” in the expressive language category, but she may still need to build her spontaneous vocabulary to near the 50 word milestone before she starts to imitate phrases or say these on her own. Use lots of modeling to continue to help her imitate new words, but withholding really will make the words more spontaneous. If you are not sure how to do this while still making it fun for her, check out video clip for the DVD and the article “Can’t vs. Won’t” in the expressive language section.
If you’re still struggling, the ideas from the DVD may help you get over the hump. Sometimes seeing how to do it makes all the difference. Good luck to you all! Laura
Comment by Laura on 22 July 2008:
Jewels - In this specific case where his social skills and intent to communicate seem to be on track, I probably would wait on the assessment until he’s a little older, say 15 to 18 months. You haven’t commented about his language comprehension skills. Does he seem to be starting to understand some language such as understanding when to pull the blanket off his head for peekaboo, interested with “bye-bye,” understanding “no”? Are his gross motor skills moving along - is he sitting, rolling, and crawling? If those things are questionable, then I would definitely pursue the assessment now.
If those areas are moving along, I would diligently work at home to be sure you’re doing all you can do to build his foundation for receptive language/comprehension, work on play skills, expand his social skills, and help him learn other ways to communicate (namely gestures & sign language) while you’re waiting on the words.
Do NOT wait until well after 2 to pursue services. 21-24 months is my “PANIC” button, so that if he’s not hitting the milestones then, absolutely, positively do speech therapy.
Hope this helps! Laura
Comment by betty on 23 July 2008:
Hi,
i have a 18 month old son. He does not point with index finger. he repeats words that we say, but not in meaningful context. he doesnt callme mama, but can say mama. he says apple, banana, teeth etc, but not when we show him these things. Just repeats what we says. Does not point to things and ask for them, just cries and grunts. he is perfectly happy playing with his toys, but does not stack blocks, just pours things out and in the container. flips books, fascinated with numbers an alphabets, does have temper tantrums, bangs head when he doesnt get his way, follows some simple commands, like go night night, he goes to sleep on hispillow, go drink water, he does it, but when I ask him to bring things to me, he doesnt. I dont know if these are indicative of autism. Please help
Comment by Jewels on 23 July 2008:
Thanks Laura for the information. Yes, our son is meeting his gross motor milestones fairly quickly and he seems to have pretty good comprehension skills. Any specific tips on what we can do to facilitate his expressive language?
Are “late” babblers typically “late” talkers or do they often end up with some sort of speech delay? Any insight is appreciated. Thanks again for everything!
Comment by Laura on 23 July 2008:
Betty - I would definitely have him evaluated by a speech-language pathologist and/or through your state’s early intervention program since he does seem to have some red flag issues concerning language, both receptively(what he understands) and expressively (what he says.) You can find out information about your state’s early intervention program by typing in your state’s name and early intervention at google.com or another search engine. In the meantime, keep reading artciles here for ways to help him at home. If you’re unsure of how to do these things, you can always order the DVD to see exactly what you should be doing at home to help him! Laura
Comment by Laura on 23 July 2008:
Jewels - Read the articles in the expressive language section for specific ideas to help him at home. Just because he’s a late babbler doesn’t necessarily mean he’ll be a late talker, but most late talkers were likely very quiet infants as well. You may also want to take a look at the articles in the apraxia section too. If you still aren’t making gains, you may need to get the DVD to see exactly what to do and how to do it. Laura
Comment by Kathy on 23 July 2008:
Hi Laura,
I had a few follow up questions. Is Apraxia fairly easy to identify? Are there different levels of severity? My daughter has only had a few appointments but this condition has not been noted. Should I specifically ask to rule it out?
Last, you mentioned late talkers tend to have been quiet infants. This was not our case at all. Our daughter babbled but it just didn’t develop from there on the same time table as her peers. Does this signify anything?
Comment by Laura on 23 July 2008:
Kathy - I just mentioned apraxia as a possibility for ANY child with a gap in their receptive/expressive skills and for ANY child who has enough vocabulary to combine words but isn’t doing that yet. Of course since I haven’t seen your daughter, I can’t speak directly about her, so I hope you don’t think I am attempting to “diagnose” her sight unseen. I’m just addressing other possibilities based on my previous experience. Just so you know - kids with apraxia usually were quiet infants, and this wasn’t the case for your daughter.
Although apraxia can be diagnosied earlier, many SLPs are not comfortable diagnosing apraxia until after age 3. If she hasn’t mentioned this as a possiblity for her, it could be that she displays none of these characteristics.
If your daughter has no other issues that “fit” with another diagnosis other than an expressive language delay, this may be all it is. She does also have the mild low tone, which can affect speech intelligibility, but usually does not affect language per se, unless there have been other developmental lags such as late acquisition of gross motor skills.
If you feel differently based on information you’re reading, please ask your SLP to directly to rule out any other specific disorder you’re concerned about. A good SLP never minds explaining what she thinks about a child and why she thinks so. Good luck as you search for answers!!!
Laura
Comment by betty on 23 July 2008:
thanks Laura. I have ordered the DVD from your site. Does not finger pointing a strong indicator of autism? I am very disappointed and sad, maybe in denial. He cries a lot to communicate his needs because of lack of speech.
Comment by sheila on 24 July 2008:
Laura,
My son is 22 months old and only has a total of 22 words - including word approximations. He has started doing two word combinations “bye mama” “dada open” - we are not pushing this he just does it. I am concerned b/c he does not have 35 plus words and now he is started to get confused when he say bye mama etc. and say ma mama or da dada etc. I am pretty sure he has apraxia - my 6 year old daughter had autism and severe apraxia. He is not showing any signs of autism but has this speech delay. He has said words and then we have never heard him say them again, only has 22 words, and will not imitate consonants and only one vowel ah. He is in early intervention, private speech, etc.
How should I handle him trying to move on to two word combos. Again, we are not pushing him to so, he is just doing it himself.
Thanks.
Comment by Ally on 24 July 2008:
hi Laura..,
sorry to bother u again.. i need ur expertise advice.. my son who’s 5 yrs old, hearing impaired and has language delays. i’ve read all ur article, they’re wonderful and helped me a lot. but to reach his age level, it’s still far from beyond.
i wonder can he learn sign language to add up some which he hard to express ?? but my SLP disapproved,she said, once he starts to do signing, he won’t use speech anymore. is that true?
as i find he’s struggling to express his feeling.. but he can read.
thanks a lot..
Comment by Laura on 24 July 2008:
Betty - I’m glad you ordered the DVD since it will give you ideas for how to work with him at home. Not pointing in and of itself is not an indicator of autism, but the things you told me about him in your earlier post certainly indicate that he has a problem learning language. I do hope you’ll take my advice and have him evaluated by your state’s early intervention program. In the meantime, keep working with him everyday at home. Don’t let your sadness prevent you from doing what you really need to do, which is help him want to interact and communicate with you. YOU CAN DO THIS! Laura
Comment by Laura on 24 July 2008:
Sheila - Well, you can’t PREVENT him from moving onto phrases, but it does sound like his intelligibility suffers when he’s sequencing longer strings of sounds, and that certainly is characteristic of children with apraxia. One thing you might try to is to concentrate on modeling lots of single words for him to imitate.
However, sequencing difficulty is the “hallmark” of kids with apraxia, and the more practice children get, the more intelligible they generally become, so it’s not a bad thing that he’s trying to move on.
I will tell you that there are apraxia experts (David Hammer in particular) who suggest introducing carrier phrases pretty early to give kids the extra sequencing practice, so again, it’s not a bad thing that he’s done this on his own. He’s trying to bump up to the next level, and you’ve got to applaud his effort!
I am so glad to hear that he’s in early intervention and speech. Congratulations for being so proactive!!! You’re doing a good job -Laura
Comment by Laura on 24 July 2008:
Ally - I do not think that using signs prevents children from talking at all. The research does not confirm this either. But let me ssay that I have not met your child and don’t know all of his strengths and weaknesses, so it’s unfair of me to contradict the advice that your SLP is giving you. You’ll have to remember too that I primarily work with toddlers and younger preschool children (3-4 years old), so she may be looking at this from a school-age SLP’s position rather than my area. I am always looking for ANYTHING that will help a child learn to communicate more effectively with his family - whether this be signs, pictures, words, or a combination of all of them! She is coming from a different perspective, so please continue to discuss things with her since she knows your son.
That being said, it wouldn’t hurt to try to introduce a few signs to him for words he’s having difficulty learning or for situations that are extremely frustrating for him when he can’t communicate his needs with words. See how it goes, and then you can be the judge if this is a good method to purue for him.
Just so you know - I am NEVER bothered by answering questions on this site. I pop out of bed every morning and rush home from work every evening just to see what moms (and dads) have written me since the last time I checked! Keep them coming! Laura
Comment by Jewels on 24 July 2008:
Thanks Laura for all your help! I’ve browsed the articles but am having trouble finding one that is applicable to his age. Can you point me to a couple articles in which I can gain tips to facilitate my son’s expressive language?
Otherwise, he’s making noises while playing with his toys.
He isn’t too quiet of a baby…he actually vocalizes quite a bit. The consonant/vowel combos are infrequent although I heard a “na” today.
I’ve noticed that his eye contact isn’t the best. It seems that he is so busy checking out other things but I know it’s one of the many red flags of autism so I thought I’d bring it up. Are there some babies who are just super active and interested in exploring their environment(obviously I’m a first time mama)? He’ll look at us when he’s interested…like when we sing a song he likes or makes noises he likes but it feels like he’s looking at other things besides our face a lot of the time. Cause for concern? Like I said previously, he’s very social with us…laughs at us and with us, smiles all the time, crawls after us and enjoys being “chased” by us.
Again, I appreciate all of your insight!
Comment by Laura on 24 July 2008:
Jewels - Here’s the link for the Social Games for Infants article -
http://teachmetotalk.com/2008/02/23/social-games-for-babies-toddlers/
I would also recommend that you read the earliest receptive language articles and the What Works and What Doesn’t Work articles. I am pretty sure those are in almost every category you select, but try in the expressive section if they are not in the receptive category. You’ll want to be sure he’s beginnning to link words to objects and events, even at 9 months old.
You might also check out the sign language articles, and as always, start with the older entries first since I have written everything chronologically which made sense at the time I began the site, but it’s making it more difficult to locate “beginner” info now. He is NOT too young for you to sign with him.
The biggest thing I’d recommend is to keep really trying to engage him and make that important connection with eye contact. The best way to do that is like you’ve already described - sing songs, make noises, and play GAMES. It sounds like you’re on the right track.
Some babies are so curious about their environments that they don’t look at people unless it’s for an obvious reasons, but I am always a little concerned when I see or hear this about a baby because eye contact really is a foundational skill for learning to imitate and communicate. Frankly, we learn almost everything we’ll ever learn in our whole lives thru imitation. If you’re not looking, it’s not likely you’ll get it.
Hope you can find the articles I suggested. I can’t link them here or I’ll lose everything I’ve already typed. If you can’t find them in the archives in the expressive language or apraxia category, send me a comment, and I’ll find it again for you.
Hope this helps! Laura
Comment by Jewels on 25 July 2008:
Hi Laura,
I’m a stay at home mom so he is my “job.” All my time is devoted to him, so I may be expecting too much too often. He often looks at us to see what we’re doing and this morning he had really good eye contact. It seems it’s more infrequent when he’s close to our faces or when there is something of high interest near him. He’s an extremely active little guy and has been for as long as I can remember so I’m hoping he is just super interested in his surroundings rather than disinterested in looking in our eyes all the time. 
Thanks for the help.. I found the social games for babies article last night and will take a look at the others.
I’m not sure what is “normal” regarding eye contact so I may be hypersensitive to him not looking in my eyes all the time.
I’ll bring it up to his pedi at his 9 month well-baby check-up to see if he has concerns.
Comment by debbie on 27 July 2008:
I am a mother of a 25month old who does not talk. He is totally switched on every other way. I have been testing all his abilities since the dr said he had an expressive speech development problem. He is very communicative, very social and outgoing, and has a best friend and 3 older siblings. He just grunts and uses signs he has developed. He does not seem to be frustrated by it. He and I are trying to do therapy at home until he gets an SLP referal it is like swimming in the dark via the internet. All your games we already do. He is very playful and loves to read Frank Asch stories and point out everything he knows. I am working with simple repetitive animal sounds just to try to exercise his ability to make sound. We do baa baa, graa, ssss, neigh, moo he cant really get but I am saying great just for the lip movement which he tries but cant seem to push out a sound. It seems that any combined movement of the mouth musculature and pushing out sound just does not coordinate. Even though he has no soft neurological problems I think he might be apraxic. I read the cherub archive and started giving him the 3-6 omega primrose gla combination and I dont know what it has done for his speech but it has cleared up his ezcyma in a matter of days after over year and half of seeing doctors go figure. This morning I think he tried to say up but he seems to have a very hard time getting it to sound through his vocal cords. I praised his for saying up and tried to keep repeating it which he did and it still was not clear if that was what he was saying but I thought if he kept repeating it I must have gotten what he was trying to say right. Do you have any suggestions on how to get sound to come out louder. He is not a quiet or shy kid so that is not the problem.
Thanks
Debbie
Comment by Laura on 27 July 2008:
Debbie - It does sound like he may displaying signs and symptoms of apraxia, but I want to ask you a few questions since you mentioned his vocal cords. Does he audibly cry and laugh? Does he yell? Does he vocalize at all in babbling or jargon? If he is vocalizing using a voice you can hear during these times, it’s likely NOT a vocal cord problem. You can take him to an ENT to formally rule it out.
As far as what to do at home - read all of the articles in the apraxia section, especially my earlier ones from February and March. Keep modeling the words and play sounds (animal noises, car and truck sounds, silly sounds) in a very playful way. Keep teaching signs to help him express himself. If you’re not sure if you’re doing it correctly, order the DVD because it very clearly demonstrates what to do. Sometimes it’s not even what to do - it’s HOW to do it, and that’s why I filmed the DVD. Since you’re in New Zealand, you’ll probably have to watch it from your computer since the players are not the same as players from the USA.
Lastly, if he’s still not making progress within a few weeks, I’d go ahead and visit an SLP who specializes in childhool apraxia and language disorders. 25 months is not too young. Good luck! Laura
Comment by Jewels on 29 July 2008:
Hi Laura,
The pedi was not concerned with eye contact at all. He says he tracks very well. He was concerned with our son still not babbling at 9 months. It surprised me that he was also concerned with our son not having fully mastered the pincer grasp or being able to wave bye-bye (he has not had much exposure to this). I had no idea our son “should” have mastered these skills by 9 months. A lot of what I read states these skills emerge by 10-12 months. In any case, he asked us to fill out the Ages & Stages Questionnaire which will then be given to a developmental pediatrician for review. I’m glad our pedi is being pro-active but I’m not sure we should be worried that our son is not demonstrating the pincer grasp and waving bye-bye. Any thoughts?
Thanks.
Comment by Laura on 29 July 2008:
Jewels - I wouldn’t be too concerned about not waving yet since many children don’t master this until between 9 and 12 months according to my sources, and I think he should already be practicing picking up smaller objects with a pincer, even if he’s not mastered it yet. Set up situations for him to practice this, but watch carefully since he’ll likely mouth whatever objects he tries. I like to use foods for this since you know he’ll mouth the object, but if you haven’t started trying goldfish, crackers, or cheerios yet, he may have had limited exposure and practice time. Try these things first before you get concerned. He’s awfully young, and it sounds like you are on top of things. Just practice, and if he doesn’t get it, then revisit the issue with the pediatrician. Laura
Comment by irene on 10 August 2008:
Hi Laura,
I am very concerned about my 10 month old daughter. She is a very happy and content baby, smiles a lot, has good eye contact. She understands a lot, like do you want to nurse, give it to mama, where is the ball etc. However, her babbling is very limited she just says bababa and vavava, and the strangest thing is that she would babble a lot every day for a week, and then stop and take a break for a couple of weeks. She also started to wave bye bye, but then stopped. She also doesn’t point or clap. She has no trouble with solids and does not drool at all. She crawls and cruises. Have you ever heard of a baby babbling in spurts with no babbling in the middle?
Thanks,
Irene
Comment by Laura on 10 August 2008:
Irene - It is documented in the general child development literature that babies may be become less verbal when they are working on motor skills and less inclined to move when they are working hard on developing speech and language. I would not be overly concerned at this point because she is very young.
I would definitely continue to work on her gestures - pointing, clapping, waving, operating easy cause and effect toys, etc… - for two reasons. First of all, gaining control over those motor actions actually helps her get ready to talk AND secondly, pointing, clapping, and waving are all very communicative in and of themselves. Keep “helping” her with the gestures, talking to her in lots of SINGLE words so she can begin to try to imitiate those first easy ones, and repeating any vocalizations she happens to make.
You’re such a great mom for being concerned about language at such at early age, but try not to let that concern worry you too much at this point. I would encourage you to continue to play with her, talk with her, and have fun interacting with her. Keep doing those social games like peek-a-boo, patty-cake, etc… so that she has a fun way to work on those gestures too. If you need more info, keep reading the site! Thanks so much for your question. Laura
Comment by Corrine on 11 August 2008:
Hi Laura
Wanted your feed back on my 35 month old son who has a speech delay. While he uses a lot of words he doesn’t pronounce them properly prefering to use the first letter of the word instead (i.e. biscuit = b). He also does not say 2 words together. Most of the time he doesn’t respond to questions. He is more likely to say yes than no. He has a quite a large vocabulary with more than 50 words which is growing all the time.
He has had his hearing tested which was ok and has attended speech therapy. The first speech therapist thought he was just a late bloomer, his second sent him for early intervention as she thought he wasn’t making eye contact, his receptive language was behind and he wasn’t playing at an appropriate level. After review by an early intervention specialist and a pediatrician it has been confirmed that he only has a speech delay however.
Socially he is very confident, playing well with others, he is very popular, he has lot’s of friends and even a best friend. It actually confuses me how he can be so social and have so little speech. He was until recently an only child and he doesn’t tend to ask for his needs, when he wants milk he will get it out of the fridge and a cup and he will show it to me or try to pour it himself, when he wants to play his favourite dvd he will put it on himself.
He will sometimes sing songs like twinkle twinkle little star (not clearly) and counts to 10. He attends childcare regularily and this has helped his vocabularily greatly and they have never expressed any concerns to me about his development.
As I have stated he is attending speech therapy and while this has helped greatly especially with his receptive language he still has a long way to go. I would like your advice on how to help him improve his speech and improve intearction with his peers. Also I see you have a DVD however Google checkout says you do not ship to Australia.
Thanks a lot for your help
Corrine
Comment by Laura on 12 August 2008:
Corrine - Thanks for your comment! It’s great that you’ve already covered your bases with other assessments to determine what might be the cause or contributor to your son’s language delay. Ruling out hearing loss and social communication problems (like autism) are good initial steps for anyone with a child who is not talking. It’s also great that he’s in speech therapy and has made so much progress receptively and is coming along expressively. From everything you’ve said, it sounds like you’re doing all of the right things, so keep it up!
Since he’s so independent at home, I would try to sabotage a few things so he has to ask for help. Try this article for more ideas on ways you can do this at home -
http://teachmetotalk.com/2008/04/20/a-little-frustration-can-go-a-long-way-using-sabotage-and-withholding-effectively-to-entice-your-toddler-to-talk/
About the DVD - the reason Google won’t accept international orders is that we want to be sure that you can play the DVD before you buy it. DVD players operate on different systems throughout the world, and Teach Me To Talk only works in North American DVD players. However, we have shipped DVDs several internationally, and they are sucessfully watching it on their computers using the DVD drive or a portable American player. Once you are sure you have access to view it, then send us an e-mail at johnny@teachmetotalk.com with your shipping address. We will send you an invoice via e-mail with approval and special directions for ordering internationally. Hope it works out for you! Laura
Comment by Hillary Martin on 20 October 2008:
Good read, thanks for the information, it was really informative.