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October 23, 2008 | Laura | Comments 78

“Red Flags” That Warrant a Referral for Early Intervention or Preschool Therapy Services

I get so many questions from parents who want to know if their child should be evaluated by a speech-language pathologist or other professional.  On my October 23 show “Teach Me To Talk with Laura and Kate” we discussed “red flags” that we note in toddlers and preschoolers that warrant a referral to an early intervention program (if your child is not yet 3) or therapy services through your local school system (if your child has turned 3 but is not yet in kindergarten). 

If you want to hear the complete discussion, please listen to the show #13 by clicking the blogtalkradio link from this page or the home page.

For those of you who would like to review the entire list we found at  www.sensory-processing-disorders.com here goes:  

Gross Motor

If a child is…

  • Not rolling by 7 months of age
  • Not pushing up on straight arms, lifting his head and shoulders, by 8 months of age
  • Not sitting independently by 10 months of age
  • Not crawling (”commando” crawling–moving across the floor on his belly) by 10 months of age
  • Not creeping (on all fours, what is typically called “crawling”) by 12 months of age
  • Not sitting upright in a child-sized chair by 12 months of age
  • Not pulling to stand by 12 months of age
  • Not standing alone by 14 months of age
  • Not walking by 18 months of age
  • Not jumping by 30 months of age
  • Not independent on stairs (up and down) by 30 months of age…an early intervention/developmental therapy referral may be appropriate.Here are some other gross motor “red flags”:
  • “walking” their hands up their bodies to achieve a standing position
  • only walking on their toes, not the soles of their feet
  • frequently falling/tripping, for no apparent reason
  • still “toeing in” at two years of age
  • unusual creeping patterns
  • any known medical diagnosis can be considered a “red flag”: Down’s syndrome, cerebral palsy, congenital heart condition etc. 


    Fine Motor

    If a child is…

  • Frequently in a fisted position with both hands after 6 months of age
  • Not bringing both hands to midline (center of body) by 10 months of age
  • Not banging objects together by 10 months of age
  • Not clapping their hands by 12 months of age
  • Not deliberately and immediately releasing objects by 12 months of age
  • Not able to tip and hold their bottle by themselves and keep it up, without lying down, by 12 months of age
  • Still using a fisted grasp to hold a crayon at 18 months of age
  • Not using a mature pincer grasp (thumb and index finger, pad to pad) by 18 months of age
  • Not imitating a drawing of a vertical line by 24 months of age
  • Not able to snip with scissors by 30 months…an early childhood intervention/development therapy referral may be appropriateHere are some other fine motor “red flags”:
  • Using only one hand to complete tasks
  • Not being able to move/open one hand/arm
  • Drooling during small tasks that require intense concentration
  • Displaying uncoordinated or jerky movements when doing activities
  • Crayon strokes are either too heavy or too light to see
  • Any know medical diagnosis can be considered a “red flag”: Down’s Syndrome, cerebral palsy etc.


    Cognition/Problem Solving

    If a child is…

  • Not imitating body action on a doll by 15 months of age (ie, kiss the baby, feed the baby)
  • Not able to match two sets of objects by item by 27 months of age (ie, blocks in one container and people in another)
  • Not able to imitate a model from memory by 27 months (ie, show me how you brush your teeth)
  • Not able to match two sets of objects by color by 31 months of age
  • Having difficulty problem solving during activities in comparison to his/her peers
  • Unaware of changes in his/her environment and routine…an early intervention/developmental therapy referral may be appropriate 



    If a child is…

  • Very busy, always on the go, and has a very short attention to task
  • Often lethargic or low arousal (appears to be tired/slow to respond, all the time, even after a nap)
  • A picky eater
  • Not aware of when they get hurt (no crying, startle, or reaction to injury)
  • Afraid of swinging/movement activities; does not like to be picked up or be upside down
  • Showing difficulty learning new activities (motor planning)
  • Having a hard time calming themselves down appropriately
  • Appearing to be constantly moving around, even while sitting
  • Showing poor or no eye contact
  • Frequently jumping and/or purposely falling to the floor/crashing into things
  • Seeking opportunities to fall without regard to his/her safety or that of others
  • Constantly touching everything they see, including other children
  • Hypotonic (floppy body, like a wet noodle)
  • Having a difficult time with transitions between activity or location
  • Overly upset with change in routine
  • Hates bath time or grooming activities such as; tooth brushing, hair brushing, hair cuts, having nails cut, etc.
  • Afraid of/aversive to/avoids being messy, or touching different textures such as grass, sand, carpet, paint, playdoh, etc.…an early childhood intervention/developmental therapy referral may be appropriate.NOTE: sensory integration/sensory processing issues should only be diagnosed by a qualified professional (primarily, occupational therapists and physical therapists). Some behaviors that appear to be related to sensory issues are actually behavioral issues independent of sensory needs.
  • Possible visual problems may exist if the child…

    Does not make eye contact with others or holds objects closer than 3-4 inches from one or both eyes

  • Does not reach for an object close byPossible hearing problems may exist if the child…
  • Does not respond to sounds or to the voices of familiar people
  • Does not attend to bells or other sound-producing objects
  • Does not respond appropriately to different levels of sound
  • Does not babble


    If a child is…

  • Having difficulty biting or chewing food during mealtime
  • Needing a prolonged period of time to chew and/or swallow
  • Coughing/choking during or after eating on a regular basis
  • Demonstrating a change in vocal quality during/after eating (i.e. they sound gurgled or hoarse when speaking/making sounds)
  • Having significant difficulty transitioning between different food stages
  • Not feeding him/herself finger foods by 14 months of age
  • Not attempting to use a spoon by 15 months of age
  • Not picking up and drinking from a regular open cup by 15 months of age
  • Not able to pull off hat, socks or mittens on request by 15 months of age
  • Not attempting to wash own hands or face by 19 months
  • Not assisting with dressing tasks (excluding clothes fasteners) by 22 months
  • Not able to deliberately undo large buttons, snaps and shoelaces by 34 months…an early intervention/developmental therapy and referral may be appropriate. 

    Social/Emotional/Play Skills

    If a child is…

  • Not smiling by 4 months
  • Not making eye contact during activities and interacting with peers and/or adults
  • Not performing for social attention by 12 months
  • Not imitating actions and movements by the age of 24 months
  • Not engaging in pretend play by the age of 24 months
  • Not demonstrating appropriate play with an object (i.e. instead of trying to put objects into a container, the child leaves the objects in the container and keeps flicking them with his fingers)
  • Fixating on objects that spin or turn (i.e. See ‘n Say, toy cars, etc.); also children who are trying to spin things that are not normally spun
  • Having significant difficulty attending to tasks
  • Getting overly upset with change or transitions from activity to activity…an early intervention program referral may be appropriate   

    ·        Difficulty making and maintaining eye contact with an adult by 6 months
    ·        No big smiles or other warm, joyful expressions during interaction with another person by 6 months
    ·        No back-and-forth sharing of sounds, smiles, or other facial expressions by 9 months
    ·        No babbling by 12 months
    ·        No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months
    ·        No consistent responding to their names by 12 months
    ·        No words by 16 months
    ·        No following simple and familiar directions by 18 months
    ·        No two-word meaningful phrases without imitating or repeating & says at least 50 words by 24 months 
    ·        No back-and-forth conversational turn-taking by 30 months
    ·        Any loss of speech or babbling or social skills (like eye contact) at any age
    The presence of any of these concerns warrants an immediate discussion with your pediatrician and insistence for a referral to an early intervention program and/or speech-language pathologist for a complete evaluation of your child’s communication skills.
    Let me also add that babies who are doing well with development exceed these milestones by leaps and bounds.  These are very, very low thresholds for all the skills listed.  If your child is not meeting these basic guidelines, please don’t dismiss your feelings. There is in all likelihood a true developmental delay or disorder present.  Seek professional help from your pediatrician, your local school system, an early intervention agency, a children’s clinic, a university evaluation team, or a therapist in private practice.  
    If you are not sure how to do this, e-mail me at laura@teachmetotalk.com, and I will help you!

    Entry Information

    There Are 78 Responses So Far. »

    1. I have a 4 years old daughter who doesnot talk like the other 4 years old do. i have braught her for speech pathologist evaluation and they diagnosed her with language disorder. but during the evalutaion i discovered that i didnot teach her about this or about that the questions which the pathologist were asking her.she is very good in learning, if i tell her anything once she won’t forget it and also she started writing down her Alphabets all by herself.i also want to mention that she stayed home for 4 years.and we donot have any family around,i myself didnot make any friends so that i can spend more time with her whenever i had off from work but my problem was i was so quiet which now gives me a guilt that probably due to which she cannot speak like she should be.now all the time i am trying to get different ideas so that i can help her. she just started going to daycare. she is doing well over there but still not talking due to kids not being friendly with her probably due to that language barrier which hurts me a lot. i want to help but donot want anybody to misjudge her because she doesnot have any development issues its only the speech part.please help me with the advice

    2. Tara - This website is full of ways you can help your daughter with expressive language. Click the category “expressive language” and read the articles, beginning with ones from last January, and then read forward to the more recent ones. Expressive language issues can be overcome with speech therapy and lots of hard work on your part at home. Read - read - read! Then play- play - play. Ask your SLP for specific ideas to work on at home. Let me know if you have any other questions! Laura

    3. Hi, can you further explain what is unusual “creeping” patterns and walking their hands up to their body to achieve a standing position? Also, my son tends to cruise along the furniture on his tip toes, but I also find him standing flat on his feet too. How do I stop him from standing on his toes when cruising? Thanks.

    4. Karen - Unusual creeping(traditionally referred to as crawling) patterns would mean anything other than a baby using his hands and knees to crawl. Commando crawling, or pulling your body with your arms while your tummy and legs stay flat on the floor, is common, but not necessarily typical. Other unusual patterns could be a child sitting on his bottom and propelling himself with his legs and feet, using both hands but with one knee down on the floor and the other foot on the floor, etc… This could indicate coordination problems.

      Walking hands up to the body to achieve standing means a kid who gets up by placing his hands flat on the floor way in front of him who then “walks” his hands on the floor back toward his body to push himself up from the floor.

      My PT friends tell me that kids are less likely to walk on their toes when they are wearing shoes.

      Hope this answered your questions! Laura

    5. Hi Laura. I conratulate you on your site. It is fantastic. I have a question. I am a native English speaker and my husband is a native Spanish speaker. Caroline is 30 months and has a very limited vocabulary. She uses about 30 words spontaneously, however none are more than 2 syllables. However, when she hears me speak English (not that frequently) she is quick to repeat 2 and 3 words together. She is receiving speech therapy in Spanish 3 times a week since the last week of December and I have seen moderate improvement but not not like I would have hoped. She sings 3 different songs rather effortlessly in English. Is it possible that she has a tendency toward English and we are stunting her ability to speak buy insisting she learn Spanish first? Should we switch gears? If so, then after she masters English, when do we begin teaching her Spanish?

    6. Rebekah - This is an interesting question. I’d recommend that you stick to Spanish if that’s the predominant language she’ll need for school and to interact with the little friends she’ll make. I don’t think she’s “hard-wired” for one language over another, or that English is any easier to learn than Spanish. You didn’t mention how she’s understanding Spanish. I’m also curious to know what her SLP thinks the issue/s is/are. Studies tell us that children who are raised in bilingual homes do speak a little later than children learning just one language. Since she’s exhibiting delays, and especially if there are delays in comprehension too, I’d stick to one predominant language for the time being, and it sounds like you’re already doing this.

      Glad you’re liking the site! Hope you pick up some new ideas! I love hearing from readers around the world!!!! Laura

    7. I think I will try to recommend this post to my friends and family, cuz it’s really helpful.

    8. Hi Laura -
      We have a 33 month old daughter. Our native language is Russian, but she has been in an English-speaking day care/preschool full-time since she was 26 month old. We have followed “one place - one language” model, so we only speak Russian to her at home, and only English is spoken at the preschool. The school has, however, some French, Spanish and Portugese speaking kids.
      Her teachers report that they “are working on communication” with her. Basically, after almost a year there, she is still not understanding or speaking English well enough. At home we have problems communicating with her as well. We would like of course to help her overcome any language/communication issues before they might turn into learning disabilities. However, we feel that our situation (because of the bilingual environment) is somewhat different from other similar cases, and have a hard time finding resources that we can use to make any progress. Can you recommend what might be helpful here?
      I apologize for such a long post, was only trying to describe the situation.

    9. Elena - I’d go ahead and try to find a pediatric SLP who can evaluate her and help you know whether she’s learning language later since she’s being raised in a bilingual environment, or whether it’s a more serious language delay or disorder. Since you’re having problems at home too, I’d think it’s likely the latter.

      When I assess children who are having great difficulty with more than one language, I always recommmend that parents pick one primary language and use this one until she’s “caught up” and understanding and using at least one language at an age-appropriate level. Are you planning on doing an English school forever? Do most of her friends speak English? If that’s the case, I’d stick to English. If not, then you should decide which language is going to be her primary language for her education and predominantly use this one of her, even at home. I hope that you can find a good SLP to help you sort all of this out and give you a better idea for recommendations that will be helpful to you! Thanks for your question! Laura

    10. Thank you, Laura. I will follow your advise and keep you posted on the progress.

    11. I have a 28 month old son who is only using vowel sounds, occansionly he will use a consonant. Only for such words as bubba, papa, dada, mama, wolf wolf. He uses the words ool, for cool or full. At for cat, hat. Ahh, and Eee, are commonly used for his “language”. He is trying to tell us stories, but gets frustrated with us, because we lack understanding on what he is trying to tell us. I have him in Speech Therapy once a week, but I would love some tips on how to move him forward. Thank you

    12. Marsha - Read ideas in the apraxia section since it will give you strategies for targeting new language while working on more specific speech development (new consonants). I also have a DVD that targets this difficulty called Teach Me To Talk with Apraxia and Phonological Disorders. It includes very basic language techniques as well as more specific recommendations for working on speech sounds. Laura

    13. Hi Laura,

      My 11 month old son is not babbling, he is very social (lots of eye contact, laughing etc). We have the full array of vowel sounds, and he’ll make “mmm” sounds back and forth with his dad and me. We’ll hear consonants within his vocal play, but none of the ma-ma-ma, ga-ga that we keep expecting. He is on the slow side of development in general (just like his dad was), sitting at 8 months, still just creeping, and so on. Is there something we could be doing to encourage him?


    14. Anne - The website is FULL of ideas for you to use with him in play, but the important thing is to keep modeling those sounds and words so he can learn to imitate. You didn’t mention his developing receptive language skills and that’s probably even more important than developing expressive language at this point. Read the articles in that section for ideas too. You’ll also want to make sure he’s using gestures - pointing to what he notices and then later wants to ask you to get for and even waving bye-bye. Gestures are a very important pre-cursor to words and sounds because then you know he’s developing communicative intent. I love that his social skills are a strength for him!! Keep playing those fun games with him! It sounds like you’re doing a great job with him and that he may be following Dad’s later pattern of development. It really doesn’t matter when he walks or talks - just that he does!! Keep trying - he’ll get there! Laura

    15. Hi Laura,

      I have a question/concern regarding my daughter’s language development and would love your opinion.

      She is exactly 14.5 months. Repetitive babbling began at approximately 5.5 months with lots of dada, mama, baba, nana, and yaya. This type of babble was frequent during her infancy, along with other types of vocal play (raspberries, yells, etc.) However, I am still waiting for the “jargon” babble to emerge. While she does have a couple of “stock” nonsense phrases which can be transcribed as “yabeedabeedabee” and “abeeabeeabee“, there is not much variety. Actually, if I ask her to “talk” to me, she breaks out with one of these phrases. There is other vocal play, just not really any of that “foreign” language type that I keep reading about.

      That said, she has about 25 words/approximations and an additional 5 animal sounds, all of which are used spontaneously and consistently. She probably uses her entire set of words and sounds 2-3 times in a day, by pointing out and labeling things she knows. There is some inflection in words as well. She has a handful of two syllable words in her vocabulary that are said rather well if not perfectly such as Mommy, apple, Elmo, doodle (as in cheese), bottle (although she says baboo), so I know that she CAN sequence at least SOME different sounds. She has several “basic” words like, “up,” “more,” “no,” “down” and she has found a way to use those thorough the day to tell me what she needs/wants. Basically, instead of a lot of nonsense, most of what she “says” during the day makes sense (at least to a familiar listener like myself.)
      By the way, receptive language is excellent.

      So, here are my questions:
      1. Is there still time for “jargon” to emerge for her?
      2. Is it a “red flag” if jargon does not emerge for her?

    16. Jen - There’s still time for jargon to emerge, and in my opinion, not a red flag if it doesn’t. She has an excellent spontaneous vocabulary for her age, so I wouldn’t worry about her at all!

      Things you can do to make sure sequencing emerges are singing and doing little rhymes with her. Ring Around the Rosies is a favorite for this age. You can usually get “Ashes, Ashes” or “fall down” pretty quickly with this game. Now these aren’t the most functional phrases, but it does let you know she can sequence some new sounds.

      Again, I wouldn’t worry about her at all. It sounds like she (and you!) are doing a great job!! Relax Mom!! Laura

    17. Thank you so much for your opinion/advice. I think this site is amazing and I have learned so much from you.

      One last question. You mention sequencing. When I say to her “all done” she says “ah duh” back. If I say “no no” she will repeat me and say “no no.” If I line up two objects like an “apple” and a “banana” and point to each, she’ll name them one after the other. If she falls, she says “boo boo.” I realize that these are not phrases, but is this what you mean by “sequencing some new sounds?”

      She is not yet imitating phrases like “more apple,” even though she has both words in her vocabulary. If say to her “more apple?” she says “apple.” Does this concern you at all? (She’s 15 months now.)

      Thank you again!

    18. Jennifer - Most children begin combining words into phrases when their spontaneous vocabulary (or words they say completely on their own unprompted by you) reaches 35-50 words. She should be able to repeat multisyllabic words and even phrases before then, but I would not be concerned AT ALL that she’s not doing this yet. Most of the time, this begins at 18 months.

      To answer your question, your examples of sequencing sounds above were right on target.

      Based on what you’ve said about her, I think she’s right on track and you’re doing a great job!! Laura

    19. This is auch a wonderful site, thank you so much.

      I am concerned about my son: he is 27 months old and has a significant speech delay. He was evaulated at 18 months and was diagnosed being at a 9 month old level. He has never called me Mama/Mommy but he can say Mama. He has been seeing a speech therapist for about 6 months now but can only say about 30 words but uses babbling words the majority of the time. When he does use words, half the time he uses them incorrectly. For example, he can say ball but if a ball is out of reach he will look at me, point to the ball and say “aaaaaaa.” His eating has slowly deteriorated and there are days when he’ll eat oatmeal for breakfast and milk for the rest of the day. And he won’t ask me for milk, he will go to the fridge and pull the jug out and hand it to me with his cup. He has wonderful eye contact, laughs/smiles/cries appropriatley and follows directions nicely. His favorite is peek-a-boo and cracks up everytime we play it. He will line up objects, but only a few times and moves on. Plus he will not get upset if I mess up this line. A couple of times he has waved bye bye or said hi to me but hasn’t for a while. I read your article “Could My Toddler Be Autistic” and there were a few items that jumped out at me. Should I be worried?

    20. Caroline - Since I can’t see him, you’re going to have to rely on his SLP and your other team members. What do they think? Have they given you a specific diagnosis other than delay? One of the responsibilities of an SLP is to discuss a parent’s concerns, and discussing this with you is a very valid way to spend treatment time. I’d also recommend that you not wait until she’s on her way out the door to ask her what she thinks. You can call her or shoot her an email to let her know that you’re going to want to talk about this so she has a “heads up” and you don’t catch her off guard. I hope it goes well for you. Good luck! Laura

    21. Hi-

      My son is 24 months and he says no words yet. He makes this weird noise and pushed his tongue down to the bottom of his mouth. Once and a while he will babble dada, but that is it. He has been in speech for 4 months and I have seen no improvement. He has been to a developmental pediatricaina and he is not Autistic. His face tenses up so much when he tries to talk. How do I help him to talk an is there a possibility that he will NEVER talk!!! Please help!!!

    22. Tiffany - I’m so glad your son is in speech therapy. Since I can’t SEE him myself, I really don’t know what’s going on with him, so I can’t help you with a diagnosis. What does his SLP say? Does she have a specific reason he’s not talking yet? Children with apraxia often display facial grimmaces or other oral groping behaviors when learning how to talk. Ask your SLP about that possibility. I also have a DVD for ideas for parents for how to work with these kids at home. It’s called Teach Me To Talk with Apraxia and Phonological Disorders, and you can find information about it by clicking the blue oval in the right hand column at the top of the page.

      Although there are some children who don’t learn how to talk, the percentage is very low compared to those who still aren’t talking at 2. You’re doing everything you can, by having him in therapy AND more importantly, by working with him yourself at home (that is the case, right?), so try not to worry so much yet.

      Read the articles here on the site for ideas and check out the DVDs so you can see strategies to help him at home. Thanks for your question and try not to worry!!! Laura

    23. Hi Laura, I (
      First off, I’d like to say that I appreciate all of the valuable information that you have put into this article.
      My question is regarding my 18 month old daughter. She has excellent receptive language skills, but falls behind in the receptive language catergory. She does very little verbally labeling and refers to almost everything as “this”. She says “nana”(for banana), “dada” and “this” constantly, although she has other words: “that”, “there”, “uh-oh”,”dow” for down, “all-duh”for all done, and “no”, she does not use them on a steady basis. You may here them one day and then not again for another for a few days. She can make 3-4 animal sounds and sings all the time. Whwn she sings she does have a few whole words within the song that she says correctly. When she does speak it always appropriatelt but does not like to imitate a word if asked. Certain words that sound similar to “this” she will attempt if asked such as “yes” and “juice” but gets mad if asked too many time. She understand what we say to her and can follow 2 steps direction and does use gestures for what she wants. With all of that said (and I apologize for the length of this), my major confusion is whether or is if she needs to be evaluated at this time or am I better off waiting until 2. Her ped. wants to wait until 2 and feels she is just stubborn. My parents have also told me that I myself spoke very little until 2 years of age. I do not want to jump the gun but at the same time I would like to get her help as soon as possible if she needs it. I am a teacher and have also been a nanny for a little boy who had special needs and received services. My gut tells me her language level is not age appropriate, but I am unsure if I am right.
      I appreciate any advice you could give me on this matter. Thank you so much and keep up your wonderful work!!!

    24. Please excuse my terrible typos and grammar in the above comment. I was trying to type with my daughter on my lap.

    25. Jennifer - If your gut is telling you to get her evaluated, then go ahead and do it. You’ll feel so guilty later on if she does turn out to have a problem and you waited wasting valuable time. If she doesn’t qualify, then you’ll know you did the best you could. Parents who proceed with services never say they should have waited, but unfortunately I know many, many parents who beat themselves up for ignoring those gut feelings and trusting a pediatrician who is much better at diagnosing and treating medical issues rather than looking at developmental problems. I also would question his judgment since he characterized your daughter as “stubborn.” Children aren’t late talkers because they “won’t” talk - it’s because they CAN’T talk. There’s an article here on the site called “Can’t vs. Won’t,” and it’s at the core of my practice. Take a look at that and see if it doesn’t make more sense than calling your daughter stubborn, lazy, or a host of other negative things that don’t do anything to HELP her.

      That being said, by 18 months the minimum number of words a child should use on their own is 10-15. However, many state programs require a child to be much more behind that it seems like she might be. She may very well not qualify yet. But that doesn’t mean you shouldn’t do anything. There are LOTS of articles here on the website to help give you ideas for working with her at home. You may want to check out my DVD Teach Me To Talk so you can SEE how to work with her too.

      Thanks for your questions - and I NEVER fault a mom for typos when she’s holding her baby and trying to type:)


    26. My son is almost 29 months and he has some quirks about him. We’re not sure what should concern us and what we can dismiss as typical toddler behavior - especially when you add them all up.
      He is a very fun, loving, and communicative little boy. He is a little shy but is eager to interact with family and pets and kids his age. He’s very eager to “help” with every thing I do.

      Lately we have noticed that he drools a lot. We don’t notice this in other kids his age. He doesn’t seem to notice that he is doing it and it doesn’t seem to bother him. Lately, he has also been putting his fingers in his mouth and chewing on them like he is teething. He has all of his teeth so I know that its not his 2 year molars coming in. He has had them for a while now.

      He picks and scratches at his face in the same spot. It seems to be a nervous habit. I’m not sure how to stop or redirect it. I started putting a band aid and some medicated cream on the spot to try healing it. He’s generally ok with this but he takes the band aid off and later gets really upset that he’s no longer wearing it. If we get to a point where his face actually heals up, its not long before he starts picking at it again.

      He talks a lot and has a good vocabulary but has trouble with some sounds for example, “truck” comes out sounding like the “F” word. Grandma = “gamma”. Grand-dad = “gwandad”. Billy = Bee.

      He frequently babbles “vay vay vay” in place of words or in between words or sentences. We’re not at all sure what it means or why he does it. He always seems very factual when saying it.

      He’s loud. He talks loud, he makes loud sounds. He’s just all around loud. We talk about using an inside voice and we will talk quietly or whisper to emphasize, but he just seems set on being loud.

      He jumps a lot. Not sure if its a new skill and its fun or if its excessive. I’ve also very recently noticed that he flaps/flicks his hand at his ears when he’s excited (for example, today he asked to watch a tv show. I said yes and he ran to the couch yelling and flapping at his ear while I turned on the tv).

      He is able to eat with a spoon and fork but needs constant reminders. He digs into everything with his hands. A lot of the time he will then get upset because there is a “mess” on his hands and he will cry and refuse to eat until I clean them. He’s becoming increasingly concerned about messes. The other day he was crying so I hugged him. He got tears on my shirt and it turned a darker color. He noticed this and got really upset about the “mess” on my shirt.

      How do I know what is typical 2 year old behavior and what, if anything should be a red flag for us?

    27. Hi,
      My almost-18-month daughter failed her hearing test. The dr. switched her antibiotic so we’re waiting to see if this works. She has NO words at this point, yet is VERY engaged in playing with others, responds to requests, uses gestures, babbles often. The question is, how long do we wait and see before we go with tubes? I don’t want her too far behind her peers as she is not speaking “real” words yet. I have contacted early intervention, but I’m wondering if the new medicine works, will we be able to tell because she’ll just start talking?? How does this work?

    28. I’d wait about 6 weeks and then meet with the ENT. If the meds work, then she’ll still need a few weeks to pull it all together, but this is just my opinion based on personal experience. If her ears are the only issue, you should see some results fairly quickly. If she’s not imitating more real words after waiting a few weeks, then you’ll know there may be another issue. It sounds like she has some great strengths, so hopefully, a round of antibiotics will do the trick. I’m glad you’re seeing EI too to be on the safe side. Keep modeling words during play (read articles here on the site & watch the DVD clips for ideas to get you started). Keep us updated with her progress. Good luck! Laura

    29. Thank you, Laura! I was so pleased to get a response. I will continue to read your articles and work with my little woman to get her words going. Keeping my fingers crossed the antibiotics will do the trick.
      Thanks again,

    30. HI. Hope I’m not asking something that has been answered! My son just turned two. He has at least 100 words and tons of animal sounds, many of which he has said in context and has never said again. He is not combining words or answering questions, though he talks constantly. He spends a LOT of time ‘reading’ his books, and then bringing them to us to ‘remind’ him what things are called, but won’t repeat the words when we tell him. Instead, he smiles to himself as if to say “yeah, that’s what I thought…” Without going in to too much detail, I have a question about consonants/pronunciation. He has a friend named “Marcus” who he decided to call “Ungus”. He has done this with many words, seemingly substituting, at random, other sounds, even though he can clearly say “Ma” and “kiss”, and does, all the time. Can you explain this? I am in the process of seeking Early Intervention, but while I wait, can you shed any light? Thanks!

    31. Juliana - Thanks for your question.I have so much to say about your question that I’m going to answer it tomorrow on the weekly podcast for May 13. Listen in as Kate and discuss your question. Better yet, you can call and ask us yourself. Email me at Laura@teachmetotalk.com if you want details for calling in to the show.

      I do want to quickly answer one thing. I would not say that your son has 100 words if he’s only said some of them once and never again. We do not count a word as a part of a child’s vocabulary until he’s saying it consistently and on his own, meaning he’s not repeating you after you’ve said it. This will be VERY important info as you have him evaluated thru Early Intervention. Only count the words he says on his own and consistently as words.

      When you’re saying he “talks” constantly, are you meaning that he says real single words that you understand and consistently recognize, or that he’s using jargon? Jargon is unintelligible sentence-length utterances. Is this what he’s doing when he’s “reading,” or do you mean he’s just quietly looking at the books by himself?

      If you can’t call in to the show, shoot me an email with these responses so I can more thoroughly answer your questions! Thanks again! Laura

      Thanks! Laura

    32. My 20 month old son probably has about 25 words, many of which are only recognizable to immediate family. Examples include: “cluck” for clock, “hat” for cat, “ter” for helicopter. He also refers to my sister as “mmmm” (we call her Em). He probably has 10 animal sounds. Do we count these as words? I’m just feeling really scared that there is no way he’ll have 50 words by 2. He also seems to have no interest in linking 2 words together in phrases, which causes me more concern. My ped says to wait until 2 to see where he is but I’m wondering if I should get a second opinion.

    33. Amy - Believe it or not, four months is a long, long time in language development at this age. I talked about this on last week’s podcast - Guidelines for counting words in a new talker’s vocabulary are: Count words that are consistent(meaning you hear the word every day or two), words are spontaneous (meaning that he says words on his own - he’s not just repeating someone else), and you can actually spell the word (meaning something like “moo” counts, but not an “odd” sound that you can figure out how to spell). When he gets a large enough vocabulary - usually close to 50 words - he will begin to combine words into phrases. Just keep building that single word vocabulary and it will happen! I would definitely wait for his 2nd birthday since he would not qualify for therapy right now. He’s still on track. Keep doing what you’re doing - hopefully with a little less worry! Let me know if you need more ideas. If you’re thinking you need more ideas for home, you may want to check out my DVD Teach Me To Talk. When you put those ideas in place, then you’ll know you’re doing all you can to help him. Either way - good luck and let us know how he does! Laura

    34. Hi Laura, My son is 13.4 months old, very happy child. He is not yet babbling baba.. or mama.. We did his hearing test on last week. Dr. said that he has normal hearing with some delay in respond to sound. He never responds to his name, never imitates any sound. He start crawling at 10 month, pulling himself up, climbing on every thing, but not walking yet(he is good in his gross motor or fine motor skills). I am really worried about his language development.
      My major confusion is whether or is if he needs to be evaluated at this time or am I better off waiting few months?

    35. Dilesha - More importantly, how is his receptive language developing? I know you said he doesn’t respond to his name, but is he following simple directions yet such as, “Give it to me,” identifying a few body parts, looking toward you or dad when asked, “Where’s Mommy/Daddy,” etc… How are his social skills? Is he interested in playing games like Peek-a-boo with you? If he waving bye bye? Is he pointing to indicate his wants and needs, or still just crying? If he isn’t doing those things, then he may qualify for services even at this young age. You could always check with your state program. In the meantime, I hope you’re using the ideas here on the website to jump start his language. There’s LOTS of good info for parents to use at home in both the receptive and expressive language categories. You may also want to check out my DVDs so you can SEE how to work with him at home. Good luck with him! Laura

    36. Hi Laura-
      I am new to your site and have literally spent the last 2 hours reading and listening to all of your valuable information! Thank you for your diligence in helping parents like myself who have genuine concerns for their children!

      I have a 13 month old boy. I just *know* something is a miss with him and I don’t know which direction to turn. In the beginning I feared that he was displaying many signs of autism but as I have been reading and researching my focus has shifted some to speech/lang and sensory issues- but honestly am still at a loss for the “odd” behaviors that I see with him. He is so wonderful and my husband and I just over the moon for this kid (our first and only right now). The feeling that something is “wrong” cuts so deep I can’t even put into words. All we want is to figure out what is going on (big or small) and help him. I apologize in advance for being so long winded :)

      I’ll just jump right in! First off he is not speaking. Not even mama or dada. He does babble. His receptive language seems to be great as he follows simple directions and will look in the direction of people/objects as we name them- such as “where’s dada” or “where’s the cat”. He will clap and wave on command, however, he does not point. He loves to play peek a boo and will eagerly hand me objects if I ask for them. He loves also to be chased and tickled. His interaction with other children, however, leave a lot to be desired. This is largely due (in my opinion) to his frequent inappropriate use of toys. He LOVES to spin wheels to the point of obsession - I literally hide his stroller in my bedroom because if he sees it he will play with the wheels ignoring everything else around him. He will spin toys that are not meant to be spun (sippy cups, DVD cases, etc). He will also “throw and chase” toys all the time. It began with balls which was fine because that’s what your are supposed to do with balls! but now it’s any toy or object in his hand. He will toss it, or ROLL it and then chase it down and do it again. I work REALLY hard at structured play- showing him how to use his toys for what they were meant for and when we are playing one on one or with my husband and I, he will happily oblige and play very well (stack rings, shake the tambourine, separate toys in bins, etc). When left to his own devices however, he almost always will (try to) revert back to spinning and throwing and chasing. Funny though he does not do this with books. He loves to “read” books and will flip through each page and feel textures and loves to be read to. He has gotten somewhat better I will say since I have not been allowing him to play inappropriately. He understands “don’t throw that” and will usually go out of my sight to sneak it!

      A few other things that aren’t as odd as I just mentioned are the fact that he will get very upset when changing diapers or changing clothes (about 75% of the time). He HATES when I wipe his hands and face after eating. I don’t know if that’s related or? For now I am most concerned with his social play or lack thereof when he is not actively engaged in structured play. Combined with not showing expressive language have just got my stomach in knots. Any insight you could provide will not fall on deaf ears. Thank so much!


    37. Hi Laura- I would also like to ask in regard to my above comment/concern- is it possible for a child to have a sensory processing disorder and NOT be diagnosed Autistic? Or so they always go hand in hand? Thanks so much.


    38. Shannon - Yes, a child can have sensory processing disorder and NOT be on the autism spectrum. However, most children who are on the spectrum exhibit sensory processing differences. Make better sense? Laura

    39. HI Laura,

      the site is very helpful! I found it last week and planing to visit it many times in the future.
      Here is my question: My daughter is 25 months and is raised 3-lingual. My native is serbian, father is French and in pre-school she started month ago - it is English.
      I believe she is a bit slower on the laguage development that I would expected. She did meet 2 year milestone with 50 words and combining 2 words togther (like 4 days before her second birthtday!) and I took her for evaluation in Early Prevention which concluded she is developing exactly for her age.
      Where I am a little concern is that I am not seeing any meaningful 2-3 words phrases: Usually is it “buye, buye something (mama, house, dogs, car)..” depending on the situation but not like “give me….” (milk, cheese…)
      I also notice lately repeating of the last word in the question especially if it is a new word she never heard before or super familar sentence: Do you want milk? She should say “milk” instead “yes” . However is 60% of the question I would get a clear “no” or “a!” (which is a version of “yes”) When I would correct it and say ” We don’t say “a” but …” she will alwasy fill the blanks, smile and say “yes!” (she does this in all 3 laguagues. I did not hear “why” or “who” questions yet. The teacher in school belives that she is where she suppose to be for her age but she also pointed out that she hears repeating of the word like “Come inside” she would repeat “inside” then but not after again. However, she believes it is normal and that it is progress withing next several months that is critical. Apart from that I don’t see any other indications that anything else is out of order - her motor skills are very good, great eye contact, smiling, trying to sing and trying to count in all 3 laguages (usually just some numbers not all). What is your advice? I am expecting a bit too much from 25 months old? I am just comparing with 25 months old that already ask why questions and combine 3 words in the phrase.

    40. Sandra - I like this question so much that I’m going to discuss it on podcast #87 (Sunday, 9/26), so tune in for that answer. Or better yet, call in yourself to talk to Kate and me! Thanks - Laura

    41. Hi Laura,

      I ordered your DVD and have been reading your site and it is very helpful. My 24 month old son was just evaluated for the early intervention program. He is delayed in several areas but I think the key is the receptive language. For example, cognition was a bit low but I think he didn’t understands what we are asking him to do. He was in the 1st percentile for his age for receptive language. I have tried some of your tips for a week and have already seen some progress. A developmental interventionist will come to our home once a week. Do you think it is also a good idea to take him to speech therapy as well or do you think that is too much for him?

      Thanks, Holly

    42. Laura,

      My son is 2 and 8 months. He is receiving therapy for speech and developmental therapy and has been for a little of 6 months. He has a huge vocabulary and speaks in 2-4 word phrases. He is not using “I” or “me”, “my”, or “you” very often. He says “mine” on occasion. We had a case worker come in to consult on whether or not to evaluate for autism. She didn’t think there was a concern because he spontaneously speaks and shows interest in others etc. My concerns are these: he still “echos” probably 20% of the time, he has always been a very independent player (although has recently been asking “mommy play” more and want to engage his toys in conversation, pretend play etc.), he has been obsessed with certain subjects, such as “football/sports” and “trains/train tracks”, he sees details in everything (lines, crosses, shapes etc.), he plays laying down with his head to the ground or like he is watching his cars with his head turned at times, he LOVES to run (although now will say next to me and walk when I ask him to, he turns his head to the side when he walks/throws a ball sometimes, he LOVES to tackle, he used to line up his cars (although not obsessed with keeping them that way …. haven’t seen him do as much of that lately, he repeats things over and over a lot (or a least until I tell him “I heard you”). His speech is improving, but he is still only asking the question “Where _____ go?”, and not any other question. His head is in the 90%, but his height is as well. Any thoughts or ideas? He is full of life and smiles and loves on me all the time. He loves me or his sister to play with him now. Should we get a second opinion or officially have him diagnosed? Thank you SOOOO much for your input!!

    43. My son had a fairly normal vocabulary until he was 19 mths when he had several seizures in his left temporal lobe. From then on, he hasn’t spoken hardly anything and we are in speech therapy once a week. He has been able to start babbling and “jargening” but no true words that are meaningful. Sometimes there are words that come out then we won’t hear them again. Everyone says once his brain figures out how to “speak” again - on the other side of the brain - he will start talking again. Do you think that your DVD would be able to help in any way and have you ever heard of something like this? Thanks for you thoughts!

    44. Shannon - My first DVD Teach Me To Talk will be helpful to demonstrate how you can work with him at home to address his language delays. You mention that he’s not talking other than jargon, but how is understanding and following directions? Is he able to identify objects at home and follow simple requests such as, “Get your shoes,” or “Put your cup in the sink.” Until he understands language consistently and can demonstrate that by following directions, he’s not likely to say much of anything. Focus on language comprehension as much as you are emphasizing talking. Teach Me To Listen and Obey 1 and 2 will give you ideas for that at home.

      I have seen many children with seizure disorders. Some recover to the point where they are catching up to their peers, and sadly, some do not. Neuroplasticity, or the brain’s ability to change and take over function for damaged areas, is the term for what you’re talking about, and it’s a very real probability for a young child. However, you’ll still want to do everything you can to be sure you’re doing your part to maximize his chances of getting better. Speech therapy is definitely recommended so that you can learn how to address his communication delays.

      Thanks so much for your questions. Laura

    45. Hi! I have a 17 month old who is fascinated by spinning and tries to spin just about everything under the sun. Someone commented on it, so I did some research and found your blog/website. Can you explain to me why it’s a concern? He’s advanced in most other areas of development and on target for the rest. Thank you!

    46. Eileen - If the spinning preoccupies most of his play so that it interferes with other areas of development, then it may be a problem. For example, if he won’t play with a toy in a way other than spinning, then his hyperfocus will prevent further development of his cognitive play skills since he won’t advance to more mature pretend play, or perhaps his fine motor skills will plateau since he’s not practicing stacking, connecting, or any other higher level coordinated movement patterns. His language and social skills could be impacted if he “tunes out” others during this time. Is he talking? Is he using toys in other ways too? If so, then you have nothing to worry about. If he’s not, then you may have to help him learn to move on after he’s spun a toy a time or two. It’s probably not the spinning per se that’s so interesting - it’s the visual movement patterns he likes. Introduce other toys that are visually appealing and more social - like popping bubbles, playing with a brightly colored beach ball by throwing, catching, and kicking, etc… If you notice other sensory processing differences that do seem to be interfering with his daily routines and development, then you should schedule an evaluation with a pediatric Occupational Therapist who specializes in sensory processing disorder. Sensory processing issues can be a child’s only concern, or they can be a part of an overall pattern of delayed/disordered development. Many of us who are completely functional exhibit sensory quirks that do NOT interfere with learning, but some children are so significantly impacted that they begin to exhibit true developmental lags. If his milestones are on track, this is likely not the case for him. I hope this information helped you! Thanks for your question! Laura

    47. Hi Laura,
      Same concern as the above. I have a 23 month old (22 months corrected age - not sure it matters anymore). He spins everything that can be spun and sometimes things that I wouldn’t even think could be spun. He also runs around at times with his eyes looking upwards. Also spins himself at times with his eyes looking sidewards. He also flaps his right arm every now and then. He LOVES ceiling fans and lights. He also spins the wheels o his car more than he plays with it the right way (which he does at times and on prompting)

      However, this has not stopped his progress in other areas. He has very good eye contact, loves to play with us (particularly peek-a-boo and chasing), loves to play with his twin sister, Loves to be tickled (asks to be tickled), started putting together 2 words at 20 months, puts about 4-5 words together now (like Big Black Bow-Bow going or sister crying or Mommy, sit down here or Blue ball under here, R(his name) get it), brings over things that interest him, understands instructions (like throw your diaper in the garbage or go to the living room and put this piece on your puzzle). His pretend play so far - pretending to comb his hair with a puzzle piece, sweeps floor with a leaf, drinks coffee out of a cup, tries to feed me coffee with the cup, tries to tie a ponytail, pretends to talk on the phone, wants me to put the towel around him saying it’s a jacket).

      I am going to have him looked at here in India (where I will be for the next 3 months after which I will be back in the US). I was hoping to get your insights on this situation. Does this sound like autism or SPD? If it is SPD, what is usually the prognosis? Can a person live a fulfilling life and do things “normal” people do? Could you please shed some light on what may be happening?

      I have been worrying myself sick (in the real sense of the word - have been such an anxious mess that I may consider seeking help myself).

    48. Hi Laura
      I have a 15 month old son who I am becoming increasingly worried about in regards to his non-existent speech and sounds. He only has one word which he uses consistently which is ‘wow’, he will randomly say ‘hello’. My son has never made any consistent sounds, no babbling or baby chatting at all and has never done mumma or dadda. When he wonders around the house he does a ‘br-br-br-br-br’ sound and other random sounds in his cot but nothing else. He will always copy actions but will not copy the sounds i.e he has a special car kept only for the change table and I make zooming noises around the room until I give it to him, when he gets it he copies the zooming action but just smiles at me mutely.
      When he wants something he grunts or does ‘eh’ and points at what he wants, he gets VERY angry and frustrated when he cant convey what he means and went through a faze of chucking things quite violently or hitting when he got frustrated by this. I would take him aside and say ‘no hit’ or ‘no chuck’ so he would understand, and this behavior has stopped. When he wants something I say what the item is several times like ‘cup’ when I hand it to him and wait for a response but get nothing in return. I go to a Mothers group where there are two 7 month old babies, they are saying more than him.
      Liam does has a very good understanding of what you are saying to him and can carry out complex commands like ‘go and sit on the step with your sister and have your snack’, or ‘go and grab the toy car and put it in the toy box’. Which he does.
      I have a 3 year old daughter who was very advanced for her age in every aspect, she was crawling at 3 months, sitting at 4.5 months and walking freely by 9 months, using several words by 12 months and using full sentences by 15 months. He does have a pacifier but he is only allowed it at bed times or when he is hurt or distressed, he is not allowed to walk around with it in his mouth.
      Is Liam behind or am I just comparing him to his advanced older sister? He is otherwise a very healthy and happy little boy and is an absolute joy.
      Thank you for your time.

    49. My son is 24 months old and has a very limited vocabulary, maybe about 10 words in total. He understands everything we say to him, responds to commands perfectly, even lets you know when he’s had a poo (not potty-trained yet) by pulling you and patting his nappy. He is very sociable, plays football, laughs, is very affectionate - every thing seems perfect - except, there seems to be a delay in his speech. When you do pronounce some words and ask him to repeat, sometimes he does (his attempts are ok sometimes, sometimes off). At other times, you can see him start to try, then he says a categorical “no” (no being one of his words).

      What do you think the problem is and how best can I help him? He has an older brother who is extremely talkative, they play very well together and he also attends play group twice a week (8am to 6pm). They confirm he’s very sociable, loves to play and run about, absolutely loves dancing but just won’t say much! I live in the UK and we don’t have early intervention programmes like I’ve read about on your site here. What can I do?

      London, UK.

    50. Hello Laura,
      Your website has been extremely helpful for me and I have just purchased your dvd (Listen and Obey) and Manual “Teach me to Play with You”. I think these resources should help but I do have some specific concerns and questions regarding my son. My son just turned three years old and we are somewhat concerned about his language and social development. He is extremely affectionate with me and my husband but does not always respond to his name. If I use a funny voice to say his name he will look at me (with a big grin). Could he just be desensitized to the sound of my voice? He appears to be uncomfortable in large groups but does well in groups of 2 or 3. He doesn’t have any problems interacting with his grandparents or aunt but doesn’t seem to be interested in engaging socially with children his own age. With respect to his language development, he has a relatively large vocabulary which includes adjectives and verbs but doesn’t talk in sentences all the time. He will however demonstrate several 4-6 word phrases on a daily basis but prefers to use 2 word phrases. He will sometimes repeat phrases over and over again. For example I pointed out a spider on the wall and said “Look a spider on the wall” & he continued to repeat the phrase about 10 times. Is this an example of Echolalia or could he simply be practicing his language skills. He started this repetitive speech at 30 months but it seems to have lessened somewhat. I was looking at the milestones chart and notes that at 30 Months they should be engaging in back in forth conversation. How sophisticated should this conversation be?

    51. Hi Erika. I’d be concerned about your little boy too. He is exhibiting echolalia when he repeats your sentences. I’d carefully analyze the longer sentences he’s using too because they’re likely also to be echolalic or overlearned sentences that he’s using in context. His true language level is likely at that 2 word phrase level since that’s what you consistently hear. I’d also be concerned about his social development. The new guidelines for analyzing how socially connected and interactive a child recommend that the relationships and interactions BEYOND A CHILD’S CAREGIVERS be the baseline for measuring - not how he interacts with family members or very familiar people. Not being interested in peers at 3 is usually a red flag. He should be asking and answering lots of questions and participating in conversation by 3 as well too, so that’s also a concern. Regardless of anything else going on, his langugage and processing skills are behind what we would expect to see for a child who is 3. That being said, I haven’t seen your child, so I have no way of knowing what is going on with him. I would defintely recommend an assessment for him with therapy to address his delays and help you learn how to target his language at home. Good luck to all of you! Please email me back with any other questions after you watch the DVDs and read the book! Laura

    52. Hi Laura,

      My child is diagnosed with global developmentally delays. He had lots of surgeries since birth. He is now 2 and 1/2 years old. He has hypotonia. Still not standing up by himself. He is followed by SP, but I want to get more help. The SP is only doing playing. He says only baba for now. He started copying my mouth to say O, but not anymore. What advice can you give me to go to a step further.

      Thank you

    53. Hi Nai. I believe that ALL intervention with toddlers should be play-based and chances are so does your SLP. There are so many prerequisite skills that must occur before a child is developmentally ready to talk, and it sounds like that is what your SLP is working on with him. Talk with her about her goals so that you are comfortable with what she’s working on and why she’s targeting those skills. You haven’t mentioned how he understands language, and this would be my primary concern. Is he following directions for you? Is he linking meanings to words? Comprehension of words must come first. In toddlers with motor issues, sometimes a big challenge for a child is the ability to demonstrate that he understands what you’re saying and this should be an ongoing focus in addition to learning how to talk. Targeting receptive language first ensure that when he can talk, he’ll actually have something to say! I hope that makes sense to you.

      Also know that children with hypotonia or any kind of muscle tone difference have to work even harder to learn to talk. Not standing at his age is a significant delay, and his oral motor muscle tone and coordination are certainly affected by this as well so it may be a while yet before he’s using words. Are you working on any kind of alternative or augmentative communication system too? This would also be a focus for me IF your child is cognitively ready to use this kind of system. For these systems to be effective, a child must be able to demonstrate some kind of purposeful motor movement to activate the system and have communicative intent. He should also be able to use understand words that are represented by pictures. If those things aren’t achievable for him right now, then the SLP is probably working to get him ready for that kind of system. Again - talk with her about these things to be sure you understand what’s going on.

      You may also want to check out my DVDs for further information. Teach Me To Talk the DVD is filled with play-based ideas to target language. I’d also recommend Teach Me To Listen and Obey 1 and 2 to work on comprehension. The 3 DVD set is sale priced right now. For more info, click here http://www.shop.teachmetotalk.com.

      Thanks for your question. Good luck to you both! Laura

    54. Hi - I just found this site through another micro preemie mama friend. My LO was born extremely premature (at 24 weeks). He was officially evaluated at 12 months actual age/8 months adj. At that time, his gross motor tested 4-5 months, fine motor 7-8 months, social 10-12 months, cognitive 10-12 months; speech wasn’t really evaluated because my son refused to participate at the time (due to his health issues, 6 of his first 12 months were spent in the hospital, so he had little interaction with people other than myself or his father, besides medical professionals).

      My son is currently 18 months old/14 adjusted; he makes TONS of sounds and noises, but no actual purposeful words. He understands a lot and cooperates as much as any 14 month old would, most of the time. We are also a bilingual household - Arabic and English. He is currently in physical therapy and currently is considered at a 12 month level for gross motor skills; fine motor skills are now between 14-16 months.

      I have a huge concern about his lack of making words; however, we are not currently living in the US - we are in the Middle East, and there are no speech/language programs that work in English (I do not speak Arabic, and I am the stay-at-home mom here every day and at every dr and therapist appointment, so an Arabic program would be very difficult as I could not follow-up at home).

      I read to him daily; he loves books. I sing songs, I label things, I am literally speaking to him the vast majority of his waking hours. And given his comprehension skills, I know this is helping him a lot.

      I just want to know what I can do to get HIM to talk. The only 2 words that he will actually copy have similar sounds - cracker (cra-ka) and cookie (coo-coo). I have tried to concentrate on one word a day (like repeating milk over and over when appropriate - do you want milk? is the milk good? did you drink all your milk? etc, hoping for a repeat, but nothing). What can you suggest that I can do at home? I looked at and considered the DVDs, but if I order them, they will have to go through customs here, and then be sent to the department that censors all media to “approve” and that can take 2-3 months before I get them.

      Anything you can suggest would be greatly appreciated.

    55. Hi Lana. Thanks for your question. You sound like you’re on the right track. Keep focusing on comprehension because that’s the basis for EVERYTHING he will learn to say. Keep focusing on your practical single words you need him to say like “milk,” etc… He will eventually be able to repeat you.

      You also want to be sure he understands the whole process of imitation - beginning by copying your actions during play.

      Other things he may be more apt to imitate right now might be animal sounds, car/truck noises, and other play sounds like fake coughs and sneezes, and then exclamatory words like, “Yay!” or “Uh oh.” My new book coming out soon is about this, but that’s probably just as hard to get through customs, right?

      Let me also ask you about your long-term plans. If you’re planning to stay there, he will need to learn to speak Arabic, even if you don’t, but I’m sure you’ve already thought of that!

      Keep reading the ideas here on the website. Since you can’t get the DVDs, watch the clips. Take a look at my Therapy Tip of the Week Videos too for ideas for how to work with him. You may also want to listen to my podcasts. You can access the archives from the blogtalkradio icon in the right-hand column of this page. The older shows will probably best address the “how to” issues for parents. Begin with shows from 2008.

      Please let me know how else I can help you! Mothers without access to quality resources really, really tug at my heart strings!!! Take care - Laura

    56. Hi Laura
      I just found this site and I love it! I am grateful for the wealth of information and am looking forward to using the material to help my son. I have a 13 month old son who currently has no consistent spontanous productions. He was slow to babble, approx 9 1/2 mo., & still only combines 2-3 syllables with minimal vowel variations ma-ma, du-du, bu-bu, nu-nu. He has always been very quite in his play and vocalizes most when he is immpatiently requesting something, using a whinny tone, and only then uses more repetitions of sounds (i.e. ma-ma-ma-ma while reaching for the high chair).

      He imitates physically by banging, waving, blowing kisses, etc, but does not imitate facial expressions or mouth movements. He attempts to imitate sounds when you really make him, but is very inconsistnetly accurate. He just tries to attempt any sound possible until you give him what his requesting.

      At times I have thought he spontaneously produced words like “up”, “open”-upu, “more”-mum, “done”-du but then he can’t imitate them and it’s so rare that I can’t count them as words. He does not say mommy or daddy meaningfully.

      Fine/gross motor are right on track, walking at 10 months. Receptive language is excellent and he is very alert, but he was not very social until 11 mo. He is extremely shy with strangers or family he doesn’t see very regularly, but he does smile and laugh a lot now, though he didn’t much until 11 months.

      Should I be concerned? What can I do right now? (He does have a pending evaluation with early intervention.)

    57. Hi Kim - Thanks for your questions. I think you’ve listened to the podcasts since you’ve specifically referenced that hierarchy for imitation - good for you! We’re not doing a new show this week, but next week’s show will help move him along. I LOVE that he’s trying to imitate and he’s still so young that accuracy is NOT important right now. It also sounds like he’s coming along socially and doing great receptively, so he’s on the right track. Have you tried signing with him? That’s one thing I’d get going on because he has the prerequisites to be successful with that. Do you have my DVD Teach Me To Talk? If not, get it and watch. I think he’ll come right along with you implementing those strategies. Good luck to you both!!! You sound like a great mommy :) Laura

    58. Hi Laura! I’ve read through your site for a while now and I appreciate all the good information it has given. I have a 15 month old daughter who has been on the later scale for developmental milestones. Crawled at 8 months, walked at 14 months. She has babbled since she was 6 months old, all but stopped while she was focused on walking. I wasn’t concerned because my son would focus on one milestone at a time.

      Now that she is walking well her babbling has returned as well as mama and dada but not said at the right person. She also doesn’t point or follow any commands which is what I’m truly concerned about. It’s hard not to feel guilty that I’ve only now just noticed this at 15 months. We have an appointment to test her hearing in 2 weeks and also a referral to Babies Can’t Wait (Georgia’s Early Intervention Program)

      My question to you is: Is there anything I can be doing at home to help her try and understand simple commands? What does this sound like and should I be as worried as I am? Thank you for your time.

    59. Hi Jennifer. Based on what you’ve said she has both receptive and expressive language delays. When kids are late with motor skills, it’s very common for language to be delayed as well. The GOOD news is that you’re getting an assessment ultra-early and early intervention is the real key in addressing issues with learning language.

      Even though she’ll probably qualify for therapy (and especially if she doesn’t), you’ll want to work with her at home to make sure she begins to link words with meanings. Toddlers must understand words BEFORE they begin to use those words to talk. Things that you can do at home are to simplify your language to her. Model lots of single words and short phrases rather than speaking to her all of the time as you would to your older child or an adult. She’s not getting it “the regular way,” so you’ll have to adjust the language she’s using. Make sure you go out of your way to name what she’s playing with or attending to and be pretty repetitive while you’re talking. For example, if she’s playing with a ball you’d say, “Ball! Look! Ball! Get your ball. Wow! Ball!”

      Have you checked out my DVDs? Teach Me To Listen and Obey 1 will teach you how to cue her so that she begins to understand more words and follow simple directions. Teach Me To Talk will show you how to work with her to help her begin to say more words. I highly recommend those products to get you started with her. Toddlers whose parents work with them at home make much more progress than those whose parents depend solely on therapy or who do nothing at all.

      Good luck to you both! Laura

    60. HI Laura,
      I’ve read through your site for a while now and I appreciate all the good information it has given. I am from Tokyo and have seen your DVD Team me to obey 2 part which is very good and my 4 yr old son enjoys it when i am playing all the activities with him. I have a 4 years old son who doesnot talk like the other 4 years old do. i have braught her for speech pathologist evaluation and they diagnosed her with language disorder. but during the evalutaion i discovered that i didnot teach him about this or about that the questions which the pathologist were asking her.He is very good in learning, if i tell him anything once he won’t forget it.

      His problem is that he cannot make sentences on his own. His motor skills are wonderfull , he can sing rythems ,alphabets and do writting. But when i ask do u like choclate or do u like milk, then he repeats the sentence, he does not say yes or no.
      I am worried that how can i help him. Thanks for your time.

    61. Hi Shikha. Based on what you’ve said, he does need therapy to address his receptive and expressive language disorder. Ask your therapist for ideas for working on yes/no questions. What you could try is a quick prompt saying, “Do you want milk, yes or no?” to see if that helps him come up with the right answer. I would also keep coming up with things he really, really wants or things he really, really hatesand using that as motivation. Modeling yes/no with high affect can also help. For example, “Do you want this ice cream? Say “Yes! Yes! Yes!” I pump my arm in the air while saying an enthusiastic “yes” or shake my head dramatically for “No way!” The bottom line is that his skills are not at the level where these questions make sense to him yet. You’ll need to keep working on receptive language so that he makes the connections. Hopefully one of these ideas will make a difference for you! Laura

    62. Hi Laura,

      Thanks a lot for your suggestion on Yes!Yes!Yes!It really worked well. He learnt to say Yes I like it and could differentiate between Yes and No. My next goal to have him understand what I am saying and respond it as well with his own answer for example what have you done in the school today ? what have you had in your lunch etc. is there a better approach to achieve this ? would really appreciate your advise on this ? Is there any DVD that you have may potentially help in these areas.

    63. Shikha - I’m so glad it was successful for him! Try the “prompts” for other questions too - “What did you eat for lunch - chicken or peanut butter?” or “What did you do at school today - paint or play outside?” It’s helpful for now that you not ask him anything you don’t know the answer for yourself! After he improves, then you’ll be able to ask new questions.

      I do not have these strategies in a DVD (but that’s a great idea!!!), but the bottom line is that he needs more help with comprehension/receptive language. Teach Me To Listen and Obey 2 teaches you how to work on those kinds of goals at home. Teach Me To Talk: The Therapy Manual also gives specific directions for how to teach these concepts and all other receptive language milestones up to the developmental age of 4. It may be a great investment for you!

      Congratulations on your success!! You can do this!!!! Laura

    64. Hi! My daughter is 22 months old and she does not say anything yet. She has 2 older brothers and they both were saying words by 12 months. Literally she doesn’t babble mama or dada. She does make noises such as EEEEEE, Ahhhhhh…all vowels. My pediatrician keeps saying if she interacts with me and seems to know what I am saying than to wait until she is 3 and see if she is talking yet. Should I be worried or just wait until she is 3 and see if she is saying anything?

    65. My son is 15 months old. He says mamamama but no other babbling sounds and he does not imitate sounds. I can see him try to shape the words with his mouth a little but he doesn’t get the sounds out at all. he has always had a quiet, rasy squeaky cry. He communicates with squeals and growls…different pitches seem to indicate different things. He plays very interactive, lots of eye contact and smiles and a very expressive face. He plays with toys appropriately and flirts. He can clap and wave but does not initiate it. He does not point. He will grab what he wants, undressed me to nurse, etc. He is also able to follow directions..”bring your daddy the diaper” and has some cuase and effect ideas…ex. I told him he had to finsih what was in his mouth before he could nurse so he spit it out. He’s done that a few times. He only has two front teeth. He is very small for his age and we will be working with a nutirtionist this month. He is not walking yet but he pulls into standing and will walk around the furniture. he also climbs on everything. just looking for some advice on what to do next. thanks

    66. Hi Michele - I’d recommend my first DVD Teach Me To Talk. Take a look at that, implement those strategies, and then see what happens. He does sound social and is understanding language since he can follow some directions, so he has the important prerequisites that we look for. I am considered about oral motor coordination, particularly in light of his feeding issues too, but it’s way, way, way too early to diagnosis any of that kind of issue.

      If you’re a reader, I’d also suggest my newest therapy manual Building Verbal Imitation in Toddlers. It will outline for you exactly how to help him learn to imitate words.

      Hopefully those new ideas will jumpstart progress as you work with him. If he’s not moving right along by 18 to 24 months, check out your state’s early intervention program for a speech-language eval, or sooner if you’re really, really concerned now. I’d also follow up sooner if the nutritionist feels he has any other red flags for a more serious developmental issue.

      Take care and good luck!! Laura

    67. Hi Laura,

      My son is 13 months old. He has been doing these odd hand movements since he has been born. His father and I used to joke that he was riding a bike because it always looked liked he was holding onto handlebars. Now that he is older, instead of it looking like he is moving his hands in a forward motion (”moving the accelerator forward on a motorcycle”) it now has turned into a circular movement. He is doing this almost all the time and especially in his highchair. He also make this ongoing screaming type noise, but he isn’t upset. This also can usually take place just about anywhere, but its usually his highchair. I don’t feel this has anything to do with eating because he loves eating. Even through the yelling he still opens his mouth for more. He has Cystic Fibrosis so he has every kid’s dream diet. He had been holding his own bottle since he was about five months old. When we switched over to whole milk (at 12 months) I did away with the bottle. The first day he could drink out the sippy cup fine but refused to hold the little handles. The next day I went out and bought these sippy tops that went on our original bottles in place of the nipples. He still refuses to even try and hold it. Which I don’t understand because its the same exact bottle he had been holding since he was young. He is not yet walking but he does cruise along the couch and furniture. He is tip toe the whole time. When I put him in his pack n play he is also tip toe and all he does and stand there and jump. He might play with toys for a few minutes but most of the day he is jumping. When he is standing completely still which is very rare, he will stand flat footed. When he crawls its usually the army crawl. He can crawl normal on his knees but he will only go a step or two and goes right back into army. When I change his diaper he refuses to bend his knees, it literally hurts my hands to get him to bend. And this has to be done because then I can’t clean him properly. He rarely babbles. He does say Mama but only when he’s desperate and it sounds more like MaaaaaaaamaMaaaaamaMaaaama all in together. If a stranger heard him they would have no idea what he was saying. Otherwise to get my attention he bangs his hand on whatever is in front of him. But its just one bang and then he looks at me. I know that sounds like he justs wants to show me what he has or just to look at him or whatever but its not he does this to tell me he wants to be picked up or he wants me to get him something. It just seems very odd to me. He does have eye contact but only when he is very interested. He doesn’t answer to his name, which he was doing a few months ago. He doesn’t really answer to anything. You have to be in his line of vision for him to notice you. But at the same time I know he isn’t deaf because I can tiptoe across the room and his head will fly in my direction. I also have a 2 year old and he never did any of these things. Normally, I just tell myself that he will grow out of it, but its really been bothering me lately. Oh also, about two months ago he started waving or so I thought. I’m thinking now he just might be flapping his hand. Does any of this sound like I should get him checked out? Are these symptoms of anything?

      Thank you so much for your help!


    68. Hi Raschel - I would definitely have him evaluated. If you’re in the USA start with your state’s early intervention program which specializes in treating babies & toddlers birth to 3. The eval will be free, BUT he may not qualify for a state program since the eligibility requirements are written so that kids with more significant delays qualify. Please mention that he’s losing self-help skills and also his hand flapping since those are both red flags. I think you’re so smart to address these issues early instead of waiting. Even though kids with cystic fibrosis aren’t thought to be at more risk for developmental delays, I have seen several children over the years with CF, so I’m glad you’re following up on your concerns.

      I’d also recommend my DVD Teach Me To Talk so that you can begin to address his expressive language at home. Hopefully it will be the jumpstart he needs! Good luck to you!


    69. Hi! My son will be turning 17months next week. He still does not say anything at all except for mama and dada. He babbles a lot but that’s just about it. After reading some articles on your site, I decided to search for a place where they can evaluate my son. And so, I found one and went there yesterday to inquire. They will be charging $60 as an evaluation fee separate from the consultation fee. I don’t mind paying the fees but the problem is that they would want me to go through the evaluation and all only when my son is already 2 yrs old. Is it really too early to evaluate my son? Am I just paranoid that my son might be having a speech problem?

    70. P.s. our household is multilingual, can this be part of the problem on why he still does not say anything else other than mama?

    71. Hi Laura, It is great to see your comments and advice here. I have a boy who is 6 month and half as at today. I really worried about his babbling. he used to repeat tatata, tetete while he was around 4-5months but since started from his 6months, he stop repeating those consonants and only say ohhhhh and ahhhhh. He seems socially, smiling and laughing with people surrounding. I want to know if there has any thing to be concerned on this.Please give me advice. Thanks,

    72. Hi Laura

      My dd is exactly 2 yrs 9 months old and is a huge fan of Everything’s Rosie series. she can repeat and enact with proper voice modulation and expressions most of the episodes she has watched but that seems to be the most of her talking. She understands everything I tell her and others tell her. knows all her numbers, colours, shapes, animals and will point to things in books and speak them out. She is beginning to put together sentences as well. But basically repeats and talks some sort of gibberish all the time related to dialogues from rosie series. How to develop more ” normal conversation speech with her? Or is it normal for girls of this age to repeat dialogues? When she wants something, she does ask for it though.

      What should I do in your opinion?


    73. My grand daughter is 2 yrs.5mo. and sounds very much like the comments by the above anamika. She watches Dora and also knows everything vocabulary wise and does say some sentences but they are things she has been taught. She too can repeat many parts of tv shows like Dora or parts of books, songs etc. I know that she needs to generate more spontaneous social speech. For example if my son takes her to a nearby lake and they come home and you ask her where she has been she cannot answer you. If you tell her” the lake” then she will say “I went to the lake”. She will be evaluated by birth to 3 soon so we will see, I know on a standard language evaluation she would score normal because most tests do not take social pragmatic speech into consideration except by parent interview. I am just not sure what she should be doing by this age. I know we should be able to understand about 90% of what a 3 year old says, just not sure of the 2-3 yr. span since children vary so much in normal speech and language development during this time.

    74. Hi Kathy - Without seeing her I wouldn’t know exactly what’s going on with her, but you’re so smart to realize that most of her utterances are not novel and she can’t answer questions. She really may not qualify for early intervention because she is already technically talking and most state programs are really designed only to provide services for children with significant delays. If she doesn’t qualify, I’d really go ahead and pursue services outside your state program. Many private practices and clinics will file your insurance if coverage for therapy is available. Hopefully you will find an SLP who is very accustomed to providing services with home programming in mind. Although you’ll take her in for therapy, the bulk of her “therapy” will still need to be done at home by her parents and by you. Have you taken a look at my DVDs? Those provide some great visual models of what and how to work on language at home. My guess is that she needs to work more on language processing/receptive language since she’s a little echolalic, so take a look at Teach Me To Listen and Obey 2 to learn how to teach her to understand more of what’s said to her. The other resource that may be helpful is Teach Me To Talk: The Therapy Manual. It outlines goals/activities through the 4 year old level, so it will be appropriate for her and for your “home therapy” sessions for a while. When she truly understands more, her spontaneous language will improve. Again, many SLPs miss this and think it’s all about expressive language, but when you work on building a solid foundation of what a child truly understands, the novel words/phrases/sentences dramatically increase. Good luck to you all! She’s lucky to have a grandmother who cares about her like you obviously do!! Laura

    75. my son is 16 months, happy maintains eye contact, flirty, payls with toys well, knows the appropriate us of each item. eg comb for hair, remote for tv. very active however he doesnt seem to be understand basic words. he does wave bye with the action. is it too early to get him evaluated

    76. My grandson is 16 months old and does not talk. He shakes his head for “no”, knows words like bottle, Mama, Dada, phone, no, yes, good when we speak them to him but he doesn’t say them himself. He knows his name when he’s called and he is very lively, flirty and communicative otherwise. He is a happy boy. My daughter and son-in-law talk to him and they all communicate well together, Baby Boy just doesn’t use words. But 16 months seems so young to be diagnosed and maybe too early to be worried. Please provide your thoughts and thank you so much!

    77. Hi there!

      First, the information on this site is fabulous. Thank you so much! I have a quick question- I am a first time mom and EVERYTHING, and I mean EVERYTHING, is a red flag to me. That being said, I have a 13 month old who is progressing just fine in every area but one- responding to his name. He will respond, just not every time. My question is, how can I tell if he is simply consumed by what he is doing or if there is an issue? I try not overreact, but it is difficult as I worry constantly. Any insight or suggestions would be much appreciated. Thank you so much!

    78. Hi Laura,
      My son is now 14.5 months and barely uses consonants to babble. He seems to be having a serious long conversation with me with only vowels!!! He’s trying to tell me something with frowns and other facial expressions but there are no words. It sounds like cooing. He says da for car. He can say dada, nana, mum, rara, ta but no real words. Oh he has just starting pointing with the whole hand or closed fist, only on request. This cant be normal! He has great eye contact, waves hi and bye. He used to say hi but stopped. He can touch some of his body parts when asked. He understands a lot but he just can’t express himself. He claps, dances, doesn’t nod his head. He stares in space sometimes and loves wheels and everything that rolls and spins. Am afraid u will tell me it could be autism.

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