Can’t vs. Won’t

Advice for Parents of Late Talkers or Toddlers with Speech Delays

I rarely…no make that NEVER, think that a child doesn’t talk because he’s stubborn or lazy. I get so frustrated when parents tell me this, or worse, when I hear another therapist say this.  If you have thought this about your child, or if a teacher, a physician, or a speech-language pathologist (GASP!) is telling you this, please re-evaluate your situation.

The truth is…

When kids can talk, they do talk.

It makes life so much easier for them, and for you!

Once they figure that out and come together cognitively (understand language), neurologically (can plan and send the message they want to convey), and physiologically (perform the complex processes that are physically required to produce sound), they do learn to speak.

Sometimes parents think that because a child can say a few words, he can say any word. They think he is somehow “holding out on them” when he’s “refusing” to say new words.

Children at age 2 or even 3 are not capable of the advanced cognitive reasoning that must occur for this kind of mental manipulation. Please don’t convince yourself otherwise.

Some parents would rather see their children as “bad” vs. realizing that they have a true developmental problem, and I am always confused by this approach.

Most children who don’t talk have no choice in the matter. If they could talk, but actually have made the choice not to talk,  they would be diagnosed with selective mutism, and this diagnosis is very, very rare. Selective mutism requires that a child use language that is typical for his age in at least one setting. If a child has used a couple of words occasionally or even pops out a phrase now and then, but otherwise doesn’t talk, she still does not meet the criteria for this diagnosis.

When a kid defaults to the same word over and over in lieu of using new ones, motor planning problems (apraxia) may be the underlying reason. The child is neurologically “looping” a word he can say. “Default” is an accurate choice of words here, because that’s what’s happened. He can’t say the new word. This is very different from he won’t say it.

The problem could be due to cognition. The child doesn’t understand very many words, so she hangs on to the word or words she can say and uses them over and over instead of saying new words. Teach her to understand new words, and she will begin to say those too.

The problem may be related to issues we see with a child who may eventually be diagnosed with ASD or autism spectrum disorders. A particular word may feel good to say or sound appealing to him, so he says the same word repetitively. Or a child may hum nonstop. Because he’s somewhat verbal, a parent assumes he can talk and is purposefully not saying something else. This is a very specific issue, usually attributed to echolalia, rather than “choosing” not to say other words.

I’ve seen other scenarios too. No matter what’s going on with a particular child, the bottom line is this:

Making a distinction between can’t and won’t is very important, and I BEG moms of children that I see as clients to change the way they think about late talking. Without even meaning to, we often treat children differently when we view developmental issues as behavioral (“He just won’t say it!”) vs. a true challenge (“He can’t say it!)

When we look at late talking as something a child can’t do (YET!), we try to help him and search for a solution. We uncover the reasons he’s not yet talking and more importantly, we find strategies that are successful.

If we think a child’s speech delay is because he won’t do it, we may throw up our hands and walk away. We may give up thinking, “He’ll talk when he’s ready,” or “I’m helpless. I’ve run out of ideas.”

Or we may push and push and push to get OUR way so that talking and communicating become a power struggle. Nobody wins those battles.

When I work with a toddler like this on my caseload, I keep things super fun so they WANT to particpate and actually, so irrestibile they can’t help but play with me. I model, model, model lots of play sounds and exclamatory words like animal sounds and fun words like “Wow!” and “Whee!” and “Uh oh.”

When a child is ready, we bump it up to include tons of single words without adding too much pressure to “perform.”

When a child is a little further along, I offer a vareity of choices for motivating items (such as their favorite things to eat, play, and d0) so that they are somewhat forced to respond to get what they really, really, really want.

Even before moving forward with those good ideas, I always teach another way to communicate, whether it is with simple gestures, signs, or pictures.

Along with changing a parents’ mindset when it comes ot the reasons behind late talking, these stategies can make the difference with a kid who seems like he won’t talk.

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For more about this topic and to find ways to help your child, please see the full listing of my products from teachmetotalk.com here.

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Comments

  1. Holly says

    I totally agree with you Laura and I’m ashamed to say that I was one of ‘those’ parents in the beginning. My son is very stubborn to begin with and therefore I kept just saying that he can do it when he wants to…however once I started reading and found out about Apraxic children ‘dropping’ words, I felt ashamed. I do think sometimes it is a little stubboness in there at times since I see it in everything else I want my son to do but I now know, it’s because he can’t a lot of the times so I don’t push too hard or get mad at him and like you said in your article, we change the way we approach the situation and try to help our child instead of getting upset.
    One quick question, do you or anyone else have a technic if you will to help with articulation for ‘f’ words? This seems to be my son new road block and everything comes out sounding like a ‘p’. I always tell him to bite his lip when trying to make the sound, but it doesn’t really seem to help or not yet anyways. Any ideas would be greatly appreciated. Thanks again you’re awesome Laura :)

  2. Laura says

    Holly – /p/ is a typical substitution for /f/ until 4 1/2 or so although many kids can accurately produce /f/ earlier. I don’t work on this sound often because most of the kids I see are 3 or under. The “bite your lip” trick is a good one. Also make sure he can do this sound in isolation or alone before you try to stick it in a word. Although we want to get sounds in words pretty quickly, we still need to make sure he can actually do the sound correctly! Talk to your SLP. She should be able to give you more tips since she actually knows your sons patterns. Thanks so much for your consistent participation. I love it!!! Laura

  3. Holly says

    Well I’m glad to hear that it’s typical until 4 1/2 so hopefully he’ll get that one soon :) Is it the same with /h/ sound? Like instad of ‘house’, he’ll say ‘shouse’ or ‘shat’for hat? I just thought that maybe you would have some other ideas/approach to the /f/ sound I could try. I have talked with my SLP, she’s a good therapist and a nice person but when it comes to giving me ideas to help my son along, she really doesn’t “offer” much advise or ideas, usually just tells me he’ll get it. Maybe I’m just too impatient but I don’t want to wait for him to ‘get it’ I want to help as much as possible at home since I’m with him everyday all day. i don’t know maybe I am pushing too hard or too impatient, I know it takes time and I don’t want a miracle(although that would be nice) I just think there’s more I/we can do for him. Sometimes he gets mad at me now and refuses to say a word if I ask him to(the stubborness part), he’ll tell me, “I already said that momma” breaks my heart. Although I’m very happy to say that he finally got the word ‘water’ down pat yesterday, no more wawa WHOOPEE!!! :)

  4. Laura says

    Holly – /h/ is a sound he should already have. That’s an early one along with /m, p, b, w, n/. Many artic books don’t even list ideas for /h/ since most kids get this sound, but I have found it to be difficult for kids with motor planning issues. I have one little girl who is about to turn 3, and we’ve worked on /h/ for MONTHS now.

    Ideas for /h/ – have him blow his breath on windows/glass and call it his “breathy” sound. Pant like a dog to help control air flow.

    One thing he MAY be doing is trying to generalize his new “sh” sound. Did he use /h/ as a substitute for “sh”? If so, he’s overgeneralized this so even words that should begin with /h/.

    Tell your SLP AGAIN that you want very specific homework. She’ll get the hint if you keep asking.

    Thanks! Laura

  5. Holly says

    I thought you would say that :( Thanks for the ideas for the /h/ sound I’ll definately give it a shot. It’s weird because with certain words he has no problem with the /h/ sound only some of them come out as ‘sh’ sound. For instance, he can say the word ‘hook’with no problem but ‘have’ and ‘house’ come out with the ‘sh’ sound. He never substituted /h/ for ‘sh’, all words starting with the ‘sh’ sound he can make, strange isn’t it?
    I will try asking her again for some homework especially with summer coming his time will be cut down again for a few months which I really disagree with and wish they would keep him going the 3x’s a week but unfortunately they won’t so homework over the ‘summer’ would be really beneficial I think.
    Thanks for the quick response as usual Laura!

  6. Jennifer says

    I just wanted to first say that I have found this site very helpful. We are just starting the process with Early Intervention and it is a little overwhelming. My son is almost 25 months old he says over 150 words and has started using 2 word phrases. But he still uses jargon a lot, his articulation is not that great and most of the time he has to be prompted to use his words. When he wants something he will point and grunt most times instead of labeling the item. I always label the item before giving it to him but I do not know how else to help him. Also there are words that he has all the sounds for but still will not say. For example his name is Andy and says candy very clearly but will not say his name. How do I help him?

  7. Laura says

    Jennifer – Let me suggest reading all of the articles in the category expressive language. Start at the end of the page with the oldest articles from January and work your way forward. I’m not going to reiterate the suggestions in those articles, but for starters, keep insisting that he ask for things. You should also be giving lots of choices before he gets anything. If you have more specific questions after reading through the recommendations, I’ll be glad to answer them. Good luck! Laura

  8. Darla says

    Thank you SO MUCH for this site! I have learned so much and your advice has really helped me out a lot with my little guy. His thearapist is way sub-par and I have taken the initiative and used your strategies and his speech is really improving. His ST thinks it’s because of something she has done but I know different. Thank you Laura!

  9. Laura says

    Darla – I am so glad it’s been helpful! Thanks so much to you for your nice compliments! Laura

  10. Kelly says

    I can’t believe how much I have learned from reading the information on this site! My 2 year old has been through 7 weeks of non-productive speech therapy, with every session ending with the therapist and my son being exhausted. I was not permitted to observe the sessions and often came away frustrated with the vague instructions the therapist gave for follow-up. My son did not respond–only playing during the session with the numerous toys that were set up in the therapy area. I have since made contact with another facility and talked in-depth with one of the therapists there. When I mentioned my son’s issues (without talking about the therapy he was currently receiving), I asked how it would be handled. I was so impressed with her responses that I scheduled an appointment immediately. Our first appointment is next week and the information on this site will certainly help me be more prepared and will give me the tools to be a better advocate for my son. Thanks!

  11. Patricia says

    I am so glad you wrote this!! I am in complete STRESS OUT MODE!! My 18 1/2 month old son is not talking. He can say MaMa, but says it really slow between sylables. Like Ma…..Ma.. That is about it. We are having the hardest time getting him to even try to imitate sounds we make. We can’t even get DaDa out of him most of the time, and sometimes he says Na Na instead of dada. (we’ve never taught him nana) Now to be clear, we have been signing with him since the beginning, and he has well over 60 signed words, understands everything we say, and is at or ahead in all other milestones. I know he doesn’t have a mental problem. But the speech lady we are seeing, is insisting that the sign is preventing him from talking, and that we have to MAKE him talk. We have tried it, it hurts me to do it, because I’m not conviced he is being stubborn. It just seems that he can’t do it. He had a normal hearing test, so that’s not it. I am beside myself with what to do, because the speech lady is so adamant that the signing is at fault. I just don’t think it is. Any help would be great.

  12. Laura says

    Patricia – Thank you so much for your post. It’s unfortunate that your SLP is discouraging signs. Please read the articles in the sign language section. Research has proven that sign language DOES NOT prevent children from talking.

    Look for another explanation. It could be as simple as an expressive language delay, but it may be something else entirely. Has your SLP considered a motor planning disorder such as apraxia? Read the articles in the apraxia section as well. I will tell you that it is very difficult to diagnose a specific reason a child is not talking at 18 months. My advice is to simply keep working on helping him. He needs a committed and positive mommy like you!

    I wanted to also let you know that we have a DVD coming out in July (I HOPE) that will outline other strategies that parents can use at home to facilitate expressive language development.

    Good luck to you and your son! Laura

  13. Holly says

    Hi Patricia….I just wanted to say from my own experience that perhaps you might want to look for another slp. You certainly do not need her thwarting your efforts to help your son. I have NEVER read anything stated that sign will stop your child from talking or impact his talking negatively in any way. I know with my son, they said they would’ve recommended teaching him sign langauge if he was younger but at the age he was at and the words that he had already, we were able to communicate pretty well. I would say if she continues to have that ‘attitude’ if you will towards your signing, then it’s time to move on to someone else who will approach your son’s therapy with different more cooperative approach with you. Just remember, you are your son’s best advocate and you do know what’s best for your son in so many ways. Don’t get discourage just get proactive :) Your son doesn’t need to feel the tension between you and his slp which I’m sure from the sounds of it there is some. I wish I would’ve taught my son to sign when he was that young, probably would’ve been a little easier road we’re traveling. Keep up the good work :)

  14. Patricia says

    Thanks for the support from both of you. You are right; there is some serious tension with her and I. Before I had him, I did the research. I know that the signing isn’t hurting the situation. Sadly I am not able to get another SLP. I am a military family member stationed in Belgium. So there is exactly one person I can work with. So basically it’s her way or the highway..which she told me in not so many words. We have, at her insistance, stopped signing for about a week and a half now, and it doesn’t seem to be helping. I guess that is probably too soon to expect any changes. We are trying day in and day out to get some talking out of my son, but not much so far. A few “m” sounds, but that’s it. And it’s like pulling teeth to get him to do that. I am still searching for resources online of some exercises and things I can do with him at home. I am also spending a lot of time on this site trying to familiarize myself with as much info as I can.

  15. Holly says

    There’s no way through your own private insurance company to get another slp? That’s too but I guess then the only choice you have is to make the best of it and like you said, do all the research you can. Maybe Laura’s video will help you out when it comes out in July :) Just a note from a mom with experience, don’t push too hard at home because your son could end up being resentful and then not want to try at all. I know with my son sometimes if I pushed too much he would start getting mad so I would just say whatever it was correctly for him to hear. Perhaps try the singing approach with him, I know a lot of kids will start singing if you will before talking. When my son was that young, I also read to him alot trying to get him to hear as many words, sounds etc possible. At lease your son is still young mine was 2 1/2 when we really realized he had an issue and was diagnosed with apraxia. I will keep my fingers crossed for you and your family and remember, no matter what, don’t give up keep fighting for him:)

  16. niyati says

    Laura , Just wanted to say a ‘Big Thank You’ for this site. Although, I am yet to see results with my child, I must say that you have addressed all those problems which were running in my mind and which no doctor / therapist was answering correctly. I hope I can write back to you at the earliest about the progress my son would make by following your tips. I wish there were more people like you in my country too(India)

  17. Shannon says

    I totally understand that some children do start talking later than others, but I have concerns about my 26 month old. I have just moved to a different state and am not sure where to start. He has said words in the past, but he is very inconsistent and has stopped talking (for me- my husband says he talks for him). He points and grunts a lot, but he follows complex commands (like if I ask him where his shoes are he will go to the other room and get them for me). Any information you have would be helpful. I will continue to read through the webiste in the meantime.

  18. Laura says

    Shannon – I would definitately go ahead and have his communication skills evaluated by your state’s early intervention program. Losing words and not using well over 50 different words and frequent short phrases by this age is a real red flag. I understand that moving may have set him back, but if moving is not the reason for his language delay, you’ll not want to lose precious time waiting for him to adjust. You can search for the early intervention program in your state by googling your state’s name + the phrase “early intervention.” The evaluation is free, and if he does need some therapy to catch up, it will be lower cost than you would likely otherwise pay or use your insurance to cover.

    In the meantime, use the ideas on this site to get you started at home. Birth to 3 is the critical time for language development. It’s good that you’re concerned now. Best of luck to you! Laura

  19. Heidi says

    Thank you for this information. A friend found it for me. My son (almost 3) has apraxia. He is very advanced in his motor and fine motor skills. He also comunicates very effectively using about 6 words and some sounds he uses in place of words(he will imitate sounds for truck, train, chicken, kitty, bear) and also some baby sign language (eat, water, shoes, please, cookie, hot). My question is, as I play with him, what words should I focus on using to help him add to his vocabulary? Also, what DVDs should I get to help us learn how to help him? Thank you very much.

  20. Laura says

    Heidi – My first DVD Teach Me To Talk demonstrates 6 easy strategies to target expressive language development and is appropriate for any child with delayed language. My new DVD specifically for treating apraxia has just gone on sale. In it you’ll find LOTS of very practical strategies for working with him at home, including HOW I recommend that parents teach new words as well as guidelines for moving from words to phrases to sentences. I hope this info helps! You can see clips from Teach Me To Talk here on the website, at this link –

    http://www.teachmetotalk.com/tmtt-dvd.html

    The clips from the new apraxia DVD (Teach Me To Talk with Apraxia and Phonological Disorder) should be posted by the weekend! Thanks for asking and I hope you find both of these DVDs really helpful! Laura

    P.S. Use the code INTRO to save $10!

  21. Amber says

    I have a (nearly) 3 year old little boy. He was evaluated through EI just over a month ago. His ‘diagnosis’ was Mixed Developmental Delay with his speech/language skills around the 18 month mark (receptive & expressive).

    I have my suspisions of apraxia, sensory processing disorder and also autism spectrum disorder.

    The biggest thing about his delays is his speech/language. Almost everything he says is a copy of something he heard before (this applies to short phrases). He will say some very simple 1-2 syllable words randomly and sometimes in context (dog if he sees a dog). He is inconsistent at best. He has horrible meltdowns when he can’t tell us things.

    Few examples:

    1. My older DS started swimming lessons yesterday morning. I took along a big bowl, water and various things he could play with while brother was in the pool. (He loves water play!) So when it was time to go, I went and dumped the water out… He had a huge meltdown over it and would just say water & point where I poured it out. It took us 30 minutes to get him to the truck and he still wasn’t happy. He will throw himself all around and down on the ground. He just kicks, screams & cries. I try my best to figure out what he needs/wants by asking him yes/no questions but he can’t even respond to those when he gets upset.

    2. We also had speech yesterday (3rd visit ever). The first 2 visits there I told the CCC-SLP lady that I he mostly would copy/imitate words/short phrases and that he really didn’t talk otherwise. She apparently didn’t care what I had to say since she actually told me (on 2nd visit) that she “had never had a child talk so much in just 2 sessions”. My mouth almost hit the floor when she said this because he had not said anything new. Only copies of what she said or his regular copy speech. (I was almost ready to leave that SLP after this…)

    So yesterday I went in with my apraxia ‘checklist’ and gave it to her and told her my concerns YET again. She did seem to listen and watch throughout the 30 min session but I still think she is just trying to brush it under the rug. I don’t think they deal with/see many cases of apraxia in our rural little town. She did get to see for herself that he was in fact copying things and not making spontaneous speech.

    3. He can say ‘elephant’ or more precisely ‘eh-e-pha’ but can’t say something like ma-ma. He uses “da-da” for me, his dad & when he needs something he will call out “da-da” He doesn’t call out “help” despite us teaching him this. He can say it fine if prompted from us first.

    4. At his 2nd speech session, the SLP kept saying “uh oh, it’s stuck” in reference to a frog toy that kept getting stuck. He brought that phrase home and that is almost all that he could/would say for the next 5 days. He would even do it in the same pitch & tone as her. It was like a parrot copying someone. Then after those 5 days of saying it everytime he got frustrated or wanted something – he just stopped. He used to say other words like purple but I haven’t heard that (and others) in a long time.

    5. He can recognize his ABCs and numbers by sight and say them but can’t say them if you just ask him questions about them. As a matter of fact, he doesn’t answer any questions we ask him except for some yes/no but this is inconsistent at best.

    6. When we tell him “I Love You”, he never says it back. He only makes the sound of a kiss but doesn’t pucker his lips. He also can’t/won’t stick out his tongue on demand or kiss with his lips puckered on demand.

    7. If he echos a long phrase or sentence usually the beginning consonants are missing except for an approximation on the first word.

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    So before this gets too long…

    What do you think? Does this sound like Apraxia? Is there anything else this could be that I don’t know of? I am really trying my best to get his care providers to help me figure this out but I feel like noone is listening to me. I just want to help him find his little voice. Life for him can be quite difficult (like many of you experience as well).

  22. Laura says

    Amber – You sound like a fantastic mom, so don’t let anyone derail your opinion about your son! I understand how you might think that motor planning is a part of his issues since he’s not puckering or sticking out his tongue, but that is probably confusing his SLP since he CAN imitate words so well, which is opposite problem that most toddlers with apraxia exhibit, and that is why you’re getting little response from her. She’s blowing you off because she’s hearing him imitate words so well.

    How you’re describing his speech-language sounds more like “echolalia” which is associated with autism spectrum disorders. For the next session, I’d begin by telling the SLP that you’ve done more reading and that most of what he says is “echolalic” and give her very specific examples of how he’s only using words she’s said or he’s used and “gotten stuck on” before. While we certainly do want a child to repeat and imitate in order to learn language, the ways you’re describing how he imitates do sound atypical, so point these out to her – especially copying dialogue from shows and books. If you’re getting no response or real “teamwork” from her to help you figure out what is going on with him, then you should probably look for a new SLP more familiar with treating children who are on the spectrum and who will be more responsive to your very real and specific concerns. I’d also tell her that if you can muster the courage. A very big part of her job is talking you through this and teaching you what you can do at home to help him. Tell her that that’s your expectation too.

    Again – you sound like a great mom to work with, and I hope you can persuade her to listen to you! Let me know if there’s anything else I can do for you! Laura

    Of course I can’t see him and don’t know what’s going on for sure, but based on what you’ve said about him, this would be something I’d be concerned about too.

    Is he getting occupational therapy? An OT who works with children with sensory processing issues can help you sort out those concerns and give you strategies to hopefully minimize the meltdowns. Your instincts sound so good though. Taking a water bowl to the pool was a great way to address what you knew might be hard for him. A good OT can help you tweak your routines and responses so that even if the tantrums don’t disappear completely (he is a toddler afterall!), life will calm down for him and for you all.

  23. Jenny T says

    Hello –
    My 20 month old son started 1/2 hour weekly speech therapy since his vocabulary is only a few words at this point. He attempts to talk with different consonant sounds and within the last two weeks he has mimicked duck & cow sounds, which is new. He was a preemie born two months early so he has also recently started weekly OT/ET for sensory stuff. He does try to mimick us, points to what he wants, and I think he understands what we’re saying/asking for the most part.
    What do you know about preemie language developmental delay? I’m concerned because the speech therapist sent her evaluation report last night and it said my son had significant delay for his age and his scores were low for expressive and receptive. What else can we be doing? I’m also wondering if maybe he’s not connecting with the speech therapist or maybe it would be better to find one that will come to the home vs. office, though I’m not sure how to tell? Thanks!

  24. Karen says

    Hi Laura,

    I’m glad that I’ve found this website. It’s very informative. However, I have a couple of questions for you. My only child is 26 months old, and he is a healthy, happy and lovely boy. He stays at home with me exclusively. I’m sure it’d cause him a bit reserved and shy. When we bring him to the playground, he’d be shy to start with, but he’s willing to mix around and take turn to play with other kids after a while.

    He has been doing very well in all his development milestones except speech. He’s an early walker, started to pull up when he was 6/7 months old, and took his first step at 9 months old. He understands us well and is very responsive (responses when we call him/his name, nods when it’s a yes, and shakes his head for no). He loves to play ball and cars, well, vehicles in general. He doesn’t line his toys up as far as what I have seen. He doesn’t play consistently with one toy, switches from one to another after a while. He loves the slides and outdoors. He used to love reading/looking at books, but not much into it lately. We’d still make sure he has his bed time story every night.

    As far as speech, he started to talk when he was about 17 months old, and had gained new words and made new sounds (moo-moo, wolf-wolf, oh~oh) along the way. Besides, he knows some sign languages. He communicates well with us by saying words and using sign languages that he knows. He has no problem pointing to, at least 15 parts of body when you ask where they’re/it’s. He is a fast learner (from us and TV shows) and able to follow complex instructions (go turn off the TV, get the disc out and put it back into the folder), he is now still.

    He had about 40 words at 22 months old (I have them listed). However, he didn’t have combination words, and started to lose 80% of his words by age 2. He is now, 26 months old only talking few words consistently daily, and replaces many words with “ba”/”pa”. Whenever we ask him what it’s, he refuses to say it or would reply “ba”/”pa”, though he knew what it’s. For example, he just waves and doesn’t say bye-bye anymore, points to a cat/truck/baby and says “ba” or “pa” etc.

    As parents, my husband and I start to get worried, we’ll for sure put him in EI once we have moved to another county in a month. Also, we plan enroll him to a daycare for socialization skill development and hopefully it helps in his speech. We hope peer pressure helps at the least.

    Apparently he is delaying in speech and losing his words. Is he under the category of Apraxia? My big concern is, if we put him under EI, will he be able to talk like a normal kid at the same age after some time?

    Thank you Laura!

  25. Diane Parker,MA-SLP says

    Hello, Jenny,
    I know the terms significant and low are scary to see as a mom, but at such a young age, there is a lot of room for growth. I have worked with many children who were significantly delayed when we started and by the time they turned 3, their speech and language were within normal limits or very close to it. Please give your therapist and your son time to work. Be sure you follow through at home with what the therapist suggests. And if you can be a part of the therapy so that you are practicing facilitating his language, his progress will be faster. Try to look forward to and take joy in all the little steps he will be making.
    Diane

  26. Laura says

    Jenny – I totally agree with Diane’s advice above. Many children who are struggling at 20 months look markedly better by 3!

    BUT you are the one in position to judge how things are going for him in therapy since you are there and I am not! If you feel there’s not a good connection, it’s certainly within your judgment to move on to a better fit. I have seen many parents wait and wait, and then when they finally make change, they regret that they didn’t follow through with their gut instinct to move on sooner. You’re in a good position to judge this since you can compare how he’s doing with his other therapists too.

    However, that 21-24 month period is a particularly challenging time for many toddlers from an emotional and behavioral standpoint. It could be that he needs extra time to connect with her and giving them both some time to get to know each other would be all it takes to get things moving in the right direction.

    As far as what else you can do, you’ve come to the right place! The website is FULL of recommendations. Read back to the older articles since those are where most of the specific “How To” information is located. You may also want to check out my DVDs to SEE the kinds of things you can do at home in play-based activities to facilitate both receptive and expressive language.

    Good luck to you all! Laura

  27. Laura says

    Karen – Thanks for your great questions! I would be concerned about your little boy too. Losing words is not a part of typical development, and it’s always a red flag. It could be due to a variety of factors, so without seeing him, it would be hard to pinpoint what’s going on with him.
    Sometimes we do see losing words as a part of the developmental history in children with apraxia. Losing words is also noted in children who go on to be diagnosed with autism, but based on what you’ve said, he’s not displaying the other red flags associated with a social communication issue. Sometimes undetected severe ear fluid from recurrent or chronic infections are the reason a child seems to lose words. Again, without seeing him, I certainly can’t say what’s causing this.

    I’m so glad you’re going to pursue EI services for him after the move. That’s exactly what I would recommend. Although none of us have a crystal ball, many children who receive EI services are functioning within normal limits by preschool or school age, but of course, every kid is a little different. You’re certainly not doing anything wrong by getting him services, and chances are, he’ll be markedly better than if you had done nothing at all.

    Have you taken a look at my DVDs? You can SEE how to work with him at home in play-based activities to facilitate his language. I always recommend that moms begin with Teach Me To Talk since it outlines the basic strategies. If he needs more specific techniques to learn to imitate, take a look at Teach Me To Talk with Apraxia and Phonological Disorders.

    Thanks again for your question! Good luck to you all – especially with that move coming up! Laura

  28. Charity says

    Hello Laura,

    I have a 27 month old son, and a serious problem.

    He has been fairly on target with all of his developmental milestones except for talking. He only says “ma ma ma …” Or “Da da da …” without any sort of real attatchments to either my husband or I for those sounds. He will every once in awhile call the dog “Dogda” and will babble in conversational cadence all of the time.

    I want to get him evaluated, however my husband is certain that my son is “Lazy and stubborn” and that this is why he is not talking, not that he can’t…but that he won’t.

    As evidence he brings up the fact that my son was very messed up with breast feeding (he would not nurse, when we brought him home from the hospital he would go 7 hours between feedings had I allowed it. Never cried for food ever in his life. He absolutely would not nurse, and I eventually had to create a formula “funnel” so it could just slide down his throat and he would not have to suck. We have finally moved beyond this and he is eating and drinking, even using a straw, the problem is my husband took it as proof that my son is just lazy and stubborn and he just won’t hear anything else.) This attitude has made it almost impossible for me to seek help, as doing so may create a rift between my husband and I.

    So to circle back around to my problem. How do I try to get help for my son?

  29. Laura says

    Charity – As you already know, your little boy really, really needs an evaluation for his language delay. Period. End of discussion. To confirm what you already know, and I’m going to be really blunt here, your husband is dead wrong about this issue.

    I wish that I could help you convince him otherwise based on knowledge of typical vs. atypical development. To characterize a very real, measurable, true developmental language issue as you’ve described (that very likely could improve with treatment) as a personality trait is a mistake that many parents have made and then later regretted. Toddlers don’t “choose” not talk. Anyone who believes that doesn’t understand human development and isn’t speaking from an educated position. The only diagnosis that relates to a child choosing not to talk is “selective mutism” and that doesn’t apply here since a child must exhibit normal language skills in one setting but then refuse to talk at other times. This is not what’s going on with your little boy since he’s not meeting his language milestones based on what you’ve described.

    Some dads and moms feel that seeking professional help is admission that something is inherently wrong with them, or their parenting, or whatever has predisposed them to being negative about wanting outside help… but it doesn’t mean that at all. Getting a child the help he needs to blossom and reach his true potential is the best gift any of us can give our children. All of us want the best for our kid, and I’m sure your husband does too. He must be very scared for some reason, and I hope you can identify and address that issue with him.

    To use the breast feeding issue as a case for “lazy and stubborn” is also very off the mark and doesn’t make much sense at all when you’re analyzing feeding from a physical and cognitive perspective. As a newborn, sucking is reflexive. Your sweet little baby wasn’t capable of “choosing” not to eat. No infant is capable of making that decision. What did the doctor say about those feeding issues then? Surely the physician recognized this as a developmental issue – not a personality difference! I hope you’ve mentioned this history of feeding difficulty to his current doctor. If not, you’ll need to talk about this as soon as possible. Feeding issues can be linked to whatever problem is causing the language delay and is very important information to pass along.

    Is there someone else you can enlist to help talk your husband through this issue? Maybe his parents or siblings, or your parents if they have a good relationship? Do you have a support system Charity? What do your trusted friends recommend you do? Is pursuing the assessment without his consent a real option for you? Will he soften his position if you share your heartfelt concern again stating that you’d rather be safe than sorry or explain that you don’t want to feel guilty later on if there’s a problem when he enters school and they ask why didn’t you get help earlier. What would happen if you state your position again clearly and calmly, and explain that you’re moving foward with the appointment anyway? Would he come around eventually or would this be a deal breaker for your relationship? Many moms (and dads!) have been in similar positions, and it’s very difficult to decide how best to proceed. I hope that you can come to some sort of decision that you can live with both now and later.

    In the meantime, keep reading the website for ideas for how to work with him to help him begin to imitate words. You may also want to check out my DVD Teach Me To Talk since this will demonstrate how you can work with your son at home using play-based activities. While the DVD can NEVER substitute for in-person professional assessment for a child with a delay or disorder, it will at least save you the guilt of doing nothing, and it will give you good information to help you move forward as you try to help your baby boy on your own. Good luck to you!! Laura

  30. Rachel says

    Hi Laura,

    My son is 26 months old and has no words. We have just begun therapy through our states early intervention program. On Monday we had our second session and the therapist told me my son was not talking by choice. She says I have babied him due to other medical problems and he now sees no need to talk. She believe I have made things too easy for him. He points to what he needs and I get them, like his cup.

    When my son tries to make words, strangled noises come from the back of his throat. He responds to some sounds but not many. We are waiting on a ABR hearing test to see if he has some hearing loss. The therapist says if it is hearing loss we will take what she calls a “gentler” approach, if his hearing is fine, we will need to be work “rigid” with his lessons.

    All of my mother’s intuition says she is way off and my warning bells are going off. My son cries through the sessions. I hold him, and she asks me to set him on the floor and let him “work through” his anger. This is not the way we parent. The only time my son has acted this way is during doctor visits and medical procedures, never at home. I believe he is scared and needs comfort. I do not want to get in the way of his therapy. He needs help but is this the way!?

  31. abbey says

    this site has been so helpful to me i have had concerns about my son who is 23 months old and yet has no words at all he rarley even makes an effort to talk although he can make some sounds mostly the da sound and the voul sounds. I am having a lot of difficulty having him accessed as im being told not to worry it will probley sort itself out, i am not at all happy to take the approach of hoping for the best or just waiting to see. I am now definetly going to take him to someone. it is a scary time and i hope to god this all turns out okay it is great to have this site to use a reference point.
    abbey

  32. says

    Dear Laura,

    Our son is 2yrs old next month. He can say 8words of which 1 is ‘Nana’ which he uses to refer to his dummy & banana. He mostly understands instructions. We’ve had his hearing tested and it fine. He still seems to have fluid on the one ear – but we are with an ENT that’s watching him. But he can hear.

    My husband is convinced that i’m looking for something that’s wrong with my son. But based on all the literature I’ve read it all points me in the direction of needing to see a SPL therapist.

    He only said hello for the first time this week. He screams/yells at a high pitched voice most of the day. He only started making the ‘ka’ sound at around 18/19months. He has started pulling me off my chair to take me to the kitchen to the side where the kettle and sweets are, he gets the milk out the fridge by himself.

    My question though is – how do I get my husband to accept that I need to have my son evaluated? His paediatrician has said that we should start with therapy at 2 (which is next month). And because my son can understand instructions my husband feels nothing is wrong. Yet he doesn’t have say 10 words yet. Any tips?

    Thanks
    Tamryn

  33. Laura says

    Hi Tamryn – First of all, ANY toddler who does not have a 50 word expressive vocabulary by 24 months DOES have an expressive language delay. This is NOT a point of contention. It’s a developmental norm… and actually it’s the low end of normal, not an average. The truth is that the “average” number of words a child is using at 2 is 200-300 words. That gap may help convince your husband.

    This is a very difficult issue for many parents. I always try to help reluctant parents understand that therapy is often the very best way to provide help early enough to make a real difference in a child’s trajectory for progress and development. ALL of the literature says that birth to 3 is a critical period for development when the window of changing a child’s brain is relatively easier to accomplish than if treatment is delayed until a child is school-age. (Search the term “neuroplasticity” if this is a new concept for you.)

    On the more practical side, if the pediatrician, who sees a wide variety of children, referred you for treatment, then it is warranted. If an SLP has qualified him or recommended treatment, then it is warranted. Most pediatricians and professionals err on the side of conservative referral since there are typically more children to treat than slots open for services. Noticing that you’re using some vocabulary specific to the UK, I can almost guarantee that an SLT is NOT going to see him unless there’s a significant delay since most parents who write to the website confirm that therapy services are often very difficult to obtain.

    Hopefully these things will change his mind. If not, you may have to agree to disagree and pursue services in spite of your difference of opinion. Good luck to you all! Laura

  34. Andrea says

    Hi Laura! Please help. My daughter just turned 14 months old. She has about 7-8 words OR word approximations (behr for bird, bah for ball, for example) but I am concerned she might be showing early signs of apraxia. Even beyond that, I’m not sure what’s normal or not. Some concerns/ questions:
    -She does not seem to use any sounds other than y, m, n and b, except in babble (have heard her babble d, t, g, for example, although t is limited). She has used k and h sounds but generally in isolation, or just practicing. Is this a limited consonant number for her age?
    -Most of her words, except baba (what we call bottle), mama and nana (for her nanny), are only one syllable, and she seems to delete the second syllable off everything. For example, “all done” is just “aaauu”, and “apple” is often “app.” Normal at her age, or more concerning? This doesn’t necessarily apply to consonants though, for instance she says ‘up’ and ‘yup’ without trouble.
    -She seems to have trouble with a couple of her vowels. Words ending in “eee” or “ooo” sounds pose problems. So, for example, a cow says “mmmmaauu” and a horse says “nya”, rather than neigh. We have heard “oh” and “eee” sounds in practice or babble but not as meaningful parts of words yet. Concerning?
    -She was a quiet baby and didn’t babble much till just before 10 months old. Even now, she doesn’t babble that much every single day… some days she is pretty quiet or will just have shorter babble strings.
    Other than that, her receptive language seems pretty good. She looks for her daddy or dogs when asked, can point to 7 or 8 different body parts, follows commands like ‘Follow mama,’ ‘Come here,’ or ‘Don’t touch’. She also does things like ‘kiss the dolly’, ‘wave bye bye’ etc, most of the time (when she’s in the mood). Sometimes she does quite well with asking her to get you objects, other times she seems to get distracted and wander away. I wonder if that’s normal too.
    Thanks in advance for any insights! I have Teach Me to Talk but am wondering if the Apraxia version would be more appropriate for her? Can you advise?

  35. jaya says

    Hi Laura,
    My son is 28 months old.HE started making sounds at b2 yrs old and now he says car ,train,bus,aeroplane(aeplane),all a to z alphabets,1 to 20 numbers (not clearly).he says a for apple,b for ball untill z ,he can recognize all a to z ,but he dosent say mama,dada,he doesent ask his needs,he uses his gestures.he can understand single words like come,sit stand,sleeping, eating,etc.but doesnt communicate with us.he can say the animal sounds,does acyions like clapping ,praising everyone like good job,or well done.i dont where he is really in speech.do i need to worry becouse he is still not calling us mama ,dada?one more thing is he is recently doing some things that worry me.he goes back and forth over lines that divide the fence or bricks,anything which is in a row.he cannot stop it untill i interfere.this is really worrying me a lot.Can u tell me what to do with him?

  36. SURYAKALA says

    Hi Laura,

    My son is 2 years old. He is not speaking even a single word, just some sounds like dd,nisa, tt etc. he is not telling bye. he is not responding to his name sometimes. he is giving more concentration to TV and his toys. I’m so disturbed due to this. kindly help

  37. Sabrina says

    I just finished listening to your podcast #134… and I am actually crying. My little man has received so many “compliments” about how well he plays in the play yard or in his crib. Once he has a toy he likes, he could care less where anyone else is. He is the little one who runs up to adults for a “hug”, where he burrows into their legs, but arches his back to get away if the adult picks him up. He turns into a TV zombie if the television is on, literally not moving, not even swallowing (drool all over his shirt and chin…) He smiles and laughs all the time, but he does stare at what he is doing and not at people. Just this week (at 21 months) he finally realized that other people are actually worth at least attempting to communicate with, and I attribute that change to the things I’ve learned from your website. And that “dazed” look that you described- we have always attributed it to him being tired because he doesn’t sleep well. Even though I have two older kids, I just thought Nicholas was more of an introvert. If I hadn’t found your website and podcasts, I am not sure when he would have started trying to communicate. Thank you so much, I’m going to share this podcast with family members who think it’s just his personality and hope that I can get them “on the ball” with me with what I’m trying to do to teach him language. They think he’ll just “get it” when he wants to, but I’ve always worried that he wouldn’t. I am so very, very grateful that I have found your resources with information on how I can help him. I have also scheduled an evaluation for ST and OT for some of his crazy sensory symptoms. I honestly can’t thank you enough.
    But about joint attention, the desire to repeat the activity with only using you as a means to an end- I never realized he was doing that, but he totally is! And the mindless narration explains why he hasn’t been “getting” language. I”m going to keep trying to get him to acknowledge me. I’m sure you have heard this before, but I am longing for the day he calls me “Mommy”- or any approximation that he attempts! I have long wondered why he can echo ANYTHING without understanding who I am… and maybe I won’t have an answer for that, but at least now I have maybe a few ideas for helping him. Even if it means a number of his epic tantrums. Because it’s worth it! Thank you for the podcast to remind me that it’s worth it.
    Thank you, thank you, thank you.
    I guess my one and only question is this- do you have any specific advice for helping him learn that I am “Mommy”? Or that Dad is “Daddy” and his sister is “Sissy” or his brother is “Bubby”? How do you teach him that these words mean these people?
    Sabrina

  38. AJ says

    Hi Laura,

    I have a four year old son who has some mild sensory issues. He talks fine at home but his teacher said he’s not talking at an age-appropriate level at school. He doesn’t have conversations with the teachers or even ask questions. I’m very surprised since he does both of those things quite well at home. The teacher said it could be his sensory issues make him feel overwhelmed in the environment and that’s why he’s not talking much.
    We are waiting on a speech eval but do you have any suggestions to help him in the meantime? Thanks!

  39. Marissa says

    Hello,

    Thank you for this forum…!

    I am a mother of 5 that took custody of my niece back in August. (Her parents were incarcerated.) In the 4 months she has been with us she has grown by leaps and bounds. She seems to have gotten on track developmentally and I am happy with her abilities as a 20 month old. (I am a little rusty with toddlers since my youngest is in 1st gr) She has about 30 words and one of the words we taught her is “Please”

    Now that we know she knows the word we are trying to model for her the context of the word, so that if she wants something we ask her to say “Please” For example a cookie, or a sip of my drink with a straw. She refuses. Since these were wants, not needs, we thought perhaps she isnt motivated enough to say it appropriately.

    So one day at breakfast she refused to say please for anything at all I offered her. Bananas, yogurt, juice, milk—it seemed as if this was a power struggle and she did want us to win. We asked her to say please phrasing it differently, and with different children modeling it, taking breaks inbetween. But the result was she would not say it and did not eat breakfast. Lunch came. Still no please. Ok, now no lunch. By dinner I had to give it up because I cant starve the kid, but I am having a hard time wrapping my mind around what is going on here.

    I suspect that she is just being stubborn, but maybe she is incapable of saying please on demand? If she is incapable of it we are way out of line and should just let it go. If she is being stubborn, I want to nip it in the bud because I know this is just the first of many many tests she will give us as she tries to push boundaries. What are your thoughts? How should I proceed?

    THANK YOU in advance,
    Marissa

  40. Laura says

    Hi Marissa. I’ve already responded to you with a longer version of this reply, but I’d like to make sure that other readers get a general sense of my recommendations. It is entirely possible that she CAN’T imitate on request, so I’d lay off these kinds of requirements, and I certainly wouldn’t withhold food since you could potentially set up negativity with eating, and you certainly don’t want that! I’d teach her simple sign language to use in this situation so then you can help her (aka -make her) respond. However, I’d not place this much pressure on her with language. Because of her rough start and slower learning pace, my first priority for her would be to establish a loving and consistent connection with you, teaching her that she CAN depend on adults to love her and take care of her. That would trump everything for me, even learning to talk. Good luck to you all – and thanks so much for a great question. I have dealt with this with many families. It’s a hard balance to acheive, especially when deciding how “fair” things are as far as discipline and behavior as compared to your own children, but they likely did not have the same developmental or environmental challenges as this little girl, but she’s so lucky to have someone who would step in to take her when her parents couldn’t. I admire you! Laura

  41. Jenny T says

    Hello Laura –
    I wrote last summer about my preemie son starting Speech. He is now 25 months and his ST has him coded as expressive language disorder for billing purposes. What is the difference between disorder and delay? He is just starting to say car again after having not said it in months. Could it be words aren’t really lost, but still ‘emerging’? Also, is conversational/jargon talk better than nothing? He sometimes talks to me like I understand him, and I just nod along.
    I just purchased your Teach Me To Talk video recently, so I need to catch up on that. Thanks!

  42. Laura says

    Hi Jenny – great question! Delay means that skills are coming in sequentially as expected, but they’re emerging slower than you’d like. Disorder is more serious because it means his development is atypical -either he’s demonstrating an uneven pattern of development – perhaps demonstrating some splinter skills such as achieving higher level skills but missing some lower level skills. OR it could be that your insurance policy won’t pay for a delay, but will pay for a disorder. Ask her directly and see what her rationale is. Laura

  43. Bri says

    Hi, I just wanted to ask you a few questions. Your website is amazing. I am an SLP and I am fighting this “he is just stubborn/you think he is delayed because of what you do” with everyone! I work with adults all day and have had minimal experience with children outside of grad school and no experience prior to becoming an SLP so I feel as conflicted as so many other mom’s who have posted!I watch other children who are younger than him that are talking in sentences and my stomach ties in knots (although people say, don’t compare!) I have been worried about my son since he was 1 month(sad I know)because he didn’t gaze at me while nursing (eye contact emerged around 3 months) and didn’t like to look in mirrors. Late on babbling (around 7 months) and no words until 15 months. I taught him a few signs which he picked up quickly. Had his first slp eval at 15 months. She said no red flags, lets wait. His speech has progressed minimally and he uses approximately 30 words spontaneously and more with lots of mommy encouragement. I recently had him evaluated again about 3 weeks ago (he turned 2 on the 10th of December) and he somehow scored over a hundred on PLS-5 and did not qualify. I have read over and over where you have written 50 words is the bare minimum that he should be doing and he is definitely not putting two words together. He has difficulty imitating me. He jibber jabbers as though he is telling me everything he wants to say but it makes no sense. The 30 words he uses are mostly intelligible. I can’t figure out why he can say elephant (elephan), quiet, hush and outside (ouide)but can’t even approximate pig or dog which comes out(gon). Also, I think he may be hyposensitive (he gags on his food all the time, has an open mouth posture and still drools some (although, he is still teething). I feel as though I am constantly doing therapy with him but making minimal progress(maybe that will change after I get your video). He is so visual and imitates actions and picks up things that I didn’t know he was even watching (he picked up a stick off the ground and put it in his mouth like a toothpick because he saw his uncle with a toothpick and tried to use my eyelash curler on his eye. His errors are inconsistent and the word banana might come out sounding 4 different ways. Some days I am certain he is apraxic, however, he kisses on command and blows out candles with no problem, blows bubbles. How much home therapy do you recommend a day? Do you have any suggestions on how I can differentially diagnose apraxia versus delay or I guess technically a disorder with him? Thanks for all the suggestions for getting your child to say mommy. It is so heartbreaking to have 5 children run up to you to say mommy at daycare except your own especially if you are an SLP!Thanks for all of your help and your willingness to share your expertise and time with so many.

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