Guidelines for Referral for a Speech-Language Assessment for Toddlers

I recently found a great article written by Marilyn Agin, M.D., and author of The Late Talker. It was written for a pediatrics journal, but it also has great information for parents who might be on the fence wondering if their child will catch up on his own, or if they should go ahead and be referred for a speech-language evaluation.

I love the beginning quote so much that I’d like to share it here:

“Not all children with delayed speech are “little Einsteins” or garden variety “late bloomers.” Some have a speech-language disorder that will persist unless warning signs are recognized and intervention comes early.”

She also includes a set of risk factors for pediatricians (and parents) to look for which might also inhibit language development:

  • Family history, such as a strong heritability factor. There’s a higher risk of continued delay if one of a toddler’s parents or siblings had long-term language and learning difficulties.
  • Otitis media with effusion causing a fluctuating hearing loss during the period of speech development. (This means frequent ear infections. If your child has had several, and?especially if he’s had to have tubes during infancy or toddlerhood, this could be a major contributing factor to his speech-language delay.)
  • Low socioeconomic status and educational level. These families are more likely to have a child with a poor outcome.
  • Parental characteristics that may inhibit speech, including the way parents interact with the child. Parents need to follow a child’s lead and provide a language model using simplified speech. Use of “parentese,” the way that many parents instinctively talk to infants in a high-pitched, sing-song voice, actually fosters language development by attracting the infant’s attention and resembling the pitch of the sounds he makes.
  • Missed language explosion. Most children experience a vocabulary spurt around the age of 18 months, but late talkers don’t. Some late talkers have an “explosion” of speech later between 24 and 30 months. If a child has not had a vocabulary spurt by 30 months, he is at considerable risk of continued language delay.

She also includes information I’ve cited in other places on the site with the signs that a child should get an early speech-language assessment including:

One major review in the speech pathology literature paints a profile of toddlers 18 to 24 months old who are at risk of persistence of language impairment at 36 to 48 months and who should receive early intervention.6 The greater the number of warning signs a child exhibits (especially the closer he gets to 3 years of age), the greater the need for early assessment. Those signs include6:


  • little sound play or babbling as an infant, with limited number of consonant sounds and, possibly, vowel distortions as a toddler
  • poor verbal imitation skills; reliance on direct model and prompting
  • immature play skills; little pretend play
  • interactions with adults more than peers
  • few communicative gestures (the late bloomer who caught up with his peers within a year used significantly more gestures than the child who had persistent delay)
  • impaired social skills or behavior problems
  • small vocabulary for age; less diverse verb repertoires
  • comprehension delay of six months or greater relative to chronologic age

This might also be a great resource for your pediatrician, especially if he or she is of the “wait and see” variety. Printing this article and taking it with you to an appointment might be a great?way to start (or re-start) a conversation about your concern with your child’s language skills.

You can read the full article at this link.



  1. niyati on July 1, 2008 at 12:58 am

    Hi! Laura

    Wanted your feed back on my 33 month old son who has a speech delay. He still uses a lot of words but is not able to join words to form sentences. He only responds to questions once in a while (not always). For Eg. If I ask him do you want food? He would reply with 1 word:’No’. ( He learnt to say ‘no’ when he was about 22 months old). But the response will not come everytime even for the same question. I heard him say’Yeah’ a couple of times recently. He is also of late repeatying a lot of words we say. ( I said’Its raining today” and he would say “today”). He has a vocab of over 50 words for sure.

    I have an 8 month old daughter after him and he is quite friendly with her. I have seen him go and hug her a few times, look her in the eyes and smile and keeps calling her’baby’. However, he is not very comfortable with his peer group. ( He was an only child and was under the care of a nanny till he was 2 years old without much interaction with other kids as we were both working). Whenver I take him to the park, I initiate play with his peer group which he seems to enjoy but needs an asurance that I am around ( come and hugs me in the middle of the play). Also, without my initiation does not show much interest in the other kids even if they come to play with him. Is more comfortable with’parralel play’ even now. He is otherwise a very active child , very close to all the people in the family incl his grand parents. Can ask for his needs ( he wants water, will say’water’ and go and take the glass from the dining table and drink himself, wants TV will hit on the TV screen and call for me, wants to be held, will say’Hold’ and raise both his hands and stuff like that), will show with gestures when I sing’Twinkle Twinkle Little Star’ or ‘Clap your hands’). Otherwise loves to go out ( I take him shopping with me / friends places etc)

    He is of late started repeating words . Wanted your advise on how to help him improve his speech and improve intearction with his peers

    Thanks a lot for your help

  2. Laura on July 1, 2008 at 7:18 pm

    Niyati – You don’t say if he’s in speech therapy or not. I would start with this if you’re not doing this already. Based on what you’ve said, he is not meeting the language milestones for his chronological age. Although it sounds like he is improving, I think his delay is great enough to warrant an assessment by a speech-language pathologist.

    As far as ideas to improve his speech-language at home, you’ve come to the right place! Read the expressive language and receptive language articles for more specfic info. Not answering questions is really a receptive language too. I’d also read the article on Making The Leap from Words to Phrases since his vocabulary sounds large enough for him to begin to imitate simple phrases.

    You’re doing the right thing by including him in social outings and being his “bridge” with other children by helping him initiate. He may continue to parallel play until his language improves. Most 3 year olds are pretty conversational, and since this is hard for him, he may have a hard time wanting to “stick it out” with a peer. Things that usually bring kids into early social games involve gross motor actions – everyone runs or jumps or crawls or building then knocking over blocks, etc… Start this kind of game with him and other kids then bow out, but stay near to reassure him that you’re there. You could also use bubbles with everyone popping bubbles you blow then give the wand to someone else to try. Him needing you there is not unusual.

    It sounds like overall he’s functioning, even socially, more near his language age-equivalency (my guess would be near the 18-21 month level based on what you’ve said) more so than his chronological age of 33 months. This is important to remember as you set expectations for him.

    I wish you all the best as you work to help him! Let me know if you need additional information! Laura

  3. niyati on July 2, 2008 at 1:31 am

    Thanks Laura! That was very helpful. I have put him on Speech therapy. Will also try the other techniques in your site for improvement of receptive & expressive language.

    Thanks again!

  4. Ashi on July 5, 2008 at 11:55 pm

    Hi Laura!,

    I need your help for my 5 yrs old son, who has recently diagonosed as having mild autism. I am really worried, especially about his speech. He got bilingual environment, but the primary language was hindi, has exposure to english in his kindy. First I thought he is confused between 2 languages and as he was dominating hindi i continued with that but then he had started having problems in kindy. I consulted some coordinator at kindy she said ok if he is picking up hindi then you go ahead with that. Now as because of othe issues he has found out to have mild autism, I am more worried about language development. He has problem both in receptive and expressive languages. but he prefer to talk in hindi, understands it better than english. But paediatric told me to now only talk to him in English, my problem is that he is going much better in hindi now, has echolalia problem also. But at the same time tried to talk spontaneously in hindi, not in English. understands hindi better than English.
    Now you pls advise me what technique I should use as I fear If i concentrate or start in English he might go back to zero in both or so. I am very very stressed and worried, pls help me.

  5. Laura on July 6, 2008 at 1:01 am

    Ashi – First of all, he really needs to be seeing a speech-language pathologist to help you tease out all of his issues. You didn’t mention if he’s done this yet.

    You also didn’t say what the primary language for his school is and for what his peers use. I would think you’d want to focus primarily on that language since he’ll need this for academics and to communicate with his friends. I hope that it’s Hindi since this is what he’s understanding better than English, but if you’re in the USA, that’s not likely to be the case.

    Like most SLPs, I believe that if a child is struggling to learn language, it’s best to reduce the complexity so that he has a better chance of becoming a proficient communicator. If his best language is Hindi, I’d stick to this at home, but again, if you’re in the USA, this is going to be difficult to accomplish.

    His language problems are compounded because he’s also demonstrating charactistics of mild autism. Again, I hope that you’re seeing a speech-language pathologist so she can advise you after meeting you, hearing your concerns, and more importantly, evaluating your son. Her advice would be better than any I could give you because of the complexity of your situation. She will be able to help you determine priorities for your son, including which language he really NEEDS to be able to function at home and at school.

    I hope this helps! Laura

  6. Ashi on July 6, 2008 at 11:00 pm

    Thanks Laura,
    I am in Australia and the primary language is English here. yes i am going to slp soon, but I have already started to talk to him in English hope it helps!

  7. Ally on July 11, 2008 at 11:08 am

    Hi! Laura,

    i have a 5yrs old son, he was born with cleft lip and palate but surgery repaired when 10 mths old.. suddenly around 2.5yrs old..his hearing was progressively lossed.. ( he can hear at birth.. and picked up some languange at those time )..

    since then.. he had language he couldn’t hear.. he’s fitted with hearing aids now.. at the beginning when we took him to see ENT .. the doctor said he’s fine… (he’s an active boy so, the doc assumed he’s having ADDH.. and not focus on what we’re saying ).. , not only 1 doc.. we’re seeing 4 docs..

    and some people said boys are late talkers.. that’s why it’s really late till we really stand on our point to let him to do another hearing test..

    he had seen SLP for 1.5 year.. but it’s not helping..
    we’re in Malaysia.. and here at least people must learn 3 languanges: chinese,english, and b.malaysia..

    he’s raised using chinese.. but i teach him english as well..I’D read ur article which said we should minimise to 1 languange.. now i’m homeschooling him as even kiddy didn’t want to accept him..

    after 3 mths from homeschooled, he’s improving.. in reading (he loves to read..but pronounciation isn’t cleared yet)..the matter is.. he still couldn’t do phonics.. so, he used his memory to remember the words i taught him.. and he’s really struggling..
    he also didn’t understand question.. whatever we ask..he’ll repeat it back.. hope u have a good advice to teach my son..

    thanks a lot…
    PS: u really have a great website..keep it up !!

  8. Laura on July 11, 2008 at 4:36 pm

    Ally – I am a firm believer in using one primary language if a kid is struggling to learn to talk. What does your SLP say about this? She may have different advice since most people in your country are multilingual, but again, if he is struggling, I still believe you should minimize the complexity for him. I would recommend that you read all of the articles in the receptive language category since he seems to be struggling with understanding language too. Good luck to you! Laura

  9. Ally on July 14, 2008 at 11:18 am

    thanks a lot Laura for ur advice..,
    i’m thinking of that too..but he used to understand more of Chinese sentences (instructions,explanation).. English in words..(numbers, color, shape)..

    however he’ll enter primary school in the next 1.5yr.. and bahasa malaysia is compulsory subject in school here (plus chinese and english as well).. no matter in normal or special school(either bahasa in government school or eng in private).. and he totally didn’t get into it..

    it’s really hard to choose what language to he understand better in chinese.. (but other people didn’t understand what he’s talking except his near family).. then he can do maths well in English (he knows number in Eng)…

    i still use visual in most of my i find out he gets understand better.. but then will it minimise his hearing capability if he didn’t want to focus on his hearing but visual clue?

    i’d thought to let him learn cued speech for a few words which he can hear well..but my SLP against it..

    again..thanks a lot…

  10. Janet on July 15, 2008 at 9:34 am

    Hi Laura,
    I have an 18 month old that I am concerned about. She has only 2 spontaneous words (ma for “more” and “uh oh”),frequently uses “ba”, “da”, and “ga” when she attempts to communicate, often leaves endings off of words, at times, there are no audible sounds when tring to imitate words with initial consonants /p/ and /b/. She will imitate words; some words are close approximations while others are not. She imitated “bye-bye” perfect not to long ago; however, has not said it since. She had tubes placed 3 months ago with no significant changes in expressive language. I had Early Intervention come out to the house a few weeks ago, however, she scored quite well with no delays noted and therefore, did not qualify for services. I am still concerned, however, I feel that she is still so young and I might be too aggressive. I will add that I was a late talker too. I would appreciate any advice that you have.

  11. Jason on July 15, 2008 at 12:50 pm

    Janet you should buy the DVD it’s AWESOME!

  12. Laura on July 15, 2008 at 4:06 pm

    Janet – I’d recommend that you read the articles in the expressive language section. It’s not too early to be “aggressive” with language – just make sure you’re doing it in a playful way.

    If you try the advice in the articles and don’t see much change, or you’re not sure exactly how to carry out the techniques, then I’d agree with Jason’s advice to buy the DVD because then you can see the techniques in action. Sometimes it’s not WHAT you’re doing, it’s HOW you’re doing it, and the DVD will show you exactly HOW to do it to make your efforts more successful.

    Whichever way you choose – good luck! I applaud your efforts for being so concerned about her now and not adapting the usual “wait and see” approach! She’s lucky to have such a go-getter Mommy! Laura

  13. Laura on July 15, 2008 at 11:49 pm

    Let us know how you like it and especially how the ideas are working for you at home or in your sessions with clients. You can send us an e-mail at or post a comment here on the site. We love to hear from you! Laura

  14. Jewels on July 22, 2008 at 12:14 am

    Our son will be 9 months in 2 days and is not babbling. We’ve heard a couple “ma-ma-ma”s, “na-na-na”s, “gla”s, and “bla”s but they are very few and far between. He smiles and laughs a lot and responds to us socially. He passed his newborn hearing screening but has another hearing test scheduled for next week, at our request. In addition, we have made a referral for early intervention assessment and are wondering if you can give us information on what to expect from the evaluation. In the event he does qualify for speech services, how are services delivered for an infant this age?
    Thanks in advance for your help.

  15. moonz on July 22, 2008 at 2:20 am

    Hi Laura,

    I have recently read ur post,which I really find beneficial for my 2.8 year old daughter who is speech delayed.Now after following ur advice given in ur post,it had really helped her to start speaking one syllwrds. She still has problem with “t”,”d”&”l” sounds.She only speaks words with “sh”&”ch” sounds,that too are one syllable.But there has been remarkable improvement in her,going from crying for every thing to be able to point or say monosyllabacally for what she wants.I am patiently waiting for her to say complete words and sentences.

    I am hoping to learn more from ur site.

  16. Laura on July 22, 2008 at 6:50 am

    Jewels – The early intervention assessment usually consists of an overall developmental evaluation of his skills in each of the 5 developmental domains including motor, social, cognitive, adaptive (self-help skills) and communication skills. It’s completed using a standardized tool so that his skills can be measured against other babies his age. With an infant this age, examiners most often rely on parental report, so be sure you are answering objectively since they will likely not be able to “see” him do every one of the skills they need to evaluate. Your evaluator will likely be a speech-language pathologist, a early developmental specialist, an occupational therapist, or a physical therapist. He or she will ask you LOTS of questions about his history and your concerns, so be very specific. He or she SHOULD also play and interact directly with your child, and be leery if the person doesn’t do this.

    I will tell you that I think it’s very difficult for a baby this age to qualify for services. For a child to get speech this young, there is usually an established risk diagnosis such as Down Syndrome, cerebral palsy, hearing loss, or another known condition which is likely to result in a communication delay. I also don’t think many SLPs in private practice would want to see him yet, especially since he is social and his hearing is okay.

    However, I am so happy that you are concerned even at his young age. There are things you can do at home to help him learn to communicate. Check out the other articles on this site, and you may want to consider the DVD. It’s loaded with ways to facilitate early language and first words at home! Thanks – Laura

  17. Laura on July 22, 2008 at 8:55 am

    Moonz – I’m so glad you’re enjoying our site! Good luck to you and your daughter! There is a link to an article with ways to work on /t/ and /d/ at home. It’s okay that she doesn’t use a correct /l/ sound yet since that’s a later developing consonant sound. Many children don’t master this sound until closer to age 4 1/2 to 5. The thing all of these sounds have in common is the ability to elevate your tongue. You can help her practice this skill by having her imitate a clicking sound or “feel her bumps” on the roof of her mouth behind her teeth with her tongue. There are other great ideas in the article I mentioned. Look for it on our home page. Thanks! Laura

  18. Jewels on July 22, 2008 at 10:01 am

    Thanks for your response. We’ve received so many mixed messages on whether we should be concerned or not at this time (since he is still quite young). We decided to make a referral based on the information we’ve received that suggested not babbling by 9 months could indicate a problem. Our pediatrician suggested we wait to refer until closer to 18 months. What are your thoughts on this?

  19. Kathy on July 22, 2008 at 11:24 am

    Hi Laura,

    This website has been extremely helpful to our family. Thank you for all of your wonderful advice and insight. Our daughter is 2.4 years old and speech delayed. She has been evaluated by both EI services and a SLP and it was determined that her expressive language is severely delayed (4th%)and her language comprehension is age appropriate. Her strengths are her social skills and cognitive abilites. My concern is that a cause has not been determined and I feel uneasy with this. She does not exhibit any autistic traits but I am not sure if there are other syndromes I should be aware of. The SLP said she would be concerned if our daughter was also delayed in receptive language but that is not the case. Since she appears to be in good health, we are just focusing on improvement. Just some history, our daughter was born with largnomalacia (unformed cartilage in the airway) and we struggled with feedings throughout infancy and it was noted that she had mild low tone. I wonder if there is a connection with the speech delay now. She has a lot of words (100-200) but I am tallying how many of those are spontanius (up to about 25). Still no real 2 word combos but recently I thought I heard a few. I was a late talking child (approx 2.5) and how do I know if this is also a late bloomer case?

  20. Laura on July 22, 2008 at 6:09 pm

    Kathy – You may not know for a while if this is a case of late talking or something else. If things move along beautifully and she’s completely caught up by 3, it was likely just an expressive language delay. If she’s still struggling at 3, then it’s likely something else.

    I have had one other client with largnomalacia who was also language delayed. We treated her issues like a motor planning/apraxia difficulty and used signs to help her sequence words to phrases. She ended up doing very well, but that’s not to say that it worked because she was apraxic AND had largnomalacia.

    Try the ideas in the article “Making the Leap from Words to Phrases,” in the expressive language category, but she may still need to build her spontaneous vocabulary to near the 50 word milestone before she starts to imitate phrases or say these on her own. Use lots of modeling to continue to help her imitate new words, but withholding really will make the words more spontaneous. If you are not sure how to do this while still making it fun for her, check out video clip for the DVD and the article “Can’t vs. Won’t” in the expressive language section.

    If you’re still struggling, the ideas from the DVD may help you get over the hump. Sometimes seeing how to do it makes all the difference. Good luck to you all! Laura

  21. Laura on July 22, 2008 at 6:19 pm

    Jewels – In this specific case where his social skills and intent to communicate seem to be on track, I probably would wait on the assessment until he’s a little older, say 15 to 18 months. You haven’t commented about his language comprehension skills. Does he seem to be starting to understand some language such as understanding when to pull the blanket off his head for peekaboo, interested with “bye-bye,” understanding “no”? Are his gross motor skills moving along – is he sitting, rolling, and crawling? If those things are questionable, then I would definitely pursue the assessment now.

    If those areas are moving along, I would diligently work at home to be sure you’re doing all you can do to build his foundation for receptive language/comprehension, work on play skills, expand his social skills, and help him learn other ways to communicate (namely gestures & sign language) while you’re waiting on the words.

    Do NOT wait until well after 2 to pursue services. 21-24 months is my “PANIC” button, so that if he’s not hitting the milestones then, absolutely, positively do speech therapy.

    Hope this helps! Laura

  22. betty on July 23, 2008 at 10:15 am


    i have a 18 month old son. He does not point with index finger. he repeats words that we say, but not in meaningful context. he doesnt callme mama, but can say mama. he says apple, banana, teeth etc, but not when we show him these things. Just repeats what we says. Does not point to things and ask for them, just cries and grunts. he is perfectly happy playing with his toys, but does not stack blocks, just pours things out and in the container. flips books, fascinated with numbers an alphabets, does have temper tantrums, bangs head when he doesnt get his way, follows some simple commands, like go night night, he goes to sleep on hispillow, go drink water, he does it, but when I ask him to bring things to me, he doesnt. I dont know if these are indicative of autism. Please help

  23. Jewels on July 23, 2008 at 2:02 pm

    Thanks Laura for the information. Yes, our son is meeting his gross motor milestones fairly quickly and he seems to have pretty good comprehension skills. Any specific tips on what we can do to facilitate his expressive language?
    Are “late” babblers typically “late” talkers or do they often end up with some sort of speech delay? Any insight is appreciated. Thanks again for everything!

  24. Laura on July 23, 2008 at 5:43 pm

    Betty – I would definitely have him evaluated by a speech-language pathologist and/or through your state’s early intervention program since he does seem to have some red flag issues concerning language, both receptively(what he understands) and expressively (what he says.) You can find out information about your state’s early intervention program by typing in your state’s name and early intervention at or another search engine. In the meantime, keep reading artciles here for ways to help him at home. If you’re unsure of how to do these things, you can always order the DVD to see exactly what you should be doing at home to help him! Laura

  25. Laura on July 23, 2008 at 5:46 pm

    Jewels – Read the articles in the expressive language section for specific ideas to help him at home. Just because he’s a late babbler doesn’t necessarily mean he’ll be a late talker, but most late talkers were likely very quiet infants as well. You may also want to take a look at the articles in the apraxia section too. If you still aren’t making gains, you may need to get the DVD to see exactly what to do and how to do it. Laura

  26. Kathy on July 23, 2008 at 6:53 pm

    Hi Laura,

    I had a few follow up questions. Is Apraxia fairly easy to identify? Are there different levels of severity? My daughter has only had a few appointments but this condition has not been noted. Should I specifically ask to rule it out?

    Last, you mentioned late talkers tend to have been quiet infants. This was not our case at all. Our daughter babbled but it just didn’t develop from there on the same time table as her peers. Does this signify anything?

  27. Laura on July 23, 2008 at 7:30 pm

    Kathy – I just mentioned apraxia as a possibility for ANY child with a gap in their receptive/expressive skills and for ANY child who has enough vocabulary to combine words but isn’t doing that yet. Of course since I haven’t seen your daughter, I can’t speak directly about her, so I hope you don’t think I am attempting to “diagnose” her sight unseen. I’m just addressing other possibilities based on my previous experience. Just so you know – kids with apraxia usually were quiet infants, and this wasn’t the case for your daughter.

    Although apraxia can be diagnosied earlier, many SLPs are not comfortable diagnosing apraxia until after age 3. If she hasn’t mentioned this as a possiblity for her, it could be that she displays none of these characteristics.

    If your daughter has no other issues that “fit” with another diagnosis other than an expressive language delay, this may be all it is. She does also have the mild low tone, which can affect speech intelligibility, but usually does not affect language per se, unless there have been other developmental lags such as late acquisition of gross motor skills.

    If you feel differently based on information you’re reading, please ask your SLP to directly to rule out any other specific disorder you’re concerned about. A good SLP never minds explaining what she thinks about a child and why she thinks so. Good luck as you search for answers!!!


  28. betty on July 23, 2008 at 10:39 pm

    thanks Laura. I have ordered the DVD from your site. Does not finger pointing a strong indicator of autism? I am very disappointed and sad, maybe in denial. He cries a lot to communicate his needs because of lack of speech.

  29. sheila on July 24, 2008 at 10:25 am

    My son is 22 months old and only has a total of 22 words – including word approximations. He has started doing two word combinations “bye mama” “dada open” – we are not pushing this he just does it. I am concerned b/c he does not have 35 plus words and now he is started to get confused when he say bye mama etc. and say ma mama or da dada etc. I am pretty sure he has apraxia – my 6 year old daughter had autism and severe apraxia. He is not showing any signs of autism but has this speech delay. He has said words and then we have never heard him say them again, only has 22 words, and will not imitate consonants and only one vowel ah. He is in early intervention, private speech, etc.
    How should I handle him trying to move on to two word combos. Again, we are not pushing him to so, he is just doing it himself.

  30. Ally on July 24, 2008 at 11:00 am

    hi Laura..,
    sorry to bother u again.. i need ur expertise advice.. my son who’s 5 yrs old, hearing impaired and has language delays. i’ve read all ur article, they’re wonderful and helped me a lot. but to reach his age level, it’s still far from beyond.
    i wonder can he learn sign language to add up some which he hard to express ?? but my SLP disapproved,she said, once he starts to do signing, he won’t use speech anymore. is that true?
    as i find he’s struggling to express his feeling.. but he can read.
    thanks a lot..

  31. Laura on July 24, 2008 at 6:15 pm

    Betty – I’m glad you ordered the DVD since it will give you ideas for how to work with him at home. Not pointing in and of itself is not an indicator of autism, but the things you told me about him in your earlier post certainly indicate that he has a problem learning language. I do hope you’ll take my advice and have him evaluated by your state’s early intervention program. In the meantime, keep working with him everyday at home. Don’t let your sadness prevent you from doing what you really need to do, which is help him want to interact and communicate with you. YOU CAN DO THIS! Laura

  32. Laura on July 24, 2008 at 6:22 pm

    Sheila – Well, you can’t PREVENT him from moving onto phrases, but it does sound like his intelligibility suffers when he’s sequencing longer strings of sounds, and that certainly is characteristic of children with apraxia. One thing you might try to is to concentrate on modeling lots of single words for him to imitate.

    However, sequencing difficulty is the “hallmark” of kids with apraxia, and the more practice children get, the more intelligible they generally become, so it’s not a bad thing that he’s trying to move on.

    I will tell you that there are apraxia experts (David Hammer in particular) who suggest introducing carrier phrases pretty early to give kids the extra sequencing practice, so again, it’s not a bad thing that he’s done this on his own. He’s trying to bump up to the next level, and you’ve got to applaud his effort!

    I am so glad to hear that he’s in early intervention and speech. Congratulations for being so proactive!!! You’re doing a good job -Laura

  33. Laura on July 24, 2008 at 6:30 pm

    Ally – I do not think that using signs prevents children from talking at all. The research does not confirm this either. But let me ssay that I have not met your child and don’t know all of his strengths and weaknesses, so it’s unfair of me to contradict the advice that your SLP is giving you. You’ll have to remember too that I primarily work with toddlers and younger preschool children (3-4 years old), so she may be looking at this from a school-age SLP’s position rather than my area. I am always looking for ANYTHING that will help a child learn to communicate more effectively with his family – whether this be signs, pictures, words, or a combination of all of them! She is coming from a different perspective, so please continue to discuss things with her since she knows your son.

    That being said, it wouldn’t hurt to try to introduce a few signs to him for words he’s having difficulty learning or for situations that are extremely frustrating for him when he can’t communicate his needs with words. See how it goes, and then you can be the judge if this is a good method to purue for him.

    Just so you know – I am NEVER bothered by answering questions on this site. I pop out of bed every morning and rush home from work every evening just to see what moms (and dads) have written me since the last time I checked! Keep them coming! Laura

  34. Jewels on July 24, 2008 at 9:02 pm

    Thanks Laura for all your help! I’ve browsed the articles but am having trouble finding one that is applicable to his age. Can you point me to a couple articles in which I can gain tips to facilitate my son’s expressive language?
    He isn’t too quiet of a baby…he actually vocalizes quite a bit. The consonant/vowel combos are infrequent although I heard a “na” today. 🙂 Otherwise, he’s making noises while playing with his toys.
    I’ve noticed that his eye contact isn’t the best. It seems that he is so busy checking out other things but I know it’s one of the many red flags of autism so I thought I’d bring it up. Are there some babies who are just super active and interested in exploring their environment(obviously I’m a first time mama)? He’ll look at us when he’s interested…like when we sing a song he likes or makes noises he likes but it feels like he’s looking at other things besides our face a lot of the time. Cause for concern? Like I said previously, he’s very social with us…laughs at us and with us, smiles all the time, crawls after us and enjoys being “chased” by us.
    Again, I appreciate all of your insight!

  35. Laura on July 24, 2008 at 10:24 pm

    Jewels – Here’s the link for the Social Games for Infants article –

    I would also recommend that you read the earliest receptive language articles and the What Works and What Doesn’t Work articles. I am pretty sure those are in almost every category you select, but try in the expressive section if they are not in the receptive category. You’ll want to be sure he’s beginnning to link words to objects and events, even at 9 months old.

    You might also check out the sign language articles, and as always, start with the older entries first since I have written everything chronologically which made sense at the time I began the site, but it’s making it more difficult to locate “beginner” info now. He is NOT too young for you to sign with him.

    The biggest thing I’d recommend is to keep really trying to engage him and make that important connection with eye contact. The best way to do that is like you’ve already described – sing songs, make noises, and play GAMES. It sounds like you’re on the right track.

    Some babies are so curious about their environments that they don’t look at people unless it’s for an obvious reasons, but I am always a little concerned when I see or hear this about a baby because eye contact really is a foundational skill for learning to imitate and communicate. Frankly, we learn almost everything we’ll ever learn in our whole lives thru imitation. If you’re not looking, it’s not likely you’ll get it.

    Hope you can find the articles I suggested. I can’t link them here or I’ll lose everything I’ve already typed. If you can’t find them in the archives in the expressive language or apraxia category, send me a comment, and I’ll find it again for you.

    Hope this helps! Laura

  36. Jewels on July 25, 2008 at 5:35 pm

    Hi Laura,
    Thanks for the help.. I found the social games for babies article last night and will take a look at the others.
    I’m not sure what is “normal” regarding eye contact so I may be hypersensitive to him not looking in my eyes all the time. 🙂 I’m a stay at home mom so he is my “job.” All my time is devoted to him, so I may be expecting too much too often. He often looks at us to see what we’re doing and this morning he had really good eye contact. It seems it’s more infrequent when he’s close to our faces or when there is something of high interest near him. He’s an extremely active little guy and has been for as long as I can remember so I’m hoping he is just super interested in his surroundings rather than disinterested in looking in our eyes all the time. 🙂
    I’ll bring it up to his pedi at his 9 month well-baby check-up to see if he has concerns.

  37. debbie on July 27, 2008 at 6:19 am

    I am a mother of a 25month old who does not talk. He is totally switched on every other way. I have been testing all his abilities since the dr said he had an expressive speech development problem. He is very communicative, very social and outgoing, and has a best friend and 3 older siblings. He just grunts and uses signs he has developed. He does not seem to be frustrated by it. He and I are trying to do therapy at home until he gets an SLP referal it is like swimming in the dark via the internet. All your games we already do. He is very playful and loves to read Frank Asch stories and point out everything he knows. I am working with simple repetitive animal sounds just to try to exercise his ability to make sound. We do baa baa, graa, ssss, neigh, moo he cant really get but I am saying great just for the lip movement which he tries but cant seem to push out a sound. It seems that any combined movement of the mouth musculature and pushing out sound just does not coordinate. Even though he has no soft neurological problems I think he might be apraxic. I read the cherub archive and started giving him the 3-6 omega primrose gla combination and I dont know what it has done for his speech but it has cleared up his ezcyma in a matter of days after over year and half of seeing doctors go figure. This morning I think he tried to say up but he seems to have a very hard time getting it to sound through his vocal cords. I praised his for saying up and tried to keep repeating it which he did and it still was not clear if that was what he was saying but I thought if he kept repeating it I must have gotten what he was trying to say right. Do you have any suggestions on how to get sound to come out louder. He is not a quiet or shy kid so that is not the problem.

  38. Laura on July 27, 2008 at 6:43 am

    Debbie – It does sound like he may displaying signs and symptoms of apraxia, but I want to ask you a few questions since you mentioned his vocal cords. Does he audibly cry and laugh? Does he yell? Does he vocalize at all in babbling or jargon? If he is vocalizing using a voice you can hear during these times, it’s likely NOT a vocal cord problem. You can take him to an ENT to formally rule it out.

    As far as what to do at home – read all of the articles in the apraxia section, especially my earlier ones from February and March. Keep modeling the words and play sounds (animal noises, car and truck sounds, silly sounds) in a very playful way. Keep teaching signs to help him express himself. If you’re not sure if you’re doing it correctly, order the DVD because it very clearly demonstrates what to do. Sometimes it’s not even what to do – it’s HOW to do it, and that’s why I filmed the DVD. Since you’re in New Zealand, you’ll probably have to watch it from your computer since the players are not the same as players from the USA.

    Lastly, if he’s still not making progress within a few weeks, I’d go ahead and visit an SLP who specializes in childhool apraxia and language disorders. 25 months is not too young. Good luck! Laura

  39. Jewels on July 29, 2008 at 1:42 pm

    Hi Laura,
    The pedi was not concerned with eye contact at all. He says he tracks very well. He was concerned with our son still not babbling at 9 months. It surprised me that he was also concerned with our son not having fully mastered the pincer grasp or being able to wave bye-bye (he has not had much exposure to this). I had no idea our son “should” have mastered these skills by 9 months. A lot of what I read states these skills emerge by 10-12 months. In any case, he asked us to fill out the Ages & Stages Questionnaire which will then be given to a developmental pediatrician for review. I’m glad our pedi is being pro-active but I’m not sure we should be worried that our son is not demonstrating the pincer grasp and waving bye-bye. Any thoughts?

  40. Laura on July 29, 2008 at 2:39 pm

    Jewels – I wouldn’t be too concerned about not waving yet since many children don’t master this until between 9 and 12 months according to my sources, and I think he should already be practicing picking up smaller objects with a pincer, even if he’s not mastered it yet. Set up situations for him to practice this, but watch carefully since he’ll likely mouth whatever objects he tries. I like to use foods for this since you know he’ll mouth the object, but if you haven’t started trying goldfish, crackers, or cheerios yet, he may have had limited exposure and practice time. Try these things first before you get concerned. He’s awfully young, and it sounds like you are on top of things. Just practice, and if he doesn’t get it, then revisit the issue with the pediatrician. Laura

  41. irene on August 10, 2008 at 12:39 pm

    Hi Laura,
    I am very concerned about my 10 month old daughter. She is a very happy and content baby, smiles a lot, has good eye contact. She understands a lot, like do you want to nurse, give it to mama, where is the ball etc. However, her babbling is very limited she just says bababa and vavava, and the strangest thing is that she would babble a lot every day for a week, and then stop and take a break for a couple of weeks. She also started to wave bye bye, but then stopped. She also doesn’t point or clap. She has no trouble with solids and does not drool at all. She crawls and cruises. Have you ever heard of a baby babbling in spurts with no babbling in the middle?

  42. Laura on August 10, 2008 at 1:31 pm

    Irene – It is documented in the general child development literature that babies may be become less verbal when they are working on motor skills and less inclined to move when they are working hard on developing speech and language. I would not be overly concerned at this point because she is very young.

    I would definitely continue to work on her gestures – pointing, clapping, waving, operating easy cause and effect toys, etc… – for two reasons. First of all, gaining control over those motor actions actually helps her get ready to talk AND secondly, pointing, clapping, and waving are all very communicative in and of themselves. Keep “helping” her with the gestures, talking to her in lots of SINGLE words so she can begin to try to imitiate those first easy ones, and repeating any vocalizations she happens to make.

    You’re such a great mom for being concerned about language at such at early age, but try not to let that concern worry you too much at this point. I would encourage you to continue to play with her, talk with her, and have fun interacting with her. Keep doing those social games like peek-a-boo, patty-cake, etc… so that she has a fun way to work on those gestures too. If you need more info, keep reading the site! Thanks so much for your question. Laura

  43. Corrine on August 11, 2008 at 10:08 pm

    Hi Laura

    Wanted your feed back on my 35 month old son who has a speech delay. While he uses a lot of words he doesn’t pronounce them properly prefering to use the first letter of the word instead (i.e. biscuit = b). He also does not say 2 words together. Most of the time he doesn’t respond to questions. He is more likely to say yes than no. He has a quite a large vocabulary with more than 50 words which is growing all the time.

    He has had his hearing tested which was ok and has attended speech therapy. The first speech therapist thought he was just a late bloomer, his second sent him for early intervention as she thought he wasn’t making eye contact, his receptive language was behind and he wasn’t playing at an appropriate level. After review by an early intervention specialist and a pediatrician it has been confirmed that he only has a speech delay however.

    Socially he is very confident, playing well with others, he is very popular, he has lot’s of friends and even a best friend. It actually confuses me how he can be so social and have so little speech. He was until recently an only child and he doesn’t tend to ask for his needs, when he wants milk he will get it out of the fridge and a cup and he will show it to me or try to pour it himself, when he wants to play his favourite dvd he will put it on himself.
    He will sometimes sing songs like twinkle twinkle little star (not clearly) and counts to 10. He attends childcare regularily and this has helped his vocabularily greatly and they have never expressed any concerns to me about his development.

    As I have stated he is attending speech therapy and while this has helped greatly especially with his receptive language he still has a long way to go. I would like your advice on how to help him improve his speech and improve intearction with his peers. Also I see you have a DVD however Google checkout says you do not ship to Australia.

    Thanks a lot for your help

  44. Laura on August 12, 2008 at 6:55 am

    Corrine – Thanks for your comment! It’s great that you’ve already covered your bases with other assessments to determine what might be the cause or contributor to your son’s language delay. Ruling out hearing loss and social communication problems (like autism) are good initial steps for anyone with a child who is not talking. It’s also great that he’s in speech therapy and has made so much progress receptively and is coming along expressively. From everything you’ve said, it sounds like you’re doing all of the right things, so keep it up!

    Since he’s so independent at home, I would try to sabotage a few things so he has to ask for help. Try this article for more ideas on ways you can do this at home –

    About the DVD – the reason Google won’t accept international orders is that we want to be sure that you can play the DVD before you buy it. DVD players operate on different systems throughout the world, and Teach Me To Talk only works in North American DVD players. However, we have shipped DVDs several internationally, and they are sucessfully watching it on their computers using the DVD drive or a portable American player. Once you are sure you have access to view it, then send us an e-mail at with your shipping address. We will send you an invoice via e-mail with approval and special directions for ordering internationally. Hope it works out for you! Laura

  45. Hillary Martin on October 20, 2008 at 5:59 am

    Good read, thanks for the information, it was really informative.

  46. Allison Sellers on November 22, 2008 at 11:40 am

    I totally missed this post on my last read, it is great.

  47. helen on November 25, 2008 at 4:01 pm

    Hi I live in the UK, my daughter is 19 months and she has 3/4 words all done,down,plum and 2 sounds roar,sss. She has around 50 signs (taught recently to help with frustration). I have been concerned about her lack of speech for awhile, I spoke to my health visitor, who contacted a speech therapist, He said he is not at all concerned about my daughter, and said that and wouldn’t be until she is well over 2 years old. I’m not sure what to do. Any advice would be much appreciated.

  48. Laura on November 25, 2008 at 9:26 pm

    Helen – Continue to read the articles on the site in the expressive language section for more ideas. Congratulations for teaching her signs, and it’s such a great prognostic indicator that she’s learned them so easily.

    Sorry that you can’t get an SLP to look at her yet! Your health care system is different from ours in the USA, but don’t forget that YOU are her most important teacher anyway.

    If you need additional ideas for how to owrk with her at home until you can get an SLP to look at her, I will tell you that Teach Me To Talk the DVD WILL work in your personal computer or an international DVD player without any problems, and it MAY work in a UK player (but it goes straight to autoload without letting you view it chapter by chapter), so that’s an alternative for you too if you’d like to SEE additional recommendations for working with your daughter. We have not made this “official” announcement on the ad yet, but will shortly.


  49. Helen on November 26, 2008 at 5:49 pm

    Thank you for your reply.I am interested in your dvd but wasn’t sure if it would be compatible with my dvd player. May I ask? from what I’ve told you about my daughter, would you have concerns about her speech, at this stage? To fill you in a little more, She didn’t babble much as a baby, although she does now but she is often very quiet, she has rarely said dada and never said mama. She has also said a few word once or twice then never said them again. Could you please tell me if I am right to be concerned? Should I push to have a second opinion?
    thanks again

  50. Laura on November 26, 2008 at 6:59 pm

    Helen – According to what you’ve said about her, she’s not quite meeting the expressive language milestones, but please don’t be alarmed because I’ve said that. She is still very young. Also let me emphasize that her ability to learn so many signs quickly indicates very good potential.

    If your health visitor can’t get you a referral to an SLP until after 2, what choice do you have other than to work with her at home? You could push for the second opinion, but it seems to me from e-mails I’ve received from parents that it’s very, very difficult to see an SLP in England until after a child turns 2 and then only if there’s a significant problem. According to what you’ve said, I’m not sure she’d get an assessment under these conditions unless you did it privately.

    My best advice would be to continue to find information and commit to working with her at home. If she’s not making good progress by her second birthday, then push hard for the official assessment.

    The DVD is shot in NTSC, but it has worked in both international and European DVD players according to everyone who has ordered it from those regions. As a back up, you can view it from your PC DVD drive as many parents and professionals who have ordered it from outside the USA have done. If you, or any other international readers, are interested in ordering the DVD, send me an e-mail at for specific instructions for ordering through Google checkout.

    I know you’re not American, but I am going to wish you a Happy Thanksgiving anyway! Laura

  51. Sarah on November 27, 2008 at 5:04 am

    Hi Laura,

    I have a 21 months old daughter who is the only child. She is in an environment of 3 languages. I speak with her in my mother language which is Persian, her dad in French, we both speak with each other and also sometimes with her in English. English is the language that people talk in here as we are living in Canada. I should mention that she spends most of her time alone with me.

    My daughter is not using words to express her needs, although she understands many words and can say very few words. she never called us as Mom or Daddy but she said that for a few times and understands the meanings. She used to say words such as happy, Abbi( =blue in Persian), Mama, Dadddy, Ba Bye, Ba Ba ( as a sheep), Haupy( = puppy, a mix of Hapou (in Persian) and Puppy(in English), Hi, Hallo (= hello), Ha..owuo(=how are you?). She is very social and pretends speaking and telling long stories with other people. Whatever she needs, she pulls our hands and shows what she wants us to do, such as playing music on my laptop, making a bottle of milk for her, putting her in her high chair, etc. She is a very active and palyful girl.

    Dear Laura, I am really worried to see her not speaking as a baby sould in her age.

    – Is it possible to be because of being exposed to 3 languages?
    – It seems to me that she has more ineterst in English since it helps her to communicate with people more. Does it mean that I should start talking in English with her?
    – Why does not she keep using the words that she knows? it is like a game for her that she gets tired of it.

    I would be grateful if you answer my questions. Thanks for the great website and wish you a great Thanksgiving!


  52. Helen on November 27, 2008 at 3:12 pm

    Thank you again for your reply, you have put my mind at rest. I will continue to work with her and see where she is when she’s 2.

    Happy thanksgiving to you, Helen

  53. Laura on November 28, 2008 at 9:10 am

    Sarah – Research tells us that children who are raised in bilingual environments speak a little later than those with only one language.

    When I treat children like this on my caseload who are demonstrating pretty significant delays (especially in comprehension, or what they understand), I always recommend that mom and dad pick one primary language and stick to that one as their “teaching” language. I also always encourage them to pick the one their child needs most to communicate with others, especially if they are going to school and need to learn to understand and talk with peers and teachers.

    If you continue to use the other languages with her, be sure you’re repeating the same word or directions for her to follow first in her “primary” language and then supplement with the other language/s.

    I have seen good success when parents have begun to focus on one language and then branch out to the other ones once their child has begun to master the first one.

    I will tell you that the newer research says it’s not living in a bilingual environment that’s “caused” the language delay. There may have been an underlying problem regardless, so don’t feel guilty about that.

    There is an article here on the site about using more than one language. It’s called Foreign Languages and Late Talkers, and I believe it’s in the parenting and expressive language sections. If you can’t find it to read, leave me another comment, and I’ll provide the link.

    Take care – Laura

  54. Sarah on November 29, 2008 at 6:44 pm

    Thank you very much, Laura. I found the article very helpful. My husband and I have already started to apply the new method. I will let you know about any improvements later.

    Have a great weekend,

  55. Holly on December 2, 2008 at 6:05 pm

    Hi Laura,

    I have a 28 month old daughter who is an only child. Im wondering if she should be speaking more in sentences. Her vocabulary consist of 50 plus words. She does say “all done,open it,bye house,bye peepee/poopie,hi mommy, hi daddy, and probably two or three more phrases i cant think of at the moment. When i take her for walks, she will point at things and tell me what they are, tree,sky,car,birds,plane,girl,boy, and so on. She can count to 10, and can sing her abc’s -with me. We have a play date once a week with 3 other kids her age. I hate to admit it but i find myself comparing. The kids there can say alot more sentences, or answer back when asked a question. She plays well and shares with the other kids. My daughter will say yes or no, or express if she wants milk water or juice.Another concern i have is, she will repeat things like if I say Do you want to go outside? She will say “outside”…and run to the door, or Are you hungry she will say “hungry” and run to the fridge”, is this normal or a sign of autism? She understands when i give her direction, go get youR shoes out of your room, put that on the table,etc. She was pottie trained in two days, so i know she understands very well. I guess my question is, am i over reacting or should i be concerned, that she is not using more two word phrases, and will repeat the last word in a sentence sometimes. Im sorry if i rambled, just a concerned mommy!

    Thank You so much for all you do,

  56. Laura on December 2, 2008 at 6:54 pm

    Holly – The expressive language milestones for children who are 27 months old include using 3 word phrases frequently. Children who are doing well with language at this age probably have well over 100 words, or even more.

    From what you’ve said about her, she is not showing significant delays, but if you are worried about her, you really should have her evaluated by someone who can actually see her and help you know for sure.

    I will tell you that from what you’ve said, she has some very positive strengths. Her receptive language is good and she is initiating communication with you. These are great indicators that she is developing a good foundation for future language development.

    Let me also add that there are LOTS of things you can do at home to help her get there expressively too. Read the ideas in the expressive language category.

    Teach Me To Talk The DVD is also full of ways you can work with her at home, especially the section on expansion since it will teach you how to help her expand her single words to phrases.

    Hope these ideas help! Laura

  57. Holly on December 3, 2008 at 1:12 pm

    Thank You so much for your reply. I already ordered the DVD, just have not received it yet. Her pediatrician doesnt think there is anything wrong, how can I talk to someone who will listen, and see if there is a delay? I will read the info on the expressive language category. Thank You again.

  58. michele on March 12, 2009 at 2:14 pm

    I have a question about my 2 yr old son. Two months ago a hearing test revealed some hearing loss due to fluid. A follow up test revealed normal hearing but impaired middle ear functioning and no fluid but still air which would indicate that the fluid has just recently cleared up. We have no way to no how long his hearing was impaired by the fluid but suspect it could be as long as a year as fluid was first noticed at his 1 yr appt but no one was concerned about it. I am pretty sure his language delays are due to fluid so am giving him 2 months and and working with him to let him catch up before having him evaluated again. (He was evaluated by early intervention at 19 months and found to have a slight speech delay but it was not enough to qualify us for services and i was not able to find a speech therapist who thought he needed services.)

    The primary things I have noticed are:

    -he isn’t combining word to make sentences…we have been working on adding verbs to his vocabulary.

    -He repeats his words twice (car car, truck truck, hot hot, mick mick…almost like they are one word…i’m not sure if this is a bad habit he has developed or something more and I don’t know how to help him with it but it seems to impair his ability to string together words

    -he has over 50 words but most are nouns and I’m not sure how many are spontaneous…we are using your techniques to work on this

    -all his words sound the same. he says the first constantant and vowel sound and maybe a constantant sound in the middle or end of the word. it is very hard to understand him and i think he has way more words than i give him credit for bc i can’t understand them. An example is ba (bath), buu (book) bu (butt) ba (sheep) bo (bottle) boc (rock), etc I think this is likely due to him not hearing well but could use advice on helping him correct this so i understand him better and he doesn’t get so frustrated.

    he repeats the same word louder and louder until it is acknowledged and I repeat the word back to him (is this normal?)

    There are some sounds that he is definitely not saying..l, r, h, g, j, that i’ve noticed.

    He’s on target in most other areas and seems to know what i am saying most of the time although he gets a bit confused with 2 part directions. he talks constantly to himself and his toys and anyone who will listen. He’s even beginning to potty train. he just seems behind in his expressive language and i struggle with knowing what is and what is not normal and some of the things i mentioned above i don’t find mentioned or discussed anywhere.

    thanks for any insight you can give me. i really like your site and have recommended it to friends who are concerned about their toddlers speech.

  59. Laura on March 12, 2009 at 11:16 pm

    Heather – Kids who have had chronic problems with fluid do have the kinds of speech and language issues you’re describing. You have great questions, so I’ll try to address them all, but if I miss any, let me know!

    Many kids do repeat one word of a phrase before they are really ready for phrases. Keep trying these. Here’s an article about developing phrases with more ideas if you’ve not read this yet –

    All of the sounds he doesn’t have (with the exception of /h/) are later developing consonant sounds. The sound /g/ usually emerges shortly before or after 3, but /l, r/ and “j” are sometimes much later to come in. I’d not worry about those yet.

    Here are some tricks for /h/. Practice blowing his breath on a window or glass door so he can see it. Once he’s doing this, try words that start with /h/ -hi, hot, help, hop, hat, etc…

    Final consonants in words sometimes don’t come in until closer to 3 either, so he’s not outside the range of normal with this as well. Usually the easiest sounds to get at ends of words are /p, t, k, s, m/. If you need ideas for specific words to target, ask me for these.

    Yelling the word you’re saying until your mom finally understands is a favorite toddler trick. No help for you here! But if he’s yelling because he’s come to expect you to repeat him, then you’re going to have to help him learn that conversations don’t happen this way. This is such a trap kids fall in to when they are difficult to understand, and it’s a hard habit to break both for mom and the child. You could say things immediately following to answer him, comment, or expand what’s said without repeating him per se so that he knows you understood him. One of the worst injuries I’ve ever gotten in my career was from a little boy who would beat the tar out of his mom (and then me!) if you didn’t repeat what he said. This went on for several miserable weeks until Mom could finally break her habit of repeating him and then move on fast enough verbally with a related comment so that he “forgot” he wanted her to say the word back.

    If he’s not becoming more and more intelligible by 2 1/2 to 3, and certainly if he’s not saying short phrases consistently by that time, have him re-evaluated by an SLP. I absolutely hate it that borderline kids often don’t qualify for services because these are the very kids we can fix usually without long term consequences! Sometimes our systems are very, very messed up in that regard!

    Hope I answered all your questions and that these ideas helped! Laura

  60. Hellen CLARK on March 25, 2009 at 8:42 pm

    I was just on your site and wanted to say I like what you are doing. Keep up the effort and keep the posts coming.

  61. Jess on April 22, 2009 at 12:57 pm

    Hi Laura, I just found this great website. I’ve been concerned for my son for awhile – he is 31 months and has a lot of single words, but is still very difficult to understand. He will say “Jacks turn” or “no, home” but not many more than 2 word sentences…. He does still use sign language with me and is now starting to use the word with the action (ie, eat) with some of his words.

    He also mainly parallel plays with others, though I have him going to play groups a couple of times a week. We did move to French speaking Canada when he was 17 months old and all of his friends are french speaking – and I can tell with new kids he just doesn’t respond to them. I just started him in bilingual daycare 2 months ago and she says he can respond to french actions and he can say a few words (merci beaucoup).

    I have no idea how to get him in speech therapy here and his doctor said not to worry until he’s 3 yo. Do you think I should really focus on finding him an English speech therapist? I went to speech myself until 8 for unclear R’s…

    Also, he seems to have a hard time remembering his activities in the day when asked at night – even when he knows the words, I usually have to prompt him and then he’ll say “yes… choo-choo trains, nuggets” or something.

    Sorry for the long post, but that sums it up! Thanks again — Jess.

  62. Laura on April 22, 2009 at 8:25 pm

    Jess – I’d definitely recommend that you go ahead and pursue an assessment with a pediatric speech-language pathologist, and hopefully one that’s bilingual. It’s hard to know if the dual language issues are what’s causing his delay, or if he would have had difficulty learning even one language. Researchers tell us that children raised in bilingual homes do speak later than their same-age peers learning only one language. One thing I would recommend is that you re-state most of what he hears in both languages so that he learns to understand both. The bilingual daycare is a good idea for him, but I’d also go ahead and see an SLP for more specific ideas. Good luck! Laura

  63. Laura on May 17, 2009 at 5:54 pm

    Question submitted via email :

    Please help. My boy, Mason, is 16 months old and not trying to say any words. He exceeds all the physical milestones and points at everything. He grunts and uses signs to communicate. Should I get an evaluation? How do I find a good therapist in Michigan? Thank you.

    Start by talking to your pediatrician to see what/who he or she recommends. If you feel like his receptive language (how he understands words and follows directions) is age-appropriate, and if he is interacting and socializing with you and other people, then you may be fine holding off until 18 or 21 months. However, if he’s not following simple commands (Get your shoes, Where’s your book, Let’s go eat) and if he’s not interested in other people and doesn’t work to get your attention to communicate, I’d recommend that you go ahead and pursue an assesssment now. If there are no words as his 2 year old birthday is rolling around, you should definitely pursue services then. .

    Every state has an early intervention program. You can ask the MD about it, or Google “Michigan early intervention” to find out the contact information.

    I also want to recommend that you check out Teach Me To Talk the DVD. This outlines the very same beginning strategies you’d learn in speech therapy so you can get a jump start on this yourself.

    Thanks for the question. I’m going to post it to the website since I think other parents may benefit from the info.

  64. AndrewBoldman on June 4, 2009 at 1:17 pm

    I really liked this post. Can I copy it to my site? Thank you in advance.

  65. Laura on June 7, 2009 at 11:15 pm

    Andrew – This is fine with me as long as you post the link and credit it to this site AND the original reference. Thanks for asking! Laura

  66. arju on April 4, 2010 at 9:42 am

    hi laura
    it seems every one has the problem with children some with hearing and other language. in my case my daughter has a severe to profound hearing loss in both ear which is diagonise recentley when she is four years even we suggested her doc about hearing but they seems to just kept on saying she is the only child and she needs to be around more children so we waited, now she has hearing loss reason still unknown. now we had her hearing aid on. she does not understand question at all. she does repeat n talk some words and sentences but is very limited. she loves to talk and even communictate using signs of her own or sounds . the problem is how i teach her to talk two way from where to begin, i been taking speech therapy for two years and still she cannot use sentence or communicate at all.i am so desperate to make her talk as she likes to talk n talk. please do help me

  67. Amy on May 2, 2010 at 7:26 pm

    Hi, I have a 14 month old son who is not waving bye bye yet. He has met all other milestones within the normal range and says a few words, claps hands, reaches, uses pincer grasp expertly, points at objects and can follow a point of reference. We have been waving hello and bye bye constantly for months but he just looks vacantly at us or just claps his hands in response. I feel like he is never going to wave! Should I be concerned? Thank you.

  68. Laura on May 3, 2010 at 8:48 am

    Amy – If he’s doing the other things as you describe, I’d not be too worried. Keep showing him how to wave. Have you physically gotten beside him and helped him wave when someone else is waving to him? Sometimes the hands-on physical assistance is what it takes to help a child begin to do this on his own. Thanks for your question, and I hope he begins to do this soon for you since you’ve waited for so long! Laura

  69. Jane on December 20, 2010 at 4:22 pm

    Hi Laura,

    Would love your advice on help for my son. He is 2yrs 10 months now. Has a spoken vocabulary of around 400 words now (possibly more that he understands), around 300 at 28months. He constructs senstences that range from 3 to 10 words long, and uses sentences more often than words alone.

    He answers questions inconsistently. When asked ‘what are you looking at?’ he will usually respond ‘I’m looking at the bus (or car, or plane or whatever) and it is usually accurate. But when asked what he wants for breakfast, it takes a lot of coaxing to get a response. He often says “no”, never “yes”. When asked ‘Yes, or no?’ he often repeats the phrase rather than making a choice. He often repeats what he last heard, probably about 33% of the time. Sometimes repeating “How old are you. I am two years old.” It’s not easy to have a multi-step conversation with him. But at the same time can express some complex emotions. Saying “I miss you,” when apart from me and his father. Or recently after having a potty training accident and throwing his toys in frustration, he told me, “I am sad.” When asked why, he said “I threw Thomas and Percy (his toy trains).” and “I did poo poo.”

    He has memorized many books and Thomas the train stories, and does quote them. Although he seems to have forgotten the words of some older favorite books that he had previously committed to memory. He can put together 12 piece jigsaw puzzles. Can recognize all the capital letters of the alphabet, knows all his colors and basic shapes.

    He makes eye contact, answers when called. Can follow directions. Likes other children, but often in a group will play by himself. In smaller groups, is very interactive and seeks the company of other children and engages them in play.

    However, issues are that in daycare, he communicates less than at home, and does not seem to interact with children as much as they would like.

    He has qualified for some speech services from the state, but I wanted to ask you what we can do to move him forward… I want to strike a balance between fun and pushing as well, so that he remains the sweet and happy kid that he is.

    Sorry for this long question, and thanks in advance for your advice.


  70. Laura on December 21, 2010 at 5:26 pm

    Jane – While it’s quite common for many children to communicate less at daycare and preschool than they do at home, if the daycare staff members are pointing it out to you, then it must be enough of a difference for them to notice.

    It sounds like expressively he’s moving along, but needs some additional help to process more complex language. Keep using your cues of giving him choices when asking questions, and sometimes visual cues really help that.

    In teaching kids not to just echo the last thing you’ve said, use choices – one for something he would want and then one for one he definitely would not want. Offer the one he WON’T like as the last option so that he has to pick the first one and not just echo what you’ve said. If he echoes the last choice, that’s the one he gets. This usually makes the point pretty successfully after a few times.

    I’m sure you’ll also get more ideas from his SLP when she begins to work with him. Thanks for the question and good luck with him! Laura

  71. Tracy on June 14, 2015 at 5:47 pm

    Hi Laura – love your site. It’s been a great resource especially when trying to understand what to do about my son’s situation.

    Would really appreciate your advise. My son recently turned two and hasn’t started talking yet. About two months ago I took my son to a visiting audiologist (none in our country at the moment) who conducted an ABR test and the results showed that there was some moderate hearing loss in one ear and moderate to severe hearing loss in the other. My son had suffered some trauma during birth and was in NICU for a little while so that was one concern but there also seemed to be some fluid in his ears so the audiologist referred us to an ENT Specialist for consultation before conducting another ABR to see if there was any improvement. After looking at my son’s ears though, the ENT Specialist said it didn’t look as bad as feared and has advised us to wait until my son turns 3 to reassess our options. We are currently following this advise but am concerned about not doing all we can, if there is something we can do, to help.

    Thanks again and look forward to hearing from you


    • Laura on June 15, 2015 at 1:10 pm

      Hi Tracy. Did your son get medicine to clear up the fluid? Did the doctor recommend tube placement? A ‘wait and see’ approach without doing something about medical interventions for a medical problem (the fluid in his ears) is not something that I think makes sense, so I understand your concern.

      There’s soooooooooooooo much you can do to facilitate language at home NOW – that’s what this whole site is about! Age 2 is PRIME TIME for teaching a child to understand and use language, so waiting is horribly outdated and often harmful advice. Give me some more information about your child and I’ll recommend some posts and some products for you.

      I know you said he’s not talking, but how does he understand language? Many times toddlers with fluctuating hearing due to fluid still do okay with learning to understand language, but some don’t. You’ll want to focus on helping him follow directions and make connections FIRST if that is an issue. Does he point to body parts and familiar people and pictures books he likes? Can he bring you things from around the house when you ask him? Does he try to communicate, even if he’s not talking? Let me know those things and I’ll be glad to point you in the right direction. Laura

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If this is Laura herself reading this email let me take this opportunity to thank you from the bottom of my heart for all that you have put forth for us professionals. I own every manual (except the autism manual) and have watched every course on DVD. I have listened to countless podcasts. All of what I’ve come to be as an Early Intervention speech therapist was absolutely to your credit. With your resources at my side I have never needed to scramble for answers and strategies and above all the clear language I use when communicating with parents. My fun, animated affect and key phrases I use have been learned through watching your example. So….thank you! May you be blessed."


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"Dear Laura,

What an inspiration!

Thank you for helping me be a better Developmental Therapist. I often listen to your podcasts which help me help families.

Your enthusiasm, professionalism and
the sheer volume of information is so great.

You are part of my team.

I just wanted you to know I appreciate you."


"Dear Laura,

Thank you for your generosity in sharing so much knowledge in such a clear and enthusiastic way.

As a retired audiologist with a fabulous and language delayed grandson, I used your podcasts and outstanding publication, The Autism Workbook, to inspire and guide me over the past year.

It works!! He went from barely verbal, no gestures, didn't respond to his name etc etc to a verbal, social, curious, ready to imitate anything, fill in the blanks on familiar "set" speech, generate his own totally appropriate and mostly understandable sentences...not just short phrases anymore... full little paragraphs...about imaginary things, what he did during the day, what he wants. True communication!

You make a powerful difference in this world! ❤"

With gratitude,

"Laura Mize, you are a Godsend. I don’t know how one human can have so many helpful things to say in a beautifully organized way, so often. Always amazes me when another super helpful email comes from you, and for free. With free YouTube videos and cheap CEUs. THANK YOU!!!"

Sheila, Canada

"I purchased the book on autism and have watched the #400s series podcasts. Laura Mize has been more effective in teaching autistic tendencies, than many professors, shadowing professions, and the 100s of books, articles and classes or videos, or live workshop speakers, have been at teaching effective practices for a child with ASD. Some of the many lessons she has taught, which I will now use, to be a more effective Interventionist, include but are not limited to: red flags, typical behaviors, self-stimulating behaviors, not taking away toys, rather showing child to play with toy appropriately. She gives examples of child's actions, "inappropriate," explains the reason for: why the child is engaging in these behaviors and how they can be replaced with more appropriate, effective fuctional and age-appropriate skills."

"I’m sure Laura gets these messages all the time, but I thought I’d share. I stumbled across Laura‘s "Autism or Speech Delay?" YouTube video when I really needed it. This video finally listed and explained some of the red flags my son was showing for autism. I share the link anytime a parent is questioning in my FB autism group. This mother I don’t even know said Laura's video changed her life. I know exactly how she feels because It changed families too. Thank you to everyone at Teach Me To Talk."


"Good Morning Laura,
I received your book (The Autism Workbook) yesterday and it is absolutely amazing! As I evaluate young children (0-3) for developmental delays and write plans for them with their parents, there are a ton of ideas that are ready to use. Others that reinforce what I have been doing, and saying, all along. Thank you so, so much for writing this incredible book and pulling everything together in one place!"


"Thank you very much for sharing your knowledge, experience, and guidance.
I’m a parent who bought the autism workbook and it’s the only clear resource I found to make a change in my son. I’m really thankful to Ms. Laura for helping out people like us all over the world."

"Laura Mize, all I have to say is that ALL YOUR STRATEGIES WORK."

ANNE, YouTube viewer

"We have 7 SLPs in our preschool (public) program for special needs children (ages 3-5) and we use your courses, books, and techniques every day! :-) We have seen our preschoolers make such great gains!"


"I just received Teach Me to Play With You, and it is ALREADY WORKING! WOW!

Girl…my son is 3 years old, and he NEVER asks for something using words. We were playing “Get Your Belly” (from Teach Me to Play WITH You), and after several times, he laughed and screamed "BEWIEEE!!!"  It was a hoot. And I can't believe he said it! I have played with him like this before, but this time I took your advice and acted CRAZY!! I will act like a total lunatic if it will get him to talk to me!  Now I can give him "the look" from across the room, and he will say it. That manual is so amazingly practical, and it is a GODSEND right now! Thank you SO MUCH!”

"I wanted to send you a quick email to say thank you. I started watching your videos/podcasts about 4 months ago. My son has gone from losing words he previously used, only having about 7 words at his 2 year check up in August (assessed at a blended 10 month language level) -- to now having so many words, increased social engagement, following commands, spontaneously requesting things, and naming letters & numbers (not in order) as well as colors. We had our monthly meeting with our SLP through the state infants & toddlers program and it felt like we were just bragging the whole time, but I knew in the back of my head it was because I have been using strategies you taught me.

We still have so much work to do with our sweet boy, but I know in my heart he would not have succeeded without the education you provided. I will continue to read your emails & watch videos as we go along this journey and face challenges, but credit is due to you, Laura.

Thank you so much, endlessly."


"I just want to tell how fortunate I feel to have found your website and you!! I became a special instructor in EI almost a year ago and I started with hardly any applicable training. I felt so lost and confused as how to help the kids I work with learn how to use words and play. Honestly, I didn't even understand the importance of play, although I always played with my kids. But, once I started to watch your podcasts and get some of your manuals I felt a weight had been lifted off my shoulders and that I could finally teach these kids and their families something of value from a real therapist and based on research!. Thank you so much for seeing the need to help other EI service providers and providing a forum to share your knowledge and years of valuable experience. I'm sure you get a lot of these emails every week if not every day, but I wanted to make I could add to those notes of gratitude!! THANK YOU again!!"


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"I was very frustrated with how speech therapy was going for my child. I would take him and drop him off and not hear much of anything from his therapist and teachers other than, "He had a good (or a bad!) day." Your materials were invaluable for us because I learned how to work with him on his speech. I learned how to teach him to talk and play. I learned how to pay attention to his cues and work with him to teach him to communicate. Without it, I have no doubt he still wouldn’t talk."


"Hi! I just wanted to say (from an SLT perspective) how incredibly useful I am finding absolutely all of your articles, blogs and resources - I only discovered your site last month and have just received all your books which I feel I am learning more than on my entire university training course!! But also the way in which you give specific, realistic, fun, encouraging ideas for working with parents is really just fantastic, I only wish I have your site sooner! Thanks so much from the UK! Kind regards."


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"I just really appreciate your courses! I have two new clinicians that I’m working with and have recommended these courses to both of them. I’ve watched quite a few and have learned so much about serving this population. To be honest, before I started implementing your strategies I was a little frustrated with the lack of progress. My skills with engaging these little ones have improved so much! Thank you so much for making these CEUs so valuable!" C, SLP