If your child seems to be a late talker, when is the time to seek help? What's normal?
By Richard Trubo
Reviewed By Brunilda Nazario
Those are often the first words spoken by a baby, and they can turn an ordinary day into a memorable one for parents.
But if children seem to lag behind their peers in their ability to talk, it can create anxiety and plenty of sleepless nights among parents, and perhaps prompt worried phone calls to the pediatrician, asking, "Why isn't my child talking?" Parents may remember that an older sibling was much farther along in his language development at the same age, maybe speaking in two- or three-word sentences at age 2 with ease. And as time passes, their apprehension may turn to panic.
In the majority of cases, however, there's no need for alarm. Most children develop language at their own pace, and there is a broad range of normal, says Diane Paul-Brown, PhD, director of clinical issues at the American Speech-Language-Hearing Association (ASHA). "Some children develop language at a faster rate than others," she says. Even so, there are times to have a child's speech and language evaluated.
About 15%-25% of young children have some kind of communication disorder. Boys tend to develop language skills a little later than girls, but in general, kids may be labeled "late-talking children" if they speak less than 10 words by the age of 18 to 20 months, or fewer than 50 words by 21 to 30 months of age.
Most experts say that at age 12 months, children should be saying single words, and may be able to say "mama" and "dada." They also should be able to understand and comply with simple requests ("Give me the toy").
The American Academy of Pediatrics lists the following milestones for the first five years:
- By the end of the second year, your toddler should be able to speak in two- to three-word sentences. She should be able to follow simple instructions and repeat words heard in conversation.
- By the end of the third year, your child should be able to follow an instruction with two or three steps, recognize and identify practically all common objects and pictures, and understand most of what is said to her. She should speak well enough to be understood by those outside the family.
- By the end of the fourth year, your child should ask abstract (why?) questions and understand concepts of same vs. different. She should have mastered the basic rules of grammar as she hears it around her. Although your child should be speaking clearly by age 4, she may mispronounce as many as half of her basic sounds; this is not a cause for concern.
- By age 5, your child should be able to retell a story in her own words and use more than five words in a sentence.
Though some children seem to lag a little behind in their spoken (or "expressive") language, their "receptive" language may be better -- that is, they may appear to understand much of what is being said to them. "When a child is not using a lot of words but seems to comprehend what you're saying and can follow commands, there is less reason for concern than if a child lags in both expressive and receptive language," says Paul-Brown, a speech-language pathologist. "Receptive language is a useful predictor to differentiate late talkers from those children with developmental delays."
The number of cases of late-talking children appears to be on the rise, says Marilyn Agin, MD, a developmental pediatrician in New York City and co-author of The Late Talker: What to Do If Your Child Isn't Talking Yet. This increase parallels the growing incidence of chronic ear infections, which can impair hearing and, in turn, contribute to speech delays. As more children spend time in child-care settings, say pediatricians, they're exposed to the illnesses of playmates that could lead to more ear problems.
"Chronic ear infections may negatively impact early learning experiences, especially if there are other risk factors present," says Paul-Brown. "The preschool years are a critical period for speech and language development."
Though many children appear to be genetically predisposed to develop speech later than others, environmental factors might play a role as well in late-talking children. For example, research is under way on whether exposure to substances such as mercury could cause neurological damage, which in turn might affect speech and language, says Agin.
What to Expect
Although children develop language skills at different rates, it is important that their progress is steady and that they reach certain milestones within accepted windows of time. Here are a few indicators of what's normal and what should raise concerns:
- Most babies begin cooing and babbling in the first year of life. "They should be babbling all of the consonant sounds, but if they're limited in this regard, it may be a red flag," says Agin.
- Babies should begin to imitate the sounds spoken by their parents. When mom or dad says, "Mama" or "Dada," and the baby doesn't imitate it, that's a warning sign, says Agin.
- Don't become overly troubled if a young child doesn't clearly say "l," "r," and "s" sounds. The ability to form these particular sounds tends to develop with time, although perhaps not until the age of 7 in some children, says Debora Downey, MS, a speech-language pathologist at the University of Iowa's Center for Disabilities and Development. Generally, no speech-language therapy is necessary, although there may be an exception if these sounds are in a child's own name (e.g. Robert or Rhonda). "These children may become self-conscious, may be reluctant to tell you their name, and could withdraw socially," says Downey.
If you're concerned about your late-talking children, see your pediatrician or seek an evaluation from a speech-language pathologist (many are certified by the ASHA). A speech-language pathologist may administer tests, analyze the child's speaking abilities, and counsel parents on ways to stimulate language development. These kinds of services may be free or low-cost under provisions of the Individuals with Disabilities Education Act.
When a hearing problem is suspected, your late-talking children might be referred to an audiologist (many are certified by the ASHA) for a hearing test. About 1 million children in the U.S. have some type of hearing loss.
How important is appropriate intervention? Late-talking children may have lingering language-related problems and develop learning disabilities in school, says Downey. "Oral language is the foundation for all academic areas, including reading, writing, and math," she says, and the more time that passes before help is sought and provided, the weaker the foundation on which future learning will be based. She compares it to trying to build a house without a framework to support the walls.
In 2002, a study by Bryn Mawr College researchers concluded that children who were found to be late talkers by the ages of 24 to 31 months old tended to become poor readers and spellers, and have weaker vocabularies, in the early years of elementary school.
"I cringe when I hear people say, 'Don't worry, he'll outgrow it,'" says Paul-Brown. "Unless your child has had an evaluation by an ASHA-certified speech-language pathologist, you don't know if that's really true."
Encouraging Normal Speech
To support normal speech and language development in your youngster:
- Talk to your baby and young child throughout the day, including during bath time, while changing diapers, and during meals. For example, get your child's attention, and then talk about what you're doing ("Look, I'm opening the refrigerator and I'm getting out food").
- When you speak with your child, talk at a level above his own. "If he's using three words at a time, you shouldn't use only three-word sentences," says Paul-Brown. "But at the same time, don't overwhelm him with very complex sentences."
- "Babies seem to pay more attention, and imitate more, when their parent talks in what's been called 'motherese,' which is a higher-pitched, baby-talk type of voice," says Agin.
- Sing to your baby, and read to her beginning at a very young age.
For additional information about normal speech development in children, as well as referrals to ASHA-certified speech-language pathologists in your community, contact the ASHA (www.asha.org).
SOURCES: Marilyn C. Agin, MD, developmental pediatrician, New York City. Debora Downey, MS, CCC-SP, University of Iowa Health Care, Iowa City, Iowa. Diane Paul-Brown, PhD, American Speech-Language-Hearing Association, Rockville, Md.