When Do You Have to Worry When Your Toddler is Not Speaking Enough Words?

 

The development of speech in toddlers is one of the most exciting times for parents. They wait eagerly for each word that their toddler utters, and each new word adds to the little victories of advancement towards successful communication between parent and child. Parents also tend to track their child’s speech and language development through interactions with other similar age group peers, or the toddler’s older siblings and relatives. These comparisons gives assurance to parents that their child is developing at a similar rate to their peer aged toddlers. So how do parents know for sure if their child is on the right track of speech development?

In speech and language acquisition, there is NO definite age as to when a child should reached a milestone. Meaning, children do not acquire speech and language milestones at exactly same age, rather they achieve their milestones at around the same stage consistently. Furthermore, speech and language development in children typically follow a natural progression in mastering these skills.

The chart below represents a child’s typical speech and language development.  The information represents the average age wherein most children will acquire a certain skill. However, it is normal that developing children do not achieve all abilities in a category until they reach the upper age in each age range.

Children at the age of 2 typically use around 50 words and at the age of 3, they usually accquire enough vocabalary to commuincate for daily living. And by 4 years of age, the child should be  able to string sentences using up to about 4-5 words. By this time, he should also be able to respond to simple what, who and where questions.

It should be noted that even if the child does not achieve one of the categories within the age range, it does not necessarily mean that your child has a speech delay. However if you had answered NO to the majority of the categories on the chart, then there may be a possibiltiy that your child is at risk for speech and language delay.

 Speech and Language Delay

Speech is the verbal production of language, whereas language is the conceptual processing of communication. Language has two parts: receptive language (understanding) and expressive language (the ability to convey information, feelings, thoughts and ideas).

Speech and language impairment refers to a person’s difficulty in communication. The person has trouble understanding others (receptive language), or sharing thoughts, ideas and feelings completely (expressive language). He/she might also have difficulty producing speech sounds correctly or fluently (speech).

Speech and language delay in children is associated with reading, writing and socialization difficulties. Several studies have shown that children with speech and language problems at the age of 2 ½ – 5 years have increased difficulty reading in primary school years. Moreover, children with speech and language impairments at the age of past 5 ½ years have an increased incidence of attention and social difficulties. Early intervention in children is encouraged to avoid meeting these problems later on in life.

The table below shows the most common speech and language problems in children (McLaughlin 2011):

Disorder	Clinical Findings and Comments
Primary (not attributable to another condition)
Developmental speech and language delay	Speech is delayed.Children have normal comprehension, intelligence, hearing, emotional relationships and articulation skills.
Expressive language disorder	Speech is delayed.Children have normal comprehension, intelligence, hearing, emotional relationships and articulation skills. Expressive language disorder is difficult to distinguish at an early age from the more common developmental speech and language delay.
Receptive language disorder	Speech is delayed and also sparse, agrammatic and indistinct in articulation.Children may not look at or point to objects or persons named by parents (demonstration a deficit in comprehension). Children have normal responses to nonverbal auditory stimuli.
Secondary (attributable to another condition)
Autism spectrum disorder	Children have a variety of speech abnormalities, including speech delay (especially with concurrent intellectual disability), echolalia (repeating phrases) without generation of their own novel phrases, difficulty initiating and sustaining conversations, pronouns reversal and speech and language regression.Children have impaired communication, impaired social interaction and repetitive behaviors/circumscribed interests.
Cerebral palsy	Speech delay in children with cerebral palsy may be due to difficulty with coordination or spasticity to tongue muscles, hearing loss, coexisting intellectual disability, or a defect in the cerebral cortex.
Childhood apraxia of speech	Apraxia of speech is a physical problem in which children have difficulty making sounds in the right order, making it hard for their speech to be understood by others.Children communicate with gestures but have difficulty with speech (demonstrating motivations to communicate, but lack of speech ability).
Dysarthria	Dysarthria is a physical problem in which children can have speech difficulties ranging from mild, with slightly slurred articulation and low-pitched voice, to profound, with an inability to produce any recognizable words.Children communicate with gestures but have difficulty with speech (demonstrating motivations to communicate, but lack of speech ability).

So what do you do if you suspect that your child may have speech delay? The first step is to seek professional advise from your doctor. The doctor might refer you to a speech and language pathologist who is professionally trained to evaluate and give intervention to children with speech and language difficulties.

In children not meeting the expected milestones for speech and language, a comprehensive developmental evaluation is important. As mentioned above, the speech and language pathologist (SLP) will assess the child through different age appropriate tests. After which the SLP will be able to provide parents a clinical impression and help design an individualised plan to meet the child’s needs/delay areas. More importantly, the SLP will work closely with the parents and other professionals for the child’s holistic development to ensure effective intervention in delayed areas.

Why is early intervention important?

Studies have shown that the first 3 years of a child’s life is where his/her brain develops and matures intensively. This is the phase wherein he/she acquires most of his speech and language skills.

The Center on the Developing Child at Harvard University (July 2011) provides a summary on the research which focuses on the critical role of a child’s earliest experiences on brain development:

• Neutral circuits, which create the foundation for learning, behaviour and health, are most flexible or “plastic” during the first three years of life. Overtime, they become increasingly difficult to change.
• The brain is strengthened by positive early experiences, especially stable relationshipswith caring and responsive adults, safe and supportive environments
• Early social and emotional development and physical health provide the foundation upon which cognitive and language skills develop
• High quality early intervention services can change a child’s developmental trajectoryand improve outcomes for children, families and communities
• Intervention is likely to be more effective and less costly when it is provided earlier in life rather than later

Effectiveness of treatment and prognosis for children with speech and language deficits vary from child to child. However, studies have shown that children who have developmental speech and language delay and received early intervention/therapy have better prognosis, with therapies proven to be effective in developing normal speech in children, by the time the child reached the age of primary school entry. For children with receptive and/or receptive language disorder, active intervention is necessary as this problem is not self-correcting. Children with speech and language problems secondary to Autism spectrum disorder also benefit from intensive, early intervention that focuses on communication. Parents should understand that they play a major role in providing intervention and integration of therapy at home for their child with speech and language delay. It is also important to note, that consistent follow-up and support are needed for the therapy to succeed and monitor progress in children with speech and language delays.

References:

1. American Speech-Language-Hearing Association (ASHA). How does your child hear and talk?asha.org
2. NIH (2014). Speech and Language Milestones. nidcd.nih.gov/health/speech-and-language
3. McLaughlin, Maura R. (2011). Speech and Language Delay in Children aafp.org
4. Goode, S., Diefendorf, M., Colgan, S., (2011) The Importance of Early Intervention for Infants and Toddlers with Disabilities and Their Families
5. Stages of Speech and Language Development. www.talkingpoint.org.uk