When to Worry About Your Child's Speech
Speech-language development begins long before a child utters his first word. By knowing what is normal — and when to seek help — you can support a lifetime of effective communication for your child.
Although communication begins at birth, the earliest consistent signs of communication are evident around 6 months. Eye contact, smiling, laughing and cooing are important, as is reciprocity, according to Elizabeth Crais, Ph.D., professor and coordinator of graduate studies in the UNC-Chapel Hill Division of Speech and Hearing Sciences.
"Parents often tend to focus on their child's speech, but communication encompasses much more than saying words," Crais says. "Cues of your child's comprehension, how your child plays, socializes and imitates you, are all important skills that we look at as well."
A child's rate of speech development is as unique as he is. Crais provides the following general guidelines:
In general, before 12 months, a child should progress from babbling to intentional sound-making (word approximations, early words, etc.), reaching for objects, giving things to you, and pushing other things away.
Between 12 to 15 months, you should hear your child's first words. By 15 months, gestures — like pointing to show you things or to capture someone's attention — are good markers that his speech development is progressing well. Once your child starts talking, his vocabulary will start to increase and he will start putting words together to mark possession (e.g., "my doggie," "daddy's sock") or negation (e.g., "no cookie," "no to eat).
By 18 to 24 months, your child should be putting words into short sentences: "Doggie eat," "Mommy go." He should also have the ability to follow a two-step command: "Go into your room and bring me a sock."
The causes of speech and language delays are often unknown. However, Diane Brinkerhoff, speech-language pathologist with Project Enlightenment in Raleigh, says parents should be especially diligent if their children are born prematurely, have early feeding problems or have had multiple ear infections, and/or do not exhibit a lot of eye contact — especially gazing into your face for smiles and feedback about loud noises, new people, etc.
Other causes for concern include little or no response from your child when you initiate communication (gestures, etc.), children who are not walking or using single words by 15 to 18 months, children who are not using two-word combinations by age 2, or children who seem to be behind their peers with regard to speech-sound development (unclear speech, struggles to form words, or can only produce a limited range of sounds).
North Carolina Early Intervention Services will provide access to speech-language development evaluations for children up to age 3. Evaluations are available through an interagency system called Together We Grow. If your child is recommended for additional therapy, EIS is obligated to provide these services to families without private health insurance.
Children 3 years and older can be evaluated through the public school system, even if the child attends private school. As part of the Wake County Public School System, Project Enlightenment offers free developmental screenings of speech, language and learning skills for Wake County children, 3 to 5 years old.
The criteria for receiving an evaluation in the school system depends on the degree of the speech or language delay, according to Crais. "There are many ways to address speech-language development in children. I prefer natural environments [home, school] and working with people who interact with the child [parents, teachers, caregivers], rather than in an isolated intervention," she says.
When to seek help
Experts agree that parents should seek professional advice about their child's speech-language development as soon as possible. "If a parent is concerned, there's a reason, so don't hesitate to ask for help," Brinkerhoff says. "A
child has so much learning to share with you — so many thoughts, feelings and ideas — you don't want to miss out because you are unable to communicate with him. Make the call and schedule an evaluation."
Mutual frustration was the tipping point for Raleigh parent Anne Meulink and her son. Shannon did not start talking until age 2, and then his older sister was the only one who understood him.
"She'd translate for him," Meulink says. "He wasn't old enough to grasp the concept of changing his words to clarify what he was saying, so when I asked him to repeat himself, he would repeat what he had said, which I could not decipher, and we both became increasingly frustrated. That's when I knew we needed help."
Shannon's preschool invited a Project Enlightenment counselor to observe him in his 3-year-old class, and he was recommended for speech therapy. He received services through Project Enlightenment, and then Wake County Schools, until the middle of first grade.
"We noticed small improvements early on and it was wonderful to finally be able to communicate with him," Meulink says. "Project Enlightenment's early intervention was key to Shannon's success. We are a middle-class family, and it would have been difficult to afford private services for him," she says.
Although Shannon's speech therapy ended in first grade, he struggled in school. "He was bright, but his handwriting was poor and he wasn't on grade level in reading," Meulink says. Several years of private tutoring and additional support from teachers were needed to keep Shannon on track. Now, at age 12, "he is an A/B honor roll student and you would never know he ever had a speech delay," Meulink says.
The Meulink family's experience illustrates the importance of early intervention. "Some things are too important to 'wait and see,'" Brinkerhoff says. "Delays in speech and language development often affect other areas as your child grows. It's best to trust your instincts and seek professional advice sooner, rather than later."
Maria J. Mauriello is a freelance writer, communications professional and the mother of two children. She lives in Raleigh.
North Carolina Early Intervention Services www.ncei.org/ei
For information about stuttering:
National Stuttering Association
The Stuttering Foundation
Seeking assistance for stuttering
Caron Lye, a speech-language pathologist and Durham parent, took her own advice when her 3-year-old son started stuttering. "If a parent is concerned, I tell them to have their child screened, so that's what I did," she says. Six months later, after Lye consulted with a speech-language pathologist with stuttering expertise, her son is "doing great. He's very verbal and loves to talk," Lye says.
Most children go through some period of disfluency in their speech, usually between the ages of 2 and 6. However, approximately 5 percent of all children experience a sustained period of stuttering that lasts six months or longer, according to the Stuttering Foundation of America. Three-quarters of those children will recover by late childhood, but it will be a long-term problem for about 1 percent.
Lye encourages parents to seek skilled intervention early on. "Stuttering is a complicated, multifaceted communication disorder, so it's important to find someone who has extensive experience treating it," she says.
"Early intervention is important. If you wait for your child to outgrow stuttering, you could be missing critical therapy time."