My Toddler Isn't Talking!!! What do I do?
I have been approached more times than I can count by concerned parents who have a 1-2 year old and are concerned about their speech progress. I'm always excited when parents come ask me questions, because it gives me a chance to let them air some of their concerns and also to give them some comfort and guidance. Every parent I know wants the best for their children and not speaking or learning to talk slower than peers is very concerning. When I am approached, I ask a few questions to ascertain the child's progress and compare it to developmental norms.
The first thing I always ask is, "How many words do they have?"
Children should start speaking around age 1 (some speak a little earlier, some speak a little later, but it averages to 12 months). By age 2, children should have 50 words and begin putting 2 words together to form simple sentences (for example, "more juice" or "mommy walk"). At 3, children should be using 3-4 word sentences and have approximately 1000 words in their vocabulary.
Secondly, I ask, "What percentage of the time can you understand them?"
By age 2, your child should be at least 50% intelligible. All children babble or use jargon (groups of sounds strung together that sound like words with intonation, but aren't really words), but by age 2, someone who has never met your child should be able to understand half of what they say. (By 3 that intelligibility increases to 75% and by 4, 100%).
Thirdly, I ask, "Can your child follow simple 1-2 step commands?"
At 18 months, a child should be able to follow simple 1-step commands (for example, "pick up the shoe"). By 2, however, your child should be able to follow 2-step commands (for example, "pick up the block and put it in the toy box"). At 3, a child should be able to follow 3-step commands (for example, "pick up the shoe, put it by the front door, and come back here").
Lastly, I ask, "What have you already tried?"
Perhaps not so surprisingly, answers vary widely here. Some parents have tried everything from reading every day, talking all the time, using flash cards, singing songs, teaching sign language, and using pictures around the house. Often, others are so overwhelmed they don't even know where to start and haven't done anything and don't know if they even should do something.
My number 1 recommendation is READ. Read everyday. Read all the time. Read to your child. Talk about the pictures. Make funny animal noises when you read about animals, act out stories like the three little pigs or Goldilocks, do crafts with the characters in the story, eat green eggs and ham. Reading is the only research-proven method to increase vocabulary in children. Again--Reading is the only research-proven method to increase vocabulary in children. No matter how many flash cards you try, your child will not learn as much as quickly or as effectively as if you read. For more information and ideas of how to teach vocabulary while reading, see the references at the bottom of this post.
I also tell parents to TALK. Talk all the time. Talk about everything you're doing. For example, if you're making dinner, narrate what steps you're following. "Right now I'm cutting the tomato. Tomatoes are so lovely and red. I love tomatoes. They are delicious. I have to be careful with the knife when I'm cutting. Now the tomatoes go in the bowl." There are two kinds of "vocabulary-building" speeds your child uses: slow-mapping and fast-mapping. For fast-mapping a kid can hear a word 1 or 2 times and remember it and use it correctly. For slow-mapping, a child needs to hear the word 30 times to remember it and use it correctly. For a child who is slower (for example a child with a language disorder) that child will need to hear the word 100 times or more to remember it and use it correctly. If you narrate what you're doing just like the example, you have used the word "tomato"4 times. That means if your child is "slow-mapping" their vocabulary you'll need to say it 26 more times. Repetition is how kids learn so get ready to repeat, repeat, repeat. You'll feel like a crazy person talking to yourself, but your child will be able to really soak it all in.
Lastly, I often tell parents to SABOTAGE. Your child has favorite things. All children do. Whether it is goldfish, Thomas the Tank Engine, or bubbles, your child has some favorites. Communication is all about using language to get something you want.
If your child's favorite things are easily accessible it's time to put them out of reach and require your child to ask you for them. The official therapy name for this strategy is "withholding." For example, if the goldfish are currently on a lower shelf, put them on a higher shelf so you have to get them instead of your child helping themselves. You are withholding something your child wants until they can ask for it. If Thomas is on the floor, put Thomas in a rubbermaid bin that your child cannot open by themselves and have them ask you to open it. We use this strategy a lot in therapy and I've seen kids make huge strides. If your child is not talking at all, start with having them point or bring the bin to you. After a few weeks of that, move on to grunting. After that, move on to using a single word (train, fish, etc.). Soon, your child will realize that in order to play with the bubbles, they must ask you--they learn that communication is key to getting what they want.
When your child has improved in asking for items, you can start to sabotage situations to require them to ask for more things. For example, if your child loves Goldfish, start by giving them 1 instead of the 10 you usually give them. They will have to ask for more. If your child loves bubbles, give them the wand, but keep the bubble solution so they have to ask for more. You can "lose" items, you can withhold parts of items, you can give them items that don't work, you can give them items they didn't ask for, etc. All of this sabotage has one goal: communication. A little frustration can help your child realize that they must communicate with words to get what they want.
One final note: Many parents ask me very specifically about sign language. Sign language is a fantastic tool for learning spoken language. My personal advice is to teach specific words. For example, don't teach the word "more." Instead, teach the words for what the child might want more of (cracker, juice, blocks, cars, etc.). When you generic words (like "more") your child will learn that one word will get them all kinds of things. The sign for more will get them crackers, pancakes, juice, cars, etc. If you teach the child specific signs though, you are giving them a chance to build and expand their vocabulary and teaching them that they must use a specific word to get what they want.
If you have any concerns about a child who does not meet the developmental norms we talked about in the beginning, do not hesitate to get an evaluation from a speech language pathologist. Early intervention can work wonders and can eliminate or diminish many speech and language disorders. For every $1 spent in Early Intervention, you will save $7 in later therapy, so never be afraid of getting an evaluation to ensure that your child receives the most effective, efficient therapy available to them.
References
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