Friday, June 15, 2012

Speech and Language-- What is Normal, and When To Worry?

Development has a range of normals, and it is difficult for parents not to compare their kids with others (advanced or slow).  Parents worry but are often afraid they are over reacting or under reacting, since there is such a wide range of normal.  Don't be afraid to ask questions and discuss your concerns.  Avoiding the issue or minimizing your concerns doesn't help your child.  Keep a log of what your child can do at regular intervals to help you keep it all in perspective.  Before your child's well visits is a great time to review your list because you know we'll ask!

Speaking early or late does not necessarily mean a high or low IQ, so no bragging or worry is due (as long as the late talker is still in normal range).  Many parents jump to the conclusion that a child who doesn't talk by ___ months (this varies) is autistic. But they forget that Dad didn't talk at this age either, and he's perfectly normal!

Do we need to screen for autism? Yes!
Is it the most likely answer? No!
Do we need to evaluate speech and language frequently in the critical first 3 years of life? Yes!

We question communication skills at all well visits at this age to be sure your kids are on track. Early recognition of a delay can start the process rolling for further evaluation and treatment.  Speech and language are two related but different things. Speech involves the sounds that we make with our mouths. Babbling is an early speech. Language involves the meaning of words and the use of words.  Both are part of communicating with the people around us.  If kids miss the important milestones it can signify a problem.

Speech and/or language delay is very common and has many causes.  It is difficult for parents (and pediatricians) to identify severity of the issue or the exact cause much of the time.  Any red flags to speech and language delay deserves further investigation.  Some of the underlying problems include:

  • genetics - some families tend to have many members who were late talkers, other genetic disorders are known to cause speech and language problems
  • bilingualism - more than one language spoken at home
  • maturational delay - the kid that always seems to get there, but takes a little longer
  • learning disorders or mental retardation - delayed speech and language might be the first sign of a learning disability or low overall IQ
  • stubborn child - needs no explanation!  
  • autism - autistic children do not communicate with others on many levels, not just words
  • deafness or hearing loss - this is why we screen all newborns and at risk children as needed, frequent ear infections can decrease hearing temporarily
  • psychosocial deprivation - if no one talks with or interacts with a child, they will not learn
  • other neurologic and physical disorders 

Sometimes I think we just miss what they're saying, since early words are not recognizable.  My general rule of thumb: 2 out of 4 words will be understood by strangers at 2 years old, 3 out of 4 will be understood by 3years, and 4 out of 4 words should be understood by a stranger by 4 years.  If you are new to listening to your child talk at 12, 15, 18 months, you will not understand most of their words and take it for babbling.  Just watch the expression on their face and hear the intonation in their voice: They know exactly what they are saying!

Normal milestones include:

2 Months:
  • Social Smile (not just gas, but really looks at you and smiles!)
  • Watches your face
  • Startles with loud sounds
4-6 Months: 
  • Cooing and babbling
  • Turn to sounds
  • Blows "raspberries" and makes cough or grunting sounds as a game
  • Laughs and squeals
  • Begins to hold objects, stare at hands, and put things in mouth
9 Months:
  • Repetetive sounds, such as "da da da"
  • Imitation of sounds without meaning
  • Makes sound to get attention
  • Understands "no" (but doesn't always follow that command!)
12-15 Months:
  • Understand several common words spoken to them
  • Follow a simple command, such as "get the ball"
  • Can say about 5 words
  • Looks at something someone is pointing at
  • Most words are not entirely clear, the beginning or end of the word might be dropped. "Ba" can mean "ball" or "bath" ~ you have to use context!
  • Point by 15 months
18 Months:
  • Can say 10-20 words, again most are not clear!
  • Can recognize many words that are used
  • Able to point to objects in a book and name them
24 months: 
  • 2 word sentences
  • 50+ word vocabulary, one or more new words a week!
  • Able to use plurals 
  • Able to repeat what they are told (depending on mood!)
30 months:
  • Knows one color
  • Recognizes some letters
  • Names 6 body parts
  • Can say words with more than 2 syllables 
3 years:
  • Speaks in more complex sentences of at least 3 words
  • Able to use pronouns
  • Can speak in past tense (but doesn't always use "tomorrow" or "yesterday" correctly)
  • Commonly stutters, not a problem if less than 6 months duration
  • Very imaginative!
  • Unfortunately learns to lie (He did it!)
If you have concerns about your child's hearing, language, or speech, bring it to our attention.  We might alleviate your unnecessary worries (Brother isn't talking as much as Sister did at this age, but he is in the normal age range) or we might help you find resources for further evaluation and treatment. 

References and For More Information:

Healthy Children
Kids Health
Language Express
Parents As Teachers

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