When to seek a speech therapy evaluation for your late talker, and what to do at home

One of the most exciting and crucial milestones children achieve is their first word. We cannot wait for the day our child begins to express themselves, tell us their wants/needs, and explore the world around them with the gift of communication. Language milestones are important for not only communication but academic success and forming relationships with others, however, some of these communication skills emerge later than expected. We call this, Late Language Emergence or LLE. It is important to identify the red flags and know when to seek therapy, but also to identify your child’s communicative strengths, and incorporate language development strategies in your child’s everyday activities. 

According to the American Speech-Language-Hearing Association (ASHA), prevalence estimates of Late Language Emergence (LLE)  in 2-year-old children primarily range between 10% and 20% (2021). In 18- to 23-month-old toddlers, the percentage of late talkers is estimated to be 13.5%. This rate rises to 16%-17.5% in 30- to 36-month-old children (2021).  Children with few words spoken between 18-30 months are typically considered “late talkers” (ASHA, 2021). Although these children have the potential to catch up, especially when they have a good understanding of language as well as appropriate play and social interaction, it is important to identify the red flags to determine if your child needs a speech therapy evaluation. 

Common red flags that persist after 18 months associated with late talkers, include limited babbling or jargon (“baba, gaga”), lack of word imitations, e.g. “buh” for “book,” limited use of early consonant sounds (/m/,/ b/,/p/,/t/ etc.), and limited use of symbolic gestures (pointing). Another common red flag for late talkers is a history of middle ear infections, as hearing plays a large role in our ability to hear spoken language which gives us the foundation for language use.  If your child is demonstrating any of these behaviors characteristic of LLE, it is important to seek an evaluation from a speech-language pathologist

However, before we become worried that our child is not communicating with words, it’s important to identify ways in which they are communicating. We use several different modalities to communicate without words every day. If your child is demonstrating some or all of these characteristics of a late talker, it is important to identify and embrace how they are communicating at this part of their personal development. Some key nonverbal communication methods include pointing, manipulation (e.g. bringing your hand to the desired object), eye contact/ gaze shifting (using eye contact to share what they are thinking about), joint attention (sharing experience of toy/ object with shifting eye gaze of person to object), as well as sign language. Common signs used for late talkers include “more, help, all done”. 

Speech therapy plays a large role in developing language; however, parents and caregivers play the most crucial role in language acquisition. Some great ways to get your child talking include providing opportunities to practice and hear rich language models all day. Daily routines are an excellent opportunity to promote language skills through use of familiar actions and words, for example, at bath time you can describe what your child is doing using words such as splashing, washing, swimming, pop, bubbles or phrases such as put on pjs,  brush teeth,  dry hands, etc. when getting ready for bed. Singing is another way to promote vocalization, play, imitation, understanding of  intonation changes, comprehension, and language development.  At the same time, it is important  to remember that as much as we want to bombard our child with language, we don’t want to use too many questions. A good rule of thumb is 3:1, which is for every one question you ask, provide three comments. This allows the child time to respond with verbalizations or approximations. Another tip to consider is acknowledging a child’s nonverbal communication such as signs or gestures as valuable communication attempts. 

Aside from daily routines, the other major activity for language development includes play, play, and more play! This is a little one’s full-time job. It is important to dive into their world and let them lead while making it exciting and interactive. This may include modeling sounds of toys, e.g. “choo choo” when playing with trains to encourage vocalizations and words. Books are another great way to strengthen the receptive and expressive language. Look through pictures and talk about them. Don’t be afraid to re-read their favorite books, as this allows them to anticipate the endings and fill in words and phrases. Book reading also allows children to match the inflection and rhythm (natural rise and fall) of your voice. Similarly, modeling is one of the most effective ways to help your child learn the language. Some children may begin to approximate words, such as “bah” for the bottle. If you hear these approximations, model the correct and full word over and over. Repeat the word or phrase over and over for your child to hear and allow the child to see your face for this visual model for correct production of the word, as this helps them see lip or tongue placement.  Additionally, giving your child choices is a great way to foster communication. For example “cookie” or “cracker”. Allow time for your child to make a verbal response or gestural response. Finally, one of my favorite and most effective therapeutic techniques is “planned sabotage”. This tool promotes communication opportunities by structuring the environment around opportunities to use language to request. This can be done at home by creating enticing opportunities such as placing desired objects out of reach on a shelf, or in a box. Additionally, modeling the request may have a positive effect on encouraging communication. 

When it comes to language and communication, every child may have their own burst of language development. Fostering language in a child’s environment and daily activities is one of the most effective ways to maximize language development. It is important to identify the strengths of our tiny communicators in order to maximize their ability to participate in meaningful interactions by expressing their wants, needs, and ideas, while simultaneously understanding red flags in order to determine the need for early intervention. If your child is demonstrating any of these red flags, we encourage you to seek an evaluation from a licensed speech-language pathologist. 

References:
American Speech-Language Hearing Association (ASH) Late Language Emergence. (2021). Retrieved 2021, from: https://www.asha.org/Practice-Portal/Clinical-Topics/Late-Language-Emergence/
Custom Sign Language ASL Flashcards. (n.d.). Retrieved 2021, from https://www.etsy.com

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