1. My son is a two year old and doesn’t say any words. The pediatrician and my husband say that that is normal
Research has shown that by 12-18 months, children display certain abilities that allow them to communicate in their own environment. They can respond when we tell them to identify body parts (head, hands, mouth, nose); they can follow simple commands like “clap your hands”; they use words to request familiar items like “teta/milk”, ball, baby”; they can request a repetition of a desirable activity by saying ”more”. Children at this age also engage in imitating sounds of animals, attempt to repeat sounds and syllables from songs; say at least 15 words and some children even start combining two-words around 18 months.
So, if a child is not showing some or majority of the previous mentioned skills, I will consider prudent to look for a speech-language assessment to determine if in fact there is a language delay, or if the child is at risk of a language delay.
Probably the pediatrician or the primary physician has told you to wait and has told you that not producing words at that age is normal but my professional opinion is you should look for a professional assessment of your child’s communication abilities. I don’t want to create any obstacle in the relationship with spouses, but moms you can review the milestones I previously mentioned and make a more educated decision. Children might develop differently but there are some commonalities they follow at certain ages.
2. My son is two year old and he communicates only using gestures, and he tries to say words but they don’t come out
This has been a frequent concern that parents bring to me. I usually start asking if they have observed a gap or difference between the levels at which the child can understand/comprehend language vs the level at which the child can communicate using words. Frequently, not always, the answer is YES.
Here is important to review some milestones children achieve with regards to their speech capabilities. Usually, by 9-12 months, we expect children to produce frequent consonant-vowel (CV) syllables in vocal play when they are interacting with caregivers or toys. Around 12-18 months, children can produce a variety of consonants and most of the vowels which provide them with the foundation to produce words like “bo/boat, ca/car, go, etc.” They start using some simplifications to produce the words but they rapidly increase the amount of consonants the can produce and start varying the location of the sounds into the words. Around 24 months, the child will not simplify words like “boat” any more. So, when I see a child that at 18 months is not producing bubbling (mama, dada, baba) or non-reduplicated bubbling (bamama, badada) or attempting to simplify words (wawa/water), I immediately check my box of red flags. If also I find that mom describes the child as a quiet baby and with a limited vocal play I will recommend a full speech-language evaluation by an SLP with no doubt.
If the child does not say his/her first words around or at 15 months, he or she is already a late talker. That is a fact based on what research have found and based on the typical speech-language development for majority of the children.
3. I speak to my child but he seems not to pay attention to me; it seems like he doesn’t obey me. Should I look for help?
Here also is important to briefly review some information about how babies and children begin building relationships with their caregivers; this is going to give us some ideas about what to observe in our children and also about the appropriateness of looking for a professional assessment. Children follow some functional developments in diverse areas of development since birth. Most, if not all of the developmental capacities are initially based on the interaction babies and children have with their environment.
Very early in life, children show interest in all the sensations of the world. They start looking, listening, moving and even calming down. Very soon, the baby starts showing interest in the world of human relationships (the parents) and it is right there when the exchanges of smiles and love begin. Child and parent start enjoying that dynamic and when the baby realizes what he does indeed has an impact on the parents (i.e.g., baby smiles and Mommy smiles back), the interaction becomes more complex, and real communication begins. Then, in the back and forth of the communication, gestures emerge and the child realizes he can link those gestures into more complex responses. For example, if a child sees a mom after an absence, she/he can run to her, put her arms up and squeal with delight. (Greenspan, 2006).
By 12-14 months we expect the child be interested in interacting and knowing how the protocol of an interaction looks like based on what I mentioned above. At this age, children also are expected to show interest in interacting, be able to follow simple commands (i.e., come here while mom extend the hands), understand other common words like “give me, bye, blow a kiss”, extend their hands to show an interest, point to desired objects, respond to his name, look at objects or people the caregiver points to and names, follows simple-familiar commands at home, understands familiar phrases for daily routines, among others.
If a young child seems not to pay attention to the adult when he/she talks to him, does not respond to his name consistently, seems not interested in having a very close relationship with the parents, definitively parents/caregivers need to consult with the pediatrician or PCP. First, it is necessary to rule out any dysfunction in the hearing path (i.e., otitis media or any type of hearing loss). Once that dysfunction is treated or r/o, parent should continue to monitor child’s behavior with regards to child’s communicative response (see above mentioned behaviors) and ask the Dr. to refer the child for a consultation with a speech language pathologist.SLPs are experienced professionals in assessing and treating any communication difficulty in children.
4. My child doesn’t speak much. Is it possible that my child is confused because he/she is exposed to two languages (English and Spanish)?
Language confusion is a popular belief in that children are incapable of becoming bilingual without experiencing confusion (Guiberson, 2018).
There is a model called CUP (Common Underlying Proficiency) that states that development in any language contributes to general linguistic development regardless of the language in which it occurs (Cummins, 1981). This model explains that there is a positive interdependence between languages, so language development in any language supports general language learning.
Guiberson, M (2018) reviewed some research that refute the concept of language confusion. With regards to infant processing skills, researchers have found that toddlers and children have the capacity to differentiate languages. For example, toddlers’ responses are different when presented with phonemes/sounds of his/her native language and a foreign language (Conboy, 2012). Also, studies have found that bilingual toddlers-age children adequately separate and use their language appropriately with monolingual L1 and L2 speakers. In addition, studies have also found that when children mix L1 and L2 into sentences, it is not because they are having difficulties differentiating the two languages. On the contrary, it occurs because the children are able to represent the distinct features for each language at a very early age (Petitto & Holowka, 2002). Code-mixing, indeed, has been described as a normal bilingual behavior. In older children, studies have found that children use what is called cross-linguistic transfer; children are capable of coordinate and exchange information across languages. For example, they can transfer skills from L1 to L2 when dealing with phonemic awareness tasks, or other linguistic tasks.
In conclusion, L1 an L2proficiency (or skills level) depend on the exposure and support children have for each of the languages. (Guiberson, 2018).
5. My child likes/prefers to play by himself most of the time. Should that be a concern?
Play is such as powerful activity in the life of a child. It serves as a mean of expression of the mental representations of the world the child has in his mind and also it serves as a mean of interpretation (Westby, 2000). It is, one of the most important ways and means the child might experience to learn about objects, their functions, events, how objects and people relate, how objects relate to one another, etc.
Play and language are closely related and somehow intertwined in most children. Through play, children learn rules of the world, social rules their cultural group might have, learn how to be more competent in his communication skills, learn how to use the knowledge they have about objects, learn how other people think and feel, learn how to negotiate, learn how to resolve problems, learn how to grow with some emotional distress, learn how to talk in sentences about the relationships between people and objects, etc. Let’s briefly review the path play follows in the first two-three years to understand how it happens.
Initially, around 8-12 months, children just explore moveable parts of toys and discover how they work. Around 18-19 months, the child begins to understand how to interact on the objects becoming himself the agent of the action. For example, the child pretends to eat with a spoon. At 19-22 months, the child starts performing pretend actions on more than one object or person. For example, child feeds doll, feed mom, etc. Around 24 months, the child starts reversing roles in the pretend play. He realizes others can be part of the play and he realizes he needs to be able to develop the theme he has in mind. For example, “I feed you and you feed me” (when playing with kitchen items, for example). That interactive pattern grows and around 30 months is when children begin to talk to dolls or other participants and assign roles in the play. For example, if they play with the Dr’s kit, he child might assign a role as to who will be the patient and who will be the Dr., also the child may plan an outcome for the pretend play.
The conclusion is obvious, a child who “prefers” to play by himself/herself is missing a great amount of opportunities for developing a more appropriate language, communication, emotional, cognitive, motor, and social skills. BUT, when a child plays by himself or herself, it is necessary to respond to the why of that behavior. Speech language pathologists are the professionals that could guide the parents in the process of finding the answer and they also be part of the team of professionals if necessary to help the child and the family to have a better outcome.
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