It’s normal for children to acquire speech and language at different rates — just as they learn to walk at different rates. But if you feel your child is having more trouble communicating than she should, don’t ignore your concerns. Early understanding and expression of language can affect other parts of your child’s development such as play skills, social interaction and the ability to self-regulate.
When should you request an evaluation? Drs. Carol Wilkinson, of Boston Children’s Division of Developmental Medicine, and David Urion, of the Department of Neurology, offer their advice and 10 tips on things to watch for.
- Don’t wait too long: It’s true that children start to talk at different ages, but you should see steady progress over time. If you’re concerned about your child’s language development, don’t wait beyond the 18-month visit to bring your concerns to your pediatrician’s attention. Early intervention services, such as in-home speech therapy, are available in many states, but setting up these services takes time.
- Social interactions: The first form of communication for most children is social. Before six months of age, babies should be interested in their parents’ faces and have a social smile. By 1, they should respond to the sound of their name. Before speaking their first words, they should be able to point or gesture at things they want, to look at their mom or dad for reassurance and to share their joy (about a new toy, for example). Let your pediatrician know if you’re not seeing these kinds of things. An evaluation for autism may be helpful.
- Is your child understanding? It’s natural to focus on a baby’s first words; picking up on problems with receptive language development can be harder. Many children use visual cues around them to figure out what is being said, so problems understanding language may not be noticed right away. In preschool-aged children, behavioral difficulties or anxiety are sometimes a red flag for a language problem. If you see troubling signs, talk to your pediatrician about having a full developmental evaluation.
- Check hearing: Sometimes hearing impairment can slow a child’s language development. If your pediatrician is referring your child for further language evaluation, ask for a formal audiology evaluation as well.
- Your home environment: Long before your baby starts talking, you and your family members can enhance learning by creating a language-rich experience at home. Talk and sing to your baby during everyday activities, read to her every day, and put her nonverbal signals (gestures, crying) into words for her. Any live, interactive language — chatting, talking, reading, singing — is more beneficial for language development than video programs. The variation in tone, content and context seem to make the difference. TalkingIsTeaching.org provides many helpful ideas, and Kinsteps.com sends free text messages with language-promoting activities.
- Language loss: If your child loses a language capacity she once had — for example, if sentences and phrases become shorter— ask for an evaluation by a specialist. The same is true for loss of social behaviors such as eye contact, turn-taking and understanding tone or facial expression. These are warning signs that bear investigation.
- Hitting a plateau: Children’s language development occurs in a step-like fashion — periods of rapid growth followed by a period of solidifying the new skill and then another period of growth. If this process seems to stall out, ask for referral to a specialist. Has your child acquired no new words for several months? Are her sentences not getting longer and more complex? Does an older child having trouble understanding figurative language (phrases like “you’re pulling my leg”)?
- Sleep problems: Certain disorders of sleep can interfere with children’s cognitive development, including language development. In particular, if a child moves his legs constantly in his sleep, or tells her parents during the day her legs feel “jumpy,” evaluation by a specialist is usually wise.
- Bilingual households: Children raised with two languages sometimes start talking slightly later than other children. However, studies have consistently shown bilingual children still begin talking within the normal range (usually between 8 and 15 months) and meet language milestones on time. Be aware of your child’s progress in both languages, so you better understand her full ability. Again, if you have concerns, don’t wait to bring this up with your doctor.
- Relatives with language problems: If language problems seem to run in your family, consider asking about having a genetic analysis done. It may not change any interventions, but it could give you a better sense of what your child’s trajectory might be based on the experience of children with similar genetic findings.