Not Talking Yet?

How Do Parents know if Their Child is at Risk of Having Speech and Language Impairment?

My child just needs more time to learn.

My child can understand whatever I say.

My child is lazy. When asked to repeat what I say, he/she won’t do it.

Boys speak later than girls. My child is just being a boy.

Does my child need speech therapy?

As parents, it is hard to know when to raise the red flag. Many well-meaning people will offer their opinions and assure the parents that their child is alright. But how do parents know if their child is delayed within normal limits or may be having speech and language impairment?

Here I would like to address a few common misconceptions.

My child is a late talker. He will grow out of it.

Parents must remember that no one can determine who is a late talker and who has developmental delay in speech and language in the early stages.

Late talker is defined as a child whose speech is not developing as much although he/she is able to understand much more. Late talkers can only be applied to children aged between 1½ to 2½ years old. However, late talkers will be able to catch up to their peers by the age of 2 ½ years old.

The only way we can identify whether a child is indeed a late talker is to wait till he/she is 2 ½ years old. But for some children, it could mean a loss of time and more to catch up to their peers later.

My child can understand whatever I say.

Parents need to identify whether it is situational understanding or understanding of the words. Situational understanding is where the child understands the instruction based on environmental cues.

For example, if we tell a child to wear his/her shoes as we open the door, the child may understand based on situational understanding. If the child wears his/her shoes without the parent opening the door or pointing at the shoes, then he/she may understand the word ‘shoes’.

Children who depend on situational understanding are more likely to be able to perform only common everyday instructions and have difficulties with unfamiliar or complex instructions.

My child is lazy. He doesn’t want to learn to speak.

No child is too lazy to speak. In fact, speaking is the easiest way to communicate. Which is easier for a two year old child? Go to the parent and say ‘susu’ or pull the parent towards the cupboard where the milk powder/bottle is kept, point at it and hope that the parent understands what he/she wants?

Children start to imitate words from between one to 1½ years old. Some children may acquire first words by one year old. Some children may only acquire first words at 1½ years old. However, if a child is still pulling the parent or pointing instead of trying to use spoken words by age two, parents should raise the red flag.

Boys speak later than girls.

While it may be true that boys tend to produce first words and sentences later than girls, the difference shouldn’t be more than a few months apart. Both boys and girls still follow the typical development where boys’ speech and language development is still within the normal range.

Therefore, if a boy has no words yet or is only speaking single words and not using sentences at three years old, parents should not think that it is normal just because the child is a boy. The child may be having some speech and language difficulties.

My child can say some words. He can’t use sentences yet but it is okay as long as he can speak.

It depends on how old the child is. Children start to put two words together from 1½ to two years of age. At this age, they would have a vocabulary of at least 50 words. If the child is still at one word level after the age of two, it is a sign that the child may be having difficulties.

To be able to combine words, a child needs vocabulary from various categories such as nouns (mummy, ball, cat), action words (eat, sleep, play), adjectives (big, dirty, wet), preposition (on, under, in).

Some reasons why children are unable to use sentences:

• Not enough vocabulary (vocabulary size of less than 20 words)
• Vocabulary consist of words from one category only, usually nouns
• Doesn’t have internal grammar structure
• All the above are red flag signs for children older than two years old.

We use more than one language at home. My child may be confused, that’s why he is not speaking yet.

Bilingualism/multilingualism is not a cause of speech delay. Although a bilingual child may have less vocabulary in one language, but he/she can have the same amount of vocabularies in different languages as that of a monolingual child.

If a child’s speech and language is not developing according to typical speech and language development, the child may be having risk of speech and language disorder.

My older child is a late talker but now he/she is doing well. My younger child could be the same.

No two children are the same. No two children develop at the same pace. So it is very hard to compare two siblings and assume they will be the same. Parents should check their children’s development stage to find out if they are following the typical development.

If the younger child is slower in development but is within normal limits, it should not be a concern to the parents. However, if the child is lagging behind by more than six months in typical development, professional help should be sought.

Red flags at different ages:

Two years old

• No first words yet
• Vocabulary size less than 50 words
• Using one word phrases
• Points or uses gestures more than using words
• Very slow growth in new vocabulary (fewer than 20 new words a month)

Three years old

• The signs above
• Not using sentences (three to four word sentences)
• Not able to answer simple ‘what, who, where’ questions
• Parents are not able to understand what child says most of the time

Four years old

• The signs above
• Not able to answer most questions asked
• Not able to tell simple story
• Strangers are not able to understand what child says

Five years old

• The child should be speaking like an adult

Seek professional help as soon as possible if you think your child may be at risk. The older the child is, the bigger the gap will be, and the more the child has to ‘catch up’ to. Early intervention helps.