A reader named Andrea posted this series of questions on Friday. Her questions are so similar to those most parents ask that I thought I should respond for everyone to read.

“My 18mo son is not talking as well as my 4yo daughter did at this same age. She was a babblemouth and he doesn’t seem to want to talk at all. I have expressed my concerns with our pediatrician and was told to not be concerned. Family members don’t seem to be interested in the subject at all. I have a few questions for you and I hope you don’t mind. Why should I be concerned about my child learning to talk at a late age? Do all children who start talking at a late age fall behind in school? How can someone tell the difference between a late talker who will catch up on his own, and a child who is not talking and is at risk for later difficulties? If my child is a late talker who will catch up on his own, then he will not need help from a Speech Language Pathologist, right?”

In order to be as thorough as possible, I am going to try to answer eachof your questions separately.

“My 18mo son is not talking as well as my 4yo daughter did at this same age.”

First of all, there are gender differences between boys and girls and as well as differences between first and second born children, and I think you are seeing both of these dynamics in your family. Overall, boys are more likely to talk later and/or have other learning challenges than girls. However, the developmental norms that experts use (including those used here on this site) consider gender differences and use those to devise the “averages” or “norms.”

Many psychologists that study birth order also note that first-borns are likely to be more verbal and are verbal at an earlier age than children born second or later in families. Reasons cited usually include that parents spend more one-on-one time with their first and only children than with their subsequent children.

“I have expressed my concerns with our pediatrician was told not to be concerned.”

This is a very common occurrence. Many times pediatricians take a wait and see approach, and many times parents regret this. Please see my lengthy commentary on this problem under “When to Worry.” If you feel in your heart-of-hearts that there’s truly a problem, there probably is. Parents know more about their children than even the best doctor who only gets a snapshot of your child every few months (and then most of those visits are when he’s at his worst – sick!). You are with him day in and day out, so you are the “expert” concerning him. Trust your own instincts, even if you are in disagreement with your doctor.

I recently evaluated a little boy whose parents were told by his ENT  that beginning speech therapy before 2 1/2 is “crazy.” I beg to differ. There’s usually a difference between a kid referred in for early intervention at or before 2 and a kid who is still not talking at 30+ months. Six months is a long time to wait for a toddler -that’s 1/4 of his whole life! By 2 1/2 the negative patterns and high frustration levels are so much more of a habit than if we had seen a child and his family earlier. It’s the information that parents get from a speech pathologist or other early intervention professional that makes more of a difference than anything in the outcome for the child. Parents can immediately tweak what they are doing everyday at home, in addition to the real “therapy” he gets, and more often than not, the child starts to progress. Waiting doesn’t make much sense to me, especially if you are truly concerned. I have never heard of a parent that regretted pursuing an assessment before 2, and I have heard many that wish they had.

“Do all children who start talking at a late age fall behind in school?”

Not all late talkers end up having academic problems. However, late talking and other developmental problems that weren’t addressed (and many that were) show up in the case histories of children who later struggle in school. There’s so much research that supports the value of early intervention  – defined as the period between birth and 3. The truth is we don’t know which of the children who talk late will end up doing fine and which ones won’t. On the flip side, there are children who talk on time or even early who later fall behind in school. There are many reasons for learning difficulties, and differences in processing language probably account for a larger percentage of problems in school than any other reason related to communication. Experts agree that a child’s language skills at age 3 are the best predictor for future academic success. Watch this podcast for the latest research about late talking.

“How can someone tell the difference between a late talker who will catch up on his own, and a child who is not talking and is at risk for later difficulties?”

No one has a crystal ball and can see the future for any child, but there are indicators and differences between kids who will eventually begin to talk and those who will struggle with communication throughout their preschool years and beyond. One large factor is child’s comprehension level. Is he understanding language? Does he follow verbal directions during your daily routines and perform other cognitive milestones such as pointing to body parts or pictures in books when asked? Kids who don’t understand many words generally don’t say many words – they talk late and the talk less. Make sure he’s understanding you.

On this same note, how is his hearing? Kids who can’t hear don’t talk either. Ask your doctor to refer him for an audiological (hearing) assessment, especially if he’s had ear infections. Your doctor may also be able to do a tympanogram in his office to detect any fluid in his middle ear. Fluid can be present with and without a true infection. You may never know if your child has fluid in his ears because he may not have shown any symptoms of illness such as a fever or obvious pain. Even periodic short term hearing loss, the kind that’s present when a kid has fluid in his middle ear, can create lags in a child’s ability to communicate. Kids with chronic ear infections may not correctly pronounce words because they don’t hear all the sounds. Some children with untreated ear infections seem to learn “not to listen.” To them it sounds like they’re under water half the time, so why bother? Let me also add that undetected hearing loss is much more rare these days since newborn hearing screenings are routine. Many times parents assume their kid can’t hear when he doesn’t respond. Usually a lack of response is related more to a kid’s ability to process language rather than hear.

Another factor is how interactive and communicative your son is without words. How does he let you know what he wants? Does he point and try to talk? Does he try to direct your behavior by pulling you up to assist him when he needs you? Is he playing social games with you and other adults? If he’s not trying to communicate using gestures or is not regularly interactive with you, insist on an immediate referral to a speech-language pathologist or early intervention program. If he is, then keep encouraging him to let you know what he wants, with or without words. Check out some of the other posts for more information about gestures.

Another factor is how vocal he is. Does he have any words? (By 18 months a child should have at least 15 words. Typically developing toddlers use 50.) Does he attempt to make noise when he tries to communicate? Is he babbling or using jargon or unintelligible longer strings of syllables that seem like he’s telling you something, even if you can’t understand? Can he imitate animal or vehicle noises? I have had some very quiet children pop out words “out of the blue,” but usually children make noise before they begin to use words. If he is unusually quiet, go ahead and get a referral now. You’ll need some tricks to get him going and help him find his voice.

Lastly, what is your family history? Do you have other late talkers on your or Dad’s side of the family? This characteristic does have a genetic link and can “run in the family.” Let me also note that knowing that other boys in the family talked late would not be a reason for me to delay pursuing additional help.

If my child is a late talker who will catch up on his own, then he will not need help from a Speech Language Pathologist, right?

If I knew the answer to this one, I’d be really rich because then we could just line up every late talking kid from here to there and I’d lay my hands on them and know…….. But we can’t do that?

The term “late talker” has come to mean anything from a kid who isn’t meeting expressive developmental milestones at 18 months, or 2, or even 3, who does eventually begin to talk. It also applies to kids at 18 months who may not learn to communicate anytime soon, but you don’t know that yet. Again – the truth is, I don’t know if your son will need a professional or not. Neither do you until you get him evaluated.

But in the mean time, there are LOTS of things you can do at home to help him learn to communicate, and that’s what this whole site is about. If you haven’t already, please read through the other posts for ideas for you at home. If you judiciously work on this for another few weeks or even a couple of months and he’s not any closer, please go ahead and discuss it with your doctor again, or better yet, make the call to an early intervention program, children’s hospital, or private clinic yourself. All states are required to provide access to early intervention services for children. Ask your pediatrician’s office who to call, search for it on the Internet, ask around, or look in the phone book. You could also start with your local public school or health dept. and ask who you should call. You don’t want to wait too long if he’s still not talking and you’re still worried. That’s unnecessary guilt, and we mothers have too much other stuff that we heap on ourselves to feel unneccessarily guilty about!

The worst thing that will happen from a referral to a qualified pediatric speech-language pathologist is that she/he will tell you that he’s fine and you’ll have wasted a couple of hours. Or you could find out that he’s still fine, but you’ll get specific things to do at home to move things along. Or you might find out that he needs services, and you’ll feel so much better that you did it now rather than later.

Besides speech therapy with babies is FUN! You’ll learn new ways to play and get great ideas for things to do at home. In most state-funded programs now with the emphasis on natural environments, the therapist comes to your home, so it’s not even that much of a hassle (other than maybe cleaning up around?the house a little bit which most of my families stop doing after they’ve known me for a while). Even if you do have to take him somewhere, it’ll be worth the trip.

Thanks so much for reading this site. I really appreciate your questions, and I hope I’ve answered them. Please let me know if there’s anything else I can do to help!

Here are the resources I recommend to families of late talkers…

Building Verbal Imitation in Toddlers – a book with a step-by-step plan to walk you through teaching your child to imitate words. The chart in the back of the manual has been described as “speech therapy gold” for parents of late talkers to help you remember what you should be working on based on your child’s stage of language development.

Podcast with the Top 5 Strategies I recommend to parents

Let’s Talk About Talking   is a comprehensive therapy manual that will help you determine what’s missing and what you’ll need to teach a toddler before they begin to talk.  All kids master 11 skills before they begin to use words. When one or more or missing, a language delay is guaranteed. The checklists will guide you toward what to work on and it’s filled with explanations and activities for parents and professionals to use with late talking toddlers.