Have you ever wondered if a child is “just a late talker” or if there’s a larger problem?

Research reveals that there are several risk factors that let us know that a child’s late talking is likely a part of a child’s developmental delay, rather than the only issue. I’ve started a series of articles to address these concerns. In this post, we’re addressing the third red flag which is:

RECEPTIVE LANGUAGE DELAY

I believe that receptive language delays are the MOST OVERLOOKED PROBLEM in early childhood development. Many parents, physicians, and sadly, even some therapists miss this delay.

In my experience, IT’S THE NUMBER ONE REASON many toddlers with language delays aren’t yet talking. This makes complete sense when you consider the obvious…

Kids must first learn to understand words BEFORE they use words to communicate.

I hope this statement resonates with you because it’s a key message that all parents of late talkers should hear and consider when they’re trying to come up with the “reason” that their child isn’t talking yet. As I noted earlier, it’s often an area parents dismiss. Many times during an initial assessment, when I ask a mom how her late talker understands language, she responds with…

“She understands everything.”

While this is true for some late talkers, many times a toddler who isn’t saying very much doesn’t understand very much.

Before we go any further, let me give you some background information about receptive language.

What is receptive language?

Receptive language refers to the language a child understands. Speech-language pathologists may also use the terms auditory comprehension or language comprehension to refer to the receptive language.

The most common way a toddler demonstrates his ability to understand language is by responding to what you say. They look at you when you call their names, follow simple directions, and participate when you talk to them.

For example, you may casually say, “It’s almost time for your bath.” A toddler who understands you:

• may get excited
• shake his head enthusiastically (as if to answer “yes” or “no”)
• run to the bathroom
• grab your hand to pull you along
• begin to gather toys he wants to take to the tub.

Those responses are different ways a child lets you know he’s understood, all without saying a word.

(Side note…Expressive language means what a child says. The expressive language also includes what a child expresses through other methods. Facial expressions and gestures are ways all of us supplement what we say. Other options include sign language, a picture system, or speech-generating device.)

Signs of Difficulty with Receptive Language

A child who doesn’t follow simple verbal commands throughout the day by the time he or she is 18 months old has a receptive language delay.

So…. if you have a 2-year-old who doesn’t respond to his name, can’t retrieve familiar items on request, or won’t point to body parts, common items, or pictures when you ask “Where’s the ___?” a receptive language problem is something to investigate.

While it is hard to truly determine what a very young child understands, please don’t ignore these warning signs. Toddlers can be little stinkers at times when it comes to “obeying” your household rules. However, a young child who tunes out language much more than he listens and who can’t follow simple verbal directions during every day routines is a very different situation. He’s not choosing to disobey – he very likely doesn’t understand what you’ve asked him to do.

Typical Receptive Language Development

I want to include a word typical language development…. most babies and toddlers understand much more than they can say. There’s concern when a toddler isn’t saying as much as other toddlers, but there’s a real problem when a child’s comprehension isn’t keeping pace. If there’s difficulty understanding words, he’s at a huge disadvantage for learning almost everything.

Diagnostic Implications for Receptive Language Delays

Receptive language delays can be attributed to any number of conditions including:

• Hearing loss, whether it’s permanent or temporary caused by ear infections or chronic fluid
• Genetic diagnoses such as Down syndrome, Fragile X, etc…
• Complications during a mother’s pregnancy and at birth including prematurity, infections, trauma, and medical conditions such as loss of oxygen
• Environmental extremes such as neglect, institutionalization, or malnutrition
• Heredity or a family history of difficulty learning to communicate and with academics
• Other developmental disorders such as Autism

Remember that receptive language skills are inseparable from cognitive abilities in young children. If a child has a cognitive delay, he’s going to have difficulty learning to understand and use language. (Read more about cognitive delays.)

To be clear, let me restate this point…

Toddlers with receptive language delays will have expressive language delays.

If he doesn’t understand what words mean, he won’t be able to use those words to communicate meaningfully.

There may also be problems beyond late talking. When a child doesn’t understand what others say, she may also have difficulty learning to interact with other kids. Unless a child makes progress and catches up (which is very possible!!), he may also have trouble with academic concepts as he starts school.

Even though this may sound a little bleak to you, don’t get discouraged. I have treated many, many, many toddlers with receptive language delays due to a variety of diagnoses (global developmental delay, autism, cerebral palsy, mixed receptive-expressive language disorder, Down syndrome, and other genetic or chromosomal abnormalities) who have made incredible progress. Please do not feel defeated if you’re parenting a child with a receptive language issue – read on!

Ways to Help a Toddler Improve Receptive Language

There are lots, and lots, and lots of things you can do RIGHT NOW to help a toddler with language delays. Actually, I have built my career on it! I’ve written (and spoken) VOLUMES of information about receptive language. In fact, I’ve had more than one SLP refer to me as “The Receptive Language Queen.” What a compliment!!

Here are two posts with fantastic recommendations –

Receptive Language Delay in Toddlers, Advice for Parents. It’s FULL of advice and contains my best written information to get going TODAY!

Early Receptive Language Targets: Learning to Follow Directions for Toddlers  gives you a list of very early comprehension milestones for a toddler. If you’re at a loss for where to start, read this list!

If you’re more of a listener than a reader, let me recommend one of my podcasts about receptive language #285. The written post also contains good, practical suggestions.

Additional Recommendations for Parents

If you’ve been reading this series, you’ll recognize my plug for intervention. Therapy can help a child with receptive language issues improve TREMENDOUSLY… but only when you’re working on the right goals. Let me explain….

Many times parents identify late talking as their only concern for their child. This makes some therapists focus on the expressive piece and direct most of their efforts toward helping a child learn to talk. When the underlying problem is a significant receptive language delay, working on talking may not help. At all.

Actually, it could make things worse because everyone, (that’s the kid, the SLP, and the parents!) may get so frustrated that nothing new is happening.

In these situations, it’s always best to address the receptive language difficulties, figure out how to make language meaningful for the child, and work together toward that goal as a team BEFORE you begin to expect to hear new words and sustain any real, measurable progress with talking.

In some cases, all I’ve done with a child is convince his parents to focus on receptive language and then….words finally began to emerge.

If you’re reading this and realize that your child may have a bigger problem than you initially thought, please know that this is a very common issue for parents of late talkers. My first recommendation is to talk this over with your child’s therapists. If your child hasn’t yet been evaluated by anyone, schedule an assessment soon.

Begin with a call to your pediatrician’s office for a referral to your local early intervention program if your child is 2 or younger. If he’s 3 or older, contact your local public school system for an assessment.

If  you’d rather not use a state or local public school, go the private route. Ask your doctor for names of speech-language pathologists who specialize in treating toddlers and preschoolers. This is super important!!

Just as you’d not go to a cardiologist for a back problem, you’d never want your toddler to be treated by a therapist who rarely sees kids this young. It’s a niche area, or a specialty. You may be wasting your time and money if you don’t see someone who has experience with toddlers.

Or take a look at your insurance company’s list of providers, make some calls, and select a practice that feels like a good fit for you and your child.

Medical Intervention

Also… verify your child’s ability to hear! Many toddlers with a history of frequent ear infections have receptive language delays because they’ve had fluid in their ears for long, long periods of time. During those times, the child has had temporary hearing loss and the language he’s heard sounded muffled, like he’s underwater. No wonder words don’t always make sense to this child! He can’t hear people talk as well as he should!

Doctors may treat ear infections differently in different parts of the world. Some pediatricians will opt to use antibiotics fairly quickly. Others may take a wait and see approach. If your child’s ear infections have lasting repercussions, as in he’s not talking yet and not understanding language, then it’s time to be more aggressive. Discuss your treatment options with your doctor and ask for a referral to an ENT to explore tube placement if necessary.

Sometimes kids can have middle ear fluid with no other symptoms, so the parents didn’t know there was a problem. Their child never ran a fever, didn’t tug at their ears, or had no bouts of unexplained crying (especially at night). There was never a reason to exam a child’s ears beyond a quick look.

If you’ve had a healthy child (or even when you’ve seen the pediatrician regularly), talk to the doctor about your concerns related to late talking and receptive language. Ask for a formal hearing evaluation to rule out hearing loss as a reason for the language delay. Competent pediatricians will suggest a hearing assessment as soon as mention a concern. If not, your doctor may be taking too many shortcuts when it comes to discussing your child’s development. Have a direct conversation about your worries and ask for additional referrals and evaluations.

WRAP UP

Toddlers with receptive language delays will have issues learning to understand and use language. Sometimes kids catch up and these difficulties resolve fairly quickly with targeted intervention. In other cases, receptive language issues may be a lingering concern which will require speech therapy and specialized services once he reaches school age. Understanding language is the foundation for academic success.

If you’re a parent, I hope that this information will help you understand what may be going on with your own child. If you’re a therapist, this is the kind of information that doctors and other professionals may not be sharing with parents of a child with a receptive language delay. It’s up to us to help families understand the depth of a child’s issues and provide hope that therapy, along with consistent parental commitment, can make a huge difference!

Keep watching for additional posts in this series! Next we’ll discuss limited use of gestures as a factor that indicates that a child is struggling with “more than late talking.”

Product Recommendations from teachmetotalk.com for Helping Toddlers with Receptive Language Delays

My best resources include:

Teach Me To Listen and Obey (2 DVD Set) focuses on receptive language or what a child understands. When a child doesn’t understand words, he’s not going to use words (aka…talk). If a toddler is over 18 months and doesn’t follow simple directions, receptive language delays are highly likely. In this DVD for adults, you’ll learn important comprehension milestones and receive recommendations for working on these skills at home and during therapy sessions. You’ll SEE video clips of me working with children with language delays during speech therapy sessions so that you can duplicate the activities.

If you’re more of a reader or if you want detailed goal lists for both receptive and expressive language matched with activities to use with toddlers and preschoolers, take a look at my book at Teach Me To Talk: The Therapy Manual. There’s a chapter on social skills that’s a fantastic guide for targeting joint attention and social interaction. This book was written for speech-language pathologists, but many parents use it as their basis for “at home” therapy.

For therapists (and ULTRA committed parents who are working with their children intensely or parents who don’t have access to services and need professional-level information), my CE courses that best address social skills are:

Early Speech-Language Development: Taking Theory to the Floor is a comprehensive 12-hour course on DVD. All areas of language development (social, receptive, expressive, and intelligibility) are addressed. There’s a long section on receptive language with goal lists and fabulous therapy activities!

Is It Autism? Recognizing and Treating Toddlers and Preschoolers with Red Flags for ASD. This course on DVD has two parts. Part Two is all about intervention. You’ll learn the most effective treatment strategies and approaches to jump-start progress in a toddler with red flags for autism, including receptive language deficits.

Both courses are approved for ASHA credit for speech-language pathologists (and if you’re in IL, it’s preapproved for EI credit!) with a certificate of completion for other therapists to use toward licensure or certification requirements.

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Links to Milestones

If you’re not sure how your child is doing with language, here’s a list of milestones to compare minimal expectations vs. typical or ‘average’ language skills. There’s quite a range.

Follow these informative links to the Center for Disease Control website with lists of skills and pictures to show you what’s normal for a child’s age range. Remember that most babies will have easily achieved the skills listed there – meaning that the standards listed are set at a minimal level to account for a wide range of “normal.” (In other words, the bar is pretty low.) If a child hasn’t met all the skills on these lists or especially exhibits the concerns in the bottom “Act Early” boxes, there is a definite reason to speak to your child’s doctor or healthcare professional.

12 months

18 months

2 years

3 years

4 years