Children learn to talk over a period of several years by listening to and interacting with their parents and others around them. Some children, however, don’t progress through the natural stages of language development, and may struggle to make themselves understood or to understand what others are saying. Some of these kids are just “late talkers,” but others may have a language disorder. If your child doesn’t seem to be talking or understanding at the same rate as his peers, you may be right to be concerned — and you may want to consider a speech and language evaluation.
Symptoms of Language Disorders
There are two types of language disorders, expressive or receptive. Children with expressive language disorders have a difficult time expressing their thoughts. Those with receptive language disorders can struggle to understand what others are saying or following a conversation. If your child’s language disorder is mild, its symptoms may be difficult to detect. He may just appear a little “spacey” or even “shy.” Look for the following basic symptoms that can indicate a language disorder. If you notice these symptoms, talk with your pediatrician or the staff at your child’s school.
Someone with an expressive language disorder will:
- Have a limited vocabulary for their age
- Use a lot of filler words like “um,” or use “stuff” and “things” instead of specific words
- Confuse verb tenses
- Repeat phrases when telling a story or answering a question
- Frequently say sentences that don’t make sense
- Have trouble learning new words
- Feel like words are constantly stuck “at the tip of their tongue”
- Often seem frustrated by their inability to communicate thoughts
Someone with a receptive language disorder might:
- Seem disinterested in conversations or social situations
- Have difficulty following directions
- Often misunderstand what is asked and answer inappropriately
- Have difficulty getting jokes
- Seem shy or withdrawn
If your child exhibits symptoms from both lists, it’s possible she has a combination expressive/receptive language disorder. Talk with your child’s doctor about your concerns.
Early Diagnosis Timeline
Children progress through developmental milestones at different ages, which is why doctors provide a range; for example, babies normally take their first step sometime between the ages of 9 and 12 months. Starting to talk is the same; there isn’t an exact age when children will say their first word or use their first sentence. Some are considered “late talkers.” These are children between the ages of 18 and 30 months who have a good understanding of language and demonstrate social skills, thinking skills and motor skills typical for their age, but have a limited vocabulary. Not every late talker turns out to have a language disorder, and some children do appear to catch up after slipping developmentally behind their peers. However, most experts agree that the development of speech and language should follow a basic trajectory. If your child exhibits the following early signs of a language disorder, consider speaking with your doctor about an evaluation.
Early signs of expressive language disorder include:
- 15 months: Vocabulary of less than three words; the child uses primarily vowel sounds when vocalizing
- 18 months: Not saying “Mama,” “Dada,” or identifying other known people by name
- 24 months: Vocabulary of less than 25 words; doesn’t spontaneously exclaim when surprised or delighted
- 30 months: Not using simple two-word sentences (noun + verb); difficult to understand most of the time
- 36 months: Vocabulary of less than 200 words; not asking for known objects by the correct name; repeats others’ words when spoken to or asked a question
- Beyond: Speaks differently from other children of the same age; uses words incorrectly or uses related words instead
Early signs of a receptive language disorder include:
- 15 months: Doesn’t look at or point at objects when they’re named; doesn’t respond when name is called
- 18 months: Unable to follow simple one-step directions, such as “Pick up the ball.”
- 24 months: Doesn’t point to body parts when named (like when parents ask “Where’s your nose?”); difficulty attending when being read to
- 30 months: Does not respond to questions, either with spoken answers or nodding/shaking the head
- 36 months: Unable to follow two-step directions (“Go to your room and get your hat”); has difficulty participating in group activities; forgets or confuses the names of familiar people
In addition, there are some early warning signs that can appear in both expressive and receptive language disorders:
- Says one or two words within the normal age range, but does not add further words and expand vocabulary
- Gestures or points in the place of speech past 18 months old
- Does not imitate sounds or words spoken by parents
- May understand language at home but has difficulty understanding when outside the home
Keep in mind that one or two warning sign does not mean your child has a language disorder, but it might indicate that you should talk with your doctor about your child’s development. Not every language disorder is developmental. In rare cases, a language disorder can develop after a traumatic brain event like a stroke, a head injury, or a neurological illness.
Getting a Diagnosis
If you’ve noticed some of these warning signs and think your child may have a language disorder, the next step is to get a professional evaluation. Language disorders can be frequently misdiagnosed — they are often misidentified as ADHD, autism, or even just “laziness” — so it’s important to work with someone who is familiar with speech and language development.
You have a few options. If your child has yet to attend school, you can get a free evaluation through your state’s Early Intervention (EI) program. If a language disorder is identified, EI staff will help you develop an Individualized Family Service Plan (IFSP), which supports your child until age 3. An IFSP lays out what services your child should receive and what parents and specialists expect the progress to look like. Parents are a key component in developing and executing IFSPs, so educate yourself and prepare to advocate on your child’s behalf.
If your child has already started school by the time you notice language delays, you can seek support from the public school system — even if your child is enrolled in private school. You can formally request that the school conduct an evaluation with a speech therapist at no cost to you. If the school feels there is no need for an evaluation or that your child is developing within normal ranges, they can deny your request. If this happens, you will receive a written notification that the school has denied your request along with information on your options. At this point, you can request a hearing to appeal the school’s decision or work with a private speech and language specialist. Even if the school provides an evaluation, you have the right to work with a private specialist if you choose. This option is often more expensive, but it does offer advantages, such as more flexible scheduling and individualized attention.
Most speech therapists test for language disorders in similar ways. It’s important for your child to be tested in the language with which he is most comfortable — even if it’s not the language he speaks at school. Difficulty with a second language is not necessarily a sign of a language disorder. Speech therapists should interact with and observe your child in various situations, as well as interview you to determine if your communication skills may be contributing to a child’s language delays. They may also try different therapy methods, to determine an effective treatment strategy.
If the speech therapist finds that your child has a language disorder, she will work with you to set up a treatment plan, which usually includes speech therapy. If the language disorder has negatively affected your child’s social and academic growth in dramatic ways, it’s possible that psychotherapy will be recommended as well.
Starting speech therapy early is the best way to handle language disorders, but if you think your child was delayed in getting the help she needs, don’t despair. Countless studies have shown that as many as 70 percent of patients respond to speech therapy, and while the rate of success is higher for young children, most older children and even adults achieve good results when working with a skilled speech therapist.