Thursday, January 5, 2017

Therapy Tip: I'm Worried About My Toddler's Language

Welcome to Therapy Thursday! Today is the day I share a tip based upon my experience as a mother of a child with special needs and a pediatric speech-language pathologist.

Today's tip is:

I'm Worried About My Toddler's Language. Now what?

For the past 10 years in my career, I have worked primarily in my state's early intervention program. This means the majority of my work has focused on providing speech-language intervention to children under age 3. Most of these children are two when I evaluate them as part of a team that decides if delays are present and/or warrant therapy. By the time I am coming to the home to talk to the parents and evaluate the child's language, most parents have had concerns for some time.

So when DO you know it's time to get your child evaluated? When do you wait and see if they will start talking on their own?

Today, I hope to help you answer these questions.

Consult Developmental Information
First, there are many, many websites that can give you information on typical speech and language development for babies and toddlers. It is important to know what is typical to decide if your child is behind. Sometimes, parents will see another child their child's age who is saying and doing more. Just because one child has more skills, doesn't mean your child is "behind." That's why the developmental norms are so important.

Here are two websites with some of this information:
ASHA's Speech-Language Development Information

Developmental Information from the Child Development Institute

Information presented in these websites are good reference points for concerned parents. These are just some of the things that a speech-language pathologist will look at when determining whether a child has a language delay or not. Parents are usually surprised by the number of questions or skills I look for even in a young 18 month old child. The number of words the child has is just 1 factor in assessing their overall language development.

If your child is not meeting some of the skills listed on developmental checklists that you have looked at, then consider a full evaluation from a speech-language pathologist.

Medical/Developmental Information to Consider
Maybe you looked at the developmental information, and you are left confused. You can read so many websites that you may be getting mixed opinions about your child. So, let's move on. If you are concerned about your child's language development but aren't sure if you should have an evaluation now or wait, then consider the factors below.

-Does your child already have a diagnosis that would put them at risk for a language delay?
-Does your child have a history of multiple ear infections or fluid in the ears? Has your child received ear tubes or being considered for tubes?
-Is there a family history of educational, speech-language, hearing, or developmental issues? This may included siblings or parents that needed special services.
-Is your child behind in meeting other milestones? Did your child sit up or crawl late, for example?

If you answer yes to any of these and have concerns with your child's language, then consider getting an evaluation.

More Specific Red Flags to Consider
Besides the developmental and medical history, I often look for these red flags when I am first evaluating a toddler. Each of these would be considered a red flag that would constitute a full evaluation from a speech-language pathologist.

-Was your child quiet as a baby with little to no babbling?
-Has your toddler ever had consistent words or skills that he/she no longer does?
-Has your child's eating ever caused you stress due to gagging or texture aversions?
-Does your child seem to ignore you when you call their name almost every time?
-Are gestures absent? (No waving, no pointing)
-Does your child play with toys in an usual manner? (I.E. spinning car wheels only on cars or simply holding small objects instead of playing with them)
-Does your child seem to ignore other people or children?

If you answered "yes" to any question above, then have your child's language evaluated by a professional. This does not mean that your child is definitely having a delay, this just means that I would not recommend a wait and see approach with these children.

Who should "wait and see" what happens?
If the above information did not alert you to anything new, then I am fine with some parents using a wait and see approach. However, give yourself a timeline to make a decision. For example, if no improvements have been made in __ amount of time, then I will call someone or talk to my child's doctor.

I do want to stress that getting your child evaluated is important if you have ANY concerns. It will decrease your stress, give you answers, and allow your child to get proper treatment if appropriate. Even if your child is tested and a delay is found, you may or may not want to start speech therapy right away. But, hopefully the professionals will empower you to make the best choice for your child.

I have evaluated children who follow directions very well, use many different gestures (even making up their own), communicate well non-verbally, seem to understand everything they are told, but just aren't saying many words. Sometimes, these parents choose to give their child time to improve without any intervention. I usually support the parents but give them a time limit (3 months) to see if their child can improve with just some parent training and parent led intervention at home.

The Bottom Line
If you are worried, just make that call for an evaluation, talk to your doctor, or give yourself a time frame to make a decision. An evaluation should give you the information you need to help your child and answer any questions you have. Getting an evaluation will not "label" your child for life. Speech-language pathologists are here to help you and your family!

Therapy Thursday is for educational purposes only and not intended as therapeutic advice. 

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