Speech delay - 18 month old - when to really worry?

[catinpajamas]

I have an 18 month old (almost 19 months) son. He babbles a lot (has done from about 10 months) but there are no words. No mama, no dada - nothing. I was oblivious to the speech milestones as I mistakenly thought it was similar to physical development. But it's not. There are certain 'hard' milestones in speech and language which he's not met.

The GPs and Health Visitors here have been useless and keep telling me not to worry (in fact today I was told to cut him some slack...). They seem to think that not speaking, even at age 2, is fine. It's when they get to 3 that alarm bells ring. I'm not satisfied with this. I feel like I'm failing him if I don't take this further but I'm not sure how much 'fight' I have to take this further.

So...does anyone have any suggestions on how to manage the worry?

At my insistence he had his hearing checked and there is an issue with his left ear (but his overall hearing is of sufficient level so it shouldn't affect his speech and language). They will monitor this again in 3 months. We've been very worried about possible ASD - esp. as there have been some additional behaviours - but overall he is a very sociable little boy.

I'm hoping possible - and recurrent - glue ear is the cause and all is fine...

[VioletBam]

Glue ear can cause speech delays or contribute to them. Have you seen a doctor? I would ask the doctor for a referral for an assessment for ASD. My friend did this when the health visitor was of no use. Her son had just hit 2...and he did in fact have ASD but he had a myriad of quite strong indicators for it.

Have you done the MCHAT quiz? It's meant to give some indication of risk for ASD>

www.autismspeaks.org/what-autism/diagnosis/screen-your-child

[NickyEds]

Does he understand you? Basic things such as getting shoes, coats etc, if you say 'dinner time' will he go to his high chair?

In and of itselfno words at 18 months is slightly atypical but nothing to worry about yet. My ds was the same. I brought it up with the hv at 19 months and she said to wait and see. I went to the SALT drop in just before he turned 2 and they assessed him and said to wait 3-4months. Went back 3 months later and he was assessed again, sent for a hearing test and a therapist was sent to his pre school. The therapist ha said he's obviously very speech delayed but it's too soon to really understand why. He scores low on the M CHAT test and doesn't have many indicators of ASD. It could be dyspraxia of some kind.....or he could be slow to talk. I've pushed for some SALT and he's starting next week. Sorry op but at 18 months it is too soon to tell just on the basis of no words (also remember that animal/car noises count too).

About managing the worry-I struggle a lot with this. In between Christmas and Easter (so in between the SALT assessments) I worried about it constantly. It was only when I realised that I was spending more time bloody observing him than enjoying him that I've just let it go. I will fight tooth and nail to get him any help he needs , I will work hard on any exercises we can do to help, but this will not define the toddler years with my boy anymore. He is wonderful and I won't let my worrying ruin this time. This was made easier though when the SALT was quite positive.

[buttertoffee]

yes yes to the M-chat.

how is his understanding? can he follow simple instructions such as get your shoes, go and find the ball? does he respond to yes/no questions? is he pointing? does he bring you stuff to show you? how does he communicate with you e.g. telling you if he wants a drink?

if your only worry is lack of words with otherwise good understanding, I would not really worry a lot. understanding is also an issue, then I would push for further investigations now.

hearing test is always a good starting point

[Runningbutnotscared]

I've heard (but have never checked) that in some areas health visitors and GP's look for lo's to be delayed in two areas (say speech and comprehension) before they will refer BUT SLT only look for delays on one area. This makes it really hard to get an early referral.

I have an eighteen month old who, like yours, only babbles with no words. HV and GP said he was too young and weren't interested so I self refered to SLT at seventeen months who were quite happy to start seeing my ds as he should (in their words) have some basic words by now.

I'm trying not to be worried (he's a great wee guy) but do want to make sure I'm not missing a window for early intervention that might sort this before it becomes a problem.

[MrsFrisbyMouse]

Don't equate not speaking with no language. The actual words are at the very top of the communication pyramid (do a quick google.)

Look at other things - does he have 'conversations' with you. Does he anticipate the next bit to favourite songs and rhymes? Is the babble have the prosody (sound and rhythm) of speech

I say these things as the mother whose 2nd child has a severe speech and language disorder. It was really obvious from quite early on just how different his speech (non) development was. At age 2 he wasn't babbling at all, just grunting - and there was very little 2 way communication.

He sounds lovely -and I know it's hard not to worry! if you want some ideas of activities you can do to support speech the iCan charity do some lovely communication cards - (and there is lots of good stuff on there website as well)

[albertcampionscat]

'words' at his age means any sound consistently used to mean something. gag-gag to mean banana, woof for dog, etc...

[GrassW1dow]

I have an 18 mo DS who has no words either....I'm not even sure that he understands anything.

He points a lot (and says 'd'ah' as he does so) and brings me books to 'read' to him etc and seems generally very sociable.

Now I'm worried!

[Miloarmadillo1]

My DD has a seizure disorder that puts her at great risk of language delay. If she was in the USA her diagnosis would get her immediate enrolment in early intervention ( speech, occupational and physio therapies). In the UK she gets nothing because she doesn't fall far enough behind to trigger interventions. There is a big gap between what a child would benefit from and what in NHS terms qualifies for therapy, and I know that's a funding and resources issue. From my experiences on Facebook groups and websites for speech delay, I think there are children who are just late talkers and will catch up without intervention, but there are also plenty who would have benefitted from early intervention and didn't get it. In my local additional needs playgroup there are several children starting school in September essentially non-verbal who have had woefully poor speech therapy input, despite parents pushing for it. In your shoes I would do as much as you can to promote language development yourself, and if things have not changed at two start stamping your feet. Some children's centres have drop in sessions with a SALT present to seek advice. I have found the website //www.talkingpoint.org helpful, Makaton signing, Sookie and Finn DVDs. The Hanen book "It take two to talk" is v good but expensive, it would be worth seeing if your library can source it for you.

[ThatsWotSheSaid]

Self refer to SALT what's the worst that can happen? Even if they say he's too young for therapy they will likely give you some good strategies to use at home. There is a lot of information on encouraging early language development online. The 'Hanen programme' is particularly good. lots of children dont speak at 18 months or older then catch up very quickly. I work with children and young people with ASD and the symptoms of ASD can differ hugely from child to child. And often include things that are typical for very young children especially those with language delay. So don't try to read too much into things, I have never meet an adult or child who doesn't have a least one autistic trait.

[Miloarmadillo1]

Sorry, it's //www.talkingpoint.org.uk

[coco1983]

It sounds like you are worried and that is reason enough to at least have a chat with a speech and language therapist. NHS speech and language therapy services in England have an 'open referral' policy, so you can just ring them up yourself and have a chat and make a referral if you need to; you don't need your GP or Health Visitor. If you want to do that you'll have to google for what number to ring for your local SLT service. You might find this helpful for thinking about when to refer for Speech and Language Therapy, and elsewhere on the blog are ideas for how to help your child whilst you are waiting for an appointment confidenttalkers.blogspot.co.uk/2016/07/should-i-worry-that-my-child-isnt.html

[ceara]

I've been where you are and it's hard not to let worries take over but as others have said, don't let the speech thing stop you enjoying this time.

I also second what has been said about self referral direct to SLT. In our area HV guidance precludes a referral before 3 unless both speech and understanding are delayed whereas the actual SLT service they are referring to encourages referrals from 18 months even if delay is in just one area, so there is no obvious reason for the HVs to gatekeep...

Waiting lists are quite long in most areas, for assessment and then again for any recommended therapy, so it makes sense to join the queue sooner than later.

The thorny issue is really best use of resources. It's quite common to have a delay at 18 months/2 years but a significant proportion of those children will catch up (meaning get back inside the typical range) by 3, without SLT intervention. My son is a good example of this. He had no words but mama and Dada at 24 months; 6 words at 27 months; and at 29 months now has a large vocabulary of spoken words - we stopped counting at 200 words a month ago - and is talking in full sentences and last week made me cry because he was able to have a proper conversation with his toddler group leader about our recent holiday. So there is an argument that it's better to wait and target resources at those children who are still delayed at 3.

But...the children who will need help are indistinguishable at 24 months from those who will muddle through by themselves. Add to that, that for those who need help, early intervention is best, and you have a strong argument against waiting.

SLT at this age would be more about you and others who care for your son, and teaching you the optimum ways to communicate with him in order to best help him. You are probably doing a lot of this already in which case it would be about giving you reassurance and confidence to keep going. As a first step I highly recommend the Hanen book "It takes two to talk" which is a very accessible guide. We got our copy when DS wasn't talking at 18 months and referred him to SLT and also saw a SLT privately, shortly after his birthday. Who knows whether he would have got there on his own anyway but I don't regret our lovely SLTs fees.