No Comprehension skills 18 months?

[Landladymews]

Hi

I’m feeling quite concerned about my 18 month old who shows limited signs of comprehension when we are talking to him, doesn’t point/wave and probably as a result has no words. He won’t for example stack blocks despite my showing him how (he just likes re arranging them). I ask him if he wants milk or yum yum and he looks at me blankly. He won’t imitate words that I say. I ask him to bring me a particular toy and he ignores me.

He is sociable in the sense that he loves meeting people and babbling away (has a lot to say in his own language), makes eye contact, smiles, has lots of funny expressions etc. He will hand me toys of his own volition so I think this is an example of what’s called ‘joint attention’. He loves peekaboo. He has clapped a couple of times when asked but now refuses to do that too.

My husband thinks he’s too young for investigations and that we should wait another 2-3 months before seeing the GP.

Has anyone else had a child who didn’t seem to be developing comprehension skills at this stage? Is there anything I can do to help his comprehension? Should I push my husband to have him seen now?

It’s been said a couple of times but do get his sight tested as well as his hearing. Children with poor vision often have delayed language development.

@rattlemehearties some children do but some don't. If there are issues then early intervention is key

Hi @Landladymews is your DS in nursery? Have they flagged up any concerns?

With the blocks, have you tried showing him how to stack them using hand over hand support? So, rather than just showing him, you guide his hands to stack them and then give huge praise as he does it.

This worked very well for my DS who has issues with motor planning - he finds it hard to imitate something he is shown visually only but picks it up when he understands the physical movements he needs to make to achieve the action. He was the same with using a spoon, and also clapping.

You can speak to your HV and also SALT should have a phone number to call to discuss your concerns.

I’m going to take a slightly different tone from several posters here and suggest that you do contact your health visitor. It may well be nothing at all to worry about, but it’s definitely worth investigating, even if it just puts your mind at rest.

My child had gross motor delay and I was constantly fobbed off by people telling me that they would do things in their own time. DC Didn’t walk until they were almost 2 and at nearly 4, they have caught up completely in the sense that you wouldn’t think there are any different when you compare them with other children. However, we have just had a physio appointment and they are still classed as having mild gross motor delay. The physio told me that they should’ve been referred to a physio at 18 months, when in fact we weren’t referred until well after two. Obviously, this is about a different set of skills than your child, but the point is that earlier intervention would really have helped. It would have helped me too as my anxiety about everything was through the roof.

If you look at the ages and stages questionnaire for 18 months, it would seem that your child is not scoring very highly in the communication area. My SiL SALT and Health visitor both say that they ask a lot of children for communication at this age so this isn’t something you should panic about. For example, my sister-in-law always says that 18 Months is very early for combining two words, and the general rule of thumb is that they should be able to combine the number of words of their age, so a two-year-old can typically make phrases of two words. If they’re not doing this for 18 months it’s absolutely no problem at all.

If you complete the ages and stages and say that you’re concerned that some areas are low, it can start a useful dialogue with your HV. My DC always scored zero for gross motor (!) but as I said earlier, you wouldn’t know that now. So please, try not to worry but do reach out and speak to professionals if you’re concerned.

www.gosh.nhs.uk/file/11531/download?token=ls1jk18R

I tried some ‘problem solving’ stuff this morning eg gave him a bottle and some small stuff and he put them all into the bottle and also gave him a small bottle with some cookie crumbs at the bottom and he tipped them out and ate them without me having to show him how. It’s where I show him or tell him what to do that he struggles. I showed him how to scribble but he just wanted to bash the pen on the paper. Every time I would take the pen to try to show him he would scream at me until I gave it back to he could carry on. A number of people have commented that he’s very heavy handed and noisy.

Speech therapist here. Joint attention and babble are really good signs. He should have at least situational understanding but it doesn't sound like that's there yet. However I'd give it another month or two then ask for referral. He sounds a bit late rather than disorder ed which is a good sign. Consider asking for a hearing test x

@The3Ls thanks! Have I understood joint attention correctly... one example being handing me toys? I think there’s also something about looking at something then looking at me.. I haven’t noticed this In terms of trying to get me to give him something but I have seen it in relation to his baby sister where if she’s crying he will look at her and then look at me or sometimes try to put her milk bottle in her mouth and look at me to see what I think.

So joint attention is a shared moment. Him babbling and looking to you cheeky smile when doing something"naughty" laughing at you being silly anything like that. He could completely catch up and it be nothing or have some language delay he is at a tipping point. Id watchful wait you are correct to keep an eye on comprehension but no need to panic just yet. Build comp by day the word before the object appears repeat when it appears and say again once it's gone. Also consider makaton signing good for comp but also reduces frustration

@Landladymews

I tried some ‘problem solving’ stuff this morning eg gave him a bottle and some small stuff and he put them all into the bottle and also gave him a small bottle with some cookie crumbs at the bottom and he tipped them out and ate them without me having to show him how. It’s where I show him or tell him what to do that he struggles. I showed him how to scribble but he just wanted to bash the pen on the paper. Every time I would take the pen to try to show him he would scream at me until I gave it back to he could carry on. A number of people have commented that he’s very heavy handed and noisy.

That sounds pretty typical for 18 month olds to be honest, not sure how many would be interested in copying a scribble!

What about when you give him instructions for something he wants to do? Ask him to get his shoes so you can go to the park? Fetch the biscuits so you can open the packet for him?

DS was similar... he's also deaf (discovered at 21 months)

Not following what you are doing when you demonstrate could just be his personality to be honest. I would actually be more concerned that he's globally behind the norm rather than any one thing - asking for a referral to a paediatrician is the best way forward especially as you don't think there's hearing concerns. Dd was a bit like you describe but also not sociable either, by 2.5 she has an autism diagnosis (but she's living independently at university, please don't worry unduly)

Id watchful wait you are correct to keep an eye on comprehension but no need to panic just yet

The thing is referral times and waiting lists vary. Also, seeking input isn’t panicking.

It might be as well to ask for a referral now just to be sure. At least ask for a hearing test to rule that in or out. If he is still non verbal at two, you will be well placed to progress assessments promptly.

@The3Ls thanks for that explanation! We do for sure have lots of funny moments where he is engaging with us eg where I copy his babbling sounds and he giggles or where he does something naughty eg tries flipping over during a nappy change or climbing stairs when the gate is left open by accident and he finds my frustration hilarious. He is very sociable. He’s just not there in terms of understanding or imitating what he’s shown yet. With the later last week he started blowing kisses when I would do it but he’s stopped that now. Thank you for the advice on when to name the object. That sounds like a good idea! I’ll looo into makaton too.

@StellaGib It was one of the activities suggested on the ages and stages questionnaire a few people suggested! He doesn’t understand “outside” or “shoes” or “biscuits” so would be meaningless to him if I said those things.

His understanding of language is definitely not quite where it should be then. You'd expect understanding of single words like shoes, milk, snack time etc by then and simple/familiar questions and instructions (Where's your nose? Go and get your shoes).

Speaking is less of a worry than understanding at this point as lots of 18 month olds aren't talking, but as a rough rule you'd expect single words/animal noises by 18 months and putting two words together by 2-2.5.

If you call your HV and explain he doesn't understand single words, doesn't follow simple instructions in context and isn't using any single words I think they would want to investigate further (probably starting with hearing). I would use those examples - he doesn't understand "milk" "shoes" "biscuit" and wouldn't be able to follow "get your shoes" or "do you want a biscuit" as that would definitely flag up a concern with language development.

@janewaysbun Did you have any signs of hearing issues? My son recognises songs that he likes and can hear a packet rustling in the kitchen next door, but others have mentioned that the frequency at which we speak is different so he might not hear that as well (this is something I didn’t know)

@movingonup20 I have wondered about personality as he often seems irritated in his baby language when asked to do something but at the same time he is also behind on walking (he rolled, sat up and crawled a few months late and is stuck on cruising at the moment)

@StellaGib precisely, my concern is about lack of comprehension rather than words as I know some kids can be late talkers.

I have also wondered if the delay could be due to our attempts to make him bilingual. We speak our ethnic language to him but between ourselves we speak in English and he watches cartoons and (maybe once or twice a week) and listens to nursery rhymes in English

My twins are 4 now and we realised there was something going on at about 18 months - they were both diagnosed with ASD when they were 2.

Many of the concerns you raised were the same here. But they were very different - one was more interested in people but not at all in toys, one was very interested in toys but would play very repetitively.

They never shared attention (eg. Bringing something just to show us, they would only bring things to us when they needed help making it work or wanted us to read the book).

Have a look and see if there’s a portage service in your area that you can self refer to, and speak to your health visitor. They may not refer you to anyone yet but they can keep an eye on things until they can do the two year check.

IME bilingual children can be on the later side to speak, but I don't think understanding is usually delayed.

@SinkGirl Interesting. My son takes an interest in both people and toys. I always thought with ASD there would be limited interest in people but it seems from one of your twins that’s not the case. My little one will often give me his blocks, stacking cups, my phone, some of his food or milk beaker... I don’t think it’s because he wants anything back I think he maybe sees it as being “helpful” in the way that he does when he gives his baby sister her bottle of milk

I am a SLT and would definitely get the ball rolling for a hearing assessment and an assessment with a SLT, it is not to young, you are doing all the right things and go with your gut :)

Stella is correct expressive language can be mildly later but no comp. Don't stop using both languages.

Yes that is true re waiting lists ours is very quick for initial. Certainly no harm in popping name down can always turn down an appointment if he comes on leaps and bounds.

[quote Landladymews]@SinkGirl Interesting. My son takes an interest in both people and toys. I always thought with ASD there would be limited interest in people but it seems from one of your twins that’s not the case. My little one will often give me his blocks, stacking cups, my phone, some of his food or milk beaker... I don’t think it’s because he wants anything back I think he maybe sees it as being “helpful” in the way that he does when he gives his baby sister her bottle of milk[/quote]
It sounds like he’s observing you and emulating things so that’s a good sign. You are absolutely right to be focussed more on comprehension than speech - if children don’t understand words they can’t understand or use them correctly.

Autism is so confusing - my boys are both bright, one has amazing problem solving skills, the other can draw all the letters of the alphabet on an iPad even with the guides removed and is obsessed with written text but it’s like he is deaf to words. They mean nothing to him and he makes no attempts to say words, whereas his twin seems to understand more and occasionally will try to say a word but usually just for a few days and then he stops.

If you can get hold of a copy, the book More Than Words by Fern Sussman is really helpful for trying to develop understanding and early communication

I would get him in the system now. No words at 18 months is a red flag. I think I read that 80% of children who are delayed at this point, or 2, catch up by a certain point(4?). However, that means 20% don't. My son who had no words at 18 months ended up being diagnosed with high functioning autism at 8. I saw other children who caught up and all was fine.
Many people(especially family inc husband,and some early years teachers)along the way will reassure you saying things like 'they all develop at their own pace' etc etc.

There is no harm in approaching your health visitor/gp to start the ball rolling. Even if all is well, you will get good advise and learn more about your child and how to support them as an individual. Good luck.

Does ASD ever manifest as lack of comprehension? I’ve mentioned before that my husbands niece has it (high functioning asd) and we both picked up around 12-18 months that she didn’t make eye contact and took no interest in people and only in objects. To me that’s how I imagine ASD i.e. a lack of social skills. Can children who appear very sociable (i.e. very interested in playing with people and very chatty with them in their own baby language) still have ASD?

ASD is diagnosed when there is a triad of impairments - social, communication and rigidity of thought (lack of imaginary play, repetitive behaviours etc). I didn’t realise our twins had a social issue until they started nursery and I saw all the other kids staring at us every time we went in the room. I realised my two never had that level of interest in others. They used to make a lot of eye contact and interact with each other when they were babies but about 18 months they regressed a lot in terms of social skills and stopped mimicking etc. But I realised later they had never had typical social development.

There’s also developmental language disorder and other things which are specific to language so it’s not necessarily autism, it’s all quite complex really.

One of my twins likes being around people, will constantly ask to be picked up even by strangers or entirely new people, but he is still very different in his social skills than other children.