No understanding of words at 21 months

[Quecwmber]

I have referrals waiting (..and waiting), but in the mean time I was wondering if anyone has experience of near zero comprehension? Every Speech and Language thread I find seems to be about speech/ sounds, with a caveat 'don't worry as long as they understand you'.

So what's the problem if comprehension is the issue? Why's it so important in comparison, what does it mean? Everywhere mentions it as key, but little else.

DD, 21 months, understands very very little even with visual clues. She has learnt 'daddy' to look at, but may not understand if he wasn't there? She follows no instructions, and possibly understands the word 'shoe' and 'mummy' but not totally. If they're near by she may twig. She gets 'where' if you look around but may bring any object, or just run out the room looking.

On the flip side, in the right mood, she repeats quite well if you name what she points at. But you start again each time, except 'shoe' which she says and 'bye' which are words she remembers as well as 'mama' (though she won't call my attention by saying it often). Everyday we name and repeat every item of clothing, yet she points and uses any sounds if she wants them, say just saying 'uurrrrr' and whinging for her sock she's taken off.

She's got a hearing test, but I'm not worried. I see a reaction to many soft sounds in different ranges plus she repeats many words, maybe 'tock' for 'sock' but quite age appropriate. She can also sing songs, but without the right sounds but to a very good tune. She may smash happy birthday/ wind the bobbin up together and another 5 others but uses some of the actions as she goes from each. She loves singing and does it a lot. She talks intently in jargon to you also all day.

She's been very very quiet passive child, but lately is getting a little bit much with other children. She used to cry at the sight of non-family members but now is starting to pinch/ shout/ pull/ hit in anger at times. She will fly at much older children if they have something she wants. She hasn't learnt this from siblings or others, her brother is wonderful with her and never hits back but tells me if she really goes to far and he can't stop her (he's just 4).

Which specialist has she been referred to? Speech therapist and audiologist? Are you in the UK?

In your shoes I would go back to your GP, not health visitor, and mention that there are more than one area of concern, such as aggression and lack of understand of speech/lack of concentration. Ask to be referred to a paediatrician or to the paediatric team for a full assessment. Do you have any concerns about her physical milestones? Walking late, sitting late, etc?

She is still very young and some children start 'getting' language much later than others, and it is still within the 'normal' range.

Try to focus on a specific set of words for a while, maybe ten words, and try to have a visual queue as well for each word (have you heard of Makaton?) and try also to get her attention before speaking to her. So let's say one of your words is 'milk' (or her favourite drink/food). You ask her if she wants milk - and repeat the word milk using the makaton sign. Show her the milk and repeat the word milk many times making sure she looks at you. It will sound silly - so you would say 'DS (clap your hands to get her attention) would you like some milk? Milk! Cold milk - Nice milk. Mmmmmm milk!' and point at the fridge. Hope you get the idea, but it involves a lot of repetition, many times a day. Also, a lot of toddlers like a specific book and don't get bored of it. Find one of those with her favourite movie or TV character, and read the book many times a day, pointing at the images and saying the words for them. You will be bored of it, but she won't, children love repetition. Peppa pig is great for this, the little books are clear and with vivid images. Give this a go for a while and see if it makes any difference.

Visual cue! Not queue

I would second rocketjam that you should be very insistent on a full assessment from a developmental pediatrician.

Lack of expressive language is less of a concern than receptive language as it may just be due to a lack of the fine motor control required to form the words with their mouth. Receptive language generally develops well before expressive language. By 12 months you'd expect a child to understand 30-100 words but only speak a few if any at all.

A lack of understanding of any spoken words at this age is outside the normal range so could point to a problem ( either with her hearing or development) that would benefit from early intervention.

If you want to work with your daughter at home while you wait for assessments try the book "it takes to to talk". It's very accessible and has lots of clear advice about encouraging speech.

I'm in the UK, here all pre-school referrals are seen centrally by all teams. I've been contacted by a specialist Sen hv who will visit to explain more about it all but it will include salt, physio and a pead when she's seen. Not sure about the exact process yet. I'm a little shell shocked tbh. I hadn't seen the hv seen birth but I popped in about motor skills to the clinic, she's been a bit low tone and uncoordinated (Eg couldn't climb stairs of right herself, Rocky balance). This improved quite a bit lately but hv still felt she needed referring. She still has poor grip with one hand and a bit immature with motor skills, starting to use a soon if pre loaded and falling less. I wasn't expecting more than a fob off but suddenly it feels like it's gone mad. Even the woman at the children's centre suddenly feels it's ok to mention her concerns at stay and play.

I obviously knew she was immature, but wasn't worried she was outside a normal range. She's tiny so she also easily slots in with much younger children at groups which I didn't really notice until I asked ages.

Milestone wise not unless off, or just ok. Just did things awkwardly.
Smiled 8 weeks,
Sat just under nine months, but until 17 months struggled to correct balance, if leaning in a high chair she'd get stuck a lot drooped over. Still some sitting falls but catches herself
Crawled 13 month, ok now but used to buckle face first
Walks, falls about every ten min I'd guess
Uses the first three fingers on one hand, pinched grip but last fingers often flexed, though can move an not stiff.

I'm quite familiar with two to talk (from work) but she's difficult, Eg after repeating sock she will just repeat it an clap herself for it without looking at the sock you're holding. I think I've said "milk" on each feed on average five-ten times since birth! I've always asked milk? Dd want milk? Mmmm milk! I like milk! Tec type of chatter. My dsis is deaf so I often sign words too without thinking. I have often sat and wonders why on earth she doesn't understand a word she hears so ducking much.surely if it was hearing she wouldn't repeat words clearly.

I forgot to say she does though also absorb what she hears! Earlier to get her attention I bashed two sticks together, I moved to within inch of the back of her head and she didn't register. I was wondering about sudden deafness. She then finished her play, found the sticks and bashed them near my head!

It could be a number of things, or nothing at all - just late development. DS2 has dyspraxia and verbal dyspraxia and he was very similar to your DD except that he has always had good balance, but poor spatial awareness IE bumps into door frames, walls, etc. Dyspraxia is also sometimes associated with low muscle tone and hypermobility. Your daughter is too young for any diagnosis, but it might be something to keep in mind when speaking to professionals. Dyspraxia takes many forms and it can be very mild, to quite severe. DS is on the mild end but still didn't speak until he was 3. I also thought he couldn't understand much, but it has more to do with a delayed response. We just couldn't 'tune in' with him. He didn't 'get' sign language either. It was very hard to communicate with him. Now at 7 he is a very chatty little boy (speech is not perfect though) and is doing very well at school and socially. See this website: www.dyspraxiafoundation.org.uk/dyspraxia-children

Agree with PP, push for a referral to a developmental paed.

my dd had (and has) difficulties understanding language. Not understanding was something that I worried about from about 15/16 months. She has now a dx of autism. Speech and language still very muvh behind but she is talking now (she is 6).

Have you had a look at the M-chat to see if it flags up anything. If it does take it to your GP (and demand referral to paed).

www.m-chat.org/mchat.php

Hi there, my son was like your child and I was getting worried that there was something wrong. He would only say urghhh for everything! He's 22 months old and just this last month he's finally started to try to talk. He can say mammy and daddy and anything that stars with d or m, quite clearly now. But he's attempting every word now which he never did before. But like I said everything starts with d ( dat=cat) and so on. Don't read all the "should be doing by this age" cause either if mine where ever spot in with any "should be doing at this age" I brought it up with my health visitor and she wasn't at all concerned she said if by 2 he's not saying anything then they will refer him. I hanged on to that fact. Please stick with what you are doing and I'm sure your child will surprise you soon. Just to add I was singing baa baa black sheep to my eldest son and for some reason stopped half way and my youngest filled in 3 dags dull, I couldn't believe it. And like you he would say nothing on demand and is now attempting to copy every word I say. Give it a couple more months before seeking medical advice x