Toddler seems behind .. should I be concerned?

[Aurora24]

My DS is 21 months old but seems pretty delayed with language.

He only regularly says four words, car, ball, bus and lights. He can say mum and dad if asked but doesn't say it without prompting. He can wave but if you ask him to wave goodbye, it's very hit and miss whether he will actually wave. He does point, but it doesn't seem to actually mean anything as such, for instance he won't point at his cup if he wants more water. He can copy clapping, and other actions, like stamping.

He doesn't seem to like other kids either or anyone to be honest except me and his dad 😅. If other kids come near him at soft play he will move to another area and sometimes will do a little cry, like he isn't happy that other kids are there.
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I know kids all develop at different times and i think I'll probably just wait until his two and then see but I'm a first time mum so I wondered whether this is the right approach. Should I mention it to someone now and if so who would you talk to, the health visitor?

His development and behaviour sounds age appropriate for 21 months but you know your DS better than anyone and if you have concerns you should definitely get some advice from your HV or your GP. He sounds very similar to my DS who was diagnosed with glue ear just before he was 2. The earlier you have your concerns noted the easier it will be to get any help he may need further down the line. My DS has had surgery to resolve his glue ear last year and now at 5 is quickly catching up with his speech and communication to match his peers.

It might be worth filling in the 20 month Ages & Stages and seeing how he scores?

That’s still so young!! At my son’s two year check I was told he was behind on communication but now he’s almost three he won’t shut up!! Honestly don’t worry there’s far too much comparison and unnecessary warnings that just stress parents out

My daughter had about 3 words at 2. 3 months later she just opened her mouth, spoke in full sentences and hasn't stopped since! She's 32!!
If he's understanding what you're saying and can follow instructions or points to the correct things it will come.

Personally when I’ve needed help with things since dd was born, it’s taken me so long to convince a HV or GP that there was an issue and I’m not just an anxious first time mum that it’s really delayed treatment. So for that reason I would personally speak to someone, there’s probably a long waiting list and if he suddenly starts saying loads of words in a month or two or three then great you can come off the list, and if not at least you’ve got the ball rolling.
I think they’re supposed to have more than 10 words at this point, but just to note they don’t have to be clear words other people would recognise, if that’s making you ‘mark’ him lower

Wait and see over the next few months is the right approach. Language comes all of a sudden. They'll go from two works to a hundred words in a couple of weeks, adding ten words a day in the explosion phase. Keep an eye, but don't stress.

In the meantime, talk to him about everything. Use simple, clear, repetitive language. Talk to him at eye level as much as possible. Read. Sing. Turn the TV or radio off if you're a background noise kind of family.

I totally agree with this. I posted about my Dd at a similar age and had lots of lovely MNers say similar things to this thread. As in, it’s all very normal and speech will come. Only it wasn’t normal for us and DD did need support which ended up being delayed.

My advice would be to do the Ages & Stages linked to earlier and if she scores grey in more than 2 areas or Blavk in any area then come back, and we can tell you what to do next

It might also be worth doing this simple progress checker. If it says that she needs support you should ask your HV to refer her for a hearing test and for SaLT. Your HV will probably want to see her again at 2 wheb she should assess her using both of these:

2 year Ages & Stages

and the 2 year Social & Emotional Ages & Stages.

My DD is also 21 months old. She also only has a few words. Uses.the words mummy and daddy interchangeably as well as calling other adults mummy and daddy. I am not concerned. My DS was very similar at this age. (I was concerned at the time). Just before he was 2.5 years old he suddenly had a 'language explosion'' and was chatting away. His speech was quite unclear and I always assumed that he would likely need speech therapy when he was older. He didn't need any speech therapy. He's now 5 and is doing well at school.
21 months is still very young and children develop at different rates.
You could ask nursery if they have any concerns? That may reassure you.

@SleafordSods thank you for the questionnaire and other link, really helpful. I did the 20 month questionnaire and I'm shocked to be honest he was behind in all areas. I thought his gross motor skills were excelling in comparison to other kids (not that you should compare) so I thought maybe he is excelling in one area and that's why he is behind in another.

The personal/social section the score was zero.

I know it says 20 month questionnaire, but is it like the 1 year one where they started arranging appointments at 10 months. I'm just wondering whether in three months time he could have improved in some of these areas.

Does the health visitor arrange a routine assessment at two or do you have to request it?

OP it sounds like you need to trust your gut. Some children are delayed with speech but you are also concerned about non verbal communication and social skills.
You definitely can't lose anything by organising an appointment with a health visitor or speaking with your GP.
Have you had plenty of opportunities for socialising with extended family and playgroups etc? Does your child attend nursery?
If not then that might explain some of the struggles with socialising and you might just need more practise.

The ASQ forms have an age range on the first page, the 22 month one is the appropriate one for a 21 month old. The 24 month one would be too advanced, although they overlap a fair amount so if he scored as behind on all areas on the 24 month form, it's fairly likely that he could be behind on the 22 month form as well.

I would definitely speak to your health visitor or make an appointment with the GP - bring the filled in form or the scoring page of it at least.

Watch and wait is fine advice if you have access to a fast referral and intervention service but that unfortunately is not the case, so it's important to seek advice as soon as you have any concerns. If you have the funds it may be worth looking into private speech therapy.

So how did they score exactly? Scoring in the grey in two areas is perfectly normal. If they score in the grey in more than two areas or in the black then I’d be asking for a referral to a Paediatrician and to Portage at least.

Contact your HV asap OP. Early intervention is key and waiting lists are long. He will be due his 2 year contact soon but it’s a postcode lottery how well that runs. Just contact them, tell them you are concerned and request an appt. If you are fobbed off tell them you wish for them to document that you are significantly concerned about his development and that they are not acting upon your request and would like to escalate your request to their team leader.
You probably won’t need to do this but some HV services are on their knees and you need to say the right things to be seen.
Is he at nursery? If so contact them and request a meeting with his key person to discuss his progress and what support they can put in place. Can they do a WELLCOMM assessment?

As someone with the same age child I'd be reaching out for support at this point. Good luck.

Omg he’s only 1
jeez

This is excellent advice. And I also agree with @BertieBotts. The “Watch and wait” approach only works if you can get a quick referral when you need it. Unfortunately, those speedy referrals are just not available.

My ds had delayed speech - a very late starter in all areas excepting crawling and walking which was bang on average. He was late learning to jump but he learned to use his balance bike aged 2 quick quickly (we used it on school for older dc run twice a day).

My ds was part time at nursery and I think that helped with friendships but I do wonder if it delayed him more because lack of 1:1.
Very experienced nursery leader who reassured me he was in the normal range for boys whose communication sometimes lags versus girls. That reassurance meant the world so I do think getting an HV to take a look is a good idea.

Unlike a lot of mums who get a flood of relief when a developmental leap occurs and suddenly speech takes off - this didn’t happen for my ds. It turns out he has slow processing problems, and so he learns differently to other kids. Speech came very slowly, littered with mistakes (pronunciation, muddling up pronouns, poor grammar). He never learned nursery rhymes - at age five if I asked him to tell me a word that rhymes with hat, he simply couldn’t do it, even if I helped. But that has improved and now he can learn things when needed.

Now age 7 he still habitually gets his past tense wrong eg runned instead of ran and his diction is poor. But he improves and we gently repeat back to him and occasionally ask him to repeat back. He struggles to tell a story because he finds it hard to order his words and thoughts so we practice what happened at school today, tell me what you did at lunchbreak. His vocabulary is noticeably worse than his peers, but he slowly gets better.

To be clear: no professional thinks he has a SEN. It’s fascinating - he is intelligent , he can concentrate for hours playing Lego, but he struggles with taking in new information, anything spontaneous where he has to retrieve information from his brain. Especially anything verbal. But strangely he can read very well - that’s easy since he has simply learned how to do it by repetition.

He is now 7 and he has found the first few years of school very frustrating, but together we are finding ways to deal with how his brain works. Lots of gentle repetition. He is very good at some aspects of maths - he can also now recite most of his times table facts (multiply and divide) in under two seconds - which gives me some hope. I try to keep him a little ahead of his class work in maths so that he doesn’t struggle as much in class, at least that’s one lesson he doesn’t feel “stupid”. It is very sad to hear your dc say they are stupid - he truly believes it. We continue to support and as he gets older we explain he isn’t stupid, everyone’s brain works a little differently and he is brilliant at some things (sports!).

Anyway I just wanted to say don’t worry too much - even on a hard journey, you can make progress. Get some advice and help. Keep your communications with dc very simple and very predictable and don’t rush him. Find something he likes (for ds it was building Duplo and his wooden trainer) and let him play that as much as he wants - play with him as much as you can. As he gets older make sure he is watching your face when you talk. Avoid screen time .

@Falalalalaaaalalalalaaaa this sounds very much like my DS2, he just could not get rhymes at all no matter how I tried to explain it. I was very concerned about this and convinced it was a sign of dyslexia. However he has now started school aged 7 - we live abroad - and about two weeks before the start of the school term, he was suddenly identifying rhymes correctly out of nowhere. He is starting to pick up reading and is really getting there much quicker than I had anticipated, not fluent yet but getting there. (I'm very pleased about this!)

DH wonders if COVID came at a really crucial time for his development because the strictest lockdowns were when he was about 1.5-2.5 - these are times where children are often observing so much from others and their vocabulary is often exploding, but thinking back to that time, he wasn't really using words much at all, he mainly used long strongs of unintelligible babbling but with the intonation of speech, and when we look back at videos he's mimicking our intonation perfectly and sometimes trying to copy the exact sounds we made as well. I think it can't purely be the lockdowns, because otherwise every child his age would be struggling, but I do wonder whether lockdown happened to coincide with some specific struggle he has.

In our case he is diagnosed with ADHD, but I think that only really got picked up because there is a family history so I knew what to look for and because he was having significant behavioural/social difficulties in nursery, he went through three in the end, not his fault. They assessed him for autism as well but said no, although TBH I do wonder if this will come back as a question later.

I had got into a bit of a rabbithole about Gestalt language processing and wonder if he possibly has something like that because it fits some of his early language development, but his language wasn't technically late, he was within normal developmental guidelines for each milestone although on the later end. Apparently there is some preliminary research going on now into the concept of "dual processors" (ie children who develop language partially in the normal way, and partially in the GLP way).

The way that he processes language is still slightly odd - he mixes up similar-sounding words e.g. today he was talking about a game and kept saying "dunk" when he meant "duck" and was then insistent DH was the one who was wrong when he tried to correct him. And then the other day he suddenly recognised out of nowhere that the word "pour" a liquid and "poor" (poor me/rich and poor) sound the same but have two different meanings, which he's never registered before. It's not an accent thing, because in our accent they sound the same. And then another day he said something like "How come in Minecraft, it's a pickact, but in this game it's a pickaxe?" and then wouldn't accept that it is also a pickaxe in Minecraft.

Something that was flagged up when he was ~6 and still not able to rhyme even though he'd had 9 months of speech therapy and wasn't mixing up sh and s sounds any more, was whether he possibly has an auditory processing disorder. Where we are, they won't assess for this unless they have struggles learning to read and it doesn't gain him any support anyway so it is unlikely we will be able to have this tested but a lot of the things I read about APD fit. He also has difficulty with things like sequencing and really struggles hugely with verbal stories. He can't follow stories without pictures (I wonder if this will change when his reading gets more fluent) and struggles even with comics, his verbal working memory appears very limited - he has OT and they are trying to work on this at the moment. If he tells a story of something that happened at school for example, it's often muddled up to such a degree that it doesn't actually make sense, and it makes it challenging for him to take on feedback about e.g. behaviour or what to do in a situation.

But he can build Lego like a champion and can identify real life bus models from about 100m distance he's also good with numbers and calculations, and we've been playing Openguessr and he's really picking up on things like spotting road signs from different countries etc. In some ways his brain is absolutely brilliant so I'm really curious to see how he will get on as he gets older.