At what age do I worry about lack of speech?

[LolaLadybird]

I originally posted this in Behaviour & Development but it was suggested I might have more luck here ...

DS is 21 mths and really only says one word which is DD's name (but this is a v simple 2 syllable word). Doesn't say mama/dada etc. He does babble quite a lot and is v communicative in other ways so often makes himself understood. Also, I have no concerns about his hearing because he understands most things I say to him. He has v little interest in repeating words back, usually just grins and doesn't try but occasionally when he does try, his attempt doesn't sound anything like the original word.

DD was already repeating words at a year old and seems to have not stopped talking since (she's now 4) which just highlights DS lack of speech.

I'm not worried about DS's lack of speech yet (she says tentatively!) but wondering at what point I should be visiting the HV to seek some help?

Hi lolaladybird
I'm afraid i would suggest having your ds's hearing checked, just incase that is causing something underlying. My dd (albeit younger) was similar and it turned out her lack of speech development was caused by hearing loss. I didn't bother with the HV (as she just said that all children develop different, which of course is true but not reassuring) and went straight to the GP for a referral to audiology.

We last saw a SALT when dd was 2 and she said to expect anything from 5-50 words by age 2. She also said the range varies enormously at this age. I'm sure you will have heard that boys are often later with their speech - as they are usually more physical. We were referred through HV mainly because dd has other issues as they don't normally refer under 2's.

Hi Lola, my son sounds very similar to yours. I've recently discovered he may possibly has a type of a cleft palate. The dangly bit at the back of his mouth is split which is a marker for a sub mucous cleft palate. Maybe its worth having a look in his mouth if possible.

On the other hand 21 months is very young, especially for boys, and if he is pointing and communicating in his own way then I wouldn't worry too much. (I know ... very hard)

I spoke with my HV at 21 months I think as there can be a long waiting list for SALT

I would say probably 2-2.6. However if you are concerned them seek help earlier. The problem though with waiting is that the waiting list for therapy can be long. Ds was referred at 2.6 and has only had one block of therapy (he is nearly 4 now) and the other children there were over a year younger??? Which has made me question whether I should have seeked helped earlier. I agree with hatchypom and think getting your ds hearing checked is a good idea. My ds was referred through audiology though he doesn't appear to have any problems with his hearing.

Well, if he is understanding you and communicating in other ways that's a big thing. I'd second (third? fourth?) checking his hearing, the not-copying-accurately thing would make me wonder about a hearing problem. If that's OK I would probably give it another 6 months before looking for a SALT referral. He's still well within the bounds of "normal".

Have you tried other forms of communication? Like signing? It doesn't slow acquisition of speech - there's evidence to show it actually speeds it up - and it could reduce frustration while he is waiting for talking to happen. Also it will reassure you that he's able to produce the words and you can check his understanding.

I would say go now because waiting times for speech therapy can be months so its best to get on the list now and insist on a referral, he will most likely be 2 before you see anyone and you can cancel if things improve. Our local Surestart centre does speech therapy drop ins so you might have something similar. You are right most children would have some recognisable words or sounds eg animal noises by 18 months; they will say some children speak later, which is true but its better to get help and then find it was not needed as just a late talker than not to get help and have a widening gap / be stuck on a waiting list for months. My child has autism and he acquired speech normally speaking from 8-26 months and then lost words. I have three boys and they all spoke before 12 months so its a bit of a myth that boys talk later. When there is a problem people want to reassure you and tell you stories about other children who spoke late etc but in our case it turned out that there was a problem if I had listened to others I would have wasted alot of time getting my son the help he needs. You might be worrying about nothing but getting help isn't going to harm him. There is a good website called teachmetotalk.com by an American speech therapist which has lots of info on it and you can download podcasts about milestones etc. Her advice is if you are worried, get a proper assessment. I have not listened to it in a while but I think she felt that although the cut off for first words was 2, this was the outside limit for referral, if a child wasn't saying mama by about 18 months that would raise her concerns. I don't agree that 21 months is young for a boy. The range is 8-24 months for first words so 21 months is behind the average, my children all had well over 100 words by age 2 which is above average but shows that the range for talking is huge. Of course not every child fits the milestones, but what is there to be gained by doing wait and see? There are lots of stories of children who did not speak until 3 and then spoke in sentences etc but also lots of stories of children who did turn out to have a problem. ICAN and AFASIC are good websites on speech issues. In my experience speech therapists would rather see a child early than late, they won't be cross with you for seeking help. Don't let the HV fob you off, the speech therapist will know what other reassuring signs to look for it is for a speech therapist to tell you there's no reason for concern. A HV is not qualified to do this. I hope that your concerns are unfounded but in my case that did not turn out to be the case and I don't see you have anything to lose my getting a proper assessment / advice.

Likewise, I sincerely hope your concerns are unfounded and your DS is still very young. That said, everyone was terribly reassuring when my DD1 was virtually silent at two & a half and she turned out to have severe Speech & Language disorder.
My advice is always the same to anyone who thinks there may be a problem - self refer to Speech Therapy ( you do not have to go through GP or HV and are probably wasting your time doing so) If nothing else they can reassure you on the phone or bring you in for an advice sessison. There will be a waiting list, so if your DS starts talking before you get an appointment that great, but you have nothing ot lose by talking to a Speech Therapist.

Hi everybody - thanks for your replies. The confusing thing is that DS has said 'mama/dada' in the past but hasn't persevered with it - it's like he just forgets. Similarly with DD's name, he could say that at about 13 months but then didn't use it for months, just starting again recently. So sometimes he can reproduce sounds but other times not. I spend a lot of time trying to get him to repeat words (not obsessively, just as part of our normal routine) but most of the time he doesn't try so it's hard to guauge whether he is able or not.

So far everyone around me has said not to worry, he'll just talk late so it's interesting to hear the other side of things. I think I might start with a visit to the HV (we haven't been for 9 mths or so)and see how that goes.

I don't think we have a Surestart facility locally (rural Somerset). Bubble2 - how do you self-refer to Speech Therapy? May also look at signing. Not something I've ever investigated before as DD has always been such a talker but it might help to reduce some of DS' frustrations as suggested.

Hi Lola
Something like this might help? www.somersetpct.nhs.uk/welcome/services/paediatric-speech-and-language-therapy/

It's the 'forgetting ' words which would bother me slightly tbh. On the other hand the fact that he is understanding and also trying to communicate is massively positive

Go with your instincts

To Bubble and Grumpy and the others ...

can I just ask when you are out and about in RL and people expect your LO to talk back to them, what do you actually say to them ? Obviously I dont want to go into his entire medical history in front of a random stranger

I'm finding myself saying 'he's shy' or 'he probably wont reply'.

I'm desperately trying not to say 'he cant speak' in front of him as I think it's probably reinforcing the fact for him.

Whats the best thing to say ... we tend to all stand around staring at him as if putting him on show will suddenly start him off !

Bubble - thanks for the link. That's really helpful. I had no idea you could self-refer so I may well get in touch and get his name on the waiting list. If we end up cancelling the appt by the time we get one then there's nothing lost.

I think children do stop using words though, certainly when they are learning new ones. I know both of mine did. 21 months is not old and if he is saying some words I wouldn't be overly concerned yet. Does he say yes or no, please, make animal noises?

I baby signed with both my DSs and I think it helps them with their language, try and do the basic signs such as please, thank you, sleep etc. you can find these on line or most libararies have them in the childrens section.

Carrotfly wish I knew the answer to that one....but I totally agree that the worst possible thing to say in front of a child is " she can't talk " ( or "she can't" in general for that matter) - have always avoided that one myself. I tend to go with something along the lines of "she's very quiet", and as you say, a full explanation is not really necessary, nor fair to go into in front of a 4 year old.I do tend to explain more if I can do it out od DD's earshot - in fact have days when I am on a mission to educate the general public about Speech & Language disorders

Completely agree Bubble.

I like that answer, quick and not in the least bit negative. May borrow that ... thanks !

GoAway - DS doesn't say yes or no but he does make a couple of animal noises. He also today said the dog's name which he hasn't done for ages (so no 'mama' but he calls the dog by name!). He also had a stab at saying a couple of other words I tried with him (tractor and bib). The big change in our house in the last week is that 4 yr old DD has just started school which means the house is a lot quieter (she really seems to talk enough for 4 of us sometimes) and I wonder if that will give him more of an opportunity that wasn't there before. Interestingly, he also repeated DD's name several times today in a questioning way as if he was wondering where she was.

I think I may persevere for a few weeks and see where that gets us. DH has read this thread and is still unconcerned but not against me self-referring for speech therapy so I'll wait and see how things go for now. Tbh, it's comforting to know I can self-refer and also what the waiting times are (max 18 weeks according to the PCT website that Bubble kindly linked for me).

dont worry! my DS could only say 5 words before he was 2...and then at a week past 2 years old he had a sudden burst of vocabulary!! he is now 2 years 6 months and can speak really well and talks in up to 8 word sentances!

OK we know that some children wake up one morning and start speaking but many don't and 'teaching' them how to speak is really hard work.

I'm sorry I've just been to another bloody useless session at SALT and I'm really, really cross.

I would say if you are worried, go to your GP and ask for hearing test, and ask to check for glue ear, and get on the waiting list for speech and language therapy asap as it can take weeks to have the initial assessment. Took us 16 weeks!

Ask your GP to check your child's ears as they might be able to see if there's liquid behind the ear drum.

Thats great that you are seeing progress. I would probably get on the waiting list though and then come off if it sorts itself out. I can't really get around what to say as he used to speak and now he doesn't and he's nearly 3. I tend to say nothing but if people ask I explain. However in your shoes I would probably just say he's shy or a late talker. The fact he grins up at you doesn't sound much like ASD if thats any consolation - my son looks past me!