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Speech Delay: To Evaluate or Not To Evaluate

Speech Delay: To Evaluate or Not To Evaluate

By Amalah

Dear Amy,

I have been reading your column since I first became pregnant, and have been following your advice since the birth of my daughter. She is a very happy, very easy kid, and we haven’t had problems with sleeping or eating (knock on wood). I’m not even sure we have a problem now, more of a question.

My daughter is now eighteen months old, and says zero words. Never a “dada” or a “mama.” I think she may have said “kitty” for a few days several months ago, but she called everything she wanted “kitty.” Since saying “kitty” didn’t get her what she wanted (including the cat, he doesn’t like her), she gave it up. She babbles in all sorts of vowel and consonant sounds, and makes “sentences” of babbles, but none if it is even close to a word.

She does communicate. She points to things she wants, waves hi and bye, shakes her head “no”, and she knows half a dozen signs. She will respond to my voice, so I don’t think there is an issue with her hearing. She can follow simple commands. Her daycare teachers say she is happy and social and on-track, but I’ve noticed that the other children in her class say “Hi” and “Bye” and even call her by name.

We just had her 18-month doctor’s appointment, and her pediatrician wants to send her to a speech therapist. The doctor has been concerned about her lack of words since the 9-month appointment. My mother didn’t talk until she was 3, and my mom says I talked late, so I wasn’t worried, but the doctor says things are different these days. Why? I thought kids developed at their own pace. I know delayed speech can sometimes be an indicator of autism, but she has none of the other autism red flags (she uses facial expressions, communicates with gestures, plays peek-a-boo, likes to hang out around other kids, plays pretend). I’m sure she will eventually say something, so why should we go to a speech therapist?

Thank you,
The-Hand-Sign-Known-as-Mama

You should go to a speech therapist because your doctor thinks you should, and because you are not a speech therapist, and therefore aren’t technically qualified to be so “sure” she’ll eventually say something.  Let me be a little extra Smackdown-y blunt here: Your mother didn’t talk until she was three. Do you REALLY want to spend the next 18 months with a non-verbal child, watching her fall farther and farther behind her peers, as her frustration levels shoot through the roof? Especially since there might have been a REASON your mother spoke so late — a reason that “these days” is entirely correctable or treatable?

Speech delays can be caused by many, many things besides a child just “developing at their own pace.” And many, many things besides an early indicator of Autism. Just off the top of my head, my son attended group speech therapy as a toddler with kids with diagnoses ranging from apraxia, oral impairments of the tongue and/or palate, hearing issues, pervasive developmental delays, premature birth and probably just a few late bloomers who nonetheless qualified for Early Intervention and no doubt benefited from it anyway. (At this age, speech therapy is done through simple play and games…it’s really fun for them! And I learned so much!)

She should have her hearing checked, because again, responding to your voice is not enough alone to rule out hearing problems. She might be fine with you one-on-one in a quiet environment, but have issues in the noisy atmosphere of daycare, for example. She might have stealth chronic ear infections that she doesn’t complain about, or even just allergies causing fluid build-up. (Both fixable/treatable issues!) And since your pediatrician has been concerned about her communication development for awhile now (the doctor likely wasn’t worried about a lack of words at 9 months, but overall a delay in her sounds or other markers she may be developing, but developing consistently late), I don’t see ANY downside of heeding the advice to get a full and proper evaluation. (I should add that the gaining and then “losing” of words was a big factor in my son’s initial speech referral at 18 months as well.)

A full speech evaluation will give you a clear picture of:

  1. What she understands (receptive)
  2. What she can say (expressive)
  3. What she can communicate non-verbally (signs, gestures, etc.)
  4. Sound development and clarity of the vowel and consonant sounds she’s babbling (is she missing some sounds, are some being formed incorrectly, etc.)
  5. Oral motor development (tongue thrust, tie, other issues with eating/swallowing/sensory input)

The evaluation may very very well turn up nothing beyond “she’s developing expressive language at her own pace.”  Great! Now you know, and maybe you’ll come away from the appointment with some valuable tools and insight on how to better encourage your daughter to talk, maybe learn some more signs to stave off tantrums and frustration. And you can then tell your pediatrician that really, all is well, we’re just going to be patient.

But the reality is you just won’t know unless you get her evaluated, and this is so not something worth being all stubborn about because of how things “used” to be. Before Early Intervention, kids were allowed to fall needlessly behind, and kids with correctable language issues fell through the cracks. I can’t tell you the number of times my son’s very real speech delays were waved away by well-meaning friends and relatives with “Einstein didn’t talk until he was three, just relax, he’ll be fine.” And sure, I imagine at some point my son would have finally started talking.  But we chose to intervene and got him caught up sooner. Which was invaluable for our own sanity (seriously, the TERRIBLE TWO/THREE TANTRUMS ARE COMING) and preschool, and…well, for HIM, my child, who learned how to speak. The intervention wasn’t painful or pushy or took anything away from his unique special snowflakiness. It taught him to talk and communicate with the world around him, and that’s an awesome thing.

Photo source: Depositphotos/titov

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Amalah
About the Author

Amy Corbett Storch

Amalah

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

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Comments

  • KP

    Go. Amy is 100% correct. Get your daughter tested by a speech therapist and an audiologist. My son was talking fairly well at 18 months (or so we thought) and we thought his hearing was fine but we got his ears checked by a specialist because of chronic ear infections and found out he constantly had fluid behind his ears. He got tubes put in and the difference was night and day. He went from what we thought was talking fairly well to an explosion of words and talking in sentences. And now he doesn’t stop talking at just 23 months. We were amazed by the difference in his communication. So go and have your daughter checked. It could be nothing but it could also be something and delaying a possible diagnosis could only make it worse.

  • Ally

    I felt the same way with my oldest and going through speech therapy was one of the best decisions we made. Learning to communicate helped him so much at home and at preschool. Both my sons ended up doing it and they actually loved it. We have a great speech therapist who came to our house and they always thought they were just playing. I learned a lot about why they weren’t talking (problems with the position of their tongues). Definitely go for the evaluation!

  • Tiffany

    Totally agree with Amy on this! I work with children (many with speech delays), and yes, most kids do eventually talk on their own, and some just are super late talkers for no diagnosable reason, but:
    A) Why take the chance? Save yourself 2 years of explaining and justifying why you’re not worried (or, save yourself 2 years of maybe being a bit worried) and just do it. Some kids just need a bit of a “boost”, even if nothing is officially “wrong”. And if something is going on, you’re 2 years ahead of the game on supporting her.
    B) Yes, most kids were fine throughout history without speech therapy, and everyones got an example of someone (Einstein or Grandma) who talked late, but my thoughts on this are that most kids were fine throughout history without LOTS of things we take for granted now, and yet we still use preschool, crayons, swimming lessons, shampoo, etc…
    Best of luck!

    • Tracey Prevost

      Help Me Grow did an assessment on our daughter when she was 20 months, and said she was speech delayed, which we weren’t surprised to hear. They said we could either wait until she turned two and see how she was doing, or ask for for SLT referral, which we went ahead and did. We got the helpful speeches from various people, whose children didn’t speak until the they were 4, and they turned out just fine. But it was one of the best things we ever did, the sessions helped her a great deal with her vocabulary, and also with her moods, she was a much calmer child once she had the words to express herself!

  • Traci

    This advice is good, but wrongly timed. From a developmental standpoint this child is still within the typical range. You really don’t need to be concerned until they are 2. At age 2, if the child is still not speaking that would be the time to follow this advice. I say this as an child development specialist as well as someone who worked with 1 1/2-2 year olds.

    Anecdotally, my son followed a similar pattern as the lw’s child. He started talking in full sentences a few weeks before he turned 2. He went from 0 to 60 right at age 2. He was also on target or advanced in every other developmental area and his receptive language was through the roof. It is normal for pretty much every kid to have at least one area that they are developing slower in. Development isn’t a straight line. You have to look at the big picture as the lw is.

    • Myriam

      There might be delays and waitlists to get services though. Not a bad idea to get the ball rolling now, so as not to lose another 6 months on waitlists at 2 yo.

      • Christine

        Excellent point. My son was referred to speech therapy at 13 months. His first appointment is next month, when he will be 17 months. The wait times in my province can be quite long, which is why our doctor choose to refer my son right away.

    • Kay

      You can have all the background in the world, but you do not treat this child, you have not seen her, you do not know if there are other language development things she isn’t doing that she should. Her doctor does know these things and has seen her, and I think it would be much better to defer to that professional opinion — particularly since, as everyone has pointed out, getting an evaluation certainly won’t HURT — rather than tell a parent from your standpoint as a specialist whether or not she should be concerned because of what you’ve gathered few paragraphs from the Internet.

      (I say this as a mental health professional whose professional organizations are all very firm on the “No diagnosing over the Internet” thing. I really believe it is wrong to use the extra clout a degree or specialization or whatever gives to discourage someone from following their doctor’s recommendations.)

  • I’ve always looked at speech therapy as something that certainly won’t HURT, so there’s no downside to doing it (unless it’s a financial issue, but even if your pediatrician refers you to a private speech therapist, if your child is under 3 then Early Intervention services would be provided free of charge if they’re deemed necessary. EI through the state might take longer to get the ball rolling and have more paperwork, but in hindsight I wish we hadn’t paid for a year of private speech therapy that should have been covered by the state!). I have two kids in speech therapy – one who has had oral motor issues since birth and DEFINITELY needed the help to catch up, and the other who seems like she might have picked up some of his poor speech patterns and will likely not need very long in therapy to be all caught up. But they attend small group speech therapy at our local elementary school and through that we’ve met a number of our neighbors and now my son is entering kindergarten knowing a number of his fellow classmates (not to mention being totally comfortable with the local school since he’s been going there for years now!). So honestly, if they’re recommending or offering an evaluation, just get it done and see what they say. Maybe they’ll say she’s totally on track, but in case they DO pick up something that you hadn’t known was wrong, better to be safe than sorry. And if they DO offer services, you could always say no . . . . or you could just look at it as an experience that won’t do any harm and might do a lot of good! 🙂

  • Jessy

    Two of my kids were exactly like this. They were both evaluated around 18 months and qualified for EI speech therapy. Their therapists were great people, but honestly I don’t think either of them needed it. The therapy didn’t really seem to make a difference, and they both did learn to talk on their own eventually. BUT! I will say that the evaluations gave me peace of mind that nothing else was going on. And the sessions were super fun for my kids even if they didn’t exactly learn to talk because of them. And it was free. So there really isn’t a down side to checking it out. Good luck!

    • Erin

      Yes! This. My son didn’t talk by 15 months, so we had him evaluated. It turned out that he didn’t qualify for services, but the evaluator gave us some really helpful suggestions for getting him going, and we also got some peace of mind. I realized my reluctance about getting him evaluated was about ME, not him, so we did it and I am SO glad we did.

      He didn’t really start talking until he was about 21 months old, and then it took off like a rocket. Maybe that will happen for your daughter too! But getting evaluated will only help her and you. Promise.

  • Kelsey

    When I was student-teaching second grade, I had a student with severe speech delays and impairments that could’ve been corrected with speech therapy when he was younger. His parents had thought he would grow out of them, but he didn’t, and he was almost impossible to understand as an 8-year-old. We as teachers did our best not to shame him, saying, “My ears weren’t quite ready to listen, could you say that again more slowly now that my ears are ready?” instead of telling him that we couldn’t understand what he was saying. He regularly ended up having gigantic meltdowns because he was trying to talk to people and communicate with them, and nobody knew what he was saying, it was really frustrating and embarrassing for him. I’m sure his mispronunciation of “th” and “r” and “l” were adorable as a toddler or really little kid, but by the time he was 8 and was finally starting to see the school speech pathologist, he was really struggling. (For example, the word “brother” was “bwuvo”, he pronounced soft E’s like O’s, so “Kelly” would’ve been “Kowy”, etc.) Having an evaluation would’ve helped him when he was a toddler, and it may very well help your kiddo too! Good luck!

    • lindsay

      This is a completely separate issue. They do not do speech therapy for mispronounciation until about age 6, and certainly not for a toddler.

      • My son has been in speech therapy for articulation issues since he was 2 and his sister since 3.5 years old. The goal is just to being them up to the age appropriate level (since there are definitely sounds that don’t emerge in typical kids until age 5 or 6 or even later). So they wouldn’t put a toddler in speech therapy for the more complex sounds, but they absolutely do provide services if they can’t pronounce the sounds that should have already developed by that age.

  • Marie

    Fantastic advice Amy. My first daughter didn’t speak until almost 2, we were in EI and she just didn’t speak. She could sign but no animals signs or anything. At 20 months when my second daughter was born she walked into the hospital room and said “the baby has a baby” (her sister had a doll in the bassinet). She then spoke in complete sentences and mastered sarcasm three months later. But EI was great nonetheless. My second daughter wasn’t speaking at 18 months and I wasn’t worried. At least she babbled and tried to say thing. But it turns out that she had profound hearing loss due to ear infections. Infections we didn’t know she had because she never complained. We discovered them at a well child visit. She responded to us so we had no idea. She was in EI and speech and even now at 9 we are still seeing the effects! So, definitely, an evaluation will never hurt. It was unnecessary for the first child but she sees her EI therapist around town and still loves her.

  • Alyssa

    Funny timing… my son just had his assessment this morning. It was great! He had so much fun, we learned a lot, and I’m so happy to know where the issues are from and some tricks to help at home. (He was referred to a one on one therapy program) We learned that we shouldn’t be testing him (can you say dog?) And instead we should speak for him and wait 5 seconds for an unprompted imitation. (look, big dog……… big dog) with praise no matter how it sounds. That we shouldn’t be asking him to use please and thank you (he can learn those later) it’s better for him to say “cup” “ball” and “truck” than to use “please” for everything.

    We also talked about how it may be his tonsils causing the delay (they are oversized and causing a tongue thrust) and how he may have hyper/hypo-sensitive oral features.

    Honestly, even the assessment makes me feel better.

    My husband’s cousin is now seeking speech therapy as a 25 year old because everyone thought it would develop at his own pace and never did, so he has spent 25 years without people being able to understand him fully.

  • bookworm81

    Please get your kid evaluated asap. As far as speech therapy is concerned the earlier the better. My son was evaluated last month at 15 months old (so younger than your daughter) and he already qualified for services because he doesn’t have any real words so I’m sure your daughter would qualify.