Our Q&A starts now!

Echolalia

• Sabrina H. Hi Amy, Can I ask what sort of echolalia you are seeing? Children will repeat language that they have heard as "practice", but you are right in thinking that sometimes they are delayed in moving past this stage.

Talking

• Sabrina H. Hi Kelly, It sounds like your daughter is making good progress in language development! Children do develop at their own pace, and language is no exception. Clearly, your daughter understands a good deal, and it sounds like she is making efforts to try to communicate with you in turn (e.g., the words, the pointing). Regarding “hearing the same sounds for different words”, that is very common for children at this age. At 16 months old, your daughter has not yet learned to make all of the sounds in English, and she has trouble with words that are more complex. For example, “mom” or “mama” is much easier to say than “milk”, because “milk” has two hard sounds (the “l” and the “k”) that are combined together at the end of the word (which is a tricky place to put sounds together). It is very natural for children at this age to take hard words and turn them into easier productions that they can actually say (e.g. “mah” or “mih” for “milk”; “du” for “juice”). As a result, many words sound the same because they have been simplified. If you want to help her in the process of learning to differentiate these words, I would recommend that you say the “correct” production after she uses her modified word (e.g., your daughter points to the milk and says “mah” to request for some; you say “milk!” right after). What this does is it gives her the correct sound model right after she has tried to make the word. This helps her in trying to match what she is doing with what she ought to be doing. Thanks for your question!

Slow talker

• Sabrina H. Hi Katrina, It is not unusual for children at the youngest ages to have words that appear and then (briefly) disappear from their vocabulary. My guess is that you’ll start hearing “mama” and “dada” again before long. I’m glad to hear that she is pointing. This is actually a very important communication skill! Think of it this way: she is actively initiating communication with you, even if she doesn’t yet have the words to have a conversation. In the meantime, if you are concerned about what to do to help her, you can certainly try some baby signs to see if she takes to them. Baby signs are a good transition into speech for some children: because children can see them, it is easier to learn them. As her vocabulary grows and she has more confidence in speaking, she will transition out of them and into just talking. One final note: I wouldn’t worry too much about comparing your two children’s language development. All children learn at slightly different paces, and research suggests that younger siblings take a little longer to learn language. (This makes a lot of sense intuitively: some of the language your 13-month old is hearing is from the 2.5 year old, who is still learning language and is not a perfect model for what to do.) Best of luck!

• Katrina Great thank you! Glad to hear about the pointing!

15 month old doesn't say anything except mama and dada

• Sabrina H. Can I ask a couple of follow-up questions before I answer? 1) How does your daughter do with eye contact? Will she look at you and smile if she sees something she likes? 2) Do you think your daughter knows the labels of a few objects, even if she isn't saying them? For example, if you said "Give me the ball!" would she know which one the ball is, even if she doesn't follow the direction to give it to you?

• Lizandra 1. Yes, she is very good at eye contact and often does that. For example, if she is playing with Daddy and is having fun she will look over to me and smile or laugh 2. I don't know exactly. I know she knows what some items represent. For example, she will take the remote control and point to the TV to turn it on. She gets very happy when Baby Einstein comes on. She also presses apps on my husbands phone. We limit her TV time to only an hour or so a day but she really likes TV. Could this b an issue? She may know the labels of other things but it's hard to tell. When I say "let's play with toys" she follows me but I'm not sure if she knows what I'm saying to her.

• Sabrina H. Hi Lizandra, Children don’t typically have very many words at 15 months of age; in fact, some children don’t have any at all! I am glad to hear that she is making good eye contact; it is a very important communication skill! This means that she is interested in sharing things with you and in interacting, which is of course the reason why we use language. I would recommend that you start using baby signs with your daughter; they often help children learn more words and (in turn) become more verbal. Think about what it feels like to go to a foreign country and hear (non-English) locals talk. If you don’t know the language, it can be hard to tell where one word stops and the next one begins! Now imagine trying to learn a particular word when you can’t even tell where words begin and end; this is the challenge of infants. They hear a stream of sounds and have to pull from it the exact sequence of sounds (i.e., the word) that matches the thing that they are learning to name. This is a difficult thing to do! The advantage of baby signs is that they are visual, and therefore easier for children to pick up on. You are demonstrating a discrete, purposeful movement, and children will learn to associate that movement (sign) with the object in time. Then, as they become better with connecting things in the world with their signs, they will transition into learning to say the words. If you continue to have concerns, I would talk to your pediatrician about your child’s development. I always think it’s better to address your concerns than to continue to wonder and worry. In the meantime, give baby signs a try! Thanks for your question and good luck with signing!

• Lizandra Thank you

6 month old speech development and signing

• Sabrina H. Hi Estelle, You are already doing a lot of great things to help your 6-month old learn language! Let’s start with signing: I’m not sure where you’ve heard that signing has the potential to delay speech, but this is not true. What signing does (as you have said yourself!) is allow children to communicate in an alternate way as they are still learning how to speak. Children will use signs while they are still learning how to move their mouths to form words, but as they are more confident in using their voice this will become the primary method of communication. Don’t be worried about using signs! Narration, reading, and repetition are all great ways to help your child develop language. I am going to add one more suggestion to that: expansion. Although your infant is still several months away from using words, as he begins to (or as he signs them), take is one word and put it in a sentence for him. E.g.: Your child sees a dog and says, (or signs) “dog.” You respond: “Dog! There’s a dog! That dog is so big!” What you are doing is modeling the next step of language, building off of what your child can already do. It’s a great technique to use at all levels! Thanks for your question!

When do you determine that a child is officially "non-verbal?"

• Sabrina H. Hi Stefanie, I’m glad to hear that your child is in early intervention services; the earlier children get into services, the better the outcomes. With that in mind, and given how very young he is, I don’t want you to lose hope on your child’s capacity for speech and language. The vast majority of children who do not have any words at 2 1/2 go on to be talkers. It is true some do not, but it is dependent on the diagnosis and degree of impairment. The other thing I want you to keep in mind is that there is a difference between “speech” and “language”. Speech is the motor action of using our mouths to make sounds. Language is about having a shared system to interact and communicate ideas like wants and needs. I have worked with children who, given their particular deficits, had difficulty with the motor movements necessary for speech. All of these children, though, were capable of language, even though they couldn’t express it by moving their mouths. Your child is similarly capable. I hope that your speech therapist has discussed with you the possibility of using alternative methods of communication with your son. Some children use these methods as a springboard into talking; I’ve worked with several children who, after signing with me for a few months, will begin using verbal speech to communicate! Other options include developing a picture system, where your child can express himself through one or more icons. Using alternative methods of communication (sometimes referred to as AAC) will not impede your child’s ability to learn to speak. What it will do is support his language and communication development, and may even facilitate his transition into using speech. Thanks for your question!

Lost words

• Sabrina H. Hi Stacey, It sounds like there has been a lot going on in your toddler’s life lately! In situations like this one, getting support services can make a big difference; you’ve done the right thing by having him assessed. It is also important to try to establish why a child has lost so many words. There can be a couple of reasons for this. Loss of words is sometimes an indicator of an autism spectrum disorder; however, this does not seem to be the case with your child. I think that the younger sibling arriving recently is possibly significant. This does not sound like it’s the only behavioral change of “regression” you observed, either. I am not a trained psychologist, so I don’t want to make any guesses about what your child might be thinking or feeling. However, I think it would be worth discussing these changes with one, who will have better insight and recommendations. Beyond that, make sure you have some one-on-one time with him every day to play together. Model good language and label what he is doing, as you typically do to encourage language development. You’ll be helping him continue to develop his understanding of language, and may encourage him to start using some of his words again. Best of luck!

Toddler Speech (Advanced)

• Sabrina H. Hi Kerri, Wow! It sounds like your son can do a lot of great things already! If you are interested in looking at where he is developmentally, the American Speech-Language and Hearing Association (ASHA) has some great resources online regarding typical milestones by year for toddlers: http://www.asha.org/public/speech/development/chart/ What to do next? Reading books together would be a great way to continue to foster his language development. Books are great for the next level of language development because they often have sentence structures and vocabulary that we don’t use frequently in day-to-day life. (For example, “ball” and “coach” mean one thing in team sports but another completely when reading Cinderella.) Don’t just stick to the words on the page, though; have conversations about what is going on. You can ask “What do you think will happen next?” or “What would you do if…”, for example. These sorts of questions will help him develop his ability to use language to talk about more abstract and difficult concepts, like his emotions or what he did earlier in the day (toddlers are often anxious to tell you what happened but aren’t so great at putting the pieces of the story together in order to do so!). Thanks for your question!

Risk to.younger sib of CAS

• Sabrina H. Hi Ann, It’s easy to compare your second child to your first, and when your first has had some challenges it is natural to be “on the lookout” for the same signs and symptoms in your second. You are not overreacting; you are just being a wonderful and involved parent! It is possible that multiple children in the same family will have apraxia of speech, but that doesn’t necessarily mean that your daughter has it. It is not unusual for a 14-month old to still be in the “babbling” stage and not have any words yet. It is also not uncommon for younger siblings to be slower in language development, because one of the models they have for language is imperfect. I would like for her to be repeating a little more than she apparently does, but whether that is temperament or the possible signs of apraxia is not clear. I strongly encourage you to discuss this with her doctor at her next visit. As I have said, your daughter may well be typically developing and have no speech or language problems whatsoever. However, if you are having concerns you should always bring them up to your pediatrician. Whether it is something or nothing, you will feel better knowing that you acted. Good luck!

• Ann Thanks. I know they all develop differently but it seems that cas runs in family as i also have a nephew with it. My oldest talked on time and very well. My second was delayed with speech because of fluid in his ears. With my third i started asking about his speech around this age and was told not to worry. But turned out he really need help so I'm just a little more careful and dont want to delay getting help if needed. I will definitly talk to pediatrician at next apt. Thanks for the imput!

Bilingual 15 month old

• Sabrina H. Hi Maria, You are already doing two of the best things that you can to help your daughter learn language! My suggestions would be, rather than to “do more”, to “be smart” in how you talk with and read with your child: In talking with your child, don’t be afraid to be a little repetitive in what you say. When you say something a few times over (e.g. “There’s the truck! You have the truck! Look at that truck!”), you are giving her multiple opportunities to learn new words, and you are giving her lots of different sentence structures for her to dissect and learn from. Also make sure that you give her some time to process what you are saying by pausing; not every second of playtime has to be filled with language! Talking about ‘the here and the now’ – labeling what she is doing, taking the word that she uses and putting it into a sentence – helps her to match the words you are using to what they label. When reading, don’t be afraid to deviate from the actual text of the book and talk about the pictures, particularly at early ages when attention is much shorter. This is called “shared reading.” You are doing the same thing you want to be doing with talking to her—sharing an experience, and using language to discuss it. As she gets older, she will want more of the story and less of the pictures; both are great ways to use books! Hope this helps!

• Maria Great advice, thank you!

Narration vs baby words

• Sabrina H. Hi Katie, What a great question! This is actually something that we research in my lab! It may surprise you to learn, but “baby talk” or “motherese” (as it is sometimes called) is not the same across all cultures. The babbling back and forth, as you described, is something that is done in the United Sates and across much of Europe, but it is not done universally. In some cultures it is even considered inappropriate! Regardless of the norms, children in all of these cultures learn language just fine. At present, your daughter is mostly concerned with learning the sounds of her language, and in discovering the rules about how the can be combined. (All languages have rules about sounds and sound combinations, called “phonology”. We know these unconsciously as native speakers.) Your daughter will be successful in this task simply by listening. Using narration will not “impede” this part of her language development. Regarding word-learning specifically: My only recommendation is that you not be so concerned with narration that you are giving your daughter sentences that are overly complex. To learn words, children need to be able to pull apart the sentence and process it. Young children, particularly, have difficulty pulling apart long and complex sentences (e.g., “That big, round, red ball in the corner is bouncing up and down slowly!”), and if they can’t pull it apart they can’t learn new words from it. Don’t overthink this idea! Just go with your intuition about speaking to her clearly, and she’ll be just fine!

• Katie Thank you so much, this is extremely helpful!

3 year old selective mute

• Sabrina H. That's a great question! Before I answer, can I ask how your child does with you out in the community (e.g., family events, playdates with other children)?

• Sunny He's comfortable talking in situations where he knows people (family or friends) but on play dates with even just two new friends he's quiet. Very shy when meeting new people (adults or kids), and especially quiet in big, loud groups if mom or dad aren't there. I should add that when he does speak at school it's in a whisper.

• Sabrina H. Hi Sunny, Thanks for providing some additional information for me. It’s good to know that, beyond just with you at home, he can reach a level of comfort where he will talk with other family members and friends. Some children are naturally shy, and that’s ok! Regarding how to help, I would recommend having someone he is more comfortable with facilitate his communication with people he is less comfortable with; this will help him build rapport with new people. For example, in play-dates, you could be the intermediary: Ask your child, “Do you think your friend would like to play with blocks or trains? Let’s ask!” Then, you ask the friend on behalf of your child. After the friend responds, you ‘interpret’: “Your friend says he wants to play with blocks! Let’s go get them!” In this way, you are a buffer to the scariness of having to interact with someone new. As he gets more comfortable with his new friend, you can back out and let them play without you. Another recommendation I would make in the classroom is using questions that have “closed answers” – i.e., your child is making a choice from a couple of possible responses. This reduces some of the pressure on him to respond. For example, instead of asking “What do you want for your snack?”, the question could be “Do you want goldfish or graham crackers today?” Asking yes-no questions also works. This encourages your child to communicate his preferences and desires, but the demands aren’t quite so high for a shy child. Hope this helps!

• Sunny Thank you! I will definitely try out these strategies!

Speech delay or normal spectrum of development for an almost 2 year old?

• Sabrina H. Hi Brett, Thanks for providing such detail! It sounds like you’ve already done a fair bit of research on language development, but I’m happy to try to provide some additional information. Regarding hearing: It sounds like his hearing is fine (no pun intended!). Hearing tests are often recommended for children who are showing some signs of delay in order to rule out hearing loss as the cause of any problems, which is probably why your pediatrician recommended it to you. Provided your son is not failing any hearing screenings, and if you have no concerns about his hearing, I agree with you that it is probably not worth pursuing at this time. Regarding comprehension of language: Your son appears to have some good receptive language skills. You do not sound worried about where he is in the process of developing receptive language, and given the examples that you listed I would agree with you that this is a strength. Regarding language production: Children show a great deal of variability in what they are capable of right around two years of age, so determining whether children are delayed is hard to do without a formal evaluation. You’ve listed several strengths to your son’s production so far, but there are also some weaknesses that you’ve highlighted. Your son’s pointing and gesturing are both great signs for intention to communicate. He wants to interact, and he’s finding ways to share information with you! Where I see some cause for concern is in his ability to actually say words. This is moving away from “language” (i.e., a system for sharing ideas) and into “speech” (i.e., the motor action of moving the mouth to form words). Where your son may be having difficulty is in his speech development. A couple of points stand out to me: first, your son has extreme difficulty repeating words, and the attempts are “nowhere near the word itself.” Second, he seems to have extreme difficulty combining things he can produce (like individual sounds or individual words) into a larger combination. Both of these indicate to me your son may be having some difficulty with the motor movements of speech production. So is there actually a problem? I can’t give you a definite answer without evaluating him. There may be. On the other hand, many typically developing children have smaller vocabularies and aren’t combining words at 22 months. He may well be “just fine,” as your gut is telling you. My recommendation would be to seek out an evaluation to look a little more closely at your son’s speech. He may well have no problems. My concern, though, is that many children that I have seen with speech problems at this age become very frustrated with trying to communicate, because they know what they want to say (their language is good), but they can’t say it (their speech is poor). Your son’s language skills are strong, and if there are speech problems I worry that he will very soon become frustrated. I think you may also find a formal evaluation helpful; even if your son does not have any problems (which would not be a bad outcome at all!), you will come away understanding more about your son’s skills. Thanks for your question. Best of luck!

• Brett Hi Sabrina, Thank you so much for your very thoughtful response! I am going to schedule a formal assessment for him to see what we can learn from it.

Advice for aspiring tri-lingual baby

• Sabrina H. Hi Nina, As you are no doubt aware, in many countries around the world children grow up speaking multiple languages. In such cases, bilingualism (or trilingualism) is a necessary skill because of the cultural context. So, your child absolutely has the cognitive capacity to be trilingual, if that is your wish. The challenge, as you have identified, is that the United States is a (mostly) monolingual country, and you are going to have to work to incorporate Russian and Hebrew. Chontelle gave some excellent advice to families in a Q&A a couple of weeks ago; you may want to check out her responses. Your daughter is going to have ample opportunity to learn English, living in an English-speaking country, so I would focus as much attention as you can on promoting Russian and Hebrew. All of the ideas and activities you suggested would be beneficial in promoting these two languages. As much as possible, you should speak to her in Russian and have your husband speak to her in Hebrew. You should also have designated activities (e.g. play time, reading) that are just in one language of these two languages. It is not that children cannot learn both languages if they are being mixed; but you’d be surprised how quickly “mixed” languages become mostly or all English if families are not careful! I also like the idea of Russian and Hebrew activities; this diversifies the number of people with whom she will use the language, and it gives her a context in which to use it. The bottom line is there is no one formula to achieve trilingualism. What you have to do (and it seems you are already doing it!) is be willing to work to create opportunities for non-English language learning. Without concerted effort on your part, your daughter would likely learn English but not much else. Creating these opportunities is the key to raising a successful trilingual! Best of luck!

Gestures & Communication

• Sabrina H. Hi Brittany, From your son's perspective, he is making clear gestures to indicate to you what he wants. He is initiating communication (by pointing), and he as a very clear idea of what he is trying to say in his mind. It is easy to understand why he might be frustrated, then; he's trying to communicate and it's not working as well as he wants it to! It is natural in the process of language development for communication to sometimes break down, and it is not uncommon for children to sometimes become frustrated when they can't express what they want to. When we use words, we take away some of the ambiguity that comes with just pointing. A child pointing at a refrigerator could mean many things; I child saying "I want milk!" is generally much clearer. As children are able, they replace these gestures with words. Is your son using his words to indicate what he wants as well? If you think he might be having difficulty using his words (which is why he is using his gestures), or if you think he has more frustration with communication than other children his age, you might want to talk to your pediatrician about his language development. If, however, he is using many words and word combinations, this may be a case where he has more in his mind than he can yet express. As I said, all children have a gap between what they understand and what they can say, and some level of frustration is not uncommon. In order to ease frustration, I would continue to use those probing questions. Add to this a model of what he can say next time instead of pointing. For example, if he points to the refrigerator, you may ask, "Do you want milk or juice?" After you determine that he wants milk, model the sentence he could have said: "I want milk." When his frustration at not being understood in these moments is already high, I would focus less on pushing him to use his words and more on modeling better ways to communicate. Hopefully the next time around he will be more willing to try to use his words from the outset. Thanks for your question!

Our Q&A is now over.

Toddler Frustration

• Sabrina H. Hi Paula, Many children have difficulty communicating when they are frustrated; you are by no means the only parent to struggle with this! Some children will "act up" to get their way, but the situation you are describing is one where many children struggle to communicate. First, your child is at an age where she can recognize her own emotions (i.e., she knows she's upset and she can't be easily distracted into feeling better), but she probably doesn't have a great way to label how she's feeling. Most three-year olds can't label their emotions. She may also not always know exactly why she is upset. Something is wrong, but expressing exactly what is going on might be a little beyond her capacity. In these situations, I recommend doing what you can to lessen the communication demands on her. You may want to try using questions where she can answer with yes or no or just one word: e.g., "Do you need some help?" I would also make a point of labeling her emotions for her, like "You look upset!" As she continues to develop in language, she will learn to label her feelings as you have modeled. She will also, with time, become better at communicating when and why she is frustrated. Best of luck!

• Paula Thank you!!!

Tongue out

• Sabrina H. Hi Katy, Your child is still learning how to move his mouth and tongue in order to create sounds, and exploring his mouth is a part of that. Having said that, I would recommend talking with your pediatrician about what you are seeing. Does your son also have difficulty with chewing and swallowing when he is tired? Your son may well be playing around with sounds, as children do when they are learning language. However, it is worth having your pediatrician take a good look at the structures of his mouth to make sure everything is developing as it should. Better to discuss these with your doctor than to wonder and worry! Thanks for your question!

• Katy Thank you, I appreciate it! He doesn't usually have difficulty chewing or swallowing when he is tired. He just started this random tongue thing in the last week so hoping it's just a phase! I'll take your advice and bring it up to the pediatrician just in case though too. Thank you!