Question

Hello

I’m hoping you might be able to help me. I’m a first-time mummy and very worried about my 22-month-old. 

Her understanding is phenomenal, but she refuses to speak. She will say mama, dada, yaya (grandmummy), daddina (grandfather) and about three other words that she’s learnt on her own. She makes other sounds that I’ve taught her (when she’s made a sound I’ve said “yes that’s what noise an x makes” or whatever) and has her own made up words for some things (dabudah is thank you for some reason!)

After spending months trying to get her to copy sounds she will usually repeat things when asked, but rarely will she offer up a word on her own.

She grunts all the time, even though I don’t automatically give her what she wants (I make her say mama, then ask her questions until I work out what she wants then say “You want mummy to… Okay, now say…”) She is frustrated that she can’t communicate (though probably not as much as me!) 🙂

Recently she’s stopped moving her mouth, forgetting things she’s been able to say a week or so ago., i.e. she could say mah, me, moo and now she just says me. After about 10 minutes, I can get her to say moo, but she won’t articulate it as clearly as she did previously.

Her father is Italian and speaks Italian to her when they’re on their own, but he didn’t speak to her at all for almost a year (he didn’t know what to say apparently!) She doesn’t spend much time with him anyway as he works long hours. I speak English the whole time and we live in London.

Her dexterity is amazing, and she understands quite complex instructions, so I know she can hear and listen and understand perfectly. She adores books and reading – I’ve read to her since she was born (and all the other things suggested including singing, nursery rhymes, objects in a bag). We read every day. She goes to playgroup so sees other children etc.

She never really babbled – if she did it was just repeating a sound rather than made up words.

My husband apparently did not say a single word until he was two and then skipped baby talk and went straight to reasonably complex sentences.

I have listened to some talk back radio around her when I’ve just been so exhausted at the end of the day that my brain is fried, and I literally cannot talk anymore! I haven’t put her under any pressure but recently, I just don’t know what else I can do to help or encourage her. It seems to me she’s got some mental block that I have just run out of ideas on how to get around it.

The only other thing is that quite often she struggles to get a word or a sound out. You can see her trying to say it, but it seems there’s some sort of block. It’s almost like she’s holding it in and struggles to actually ‘spit it out’ (sorry – that’s worded terribly but I don’t really know how to explain it!)

The last couple of weeks I’m finding it really overwhelming, we just seem to be going backwards. I’m upset (which doesn’t help her), and I’ve got no support.

I would be very grateful if you have any suggestions, please!

Many thanks for reading this far!
Kind regards
Cam

Answer

Dear Cam,

Thank you for your question. Congratulations to you on the arrival of your first child – it’s a life-changing event for sure! I never saw myself as a person who worried much about anything until my own little girl arrived and suddenly I had loads of worries!

First of all, it’s really good that she understands everything. The language outcomes for children who have delayed expressive language (i.e. talking), but good comprehension are encouraging. And she has two languages, Italian and English. This does not put her at risk of language problems in any way. It’s also wonderful that she loves books. Interacting with her using books is a key way to build her language and communication. How you do that is important – I have an e-book on the best way to use books to encourage language development which you can check out here.

Some general things to bear in mind are that there’s a lot of individual variation in the language development of young children, which can make it difficult to identify delay or who is likely to grow out of it. And there’s also variation in the research in terms of definitions of what late talking actually means in terms of numbers of words used at particular ages.

For example, children are considered late talkers when they are between 18 and 35 months old, understanding what you say to them, BUT they have limited expressive vocabulary. This means that they don’t use a lot of words or a lot or different words and word combinations

To be considered a late talker, all other areas of development need to be typical – things like their play and when they walked, hearing, and so on.

If your child is 24 months old and does not yet use 50 words, they’d be considered a late talker. Elizabeth Peña, a well-reputed researcher, says that between 18-20 months, you should expect your child to be using at least 10 words and those words would be distributed across the two languages. She might have more words in one language than the other. It’s the total amount you’re interested in. About 15% of all children are thought to be late talkers with 50% of them growing out of it without intervention and the other 50% need intervention. But again, it’s hard to work out who will need intervention and who won’t.

Your little girl is using some words – the sounds for cars and animals for example also count as words at this stage. And you describe her as refusing to speak. There are two ways of looking at this. Part of normal development is where children are developing a separate sense of self. It’s called counterwill and is very frustrating for parents! But it’s a good thing in that it shows her emerging sense of self. If she senses pressure on her to perform in relation to talking, then she may well assert her emerging self by refusing. Difficult as it may be, counterwill is a good thing because it shows the emergence of a separate self and helps to ensure that children will be lead only by those to whom they’re attached.

The other way to look at this is in relation to natural communication. It’s not naturally communicative to say to a child “Say car” or “What’s that?” when you know the answer, for example. (You can read more about this and what to do about it here.) The more effective way to encourage her to use the language she has is to create opportunities where she experiences a need to communicate and experiences something positive as a result of her communication. These strategies are called communicative temptations.  I’ll give you one example here and you’ll find lots more of them here.

You give her lunch, but you don’t give her the spoon she needs to eat it with. Then you wait for her to take her turn and for her to indicate in some way that there’s something amiss. It doesn’t matter what she says or does really – you want her to take a communicative turn and accept her turn as it is. Then, let’s say she says something like boo. You say “There’s no spoon! I forgot the spoon! You need a spoon!” The important thing here is that you say the word without stressing too much – it needs to sound natural. You can watch a quick video on how exactly to that here. It seems like you are doing this already when you say things like “That’s what noise an x makes”. So keep doing more of that. You’re saying it as she would, if she could.

You have also put a lot of effort into trying to get her to copy sounds. Now you might be coming up against the counterwill here too. Again, we have the issue of what’s communicative and what’s not. You’re right in trying to encourage her to imitate you, but it does need to be done in a natural, fun and games kind of way. What you can do is imitate her. Let’s say you’re playing with blocks and you’re both building towers. She knocks over her tower. Then you knock over yours. She looks at you. That’s her turn. It is your turn next, and you say something like “I knocked it down!”

Another way of encouraging her to use the words she has is to offer her choices: saying things like “Do you want milk or juice?” and waiting for her to take a turn. Let’s say she “grunts”, then you say it as if she would, if she could. Let’s say she says do. Then, like before, you say “You want juice. You like juice. Yummy juice.” I would stop asking her to say mama and focus on working out what she’s trying to communicate to you. When you have it worked out, don’t ask her to say it – there’s no communicative need as you’ve worked it out together. It’s better for you to say it like “You want the red dress…” and so on. It might also help to acknowledge her feelings of frustration by saying things like “Sometimes it’s hard to tell me what you want”.

As for her forgetting words, it’s important to remember that word learning is complex and takes time. It’s not that unusual for toddlers for do this – language development takes a long time! And it might also help to remember that at 22 months, you can expect to understand from 25-75% of what she says. That’s quite a range so don’t expect to understand everything.

When should you consider going to see a speech and language therapist? The Hanen Center in Canada recommends that you refer your child when/if:

• They’re 18 months old and not using at least 20 words, including different types of words, such as nouns or names of things (cup, biccie for biscuit), verbs or doing words (eat, go), prepositions or location words (up, down), adjectives or describing words (hot, mine), and social words (hi, bye). They need different types of words so that they can combine them into phrases like want biccie.

or

• They’re 24 months old and they aren’t using at least 100 words and combining 2 words together. The word combinations need to be original. Phrases like Thank you. I want to. All gone! What’s that? don’t count as genuine phrases. They’re chunks that are learned as one unit. Examples of real word combinations come from the child themselves, that they haven’t heard before. Things like: “kitty gone”, or “dirty dress”.

I think it would be a good idea to see a speech and language therapist who can assess her speech and language in more detail. It’s never too early to see one. We can assess children from a very young age. And it’s better to be referred and not need the referral than need it and be stuck on a waiting list. Please listen to your instinct and ignore comments like “Oh she’s too young to see an SLT”. That’s just not true! And the outcomes for children where the diagnosis is made later are not as positive as when the problem is identified early.

To sum it all up, I’d take the focus off trying to get her to talk or imitate you and focus your attention on what you say and how you say it. Create as many opportunities for her to have a natural need to communicate as possible. Laura Mize who is an American SLP has some great videos on YouTube with fun, natural ways to encourage toddlers to talk. Here’s one example of her using choices to encourage talking.  I’d also be kind to myself – you’re doing your best at one of the hardest jobs in the world.

All the best,
Mary-Pat

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Mary-Pat O'Malley-Keighran

Mary-Pat is a lecturer, author, researcher, speech and language therapist and lover of all things to do with speech, language and communication. She has over 20 years’ experience of working with families and 14 years’ experience of teaching in university. Mary-Pat has done extensive research in communication: parents’ experiences of speech and language therapy, story-telling in bilingual children, how newspapers tell stories about adults with communication problems, how midwives and pregnant women talk to each other during hospital visits, and more. She is passionate about humanizing the health care and education systems by showcasing the importance of how we say what we say. She also passionate about understanding children’s perspectives in communication with adults so that we can communicate more compassionately with them. Mary-Pat is currently a lecturer in speech and language therapy at NUI Galway on the lovely west coast of Ireland and you can find her blog at Talk Nua.

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