Many parents hear some version of the same advice when they have concerns about speech development: give it a little more time. Boys sometimes talk later. Someone in the family did not talk until age three and turned out fine.
And sometimes children who are late to talk catch up on their own.
The hard part is knowing which children will catch up and which ones would benefit from support.
Melissa Harrell has practiced as a speech-language pathologist for 14 years and serves as the discipline advisor for the speech therapy team at Associates in Pediatric Therapy. We asked her when she recommends waiting, and when she thinks an evaluation is the better next step.
“I would say any age or any milestone,” she said. “That’s my motto. I’m not a wait-and-see person. I don’t recommend wait and see.”
Why “wait and see” is such common advice
Some children who talk late catch up on their own. That part is true.
Harrell’s concern is that there is no reliable way to know ahead of time which children will catch up without help.
“There are going to be those children who are just a little bit behind, and they will catch up on their own,” she said. “The problem is we don’t know who those children are. So it would be better to provide the support that most children will need, rather than waiting for the few children who will grow out of it on their own.”
Asked whether it comes down to not having a crystal ball, she said, “I don’t. It would make my job so much easier.”
For parents, that means the decision is less about predicting the future and more about deciding whether it makes sense to get more information now.
Speech and language milestones worth knowing
The CDC’s developmental checklists describe what most children, about 75 percent or more, can do by a given age. They are not a pass-or-fail test, and missing one milestone does not automatically mean something is wrong. But they can be useful reference points.
By 18 months, most children try to say three or more words besides “mama” and “dada” and follow a one-step direction without a gesture, such as handing you a toy when you say, “Give it to me.”
By 2 years, most children put at least two words together, such as “more milk,” point to things in a book when asked and use gestures beyond waving and pointing.
By 30 months, most children say about 50 words and combine two or more words with an action word, such as “doggie run.”
By 3 years, most children hold a conversation with at least two back-and-forth exchanges, ask who, what, where, or why questions and talk well enough for other people to understand most of the time.
Children develop at different rates, so a milestone should not be treated like a deadline. But if your child is missing several skills, has stopped using skills they previously had or you have an ongoing concern about their communication, it is worth talking with your pediatrician or a speech-language pathologist.
Why earlier support can matter
The CDC notes that early intervention is likely to be more effective when it begins earlier in life. During the first few years, children are developing language, communication and many of the skills they will continue building on as they grow.
Harrell also looks at it from a practical standpoint.
“Why not give them the support now rather than them struggling for a while before they figure it out?” she said.
Communication difficulties can be frustrating for young children, especially when they know what they want but have trouble expressing it or being understood. As children get older, communication skills also become more important for following directions, learning at school and interacting with other children.
An evaluation can help determine whether a child is developing within the expected range or whether some additional support could make those things easier.
“But my child talks fine”
When people think about speech therapy, they often picture a toddler who is not talking yet. We do see many young children for speech and language concerns, especially around the toddler years.
But speech-language therapy is not only about learning to talk.
“I see a lot of probably like six to ten-year-olds who, if you heard them initially, you would go, why is this child in speech therapy?” Harrell said. “But in school they’re struggling with written language. They can’t follow the multi-step directions their teachers are telling them, and you wouldn’t recognize that from a conversation. Or they’re struggling on the social aspect. Yes, they can have a basic conversation with you, but they’re struggling with keeping their friends because they’re being too direct, or they’re telling their friends what to do instead of asking, and their friends don’t like that.”
For an older child, signs that a speech-language evaluation may be helpful can look very different.
You might notice:
- Homework or written assignments taking much longer than expected
- Difficulty following multi-step directions
- Teachers frequently needing to repeat or rephrase instructions
- Writing skills that seem much weaker than verbal skills
- Difficulty understanding social cues or maintaining friendships
- Trouble organizing thoughts or telling a clear story
“There’s a lot of different reasons we’re seeing them at an older age that are just as helpful as seeing them at a young age,” Harrell said. “It’s just for completely different reasons.”
What happens during a speech evaluation?
A speech-language evaluation looks different depending on the child’s age, concerns and communication skills.
“At the evaluation, you’re going to sign in. I’m going to bring you and your child back to a room. You’ll never be separated from your child,” Harrell said. “We’re going to talk about your concerns if we have not already.”
For younger children, much of the evaluation may look like play.
“If your child is two, I am not having them sit down and do some kind of drill work. They’re playing with me and they think that they’re just enjoying toys and looking at pictures.”
The therapist is observing how the child communicates, understands language, interacts and uses speech sounds. Depending on the concern, there may also be more structured activities or standardized testing.
Afterward, the therapist talks with the family about what they observed and what they recommend. That might include therapy, strategies to work on at home, monitoring development or checking back at a later time.
“Ultimately you take that information and do with it what you want to,” Harrell said. “I make my recommendations, but ultimately it’s the parent’s choice how they proceed.”
Parents also often come into an evaluation wanting to know why their child is having difficulty, and sometimes there is not one clear answer.
“We might not have a perfectly clear answer about why your child hasn’t started talking or isn’t putting two words together,” Harrell said. “But what we do have is a clear trajectory on what we can do to help you help them.”
What if the evaluation says everything is okay?
That is still useful information.
“Just do it. Just get the assessment,” Harrell said. “It’s going to put your mind at ease if there is nothing wrong, if they’re not behind in their skills. And if they are, we’re getting the support early.”
An evaluation does not automatically mean your child will need therapy. Sometimes families leave with reassurance and a better understanding of what to watch for. Other times, the evaluation identifies an area where support could help.
If you have concerns about your child’s speech, language or communication, talk with your pediatrician or reach out to us. Our speech-language pathologists work with children from birth through age 18 across Kentucky, Indiana and Tennessee, with teletherapy available when appropriate.
This article was reviewed by the pediatric therapy team at Associates in Pediatric Therapy for clinical accuracy and relevance.
Reviewed by:
- Melissa Harrell