At what point is lack of language development and speech in a toddler a cause for concern?

[WindyCityMom]

This isn't about my children it is about a member of my family.

He is almost 30 months old.  His vocabulary is "car" (ga), "shoe", "go away", "ouch" (asch), "mama", "no", "Choo-choo" and "Ti" (his attempt of "titi" but I think the "t's" are an issue for him).  That is it.  The only sentence he forms is "go away" ("gaway") and I'm not sure he knows they are two separate words as he learned it from his older sister as she is always yelling at him to go away.  Pre-teen

At what point is this a concern?  I am reading many conflicting things online.  His mother works all day and talks baby-talk to him a LOT in English.  He normally only sees them for a few hours a day.  He spends the majority of the day with his grandmother who baby-talks to him in spanish but he does spend most of his time at her house in front of the TV watching PBS kids.  He has been watching PBS kids for hours on end M-F for over six months, and has not picked up any words from it.  I'm a bit conflicted about his TV time, I don't know if it is helping him or hurting him.

He goes to activities with us 2x/wk.  I talk to him as normal and I am the only person (according to his mom and his grandma) that he has a "conversation" with.  He baby-talks to me and has a "conversation".  I try to engage him and speak to/with him as much as possible.

However, his lack of speech has had me concerned for awhile.  The last time I knew a child who was this speech delayed he had hearing loss.  The child in question has no hearing loss according to mom and his doctor (according to his mom).  In the past the recommended speech therapy but mom never took him.

I'm really at a loss- do I suggest EI?  Could there be an underlying issue here?  My daughter wasn't extremely verbal but her vocabulary was about the same as his at 15mos.  My youngest (12mos) is just starting to pick up words and my DH is worried that in a few months she will have a larger vocabulary than the child in question.  He's worried about this child.  He's worried about what will happen when the child starts preschool this September (though he does need to be potty-learned by then).

I'm just not sure.  My DH keeps asking me about this and I really don't have any answers.  If this is an issue where EI is probably necessary, how does one go about bringing it up to the parents?  And I am shocked that their ped has done nothing else.  I wonder if the mom is lying to the ped and just saying he's shy or something.  My DD has never said more than a few words to her doctor, but our doctor knows she's just very shy (and my DD is, and she knows tons and tons of words and speaks in full sentences.  She's 3.).  I wonder if their doc is just taking the mother's word for it.  I can totally see her lying to the ped.

This little boy is very dear to my heart and I care for him a great deal.  I don't know if I should be doing anything.

[WindyCityMom]

There is one little boy in the family with autism though he is a kind of distant cousin.  The entire family is in denial that such things exist (spd, adhd, autism, and more) and that they are just "made up" by overprotective parents who don't know how to parent their children.  As a mama (with SPD!) of a child who likely has SPD I find it hugely offensive but I don't know how to change their thinking.  Anyhow.. from teachmetotalk.com I found this list on their Autism page.  Bolded are those that apply to the child in question.

• Does not consistently respond to his/her name.
• Cannot tell you what he/she wants with words or gestures.
• Doesn’t follow directions.
• Seems to be deaf at times.
• Seems to hear sometimes, but not others.
• Doesn’t point or wave bye-bye (past 15 months) or use other gestures such as shaking his head “yes” or “no” appropriately and back and forth in conversation.
• Used to say a few words or babble, but now he/she doesn’t. (there are a few words that used to be part of his vocab. but that he doesn't use anymore despite hearing them and being in situations where he used to use them.  "train" and "truck" are two of them.  also "teta", his bottle.)
• Throws intense or violent tantrums.
• Has odd movement patterns such as flapping arms or shaking body, especially when excited.
• Shows other odd visual behaviors such as staring repeatedly at spinning wheels on a toy or shifting his eyes to the side as he runs.
• Seems hyperactive much of the time; is always “on the go.”
• Is often uncooperative or oppositional during daily routines.
• Doesn’t know how to play with toys. Might spin or line them up excessively.
• Doesn’t smile when smiled at.
• Doesn’t make eye contact. He/she seems to look right through/past you.
• Gets “stuck” on things over and over and can’t move on to other things.
• Seems to prefer to play alone.
• Gets things for him/herself only without asking for help.
• Is very independent for his/her age.
• Seems to be in his/her “own world.”
• Seems to tune people out.
• Shows very little interest in other children.
• Or may interact inappropriately with other children.
• Walks on his/her toes.
• Shows unusual attachments to toys, objects, or schedules (i.e., always holding a string or having to put socks on before pants).
• Spends a lot of time lining things up or putting things in a certain order and gets upset if this is disrupted.
• Has delayed speech-language skills when compared to other children of the same age.
• Memorizes and quotes long scripts of favorite TV shows, sing entire songs, or label lots of objects, but he/she uses very few “real” or meaningful words to ask for things or participate in conversation.
• Repeats what he/she hears rather than using words on his own.
• Learns to read at age 2 or 3 (or has a very strong interest in visual symbols such as letters and numbers), but has difficulty communicating with others in a meaningful way.
• Is a very picky eater. May eat only 3 or 4 different foods.

[melissa17s]

I would consider talking to local school district to see if their speech pathologist can evaluate him.  I have heard mixed things about children in a multilingual situations, and that they can be slower to speak and that boys can be slower than girls.  This article was just on npr Monday, and although it is not your situation, it does stress the importance of adults talking to children.  

My ds was slow to speak.  When he did he did full sentences, but up to that point, not much. He started speaking at 2.5 years. He did have very poor annunciation. We did see the school's speech pathologist, and she said he was still in the range of normal.   We have since found out that he has a seizure disorder that effects the parts of his brain that process speech among other things.   

Probably good to keep bring the subject up with the mom and grandma- encourage them to try more options for evaluation as long as the problem persists.

[khaoskat]

Our old pediatrician, who we recently fired, told us with DS2, that if by the age of 2 he couldn't form 5 two word sentences then we needed evaluated.  This is with us at 15-18 months telling him he has NO vocabulary.

It wouldn't hurt to have him evaluated by Early Intervention.  Since he is under the age of 3, the school district wont get involved yet.  Although once you get EI involved, since he is so close to transitioning, you will probably get the school testing done about 4-5 months from now, and then transition into it.

[fairejour]

Tell them you are worried about his hearing (which very well could be an issue) and maybe they would be more willing to hear it that way. Then, when they get his hearing checked, the language piece should come up.

[Emmeline II]

My ds(6.5) started talking in short sentences just after 2.5, he has no hearing loss, no speech problems and we are not a bi-lingual family.

You could try giving them the number to early intervention (perhaps volunteer to call for them?), tell them that the evaluation is free, and if they would like to do it they need to call soon as he will age out of the program at 3yrs.

[Llyra]

From what you're describing, I think I'd be concerned. The EI criteria here state that a child who's not putting two words together at that age may need an evaluation. Plus, the research is pretty clear that children do not learn language from the TV the way they can learn it from real-people interactions. The amount of TV time you're describing would concern me a lot. Children in multilingual situations seem to have different language acquisition patterns, though, and I don't know a lot about that. But it can't hurt to suggest EI-- the eval is free and is done at home. The services are provided on a sliding scale--- when my DD1 was this age, she was receiving services. DH and I had at the time a middle class income, and our services were free of charge based on the scale here in NJ. Furthermore, if you wait until the child reaches 36 months, the EI system changes, and is then provided differently through the school system, so there's a reason to get it done now while the child is still under 3-- it's less complicated.

[WindyCityMom]

Thank you everyone!  

I talked to my MIL (of all people.. we were at the eye doc, DD had a scare and I needed a ride) about it.  I brought up her friend's son (a month older than the child in question) who is undergoing speech therapy and has made a remarkable improvement.  I know that EI got involved there and they did take him to speech therapy.  I talk to that mom as well, though we don't get along very well so I can't really go asking her questions.  I then brought up the child I'm talking about (nephew) and asked whatever happened to the speech therapy the doc suggested.  MIL shrugged and said "hmm,  I don't know".  I then asked a few more questions but she was trying to change the subject so I dropped it.  I really don't know what to do, kwim?  Everyone else close to the child is so resistant to any kind of help and it doesn't help that no one seems to think there is a problem.

He seems to be a bit behind cognitively as well, and I really feel bad for him in this sense because he is a big husky kid and looks older than he is (at least compared to other family members who are generally petite).  Everyone treats him like he should act older.  He puts everything in his mouth (not uncommon, lol) and today his grandfather yelled at him when he put a toy screwdriver in his mouth.  He yelled, hit him, and took his toy away and said that he'd put hot pepper on it.  I think I would have cried if I were a 2yo child.  I told grandfather that's not cool and he muttered and walked away from me.  Yesterday his grandmother got mad at him because he threw a toy car at the ground (he does this often, but it is never out of aggression and always part of his play) and she rose her hand up like she was going to smack him and he ran to me.  I told her that it wasn't very nice and that children shouldn't be hit (language barrier also) but she appeared not to hear me and proceeded to search for the child's plastic tool belt so she could hit him with it!! She didn't find it, but oh my goodness.  I don't know how his mom can leave him with these people.  I mean, I have him 2x/wk all day most days (took on that responsibility again after much thought.. )  But 16-20hrs/wk out of his entire week is NOTHING.  I just feel ill thinking about it.  

Cognitively he doesn't seem to be at his age level.  His actions and ways of doing things seem more in line with an 18 month old than a 30 month old.  Sometimes he does act "his age", but ends up having a meltdown because he doesn't know how to communicate his wishes, etc.

I am really wondering if he is autistic.  I spent a very long time watching videos of autistic 2 year olds on YouTube yesterday, and I saw a lot of things that my nephew does.  He does the arm flapping thing, randomly bursts into fits of laughter, spins everything, spins himself in circles constantly, and walks on his toes almost 100% of the time if he's walking at anything faster than a normal speed.  We always thought it was because his shoes were a few sizes too small (you may remember my posts) but even with shoes the correct size and when barefoot/socks which is only when he comes over to our house, he does it too.  

Oh, and the point about the TV is that he's watching it so much yet doesn't repeat anything about them, not even a single word.  I'm a bit surprised by that.  Also he's obviously not watching TV when he is with us, but ykwim.

[PikkuMyy]

From the number of items you identified on the checklist, it sounds like he's most likely on the spectrum. The longer his parents wait to get services, the harder it will be for him when he enters the school system. It's tough, because it sounds like his parents are very much in denial, and yet his family is clearly having a tough time with him at home. EI would provide services to teach him to communicate, support parents, give him better play skills, help his sensory needs, etc. But they have to be open to requesting them. You can't do it for them.

Was speech therapy the only thing recommended? Do the parents know the broad spectrum of services that EI can provide for them to make life easier and happier?

[Linda on the move]

Originally Posted by WindyCityMom 

I then asked a few more questions but she was trying to change the subject so I dropped it.  I really don't know what to do, kwim?  Everyone else close to the child is so resistant to any kind of help and it doesn't help that no one seems to think there is a problem.

It doesn't sound like there is anything you can do. This isn't a situation that you have any control over.

Does the child see a doctor regularly? In a regular physical, some of this would come up and the doctor could suggest an eval.

If not, when he reaches school age, or if they enroll him in preschool, he will be flagged for a screening.

[WindyCityMom]

Originally Posted by Linda on the move 

Originally Posted by WindyCityMom 

I then asked a few more questions but she was trying to change the subject so I dropped it.  I really don't know what to do, kwim?  Everyone else close to the child is so resistant to any kind of help and it doesn't help that no one seems to think there is a problem.

It doesn't sound like there is anything you can do. This isn't a situation that you have any control over.

Does the child see a doctor regularly? In a regular physical, some of this would come up and the doctor could suggest an eval.

If not, when he reaches school age, or if they enroll him in preschool, he will be flagged for a screening.

Are such screenings mandatory?

[WindyCityMom]

Originally Posted by PikkuMyy 

From the number of items you identified on the checklist, it sounds like he's most likely on the spectrum. The longer his parents wait to get services, the harder it will be for him when he enters the school system. It's tough, because it sounds like his parents are very much in denial, and yet his family is clearly having a tough time with him at home. EI would provide services to teach him to communicate, support parents, give him better play skills, help his sensory needs, etc. But they have to be open to requesting them. You can't do it for them.

Was speech therapy the only thing recommended? Do the parents know the broad spectrum of services that EI can provide for them to make life easier and happier?

Afaik, yes.  The parents don't believe things like Autism, SPD, ADHD, etc. exist.  There are members of the family with each of them and everyone thinks they're made up.  One member of the family has a son who is autistic and a daughter who has some SN (not sure what kind but I know EI was a part of her life before she hit 3, I think she's still in a special school) but they just did it because it was free.  Their oldest daughter has some SN also (I think she is autistic as well, though she functions very well, she is 11yo now) but nothing was ever done  for her.  This person denies that her kids have special needs of any kind.  

It's really sad.

I was just wondering if there was anything I could do but I suppose there isn't.  I don't know how to even bring it up, which I'm probably not going to do because I don't want to be shut out from this little boy's life.  We actually take him places and do things with him, as opposed to leaving him in front of the TV and hitting and yelling at him all day.

[Linda on the move]

Originally Posted by WindyCityMom 

Are such screenings mandatory?

Exactly how it plays out will depend on what he is like once he hits a classroom. We knew a family who was in TOTAL denial. Things were never good for their son, but got worse each school year. Third grade was the year the sh*t it the fan. He truly could not function. He would hide under his desk, he could not do the school work, and he had outburst that were scary to the other children. His parents really weren't given an option. He's now attending an autism specific school.

Honestly, it's one of the good things about our public school system. Kids with special needs whose parents are in complete denial have a 2nd chance for intervention.

I do believe that it's better for kids to get intervention earlier, and that things are generally better for kids who have parents who advocate for them, but there is a safety net out there.

I think that you are doing what you can -- being nice to him, interacting with, keeping lines of communication open.

[Eyelet]

Sadly, I don't think there's much you can do unless the parents are on board. If he still functions on this level when he enters pre-school/kindergarten, as a PP said the school will flag him and the parents won't have a choice but to deal with it. 

My DS was diagnosed with autism at 33 months old, but his issues were severe and very obviously pointed to ASD. We also had to go through three different evaluations to get the correct diagnosis. If this boy is not getting enough interaction (sitting in front of TV all day) and also faces the added difficulty of trying to master two languages, it could be other issues besides ASD. At such a young age (and considering the other factors), my hankering is that most doctors would be hesitant to diagnose him as such yet. 

Do the parents plan to enroll him in pre-school?

[WindyCityMom]

Thanks.  They do plan to enroll him in preschool with the Chicago Public School system.  They've only applied to one school so far, so hopefully he gets in.  He isn't potty-learned and I honestly can't see him being potty ready by his 3rd birthday (or by the time school rolls around a month later) so there is that hurdle as well.

I am so deeply sad for this little boy on so many levels.  Grandmother came to playgroup today and just yelled and yelled and yelled.  The time came to put his coat on and he flipped.  She yelled more, he cried more, he went into a violent tantrum and it got ugly.  She was yelling at me "Force it!  Make him put it on! Be rough!" and I pulled him aside and gave him the worlds biggest hug and just held him for about a minute.  My heart just broke into a million pieces for this boy.  He stopped crying instantly.   Right away he stuck out his arm to put on his sweater and coat.  I have never ever seen him attempt to put his clothing on.   He won't even push his arms through the sleeves (it's like dressing a giant newborn).  But he did.  And he was happy about it.  I am so confused.  I feel like he might be somewhere on the spectrum because of the things he does (spinning, tip-toes, lining things up, violent tantrums, speech issues) but then I wonder if he's just starved for affection and attention.  

I'm totally at a loss and I can only hope that he is miraculously potty-trained by the Fall and that he gets into preschool, and that the teacher doesn't just look the other way as everyone else seems to do.

lxla- what kinds of things was your son doing that threw up red flags for you?  I'm just curious if there's anything I may be missing here.  Heck, maybe he's not on the spectrum at all.  Not even close.   Maybe I'm way off.  

[Eyelet]

Quote:

Originally Posted by WindyCityMom 
lxla- what kinds of things was your son doing that threw up red flags for you?  I'm just curious if there's anything I may be missing here.  Heck, maybe he's not on the spectrum at all.  Not even close.   Maybe I'm way off.  

Keep in mind every child on the spectrum is going to be different, some displaying more severe symptoms then others. Your nephew may be on the spectrum, but there's really no way to tell for sure unless he's evaluated by an experienced team/doctor.

My DS is 13 now, and is moderate-severe on the spectrum. He is still nonverbal. We became concerned about him when he was about 9months old because he was completely indifferent to everyone around him. Did not smile, want to be held, nursed, and never went through separation anxiety.

Additional concerns:

-Very poor sleeping habits. DS slept for 2-3 hours tops every night and still had bountiful energy.

-Never responded to his name. I would have to pick him up to get his attention.

-By 33 months, still hasn't even attempted to utter a word. 

-Did not respond or acknowledge language spoken to him.

-Would go from content and happy to violent tantrums without apparent reason.

-Would not observe other children or adults.

-Refused to wear most clothes. Would rip off diapers constantly.

-Would attempt to 'eat' anything, extreme pica. 

-Had absolutely no pretend play. 

-Extremely unusual playing habits. Would never appropriately play with a toy. Toys were 'organized' never engaged with.

-Was indifferent to pain. 

-DS would often purposely hit himself in a self stimulating fashion.

Again, this is just what my DS displayed, and ASD will present itself differently for every child.

[Linda on the move]

Originally Posted by WindyCityMom 
  I'm just curious if there's anything I may be missing here.  Heck, maybe he's not on the spectrum at all.  Not even close.   Maybe I'm way off.  

It's really not your job to diagnosis him. And a child can't be diagnosed over the internet. My experience is that the more people understand about the autism spectrum and the more experience they have with different people on the spectrum, the fewer definitive statements they make.

It is difficult to tell what is "late blooming,"  what is "poor parenting," what is "learning two languages" etc.  He may just have fluid in his ears and have some sensory issues.

And kids can show different "symptoms" at different ages. My DD has had different labels at different points, and I got her a nice new eval when she turned 13 to settle on what label should most likely go with her into adulthood (Aspergers). But it isn't a label that would have been appropriate to give her at age 3, when she was officially labeled as having "autism like behaviors."

If you would like a good book to read, "Quirky Kids" by Klass is an wonderful overview of this SPD, high functioning autism, non-verbal learning disability, etc., and the issues that come up raising a child who is "quirky."

And as the mom of a kid on the spectrum, I personally find it annoying when people with no training say that a child they know has (or doesn't have) autism based on their observations.

[WindyCityMom]

Originally Posted by Linda on the move 

Originally Posted by WindyCityMom 
  I'm just curious if there's anything I may be missing here.  Heck, maybe he's not on the spectrum at all.  Not even close.   Maybe I'm way off.  

It's really not your job to diagnosis him. And a child can't be diagnosed over the internet. My experience is that the more people understand about the autism spectrum and the more experience they have with different people on the spectrum, the fewer definitive statements they make.

It is difficult to tell what is "late blooming,"  what is "poor parenting," what is "learning two languages" etc.  He may just have fluid in his ears and have some sensory issues.

And kids can show different "symptoms" at different ages. My DD has had different labels at different points, and I got her a nice new eval when she turned 13 to settle on what label should most likely go with her into adulthood (Aspergers). But it isn't a label that would have been appropriate to give her at age 3, when she was officially labeled as having "autism like behaviors."

If you would like a good book to read, "Quirky Kids" by Klass is an wonderful overview of this SPD, high functioning autism, non-verbal learning disability, etc., and the issues that come up raising a child who is "quirky."

And as the mom of a kid on the spectrum, I personally find it annoying when people with no training say that a child they know has (or doesn't have) autism based on their observations.

Thank you for putting that in perspective.  I'm still questioning what options there possibly are as far as opening up the parents eyes and getting them to question whether or not their son has any issues going on.