Why isn't my toddler talking in sentences yet?

July 26, 2008 1:14 PM

ParentingFilter: My two year-old isn't speaking in sentences yet. Should I worry?

My son has been saying words for over a year. However he rarely uses two-word phases other than saying hello to the dog or cat. He does chat to himself, but it's nothing that can be identified as a word, just sing-song, Cocteau Twins-type vocalizations. When he wants to communicate, he mostly points and gestures, occasionally saying a word to emphasize the point. When he gets angry, he cries and vocalizes, but no actual words. I have to go down a checklist of possible causes until I find the right one - then he'll either nod or repeat the word. He has never uttered a sentence. However, in all other respects, he seems to be a bright, normal little boy.

I didn't think it was a problem until I spoke to his pediatrician who raised the concern that he might be autistic. I'm pretty sure that he isn't - he's very social, loves to show-off to adults, likes to be around and play with other kids, is affectionate, likes to be cuddled. Doesn't flap his hands or do any other type of stimming. He is, however, pretty rigid about what he eats, likes arrange his toys in a long line and can get really upset if someone moves one of them even slightly.

The other thing that she mentioned is that he might have an "receptive-expressive language disorder". I kept a diary of the words that he has uttered and he actually has a pretty large vocabulary - he just doesn't use it very often. My husband thinks I'm worrying too much and that he'll come around soon enough. I don't want to make a problem where none exists, but the more 2 year olds I meet, the more concerned I get. There is a big difference between their language skills and those of my son. Help me, hivemind!

posted by echolalia67 to health (32 comments total)

It could be an autism spectrum disorder- Sensory Integration Dysfunction produces kids who make eye contact, cuddle, are social, etc., etc., but who like to have really structured environments and often lag behind linguistically because of proprioception issues. My daughter only had about 10 words when she turned three; she's in 1st grade now and ahead of other six year olds with occupational and speech therapy. Find out if there's a First Steps program in your area who can evaluate your child- your doctor can refer you.
posted by headspace at 1:31 PM on July 26

I may be reading too much into your name, echolalia67, but I'm struck that a) echolalia is associated with autism, among other syndromes including Tourette's and b) if you were born in 1967 you were pregnant in your late 30s, which is statistically associated with autism. Any genetic proclivity suggests it might be a good idea to have your son evaluated.
posted by carmicha at 1:35 PM on July 26

I chose "Echolalia" because I was a psych major in college and really liked the way the word sounded. I was indeed born in 1967. No cases of autism in the family.
posted by echolalia67 at 1:44 PM on July 26

I took forever to start talking, and, when I did, it was in complete sentences. I've heard this before for other smarty-pants kids, too. (Similarly, bilingual kids take longer to start talking. More processing going on before the brain commits.) Since you're taking all the precautionary steps, this is just one counterpoint possibility. Or, I have no idea what I'm talking about.
posted by zeek321 at 1:44 PM on July 26

This sounds exactly like our experience with our son. He was a pretty late talker, and was often prone to pretty nasty tantrums. Loved to line things up and got uptight if you moved them. We had him evaluated at Children's Hospital of Pennsylvania and they told us that he had a form of Autism called PDDNOS ("Pervasive Developmental Disorder, Not Otherwise Specified"). In other words, our son had fallen into the bottom of the diagnostic Pachinko machine.

He's a pretty normal kid a few years later; picky eater, and a little behind the curve emotionally. No problems with his speech at all.

A good friend of ours also received a diagnosis of autism for their late-talking daughter. Fortunately, they got a second opinion and discovered that their daughter's jaw muscles were underdeveloped. She, too, is now a perfectly normal and delightfully-speaking child.

To answer your question, I wouldn't freak out. I think keeping a list of his vocabulary is an excellent idea. Also, consider something like the Signing Times DVDs. They're aimed at families with hearing impaired children, but our kids love them. If your son is having difficulty communicating verbally, having another method with which to express himself can be wonderful. We're pretty sure that our son's tantrums were a result of his frustration at not being able to communicate. If only we had discovered those videos earlier.

Keep logging his vocabulary and behavior (tantrums, etc.) so that the doctors you deal with can have a complete picture of your son. In the end, there's no harm in getting some speech therapy, and many insurance companies will pay for it. Even if your son's just a late talker, the therapy may help bring him along.

For a flipside thought, my daughter was speaking like a five-year-old at two-and-a-half (which made for some wonderful insights into her little head). She's five now and she's not a prodigy; just the most beautiful little girl on Earth a regular little girl. Kids on either side of the development curve tend to gravitate towards the median.

Good luck!
posted by DWRoelands at 1:44 PM on July 26

take him to a speech-language specialist. there are a lot of reasons why kids talk late. if it makes you feel better, einstein didn't say a word till he was two.
posted by thinkingwoman at 1:48 PM on July 26

No. There's a world of differences in how any child might develop. And between 1 and 3 -- all bets are off.

Important to your question though is, two and what? One can pilot a supertanker between the gaps that exist between 2.00 and 2.75. With our 2.75 year old boy in tow, we just spent three days with his 2.5 year old cousin. While both do speak, the cousin's speech is an odd staccato of words -- with the rhythm of a march, none of which he says completely -- just the starting sounds. Our boy speaks volumes but his "sentences" are often a mess.

Your pediatrician might simply be tossing out all the possibilities. Our old-school pediatrician (teaches at Harvard Med.) might have told you to take a vacation. But even if your boy is autistic, I am having a hard time imagining what that might mean for the 2-3 year-old set. Half the time our boy is speaking in tongues and might as well be channelling Satan himself. Frankly…sometimes I wish he would just shut his pie hole.

I will ask one follow-up: is he getting enough sleep?
posted by Dick Paris at 1:48 PM on July 26

I'm going to give a somewhat educated guess (I have a beloved nephew with autism and try to keep informed) that your kid does not have autism.

If your child is two and is pointing and gesturing I would not worry about autism. Autistic kids rarely gesture or point, and if they do, it is at a much later age.

That being said, it wouldn't hurt to be evaluated if you are concerned. If your pediatrician said your son may have autism just because he isn't stringing sentences, if she failed to address other behaviors, or ask more probing questions about his behavior, I would blow her remark right off. I'm sure your doctor is competent, but this kind of pisses me off that she would suggest autism over sentences at two. Was this her only criteria? Ignore my rage if she delved deeper.

Google M-CHAT. Modified Checklist for Autism in Toddlers.

echolalia67, try not to worry, and be careful with reading into answers. Everyone's experiences are going to be different.
posted by LoriFLA at 1:50 PM on July 26

If it helps with any perspective: I currently nanny for a two year old who is still working on saying words intelligibly. She hasn't even formed real speech, let alone real sentences. She's perfectly normal and communicates just fine with sign language, pointing at things, and facial expressions.

She also is really fussy about what she eats and cries if crumbs get on her hands, but it's not because she's on the autistic spectrum; it's because two is a really, really meticulous and fussy age.
posted by grapefruitmoon at 1:51 PM on July 26

Another little test you can do is "joy sharing". Get a bottle of bubbles and blow them. Ooh and aah over the bubbles. Look at your son and smile and make happy expressions about the bubbles. See if your son "shares the joy". Does he smile too? Does he laugh or smile and look at you in the eye and the bubbles when you are blowing the bubbles. If he is "joy sharing" and pointing and gesturing these are very good signs he is not autistic.

Again, I'm not a professional, but I do know some things about autism.
posted by LoriFLA at 1:54 PM on July 26

I have a nephew who, at age 2, was very much the way you describe your son. A lot of grunting, pointing, and nodding, but very few multiple-word utterances. It turned out that he had weak jaw muscles, which made talking VERY taxing. After working with a speech pathologist and an occupational therapist, he's quite a "normal" five-year-old.
posted by arianell at 2:00 PM on July 26

Headspace's answer has lead me in an in an interesting direction - when I was 11, I was assessed for a learning disability which lead to a special ED afterschool program and this weird-assed physical therapy that involved goofy exercises, such as being asked to put balls in baskets while being spun around in a sling. Looks like I probably had a type of sensory integration disorder and the weird-assed physical therapy was probably sensory integration therapy. Maybe there is something genetic going on.
posted by echolalia67 at 2:09 PM on July 26 [1 favorite]

You're in California, like I am, so you have free services available to you from the Regional Center. I would highly advise taking advantage of them. Even if nothing is wrong, it's better safe than sorry.

And your story sounds similar to mine. When my two year old had his checkup, his pediatrician suggested contacting the Regional Center because my son did not use two word phrases and he did not look her in the eye. My son liked to line up his cars in a row also and just as your does, got very upset when anyone moved them. He's also very affectionate and nothing like what you would consider to be typically autistic. The question I'd ask you is: Does your son seem to be controlling in his behavior? The rigidity with the food and the toys seems to suggest that. It was certainly the case with our son.

I felt much the same as your husband did but called the Regional Center anyway. We started receiving services from them and my son was eventually diagnosed with Autism Spectrum Disorder (ASD) by the LAUSD (Los Angeles Unified School District).

However, because we has started receiving services so early (specifically FLOOR TIME before the age of three and ABA after the age of three, he is doing just great now at 4 1/2. People can't believe that he was ever diagnosed with ASD. That's not to say that he doesn't have his moments, but he's more eloquent than I am, is able to use words even when a peer hits him and will do just fine in school (*Fingers crossed*).

And that leads me to my most important point. He's doing so well because he received early intervention. Early intervention is the key to treating Autism and the earlier you get started the better. When I compare his behavior from last summer to today, for example, it's unbelievable the progress he made.

Some may say that it was just a matter of growing up. But I have worked with some very well respected people in the field who are convinced that he was significantly impaired and now he isn't. Having lived through it, I tend to agree with them.

So call the Regional Center, get the process started. If he is on the spectrum, he will get much needed services in a timely manner. If he isn't, the skills learned in floor time and ABA are skills that all kids can use, and you can be grateful that he isn't on the spectrum.

Feel free to memail me if you have more questions.
posted by cjets at 2:10 PM on July 26 [1 favorite]

If your child is two and is pointing and gesturing I would not worry about autism. Autistic kids rarely gesture or point, and if they do, it is at a much later age.

I would have to disagree. I know plenty of autistic kids (apart from my son and nephews) that can point and gesture. There are many kids (and adults for that matter) who are very high functioning but still on the Autism spectrum.

I know a mistake I made when we first started services with my son was confusing what I would call classic autism (when a child has completely withdrawn from the world, doesn't speak, doesn't understand speech, can not be controlled) with ASD, which is Autism Spectrum Disorder. You would not necessarily believe thatmany of these kids are on the spectrum because in many ways they seem so typical. And, with the right treatment, they can be very productive, if not outright geniuses.

People like Einstein, Beethoven and Mozart among others are all suspected of being on the Autism spectrum. They mention Van Gogh as well but I'm not sure I'd want that for my kid.

ON PREVIEW: Yes Echolalia, that sounds exactly like the OT my son went through for sensory issues.
posted by cjets at 2:37 PM on July 26

I am a speech-language pathologist, if you want to email me privately. However, it's unethical for us to do any sort of diagnosis over the internet. I can email you some intensely detailed developmental checklists, though!

I highly recommend you get an evaluation by an SLP. If you're in the U.S. you can do it for free through ECI (Early Childhood Intervention). Google your city + ECI to find your local chapters. You might also go for a private evaluation, if your insurance covers it.
posted by kmel at 2:42 PM on July 26 [2 favorites]

I am involved with autism research for young children, and it seems to me that language delays and early autism diagnoses are pretty muddled up - we see a lot of kids diagnosed with autism who, when we do autism diagnostics on them, really don't actually quite present as autism. But if they have similar enough delays or symptoms, it's easier on their doctors to diagnose them as such, either because they qualify for better intervention services with that diagnosis, or because it's just hard to diagnose at that age unless you've had a lot of experience with both autism and language disorders.

Which is to say: Don't go off the deep end worrying about labels right now, whether it's autism or any other particular diagnosis. But why not go ahead and see a speech-language pathologist and/or an autism specialist and get some diagnostic testing done? Maybe you'll find out you had nothing to worry about, or that there is some specific diagnosis that fits, or maybe just that there are some delays in various areas. Whatever the result, whoever you talk to should be able to direct you in some different types of interactions you can work on with your child to improve any areas where he may be a bit behind for his age. It would probably ease your mind, and if there is a diagnosable problem, will let you get started with early intervention.
posted by Stacey at 2:44 PM on July 26

Dick Paris - He'll be two this week. And he is a *terrible* sleeper. Impossible to get to sleep, impossible to keep asleep, wakes up tired and cranky.

cjets: Your story does sound really similar. He 's very controlling with food (refused to eat anything but crackers, bits of apple and banana, peanut butter sandwiches, and corn when we went away for the weekend) and gets really bent out of shape when his toys are moved or don't do what he wants them to. Hates any clothing that's snug around his wrists, too. Regional Center... will check that out on Monday.

Thank you for your responses so far and keep 'em coming.
posted by echolalia67 at 2:46 PM on July 26

Most of the above advice is generally spot-on. I just want to chime in that you're certainly not alone, and there are many, many resources for you to take advantage of.
posted by Cool Papa Bell at 2:54 PM on July 26

Regional Center... will check that out on Monday

Here's a list of Regional Centers for the state of CA

There are some very helpful people there. But it is a government bureacracy so call early and often until you get assigned a caseworker. The first step will be hearing, speech and OT evaluations. And then they'll assign services based on the evaluations.

And if you don't get the services you want, fight it. You can appeal everything.
posted by cjets at 3:07 PM on July 26

I would have to disagree. I know plenty of autistic kids (apart from my son and nephews) that can point and gesture. There are many kids (and adults for that matter) who are very high functioning but still on the Autism spectrum.

I understand that there are plenty of high functioning people on the spectrum. I don't claim to be an expert and I'm not being argumentative, but I'm saying it is very rare to find an autistic person that points and gestures at two.
posted by LoriFLA at 3:26 PM on July 26

I'm not an expert on autism, but I've been around a fair number of toddlers. And know some ASD teenagers. Your little one sounds...two. Imposing order on the world in the ways that are available -- lining up toys, being picky -- are normal, and certainly there is a lot of room for individual rates of speech development at that age. I think it's a bit early to start looking for ASD from what you've mentioned.
posted by desuetude at 4:21 PM on July 26

My son didn't have a whole lot to say (just like yours) till he was three years old, and he used to line his blocks up in a straight line all the time.

He just graduated from the Air Force Academy.

So it's okay to relax a little.

I'm betting that your child was an early walker, or in other ways has developed in other areas...lots of times kids do great in one thing and lag behind in others. One of my other kids talked early but was less interested in walking.

Having said that, you are the mom, and I find that a mom's instinct generally kicks in if something is wrong. If you didn't see the problem till the doc said something, perhaps there isn't a problem...why not seek a second opinion, preferably with someone who is expert in this area? It couldn't hurt, and you'd probably feel better. But I am betting your child is perfectly normal-and probably gifted.
posted by konolia at 5:06 PM on July 26

Argh. Yet again I'm glad I had my kids before autism and seven bazillion other unlikely DSMV diagnoses were so prevalent as to be theoretically seen everywhere. First off, all the two year olds I have ever known (I have two kids. My friends all have kids. I taught and designed classes for all ages at a major museum. And so I've hung out with a lot of preschoolers over the years.) like to line up cars and blocks and food and whatever else happens to be around in long lines, often organized by colors or sizes or types or shapes or sometimes by some principal apparent only to the two year old in question. Seriously, they all do that and most of them get pissed off when something is moved out of line. I mean, wouldn't you? It takes effort to make those long, long straight lines.

Some kids talk early - my daughter started in whole sentences at about 10 months. Some talk late - my son didn't bother with sentences until he was about 26 months or more and then he didn't use many; he relied on a few interesting words and two or three word combinations until he was almost three. He's sixteen now and he talks just fine - in fact, he likes to argue for hours, at length, until you believe the sky is green and grass is blue. As konolia says, a lot of kids tend to balance the walking versus talking thing: my daughter, early talker, didn't walk until she was 16 months. My son, who used a whole expressive variety of one word comments with the very rare occasional sentence as above, was climbing out of his crib and up to the top of the refrigerator at 11 months.

Seriously? I would stop worrying, love your kid and wait until he's a little over three before I went into any kind of testing. If he's still not using sentences a year from now, I'd begin to be concerned. But he just turned two. You'll be amazed at how much change the next six months to a year will bring.
posted by mygothlaundry at 6:07 PM on July 26

He'll be two this week.
Oh gosh, that's way too young to expect full sentences, let alone consistently-coherent language, from a child. Our yard was filled with 2.5 year old boys this weekend and every one of them was babbling incoherently (the girls' speech was more developed, but that's par for the course). The 3-year old boys were speaking much more clearly, in full sentences. Don't worry about it--read lots of stories together, encourage conversation, ask your child to identify objects throughout the day...everything will click into place before you know it.
posted by prinado at 6:39 PM on July 26

I would stop worrying, love your kid and wait until he's a little over three before I went into any kind of testing. If he's still not using sentences a year from now, I'd begin to be concerned. But he just turned two.

Wow. I could not disagree more. If he is on the spectrum, the years between two and three are critical for early childhood intervention in dealing with autism. If he isn't, then all you've wasted is the time spent for three evaluations. Remember, this service is free from Regional Center.

This from the CDC:

Research shows that early intervention can greatly improve a child’s development.[1],[2] CDC is working with national partners on a public awareness campaign to educate parents about how important it is to track their child’s development in the first few years of life. The campaign, “Learn the Signs. Act Early,” teaches parents, health care professionals, and child care providers about early childhood development, including early warning signs of autism and other developmental disabilities.

Here's another site regarding early intervention:

According to the National Academy of Sciences, "the diagnosis of autism can be made reliably in two-year-olds by professionals experienced in the diagnostic assessment of young children" with autistic disorders. Early diagnosis is crucial because education is the primary form of treatment, and the earlier it starts, the better." Autism and PDD: Fact Sheet.

Look at this way. It's win, win for you. If he's a typical child, then you'll sleep better at night. If he happens to be on the spectrum, then you've gotten the process started ASAFP (as soon as fucking possible).

I realize that as a parent of an autistic child that my reactions may be emotional, but I just can't understand anyone would advise that you NOT get your kids evaluated. The fact that you're asking the question, much less the details you shared ( You said: I don't want to make a problem where none exists, but the more 2 year olds I meet, the more concerned I get. - Boy can my wife and I tell you about that.) were red flags for me, and clearly for you as well.

I think it's great for everyone to share all these stories about how your or your friends kid's didn't speak or babbled and ended up not being on the spectrum.

And, Echolalia, chances are your son is not. And I certainly hope that's the case. But 1 in 90 boys do end up on the spectrum. So, yes, all kids are different but Echolalia, if you have any doubts? Please get him evaluated. I can't tell you how many parents of Autistic kids that I've met that wished they'd gotten their kid into treatment earlier.
posted by cjets at 7:16 PM on July 26

How big is your kid's vocabulary? My pediatrician's guideline is 50 word vocabulary at 2nd birthday, with the odd 2 word phrase here and there. Your kid might be on track. There is a huge difference between 2 and 3. In that year, kids learn hundreds of words and build sentences. If it were me, I'd wait and see.
posted by crazycanuck at 7:58 PM on July 26

He's just now 24 months? Don't worry about it. He sounds exactly like my son - he had 10 words at 24 months. He didn't say "mama" until he was 20 months old. Super anal retentive? Check. He's 30 months and talking like crazy now.
posted by peep at 8:08 PM on July 26

My pediatrician's guideline is 50 word vocabulary at 2nd birthday, with the odd 2 word phrase here and there. Your kid might be on track.

I dropped off a bit in my logging of his vocabulary in the last few weeks, but at last count, it was about 100 words. This is why it something seems off - he's taking in enough language to be able to say about 100 words, but rarely speaks to communicate, preferring gesturing and vocalizations. It just doesn't add up.

He'd been saying words for about a year and was chugging along just fine, until earlier this year, after the whole family was sick with a never-ending merry-go-round of cold and flu for about 3 months. His language development seems to have plateaued since then. I didn't express my concerns to anyone until the pediatrician asked about his speech and behavior and brought up Autism back in April.

I took a wait-and-see attitude, wrote down his vocabulary and met with her again in the beginning of June. She suggested that I take him to a speech-language-pathologist. My husband and I talked about it and decided to give it some time to see if his language development picked up speed again before going in for an evaluation. So far, it hasn't.

I keep going back and forth - am I making a big deal out of nothing, or am I losing precious time by not getting him evaluated right away? After reading this thread, I think that I'm going to get him evaluated, for my peace of mind if for no other reason. Can't hurt, might help.
posted by echolalia67 at 12:04 AM on July 27

Blogger Amy Corbett Storch had similar concerns about her son, who at 18 months barely spoke. He turned out to have a sensory processing disorder which, with some intervention, seems to have pretty much cleared up. Although your kid sounds different than hers, I though you might be interested in reading about her experience. Here are all her posts tagged with "speech delay"- read from the bottom up.
posted by pseudostrabismus at 12:25 AM on July 27

I didn't talk till I was 4. My parents thought I had gone deaf and sent me to therapists and doctors, but my hearing was fine. Turns out it was a language issue - 3 languages in the house and I was getting a little confused (something like what zeek321 refers to). My family stuck to one language and I eventually entered kindy, and I was fine. Can't stop talking now. Haven't had a diagnosis of autism or anything along those lines.
posted by divabat at 3:31 AM on July 27

echolalia67, that's an important bit of info...go get him checked now, then. If it is autism, the earlier the better to make sure he gets intense therapy. Also, you might want to have his hearing checked.

Hopefully and probably, he is okay, but it is much better to be safe than sorry. Here's to hoping that in about 17 years or so your tot is getting acceptance letters from service academies, or at least Harvard!
posted by konolia at 12:27 PM on July 27

Has his hearing been tested? You say that there was a round of colds and flu in your household. Maybe his ears are affected.

Does he have a sibling who does the talking for him? My youngest sister was a late talker; my mom said my other sister and I would do all the talking for her.
posted by cass at 9:56 AM on July 30