Ideas for late-blooming toddler?
September 29, 2018 1:04 AM   Subscribe

My daughter is 2.5 and is (hopefully, only) a late-bloomer, especially in language. We are on a wait list for a further evaluation, and just got off the wait list for speech therapy. I'd love advice on what else I should be doing to help her.

My daughter (2.5) hit her major milestones at the tail end of normal -- 16 months walking, late to roll, sit up, etc. She was also late with language -- I can't remember when she said her first words, but I know I began to worry about 18 months. She was evaluated then by a speech therapist (we live in the UK, so this was NHS) who said it was too early to tell. At 2, she was diagnosed with a "moderate" speech delay, as she was not putting two words together. We got on the wait list for more therapy.

I always thought she would just catch up, and we had a few private sessions of speech therapy. But she hasn't. Her vocabulary is large -- at least 200 words, but she rarely puts them together. She also likes pronouns -- "eat it," "hold it," "read it" and she says "there" a lot. Articulation is also not great and people outside the family can struggle to understand her words. If she wants something she will just say the word "babies" "apple," etc rather than a sentence. Her understanding seems to be good though.

She's also not very coordinated and falls a lot (also struggles with a scooter, etc.) We've recently had a few playdates with families from our birthing group (so exactly the same age) and I notice how dreadfully far behind she seems behind the other kids (and my older kiddo at this age.)

She does like imaginative play, but less so maybe than other kids. She loves her baby dolls. She tries to do simple puzzles (she's good at the peg puzzles and is past those) but can only do 2-3 pieces. She's only recently become very interested in books (before she got bored very easily, but now she wants you to read to her.) Her favourite thing to do is follow her big sister around. She really is a very happy, loveable kid though and seems contented.

I am a bit disappointed with the speech therapy so far; it's more about teaching the parents (which makes sense) but I'm not sure it's stuff we haven't been doing already. Either way, I don't see it as a magic bullet I hoped it would be. She just started a half-day nursery program that I think will be great for her. I am home with her the other half of the day, and I'm wondering what else I can do to really support her.

So I'm looking for 1:1 ideas of things to do with her, resources, etc. And if anyone has any ideas for further therapies (esp. in the UK, where this stuff seems thin on the ground), that would be great. We will pay for private services if we really think it will help (but on a tight budget).

I'm also open to encouraging stories of your own late bloomers! :)

(We're also on the long NHS wait list for a further evaluation, but both speech therapists we've seen also work with kids with autism and they aren't worried about autism, and think she just has a development lag. But I will of course look into it.)
posted by heavenknows to Grab Bag (13 answers total) 7 users marked this as a favorite
I'm a speech therapist in the UK (though I work with adults these days). The best evidence for therapy with communication delay in very little children is exactly what you have seen so far - working with the parents to optimize the language input the child is getting. It may be that you already were very close to that so it may feel that you got nothing out of it. When I was training I had a placement at a specialist centre for children with speech disorders and they wouldn't even accept referrals until age 4.

I assume you have had a hearing test.

There are systematic programs like the Hanen "It Takes Two to Talk" which might be worth looking at. Unfortunately SLT services in the UK are uniformly extremely stretched and for my toddler we are looking at private therapy (I can't remember enough to do it myself!).
posted by kadia_a at 1:56 AM on September 29, 2018

You are probably already doing this.

Conversation is key to speech, so any kind of conversation that you both enjoy is good. But there are many kinds of conversation. Don't just model and try to entice her into conversation which stretches her ability, make sure she also gets to practice conversation that is at her current level, and which is easier than her current level. Just like with reading it is good for a kid to keep reading picture books for speed and fluency after they start reading chapter books, it's good and fun for her to spend time on simple conversation.

Try playing a game of conversation with out words to practice the give and take and flow of conversation. Imagine a conversation where her toy box is too full to close: "Whine of frustration" "Huh?" "Emphatic grunt and point" "Sympathetic noise" "Slightly less frustrated whine" "Questioning noise" "Interested hmmm" exploring situation, pokes at each object that is sticking out with a repeated nmp, nmp, nmp, for each one. Questioning "Hmmmm" directed at the object projecting most. Take her hand and place it on one part of the offending object. "Wup." Place your own hand "Wup" Theatrical "Eeeek....Oooook...." as you wriggle the object side to side. This can be done as a game playing with a toy animal such as monkey that has an excuse for not talking - "Monkey's can't talk.. But we can!"

Doll play with a soft toy or doll that is her baby and "hasn't learned to speak very well yet" can encourage her to model using words. The toy can be acted out going around and squeaking meaningfully at her, while you prompt her, "Better tell him no - he'll be sick if he has another goldfish cracker."

See if you can get her to sing as in."I don't wanna go to work, but I gotta! I don't wanna put my coat on but I gotta! I don't wanna put my boots on but I gotta! I don't wanna say good-bye but I gotta!" Her version can be "Daddy don't wanna go to work, but he gotta... etc." sometimes singing is easier. Songs like "This is the way we wash our clothes" are good for this. So is Ride of the Valkyrie, Jingle Bells and other tunes where you make up the words for the situation entirely.

Also check it if is easier for her to talk in unison or without others or without anyone hearing her. My late talker would initially only talk if at least two other conversations were going on in the room at the same time.

Drill easy phrases and words: Thank-you! Time for lunch! Time for bath! Time for bed! Time to read! Time to colour! Boots go in the cupboard! Dishes go in the sink! Crayons on the table! Get her to drill you in doing what she says. If she says Crayons go on the table! you put the crayons on the table. If she says "More potatoes please!" she gets more potatoes. This should be done as chants at first if that helps. Explain to her that words are powerful and you use words to get what you want, and she can do that too

Model inflection. Say an amazed "What in the world...!" with out enunciation and pronunciation, and say it with enunciation and pronunciation and get her to do it too. Use other emphatic phrases like, "Kitty is not my friend."

Read to her as much as you can and get her the means to learn to type, in case she has lingering issues with speech. She needs to keep picking up vocabulary and meaning, even if she has delays in verbalizing.

Often the brain is going faster than the mouth. Model talking really really really fast and see if she can pick that up. If she can, as happens with some hyperlexic slow talking kids, you are better off with her talking really really really fast at home than being tongue tied and she can learn to slow down her speech after she develops it.

Teach her to read as early as possible, as if she has auditory processing deficits, books can easily make up for sounds turning into white noise when she gets overloaded. Reading, of course, is for fun.

Take note of when she can and when she does not speak and look for patterns such as when there is music playing in the background, or when she is tired, or if she is in a bright location.

See what happens if you have her in a very, very quiet environment. If she is hypersensitive things like a refrigerator humming in the background can overload her, or even give her migraines. In a kid her age migraines would probably present as throwing up frequently and easily and being irritable. There is often no pain, only sudden nausea in a kid that age, and the pain only becomes obvious later, perhaps when she is five or eight-years-old.

Encourage her to have a very expressive face as an alternative and additional means of communication. My late talking daughter can do amazing things with her eyebrows, or the quirk of a cheek muscle forming a moue or a half smile or a dimple, or a flat line.

Get her to practice word retrieval. What shall we put in the salad? Hopefully you can coax her to name a half dozen items, and then in later sessions to include conjunctions and sequencing information: tomatoes and raisins, lettuce or macaroni, tuna with mayonnaise, lettuce then bacon bits, tomatoes on top.

Expose her to words that she will enjoy saying. "Aggravating!" (Deep exasperated sigh) "Banananana." She knows how to say banana but she can always be extravagant when she says it. Bless my button boots! Shave and a haircut. Lollipop. Squelch! Geronimo! Cowabunga! Suffering Succotash! Pestiferous! Exclamations come from a different part of the brain than discoursive words, which is why people who have strokes may be able to swear but not to talk. So if you can get her more confident and comfortable with speech by tapping in to this part of her brain.

Play a game where she can give commands. Ask her questions. "Where would you like me to put teddy" If she says "Bed" slide the teddy under the bed. "Under the bed? On the bed? In the bed?" If she replies "On" playfully make it difficult. "On the lamp? On the dresser? On your shoe?" When she says "On the bed,' Triumphantly get it right.
posted by Jane the Brown at 7:43 AM on September 29, 2018 [22 favorites]

Anecdotally, my MIL loves telling the story of my husband that was basically speaking in one or 2 words at a time at the same age as your daughter. She said when he finally started speaking he skipped straight to complete sentences & he hasn't stopped talking since (seriously the guy never shuts up). So yeah that's my encouraging story.
posted by wwax at 8:02 AM on September 29, 2018

She's also not very coordinated and falls a lot (also struggles with a scooter, etc.) ... She's only recently become very interested in books (before she got bored very easily, but now she wants you to read to her.)

I think it's a great sign that she wants you to read to her, and it reminds me of some of the visual processing exercises I've been assigned to complete, and specifically the tracking exercises, which I'm personally hoping will help with my "visual motor integration, commonly called eye-body or eye-hand coordination."
posted by Little Dawn at 8:51 AM on September 29, 2018

This is so wonderful! Thank you so much.

Kadia, I didn't mean to put down speech therapy! I think it's great. I was only making the point that I thought it would be MAGIC and it's more like hard work of the kind we're doing anyway. :). And we did get a hearing test privately -- the wait list on the NHS was shocking. Early intervention is really where the NHS has let us down, I feel. I also just ordered the Hanen book!

And Jane, how can I thank you enough? You've given me more ideas of things to try than I've gotten in several sessions of speech therapy. I'm really and truly grateful for you taking the time -- I am going to try each and every one of them.

Had never thought of visual tracking -- I actually think this is what my older kiddo needs!

Thanks all! I'm always open to any other ideas anyone has as well :).
posted by heavenknows at 11:37 AM on September 29, 2018 [2 favorites]

I love love love Baby Signing Time. It combines text with words with gestures with pictures with live action videos and song. What a great way to learn about "eat" - see the text, hear the word, watch a gesture, watch children making the gesture, watch children making the gesture and then doing the action, and singing a catchy tune about it. Even better is to watch the eating video while having a snack. (My kid didn't have verbal delays but loved Signing Time and I am convinced that it helped him access new ways of communicating.)
posted by xo at 11:44 AM on September 29, 2018 [1 favorite]

Any chance there is more than one language in her daily life (either at home or with a caregiver?) It's sort of common among multi-lingual households to see speech delay. Ime the kiddos catch up around 3-3.5.

Eta: that doesn't mean you should ignore your concerns, just adding that it may be another explanation.
posted by vignettist at 3:20 PM on September 29, 2018

My daughter, also a second child was a bit delayed in speaking, as well, but mainly because big brother was always anticipating her words and speaking for her. He had to learn that she needed to use her words. Any chance that could be happening to any extent?
posted by poppunkcat at 4:32 PM on September 29, 2018 [1 favorite]

My youngest is also speech delayed (and, yeah, you've probably been told a bunch of times that younger children tend towards delays, because of their adoring elder siblings talking for them!).

In addition to things mentioned above, our speech therapist has us singing a lot of baby songs -- BINGO, wheels on the bus, Old Mac Donald, etc. -- and she began by mimicing the tune, and now is saying some of the words (EIEIO, in particular, and letters in bingo).

Our therapist has also emphasized animal sounds, and my toddler will do a lot of animal noises when she won't say animal names. (And "moo!" got us "boo!" got us "blue.")

Doll play gets a lot of words out of her. I spend a lot of time diapering a panda (she always notes "UH OH!" to let me know he has a diaper rash, she's obsessed with this panda having a diaper rash) and putting him to bed and I say "night night!" and my daughter prompts the panda, "Ay NI NI!" (say night night) like we used to prompt her and then has the panda wave and say "NI NI!" The panda calls for his mama and daddy, he says his brothers' names, he asks for milk, she'll use a lot of words when she's taking care of panda and pretending to talk for him.

Can you enlist your older child as a tutor? My toddler has only a certain amount of patience for playing animal sound games or singing baby songs with me, but she will do them FOREVER with her beloved older brothers. Our speech therapist actually taught them some simple games to play with her to help her with her speech, and they LOVE being the big kids in charge of helping her, and she LOVES having their full attention and interest. Exploit that big-sister adoration!
posted by Eyebrows McGee at 4:47 PM on September 29, 2018

I feel a little like Charlie Brown when they're looking at the clouds here, but still I'd like to report that my grandson was quite delayed in speech. When he started getting weekly speech therapy (quite expensive in the U.S. and not covered by most health insurance) he improved quite rapidly. I think you are correct that it is no magic bullet--the parents and family see the child much more than the speech therapist.

Getting actual therapy was slightly inhibited by the fact that an uncle was speech-delayed and eventually caught up, so that side of the family just assumed that delayed speakers always catch up. Funny how good we are at generalizing from one instance. It's almost as though there were some survival benefit to assuming that if the leopard ate someone else it will try to eat you too!
posted by Gilgamesh's Chauffeur at 6:05 PM on September 29, 2018

"When he started getting weekly speech therapy (quite expensive in the U.S. and not covered by most health insurance) "

Just as a note for later readers -- if your child is under the age of 5 in the US, speech therapy is provided through Early Intervention, a nationwide federal program that provides services for free or at very low cost for children with developmental delays. You have a legal right to these programs and they are paid for via taxes. You should not have to go through your health insurance (although the state may also bill your health insurance, but that's not your concern).
posted by Eyebrows McGee at 9:09 PM on September 29, 2018 [1 favorite]

My daughter, also a second child was a bit delayed in speaking, as well, but mainly because big brother was always anticipating her words and speaking for her. He had to learn that she needed to use her words. Any chance that could be happening to any extent?

My younger brother didn't talk until I went to pre-school and he had to. He didn't read for himself until I went to middle school and again, he had to. He didn't learn to drive until I went to college... you see a trend. He's always been kinda lazy! Also I was a very indulgent older sibling.
posted by fshgrl at 10:56 PM on September 29, 2018

My son (an only child) is about five months older than your daughter and has what his peadiatrician describes as a "severe" speech delay; worse than what you describe. He didn't have any physical delays, and he is sociable and communicative (the doctor says he is probably not on the spectrum), but he didn't say a single word until well after his second birthday and with less than a month until his third birthday his speech is at a level that would be normal for a one-year-old. The speech therapy that he has been undergoing for over a year has been very expensive, disappointing and frustrating. We are currently trying to follow the Hanen program and he is progressing, slowly, but I've resigned myself to the fact that there is no magic bullet for this and I just try to be happy about the progress that he does make. The only useful information I can give came from his new paediatrician a few weeks ago: kids tend to respond very well to speech therapy after the age of three, but before that age it makes much less difference. And the progress that is made before the age of three is not necessarily an indication of the progress that can be expected between the ages of three and four.
posted by nikodym at 2:51 AM on September 30, 2018

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