As a rule of thumb, most children should be saying single words by the time they’re 12 months old and stringing two words together by 24 months. They should also, by 24 months, speak clearly enough that you and other caregivers (relatives, babysitters) can understand them around 50% of the time.
If that isn’t the case, or if you’re concerned about any aspect of your child’s speech or language development, it’s best not to delay a visit to the pediatrician in hopes that they’ll catch up.
“The most important thing I would say to parents is that if your child is having difficulty communicating and engaging fully in the world around them, it’s best to bring them in for an evaluation,” says speech-language pathologist Kristen Lyrek, who sees patients at the University of Minnesota Health Pediatric Specialty Clinic in Woodbury.
“Research has shown that the first three years of life are so important. Early intervention, birth to age 3, is a critical time for language exposure and development. We generally like to see children at 18 months if there is a concern about speech or language development or social interaction skills.”
At more than a dozen clinics where Fairview, HealthEast and M Health offer pediatric speech therapy, we see children up to age 18 with a variety of conditions – some simple, involving pronunciation of basic sounds, and some complex, such as motor speech planning disorders.
“We see children with childhood apraxia of speech, for example,” Kristen says. “With this condition, children have difficulty with the precision and consistency of movements required to form understandable speech.”
It’s a difficult diagnosis, because there’s not a lot known about what causes it. “Sometimes it can be present with other neurological disorders, but many times the cause is unknown and seen in children with otherwise normal development.”
“Children with this condition are usually really bright, which also makes it difficult,” Kristen says. “I know that they want to say a certain word, but they can’t say it.” Children with this condition who have no other neurological issues often understand language very well; it’s that they have a hard time coordinating the movements needed to form words and sentences.
To counteract this, Kristen and her colleagues work with children by “starting with the skills they do have.” For example, they’ll find sounds or words that the child is able to say and “then build on that. We do a lot of repetition to redo the motor planning in the brain. But we do it in a kid-friendly, entertaining way.”
Speech therapists also see patients who have trouble socializing with others, such as kids with autism spectrum disorder, cognitive delays, or behavioral issues. For these children, speech therapy helps prepare them for situations in school or everyday life. “We sometimes take the children around the office, and practice greeting people and having a conversation,” Kristen says. “We work on things like how you ask questions.”
Therapists emphasize the importance of working with the family on all aspects of a child’s treatment plan. Overwhelmingly, the parents of young children “want their kids to be ready for kindergarten,” Kristen says. “My goal is the family’s goal. It’s a collaboration.”
Kristen emphasizes that there’s no downside to getting your child checked out.
“I tell parents that if they’re not sure, if they’re on the borderline, don’t wait. There’s no harm in getting an evaluation. If nothing else, they can get peace of mind. And if their child needs therapy or other services, it is so valuable to get that process started early.”
If a child does need therapy, it will be offered in a manner that doesn’t feel like work.
“We like to use a lot of imagination and play-based therapy,” Kristen says. “Kids learn through playing. We teach language through play with a purpose. So we will do lots of imaginative play. We focus on repetition of words they would frequently use. To get them to request things using one of those words, we might use motivational toys.”
Also important in achieving success with speech therapy is letting children make decisions themselves. “Giving children choices can be really powerful,” she says. In her experience, children are more likely to try to say the words they choose themselves.
Whatever the individual goals of each family, Kristen stresses that the overall aim of speech therapy is to “make the child as successful in their everyday environment as they can be. If that means they can communicate verbally, great. If not, then success could mean finding another way for them to become functional communicators, so they can experience their environment to the fullest.”
It’s the most satisfying part of her job. “You open up this whole new world to the child,” she says. “Their independence increases because of that achievement, and the whole family dynamic improves.”