When a child is talking only a little, or not at all, it is a cause for concern.  Many children begin to see a speech therapist after their second birthday because they only say a few words, or none at all. A natural question a parent may ask at that point is “Why? Why is my child not speaking?”  And as a speech-language pathologist, I am often asked this question. 

Sometimes it’s very hard to know. If a child is not talking, we have very little data. But there are other signs we might see.  I’ll say up front that this article isn’t going to be a well-researched one. Instead, it will be descriptive.  I’m going to describe the profile of some children with delays which impacted their speech and language development. Having treated kids for nearly 10 years at this point, I’ve had the opportunity to observe “late talkers” grow into children whose speech and language delay or disorder can be more clearly defined. 

But first, a thing to know:

Milestones

Most kids begin speaking between the ages of 9 months and 15 months. The exact age range varies depending on what source you look at.  But first words should come in that window. Vocabulary should build steadily, maybe even explosively, and by age 2 a child should be able to say at least 50 words (yes, even you, bilingual child!).  Things like “uh-oh” count as words, and so does “wuh-wuh” if that’s how the child is saying “woof-woof” for “dog.” By age 3, a child should have so many words that a parent isn’t going to be able to count them.

Having established that, here are some factors which can impact development, slowing expressive language acquisition and resulting in a child whose words develop more slowly.

Articulation

Articulation means “pronunciation,” more or less. Forming consonant and vowel sounds, forming different kinds of syllables, and saying them out loud by moving your lips, tongue, etc.  If a child has an articulation disorder, they might talk on time and just be hard to understand.  Articulation disorder certainly does not always mean there is also a delay in vocabulary skills.

In some cases, though, an articulation disorder goes hand-in-hand with a language delay. More severe forms of articulation disorder, such as Childhood Apraxia of Speech, often come along with a slower rate of vocabulary acquisition (but again, not always).

If articulation skills are slowing a child’s rate of language learning, that child might:

• Say some words that a parent can understand, but the words are pretty far off from what it should actually sound like

• Drop syllables from words, or have a hard time using two different consonants in the same word (“potty” becomes “poppy”)

• Learn sign language faster than verbal words

• Be a little “droolier” than you would expect for their age.

Therapy for articulation at age 1 or a young age 2 is not very viable; therapy will usually focus on creating a language-rich environment, and maybe modeling some articulation targets.  If the child is not speaking very much, you simply won’t know if or how much articulation is affected, or whether articulation itself is a factor contributing to language delay.

Language

A speech-language pathologist who says “language” is referring to vocabulary (how many words do you understand, how many words can you say, regardless of how they are pronounced) and grammar / sentence structure (how long are your sentences, are you using grammatical inflection and is it correct). 

A language disorder might be “expressive” (child understands everything OK but doesn’t say much) or “mixed receptive-expressive” (child doesn’t understand as much as they should for their age, and also doesn’t say enough). 

Sometimes a language disorder occurs in isolation: that is, articulation is OK, social communication skills are OK, but language skills are delayed.  You can consider it a form of learning disorder. A young child who is not talking at all might catch up to peers without therapy, but they also might not.  When a delay in language skills is detected, we do know that the best chance to catch up is to start intervention early. For young children (age 1, 2) this most often takes the form of modeling simple words and phrases, following the child’s lead in play, and help to make changes in the home environment to create as rich a language environment as possible.  We sometimes call these strategies “language facilitation” strategies.

Language facilitation can be learned pretty easily by parents and done at home. I especially like this because a bilingual parent can use the strategies in their native language even if the therapist cannot speak that language.  If a child is just turning 2 and has few words, I usually recommend doing about 3 months of therapy until the parent is comfortable using those strategies at home.  Then, try at home for a while.  Visits with a speech therapist might not be necessary because, if the job has been done well, the parent can do the therapy just as skillfully as the speech therapist can.  The child might come back at age 3 if concerns persist.  At that age we might have more therapy tools that are relevant.

It’s fair to say, though, that using language facilitation strategies is not enough for some kids. Especially when the language disorder is more severe, using language facilitation alone is not going to produce satisfactory progress.  When we see other signs going along with the language disorder, we might use more tools even from an early age.  That brings us to our final topic.

Social Communication

This is most commonly associated with Autism Spectrum Disorder (ASD), but delays in social communication skills are not exclusive to ASD.  Sometimes a child who is later diagnosed with an Attention Deficit may also show delays in social communication skills.  If a child at age 2 is not talking, there are other ways a child should be attempting to communicate, if social communication skills are developing normally. That includes:

• Pointing at objects they need help with (such as something the child can’t reach)

• Pointing at objects they just want you to look at (like an airplane in the sky)

• Noticing and shifting attention when you point to things

• Holding things up just to show them to you

• Occasionally looking at you while you play together, to make sure you’re paying attention

• Looking at you, then looking at an item of interest, then looking back at you. We call that a “3 point gaze” or and that is developing before age 1!

Those all fall under the umbrella of “nonverbal communication,” which is just one part of social communication skills. Social communication is really the underpinning of language and it begins to develop even before language (like words) begins to develop.  Other things you would expect a child to be by age 1 are shifting attention when someone speaks and sharing facial expressions with caregivers (maybe you’ve heard of the “social smile?”).

If some of those crucial behaviors are missing, therapy might be very direct and hands-on with a child even from a very young age. I find this to be an area in which individual therapists differ very strongly. I personally tend to employ PECS as young as age 2 when basic social initiation has not developed, whereas I would tend to use only language facilitation strategies if social communication is developing at an expected rate.

If a child is very young (age 1 or 2) and not speaking, a speech therapist will be looking for those kinds of social communicative behaviors. If the child is communicating in those ways but not speaking, social communication skills are probably not a concern. If those communicative behaviors are not being seen regularly though, further evaluation is a good idea. If Autism is a concern, evaluation can be done by a neuropsychologist or a team of providers at an Autism Center such as the UW Autism Center or Seattle Children’s Autism Center. 

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I hope this article has brought some clarity. When I hear “Why is my child not speaking,” the most truthful answer is very often “We don’t know yet.”  Maybe they will start talking very soon. Maybe they will start talking but their pronunciation will be hard to understand. Maybe I am seeing some other things and will encourage additional evaluation.  These are the things I’m usually thinking about.  The best and most hopeful thing to do is to start therapy as soon as it’s clear that language is not developing quite as quickly as you might expect.