Is My Child a Late Talker? Noah's Story Part One

Meet Noah

Sarah, a devoted mother and a friend of a friend, began to notice that her son Noah’s speech wasn’t progressing as quickly as her friends’ children. She observed this early on, around 10 months, and mentioned to her husband that he didn’t babble like the other kids in the playgroup. Her husband argued that every child develops at their own pace, and Noah was attentive and acquiring many new motor skills. Perhaps he was just more focused on motor skills.

So she continued to observe Noah, celebrating his milestones along the way. He started saying “mama” and “dada” around 13 months, but his babbling remained limited and he wasn’t using any other words. Friends reassured her, saying that he was still young and developing at his own pace but when she thought about her older son’s development, he was communicating about 25 words by 15 months, she decided to wait a few more months to see if he would have his “word spurt”.

Seeking Guidance

By the time he reached 18 months, his vocabulary had expanded with three additional words: “ball,” “kitty,” and “banana.” Interestingly, while he occasionally imitated animal sounds while reading a specific book, he rarely imitated other words. Seeking guidance, she consulted the CDC guidelines and discussed her concerns with Noah’s pediatrician, who advised her to wait until he turned 2. According to the CDC, children should be able to say at least 3 words other than “mama” or “dada” by 18 months, but something still didn’t feel quite right. If you’d like to learn more about why this specific CDC milestone is concerning please read our post about late talking.

Sarah took note when other children Noah’s age were using short phrases and seemed to imitate constantly. This is when Sarah decided to approach me. She described her son as a little boy with a multitude of strengths and how he took delight in helping her around the house (you could find no better duster!). Yet, despite her joy, she couldn’t shake off her worries. “Could you please evaluate him?” she asked. This scenario has been repeated many times in my career and is why I wanted to share Noah’s story with you.

Meeting Noah

I visited Noah at his house for the first time when he was 19 months old, and he eagerly gave me a tour. Leading me into the living room, he proudly presented the giant tower he had made using magnetic tiles. It was impressive! As an early language development specialist, there are a few key aspects I observe when initially meeting a new child:

Questions for Parents Concerned About Language Development

1. How does this child communicate with others?
• Noah effortlessly conveyed his needs through non-verbal means, using a variety of gestures to guide me where he wanted to go and inviting me to join him in his play. I immediately noted he was using an extended index finger to point, that is a good sign! His communication skills, despite not having many words, were impressive. However, I couldn’t help but notice he was very quiet during our visit. There were no vocalizations or any other sounds. This observation raised some concerns for me, one of my first tasks in working with Noah was to get him noisy!
2. What is the child’s environment like?
• When observing Noah’s home, I noticed that his mother, Sarah, was very responsive to him. She understood what he wanted and was even using some great speech therapy strategies like narrating to him what he could say when asking for things.
3. Does the family or other caregivers speak any other languages with Noah?
• Noah has not been exposed to any other languages. Bilingualism does not cause a language delay, or make a language disorder more severe, but it is important information to keep in mind when learning about a child with potential language difficulties.
4. How does the child respond to attempts to engage him in conversation?
• Noah responded well to attempts of engagement. He would follow my gaze and seemed to understand questions or commands given to him. This shows that he has a good grasp of receptive language, an important foundation for expressive language.
5. What is the child interested in?
• Noah loved playing with his magnetic tiles, but he also made me a “coffee” in his little toy kitchen and we also read a few of his favorite stories. Before embarking on speech therapy at such a young age, it is crucial to understand and embrace a child’s individual interests and what they are already doing in their everyday life. It’s not about rigid table work or book tasks; it’s about fostering connection and building upon their existing strengths and incorporating language learning within the natural rhythm of their life. By truly grasping a child’s interests and what their life looks like, we can better meet them where they are and facilitate their growth.
6. How does the child imitate?
• During my observations with Noah, I explored various forms of imitation. Could he imitate big body movements (yes), little body movements when following along with fingerplays and movement songs (yes), facial movements like sneezing and making a surprised face (yes), exclamatory words like “Wow!”, “Boom!”, and “Uh oh!” (no). Imitation is how we learn everything, and without strong imitation skills, vocabulary development may be hindered. Therefore, we decided to prioritize improving Noah’s imitation abilities over the following weeks.

These questions help guide treatment if applicable and assess different aspects of language skills, including receptive language skills (understanding language) and expressive language skills (using language). I learned that Noah really struggles to imitate single words. He didn’t imitate me (which I wouldn’t necessarily expect on the first meeting!), and Sarah confirmed that he also didn’t imitate words with the family either. We both agreed that Noah was a great communicator with the gestures he did have! We also agreed that he seems to understand and follow directions, both with and without gestures, and respond to his name being called. While his vocabulary is not constantly growing expressively, he can identify basic body parts and understands many words. He is not very vocal and does not take turns vocalizing. Noah does not imitate many environmental sounds or animal sounds. Additionally, he responds appropriately to the word “no”.

So, “Is My Child a Late Talker?”

After carefully observing Noah, reviewing standardized assessment data, and considering parent input, we reached the conclusion that Noah had specific and significant needs related to expressive language development. He showed signs of late language emergence or late talking. While his receptive language skills were developing as expected, his vocabulary consisted of only 6 words at 19 months. The average 18-month-old has around 50 words and is starting to use simple phrases. Furthermore, Noah’s imitation skills were weak.

Considering these factors, we determined that given Sarah’s concern about his language development, we decided that parent-mediated intervention with my role being that of a coach to Sarah would be the best fit for their family. There were many positive signs for Noah’s prognosis! He was using a variety of different gestures to communicate, there is no family history of language impairment, and he lives in a highly responsive environment with a family motivated to support his development! We arranged to meet at their home once a week for up to an hour each session. We adjusted our session length and frequency depending on the needs of their family.

The Plan

We agreed we would focus on :

• Improving imitation
• Making noise, silly noise, loud noise, whispering noise, noise!
• Learning language strategies
• How to incorporate language strategies into their everyday play and routines
• Celebrating his growth along the way!

Over the next few weeks, I will continue to delve into Sarah’s journey as what I like to call a “parent interventionist” (with my guidance!) and her role as a language model for Noah. Together, we will explore Noah’s progress and growth in language. I invite you to join me on this journey, where we will witness firsthand how speech therapy can positively impact your child’s development. This story has been shared with the express permission from Sarah (names have been changed to protect privacy).

Interested in learning more about late talkers? Check out our other posts about late talking:

• What is a late talker?
• What you need to know about developmental language disorder (DLD)
• Tips for helping late talkers