Ask Dr. Marla: Delayed Speech

Q. My 27-month-old niece STILL hasn’t started talking, even though she understands almost everything we ask her to do. She’s smart, but should I be concerned whether she has a speech disability?

A.  You are right to be concerned if the child is not talking at all. I am wondering if this is a shared concern of the child’s mother. Does she talk to her parents? Has her hearing been tested?

Typical developmental milestones can vary but here are some guidelines that we as doctors follow:

• By six months babies begin to use consonant sounds in babbling such as ‘dada’.
• By nine months there is typically an increased variety in sounds and there often is that constant stream of babbling.
• By a year, the toddler uses ‘mama’ and ‘dada’ correctly.
• By 15 months, a child typically has a vocabulary of five to 10 words and understands at least 50 words.
• By 18 to 24 months, we expect toddlers to use simple phrases and use two to four-word sentences. They often will repeat words overheard in a conversation.

There is a difference between speech and language. Speech is the verbal expression and includes the way words are formed. Language is the entire system of not only expressing but also receiving the information. It is the understanding part and the being understood. As a result, language is verbal but also nonverbal. Your niece, it seems, does understand language in that she can do what is asked of her.

Experts cite many reasons for delays in speech and language. In an otherwise normally developing child there may be problems in the area of the brain that is responsible for speech. Hearing problems could also contribute to problems with speech.

I am concerned that she is not speaking. By 18 months, children should be speaking and by two, should be using two-word sentences. It is reassuring that she understands everything she is being asked to do and can follow instructions. In addition, you have not alerted me to any concerns about her movement milestones or social and emotional milestones. The fact that you are saying she never uses speech after age two is a definite warning sign that should not be ignored. I would encourage her mother to have this conversation with her physician to assess whether or not there is a developmental delay. While each child indeed can develop at their own pace, this should be assessed.

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