Communication Challenges and Your Child
By Kelly Stafford, M.A., BCBA, LBA
In 1946, Dr. Benjamin Spock changed the world of parenting forever. His book, The Common Sense Book of Baby and Child Care, sold 50 million copies, but more importantly, Dr. Spock created an industry of parenting advice that continues today. As a result, besieged parents receive a torrent of advice from books, blogs, posts, clinicians, family, and friends – even friendly folks in the grocery store: “My child crawled at six months, walked at ten months, and said ‘mommy’ at twelve months. This is what I recommend.”
You’ve probably learned to tune out well-meaning advice. You understand that children have different personalities, different learning styles, and different rates of development. This is especially true with speech and communication skills.
All children develop at different rates, but they usually follow the same natural progression – or milestones – when mastering skills. Milestones identify if a child needs extra support or is developmentally on track. (1) When a child fails to meet these milestones, they may be diagnosed with a communication delay or a communication disorder. A delay versus a disorder can look the same, but they are clinically different and demand different approaches in support.
What’s the Difference Between a Communication Delay versus a Communication Disorder?
The terms communication delay (or speech delay) and communication disorder (or speech disorder) are often used interchangeably when they are different concepts. A delay means that a child is developing language in the typical fashion and sequence, but at a slower rate than other children of the same age. A disorder means that language is not developing and communication skills are not being acquired as expected by children of the same age. These children will need a more intensive therapeutic approach.
The terms communication delay (or speech delay) and communication disorder (or speech disorder) are often used interchangeably when they are different concepts. A delay means that a child is developing language in the typical fashion and sequence, but at a slower rate than other children of the same age. A disorder means that language is not developing and communication skills are not being acquired as expected by children of the same age. These children will need a more intensive therapeutic approach.
Here are how delay and disorder differ:
Delay - At 18 months a child only has 2 words (should have 10 words). Over the course of time, the child begins to add more words and eventually acquires a vocabulary of 10 words. The child develops speech sounds in a typical order and manner over time, but just at a slower rate. (2)
Disorder - At 18 months, a child is not producing any vocal sounds. As the child continues to get older, verbal speech milestones continue not to be met. The child is not meeting milestones as expected. (3)
These 18-month milestones are not determinative of a delay or a disorder. A diagnosis requires further testing and a deeper look into the child’s development. If you have concerns about your child, make notes of the communication issues you see to discuss with your child’s doctor.
What are the Signs of a Communication Delay or Disorder?
Before identifying whether a delay or disorder exists, it helps to understand the typical milestones:
- A child’s first word occurs around one year of age, give or take a month or two. Children start producing words around 15-16 months and have a vocabulary of 10 words by 18 months of age. (5)
- As vocabulary grows, children should start combining words (e.g., “Go car”). This occurs around 24 months of age. (6)
- The first sounds you might hear are p,b,m,h,w, and sometimes d. (7)
- You may notice around 18 months that your child recognizes familiar objects, names, and points to some body parts. (8)
- Children between one and two years begin to listen to short stories, point to objects in books, and follow simple directions. (9)
For more information, check out the comprehensive list of developmental milestones from two months to five years at the CDC website.
Typical Features of Delay and Disorder
If your child does not meet the developmental milestones above compared to peers or exhibits any of the features below, please discuss with your family doctor:
- Your child is difficult to understand by others.
- Your child uses a limited number of sounds.
- Your child is experiencing difficulties with hearing.
- Your child is producing speech that is unclear compared to peers.
- Your child appears to become frustrated when not understood by others. (10)
What Causes a Communication Delay or Disorder?
Communication delays and disorders can be caused by genetics, environmental factors, brain development, and other factors. No matter the cause, it’s essential to acknowledge the problem and seek an expert’s advice. Your child’s doctor might recommend an evaluation by a trained clinician to see what’s causing the difficulty. Ask your doctor about state-funded programs that may help pay for evaluations. These programs often have age limitations, so it’s best to act when you first have concerns. Below are some of the providers that might be involved in a clinical determination:
- Audiologist: Your child might be referred to an audiologist to rule out a hearing problem.
- Ear Nose and Throat Doctor (ENT) or Otolaryngologist: Children with multiple ear infections might need to see an Ear, Nose, and Throat Doctor (ENT) to determine if any hearing issues result from infections or hearing loss. Tonsils and adenoids can also impact speech development. An ENT can also help determine if any structural causes might impact communication. (11)
- Speech-Language Pathologist (SLP): A speech-language pathologist (SLP) works with receptive language (understanding), expressive language (speaking), feeding skills, and social language. A comprehensive evaluation by an SLP can help determine the area of communication impacted (understanding vs. speaking).
The Importance of a Diagnosis
Talking with a professional and identifying a communication delay or disorder will help your child get the support they need. If left untreated, your child may experience difficulties communicating wants and needs, engaging in academics, engaging in social interactions, and leading to mental health challenges, such as anxiety. (12)
In the Dr. Spock era of the 1950s, children with communication challenges didn’t enjoy the resources we have today. Fortunately, over the last fifty years, troves of research and accrued expertise now give children with communication challenges an equal footing in society. We now have communication diagnostics, protocols, specialized professionals, and adaptive technology to bring disabilities of all kinds out of the shadows so that all children can lead joyful, productive lives.
Please do not hesitate to reach out to medical professionals about your concerns. Your child needs your voice to help support theirs!
About The Authors:
Kelly Stafford, MA, BCBA, LBA is a Board-Certified Behavior Analyst licensed in Oregon and Washington. She worked in a private special education school setting for six years before switching to a clinical setting in 2019. Kelly is a Lead Board Certified Behavior Analyst at Gemiini Systems and Wynne Solutions Behavior Services.