Does a two year old need speech therapy?

It's not uncommon for parents of a late blooming two year old to be told, "Don't worry, lots of kids don't talk much at two," or "Your brother didn't talk much until he was four, and then he never stopped."  My opinion is that if a parent is concerned, it's usually because he or she has noticed slight differences between the child and peers.  Parents usually know!  My advice is always to consult with your child's health care provider about a referral to a speech and language pathologist for an evaluation.  Three year olds can be evaluated through your school district without charge, but don't wait that long unless your child's pediatrician and teachers feel that is wise.

Why the urgency? If a child is lagging behind in either expressing or understanding language,  a “wait and see” attitude can make things worse.   The early evaluation of speech and language that leads to the right program can make the difference between a child who leaps forward or gets left behind.  Two year olds don’t play very interactively, and the difference between a chatty or quiet toddler may not seem noticeable in a playgroup.  By three, children are interacting, asking questions of each other, listening to stories and using words to solve problems.  Children who are a little behind will still be able to keep up with play, although they may begin to watch more than engage if they can’t always jump into the other children’s activities. At four, children are highly interactive, playing imaginary games, reporting on their interests, asking questions again and again and building conversations based on how another child responds.  A child who has seemed “a bit behind” at three can find himself sidelined from group activity at four.  At that point, he’s not behind just in vocabulary and sentence formation--he’s losing ground socially as well.  

"Home Based Speech Therapy"

You don’t have to wait for a speech evaluation to get started on speech “therapy”.  Parents and childcare providers can enrich a child’s speech and communication at home by being aware of some of the techniques of speech therapists.  Here is a program that I wrote out for an almost three year old “Charlie” who was waiting for his formal evaluation appointment.  Charlie’s parents were aware that he needed extra help, and they wanted to get started.  All of these ideas are suitable for any child (many are adapted from publications of the American Speech, Language and Hearing Association

Speech and Language Program for Charlie

Charlie is on his way to the “next level” in speech, and we want to help him get there in every way we can. 

Right now, Charlie is able to listen and understand differences in meaning. For example, he understands the difference between "up and down," "in and out," and "big and little." He can follow requests or directions that have two parts to them (e.g., "Get the ball and throw it to me"). 

Charlie is expressing himself in words.  He’s learning new words every day and is beginning to use 2-3 word phrases to talk about things ("My truck") and ask questions ("Where' s mommy?"). His speech is understandable to family members most of the time.

Now that Charlie is almost three, his language will begin to expand even more. In the next year, expect that he will talk in sentences of four or more words. He'll talk about activities (e.g., what was done in preschool that day) easily and fluently, without repeating syllables or words. He’ll understand and answer simple who, what, and where questions. He’ll be able to join in conversation and play with other three and four year olds.

Here are the ways you can help Charlie get to that level--post this list and try one new idea every few days--you will be amazed at how much progress he can make and how much fun you will have helping him.

Use clear, simple speech that is easy to imitate. Show Charlie that you are interested in what he says to you by repeating what he has said and expanding on it. For example, if Charlie says, "pretty flower," you can respond by saying, "Yes, that is a pretty flower. The flower is bright red. It smells good too. Do you want to smell the flower?" 

Let Charlie know that attempts at communicating are important to you by asking him to repeat things that you do not completely understand. Give Charlie hints about how to help you understand. For example, "I know you want a block. Tell me again which block you want."

Expand on Charlie' s vocabulary. Introduce new vocabulary through reading books that have a simple sentence on each page. Continue to name objects and describe the picture on each page of the book. State synonyms for familiar words (e.g., mommy = woman = lady = grown up = adult), and use this new vocabulary in sentences to help Charlie learn it in context. 

Put objects into a bucket, and have Charlie remove one object at a time, saying its name. You repeat what Charlie says, and expand upon it. "That is a comb. Charlie combs his hair." Take the objects from the bucket and help Charlie group them into categories (e.g., clothes, food, drawing tools, etc.). 

Cut out pictures from old catalogs and make a scrapbook of familiar things. Help Charlie glue the pictures into the scrapbook. Practice naming the pictures, using gestures and speech to show how you use the items. 

Look at family photos and name the people. Use simple phrases/sentences to describe what is happening in the pictures (e.g., "Sam swims in the pool"). 

Ask Charlie questions that require a choice, rather than simply a "yes" or "no" answer. For example, rather than asking, "Do you want milk? Do you want water?", ask, "Would you like a glass of milk or water?" Be sure to wait for the answer, and reinforce successful communication. "Thank you for telling mommy what you want. Mommy will get you a glass of milk." 

Sing songs, tell rhymes, and play finger games ("Where is Thumbkin?"), and tell nursery rhymes ("Hickory Dickory Dock"). These songs and games introduce Charlie to the rhythm and sounds of language. 

Strengthen Charlie' s language comprehension skills by playing the yes-no game. "Are you a boy?" "Is that a zebra?" "Is your name Joey?".

Sort pictures and items into categories, and increase the challenge by asking Charlie to point out the item that does not belong in a category. For example, a baby does not belong with a dog, cat and mouse. Tell Charlie that you agree with his or her answer because a baby is not an animal.  

Expand on social communication and story-telling skills by "acting out" typical scenarios (e.g., cooking food, going to sleep, and going to the doctor) with a dollhouse and its props. Do the same type of role-playing activity when playing dress-up. As always, ask Charlie to repeat what he has said if you do not understand it completely. This shows that what he says is important to you.

READ, READ READ! Now you can read books that have a simple plot, and you can talk about the story line with Charlie. Help Charlie to retell the story or act it out with props and dress-up clothes. Tell him your favorite part of the story and ask for his favorite part.

Every one of these ideas will work for any child, because children are always wanting to learn and expand their skills.  So it doesn't make any difference if your child's speech and language is ahead or behind-- these strategies will help him get ahead.