When your child is slower to talk than your friends’ kids, it’s natural to worry: What’s wrong, and how can you fix it?
More often than not, late talking is just a temporary stage, not a sign of a problem. But increasingly, late talkers are being wrongly labeled as having autism.
“Almost all kids with autism are late talkers—but not all late talkers have autism,” says Stephen Camarata, professor of hearing and speech science at Vanderbilt School of Medicine and author of Late Talking Children: A Symptom or a Stage?
Too many late talkers are winding up in “the wrong clinical bin” as a result of the push for early screenings and early interventions, he told me.
Rather than being on the spectrum, many of them simply have a different learning style.
What’s most helpful to you and your late-talker:
First, don’t panic: Late talking has MANY explanations.
That first cherished mama, dada, or other first word typically shows up around 12 months. But (big, important BUT) there’s wide variation in when kids start to talk. First words before the first birthday, or after the second, aren’t uncommon.
About one in every 9 or 10 kids starts talking late. “More than half the time, nothing is wrong and late talking is just a stage,” Camarata told me. If you follow a group of 2- and 3-year olds who have language delays, as many as 60 percent will be speaking just fine a year or two later. (In addition to his 30 years of clinical experience, he knows firsthand the angst involved: He was told that his late-talking 3-year-old, one of his seven children, was “mentally retarded,” the label used then, and bound for a life of special-ed. Instead, he finished college, on scholarship.)
For just under half of late talkers, something is going on, and it’s important to figure out what. Among the possibilities:
An expressive language disorder, meaning some kind of trouble learning to speak (the most common reason)
An intellectual disability
Autism (fewer than one in five cases of late talking, says Camarata, and one in 50 of all children)
A physical problem, such as a hearing problem or a neurological disorder (like epilepsy)
A speech disorder, meaning an inability to pronounce words so as to be understood
If your child still isn’t saying words at 18 months, be sure to bring it up with his or her doctor. Don’t just assume your child will simply grow out of it. A physical exam and a hearing test to rule out problems is always the best first step, Camarata says. Then a speech pathologist can check for language disorders.
Worth mentioning here: Don’t let your mother-in-law, neighbor, or anybody else tell you that this is a problem linked to poor parenting, vaccines, a nutrient deficiency, or environmental toxins. None are true, says Camarata.
Pay attention to more than your child’s language.
Besides language, other behaviors can provide important clues to what’s wrong (or not). For example, can your child understand what’s said to him? Follow some simple directions? Do pretend play? Communicate with gestures? Make sounds? Kids with these “receptive language skills” tend to be smart and do talk eventually—just not on time with their peers.
All kids learn at different paces. Some are more verbal and social. About 15 percent learn in a more visual-spatial-analytical way. And these kids—much more often boys—tend to also be late talkers.
They often share other traits too:
Good at puzzles
Little “escape artists” (good at getting out of cribs, rooms)
Curious about how things are put together
Like hands-on learning
Clever problem solvers
Slow to potty-train (ages 3 or 4, rather than 2 or 3)
Many of these kids later prove extra-proficient at math and science; some become early readers. (Camarata’s own son, in third grade, was doing fourth- and fifth-grade math but first-grade reading.)
At the extreme end of the spectrum of this learning style is what’s been dubbed “the Einstein syndrome.” The name comes from the famed physicist, who didn’t speak ’til age 3 and still wasn’t fluent at 9 but proved no slouch in the smarts department. There seems to be a trade-off in the brains of these precocious kids: less verbal focus but amazing reasoning and analytical abilities. Other famous “Einsteins” include Nobel winners Richard Feynman and Gary Becker, pianists Arthur Rubenstein and Clara Schumann, Virginia Woolf, and Winston Churchill.
Beware of “Silicon Valley syndrome.”
“Most kids with this more visual-spatial-analytical learning style aren’t necessarily geniuses; they’re in the middle,” Camarata told me. “But because they’re late talkers, some people may assume there’s something wrong with their thinking ability.”
A new wrinkle he’s been seeing is what might be called “Silicon Valley syndrome.” Many late talkers’ parents are engineers, computer scientists, accountants, and others in similar analytical professions. (In one of his studies, more than half the dads of late talkers had analytical occupations, compared to less than 13 percent of the total labor force.) Music and medicine are over-represented too.
Living in affluent areas, these families tend to be quick to access help (a good thing). But they get caught up in the rush to diagnosis and steered to early intervention programs for problems like ASD—which aren’t good for kids who don’t really have autism, which is itself often an unreliable diagnosis in toddlerhood.
A 2007 University of North Carolina study found that almost one in three kids who had been diagnosed with autism at age 2 did not fit that diagnosis at age 4.
“My big fear is that we’re making that whole learning style—kids with a visual-spatial-analytical learning style—into something kids need to be treated or medicated for, that’s not really clinical,” Camarata says. He’s seen a “huge change” toward this over the three decades he’s been practicing.
“Early intervention is good if it’s for the right problem.” he adds. “But if not, it can deflect or derail the natural development for that child. It’s not easy—we don’t have good answers.”
If you’re given a diagnosis, ask HOW it was made.
Given how often late talking is misidentified as something else—and the perils of treating the wrong thing—it’s really important to understand the process used to diagnose your kid.
Too often, Camarata says, clinicians make a confirmatory diagnosis. It goes like this: Not talking at 2 is a flag for autism. What are other signs of autism? Tantrums, ignoring parents, being shy of strangers, a toe walk. Check, check, check. The problem is that these things are common in all toddlers. They don’t necessarily confirm being on the spectrum. A differential diagnosis, teasing out the cause from other possible causes, is more time consuming but critical.
In the past, autism wasn’t identified until kindergarten, by which point tantrums and anti-social behaviors would stand out as being developmentally unusual. But since the American Academy of Pediatrics began recommending autism screenings for all toddlers at 2, more false-positives are turning up, Camarata says.
Ask if the label would apply if the child were not a late talker.
Ask what other explanations have been ruled out. Beware that late talking also tends to get mis-labeled apraxia (a very rare condition) and hyperlexia (basically, early reading).
Encourage experts to use plain English. When you hear terms like “pervasive developmental disorder” or “social deficits,” say: “Are you saying my child has intellectual disabilities?” “Are you saying my child has autism?”
Don’t let yourself be talked into (or bullied into) an explanation or a treatment plan. Keep asking questions.
Get a second or third opinion—from practitioners who don’t work together. Experts who can help include developmental-behavioral pediatricians, neurologists, child psychologists, and speech-language pathologists.
Ask the practitioner what percent of kids that he or she sees are diagnosed with autism or apraxia. If it’s almost all of them, be sure to get another opinion.
Be sure you’re getting the right early intervention.
Clearly, identifying autism or other disorders early is useful. But a big problem with a wrong diagnosis of late talking is that it sets your child down the wrong path for treatment.
New findings on early brain development seem to show that the brains of some late talkers, who are otherwise normal, may just be organized differently. Forcing them to talk before their brains are ready—or just as bad, treating problems that don’t have anything to do with their actual needs—can set them back.
If the cause for late talking isn’t certain at age 2 or 2 and a half, treatment should focus on teaching the child how to talk, Camarata says. (If it’s really autism, other features will become more apparent with time.) He recommends avoiding oral muscle exercises (like stimulating the tongue with an electric toothbrush), rubbing brushes on the arm, chelation therapy, blowing bubbles, wearing headphones, brain-training computer games, special diets, or other treatments that are either disproven or irrelevant to talking. And parents should always be invited to be part of any treatment, never excluded.
Remember also that half of late talkers will start talking on their own. Ever hear of kids who “outgrew” or “aged out of” autism? Camarata told me he wonders whether these were kids who were misdiagnosed in the first place. “You can improve autism, but the core features stay there,” he notes.
Trust your gut
What if you’re told it’s autism but you don’t believe it? What if you’re told it’s nothing but have a lingering sense that something isn’t right? Keep asking a lot of questions, advises Camarata.
Especially with autism, you want to be sure the clinician is using the latest diagnostic language, which was revised in 2013. Asperger’s syndrome, processing disorder, and sensory integration deficit are no longer widely accepted, he says.
Sometimes it simply takes time to figure out if late talking is a symptom of a problem or just a stage. As your child grows older, a diagnosis will become clearer.
If your late talker is among the majority who eventually wind up speaking normally—and on some days, never stop talking—you may marvel that you ever worried so. It’s always right to be concerned and to seek the right explanation, Camarata says. Just don’t let your understandable concerns rob you of the present moments with your child. Late talking may be a phase, or not, but your child is only a toddler and a preschooler once.