Edition: U.S. / Global

PERSONAL HEALTH; Advice for Perplexed Parents of Late Talkers

Published: June 8, 2004





What's Normal?

My twin grandsons had just turned 2 when their parents decided to take a vacation without them. The boys, who were told that Mommy and Daddy were going to the beach, looked at their parents' wedding photograph each day they were gone and said, ''Mommy, Daddy, bitch.'' We laughed at the mispronunciation, but it was clear that the boys got the message and could voice their understanding.

Now, from reading ''The Late Talker: What to Do if Your Child Isn't Talking Yet'' by Dr. Marilyn C. Agin, Lisa F. Geng and Malcolm J. Nicholl, it is also clear that the boys were well within normal range in their language development. Typically by age 2, children use a variety of two-word combinations (more cookie, mommy work), know at least 50 words and mostly use words to communicate.

Now that the boys are 4, I was reassured by the book that their difficulties pronouncing ''l'' and ''th'' and their frequent failure to string two consonants together (''geen'' for ''green'') is also within the range of normal.

As ''The Late Talker'' points out, it is not unusual for a child of 4 or 5 to mispronounce l, s, r, v, z, j, ch, sh and th. A 5- or 6-year-old who says ''tiziz'' for ''scissors'' does not have a speech or language disorder.

The authors note: ''All children misarticulate sounds in the course of normal speech development. They may use sound substitutions, like 'wady' for 'lady.' They may omit sounds, saying 'baw' instead of 'ball.' Or they may distort a sound, so that 'spaghetti' comes out as 'psketti.'''

The book continues, ''Concern arises when these errors continue beyond the time when a child normally outgrows them'' -- usually by 7 or 8.

But the authors caution that some parents of children with what they think are speech delays go overboard in trying to speed development. They write, ''Excessive parental concern can also impede the child's language development, and counseling may be needed for the parents.''

Real Problems


Studies have shown that without any intervention, half of children with delays in the ability to express language at age 2 catch up to their peers by 3, and that another 25 percent have normal speech when they start school. But ''this leaves 25 percent of late-talking children who do not grow out of their problem before starting school,'' the authors of ''The Late Talker'' note.


Speech and language difficulties can have many causes, including an undetected hearing impairment, poor oral muscle tone or coordination or a neurological disorder like Asperger's syndrome, a mild form of autism, or apraxia, a breakdown in the transmission of messages from the brain to the muscles in the jaw, cheeks, lips, tongue and palate.

The parents of a bright man I know who said nothing, not even ''Mommy'' or ''Daddy,'' before age 3, were told by child development specialists in 1970 that their son was perfectly normal. Once he started talking, he spoke in full, complex sentences. But years later he received a diagnosis of Asperger's syndrome, which severely impairs his ability to relate to others.

The son of Mrs. Geng, an author of ''The Late Talker,'' also had delayed speech and other problems that turned out to be related. He could not blow out the candles on his second birthday cake because he was unable to purse his lips. Nor could he smile. Except for ''ma,'' he said nothing but ''mmm'' to indicate anything he wanted. Eventually, doctors told her that the boy had apraxia.

Too often, when parents express concern to the pediatrician or preschool teacher about what they believe are a child's speech and language problems, they are told to ''wait and see.'' That can result in the loss of precious time, during which the child might be receiving therapy.

Mrs. Geng is glad she did not wait until age 3, as suggested by the pediatrician, to have her son's speech and hearing evaluated and therapy begun. Preschoolers who cannot communicate effectively may have difficulty playing with other children and may become frustrated when they are unable to make their needs known.


The authors of ''The Late Talker'' point out that ''speech and language disorders are the No.1 developmental impairment in children under the age of 5.'' They offer age-appropriate guidelines to help parents detect early warning signs of serious communication gaps and urge parents to act if they find reason for concern.


If 'Spaghetti' Is 'Psketti,' Should You Worry?

The authors of ''The Late Talker'' list behavior that can be early warning signs of possible serious communication problems:

Toddlers who have little sound play as infants, who produce a limited number of consonants and make vowel errors.

Toddlers who do not try to imitate word combinations when prompted or fail to use gestures to complement their communicative efforts.

Children who do not show a vocabulary spurt by 30 months.

Children who at 33 months use a limited number of all-purpose verbs -- want, go, get, do, make -- as in ''Me make water down.''

Three-year-olds who often omit consonants at the beginning and end of words, or who substitute consonants most often found at the end of words for front ones, as in ''gun'' for ''done.''

Four-year-olds with weak grammar, as in ''Her goed home.''

Children who are unable to repeat nonsense words of two or more syllables. Jane E. Brody

Drawing (Drawing by Sara Schwartz)