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Should I Worry if My Very Active Toddler Is Not Talking? (15-24 month)

If your very active toddler is not talking, you can help your toddler start talking by encouraging imitation, setting up playdates, or using gestures. However, if your 18-month-old does not say at least 5 words or you are very concerned, discuss this with your child’s doctor and consider consulting a speech-language pathologist for evaluation.

It’s common for children to reach developmental milestones at their own pace, and some may not start talking until later. However, recent research indicates that early detection and treatment of children with language and speech disorders is associated with better outcomes. It is important that parents are familiar with the key milestones in the development of receptive and expressive language and speech.

A toddler being held by a woman points something out to her.

How many words should a 15 month old say?

A 15 month old not saying words is not a cause for concern as long as they can point to body parts and follow single command without gestures, and participate in conversations, according to the Stanford University School of Medicine guidelines.​1​

How many words should a 16 month old say?

An 16 month old not saying words is not a cause for concern as long as they can point to body parts and follow single command without gestures, and participate in conversations, according to the Stanford University School of Medicine guidelines.

How many words should a 17 month old say?

An 17 month old not saying words is not a cause for concern as long as they can point to body parts and follow single command without gestures, and participate in conversations, according to the Stanford University School of Medicine guidelines.

How many words should an 18 month old say?

An 18-month-old should say at least 5 words beyond mama and dada, and follow simple commands with gestures, according to the Stanford University School of Medicine guidelines.

How many words should a 19 month old say?

An 19-month-old should say between 5 and 50 words beyond mama and dada, and follow simple commands with gestures, according to the Stanford University School of Medicine guidelines.

How many words should an 20 month old say?

An 20-month-old should say between 5 and 50 words beyond mama and dada, and follow simple commands with gestures, according to the Stanford University School of Medicine guidelines.

How many words should an 21 month old say?

An 21-month-old should say between 5 and 50 words beyond mama and dada, and follow simple commands with gestures, according to the Stanford University School of Medicine guidelines.

How many words should an 22 month old say?

An 22-month-old should say between 5 and 50 words beyond mama and dada, and follow simple commands with gestures, according to the Stanford University School of Medicine guidelines.

How many words should an 23 month old say?

An 23-month-old should say between 5 and 50 words, 2-word combinations, or utterances, according to the Stanford University School of Medicine guidelines.

How many words should an 24 month old say?

An 24-month-old should say at least 50 words, 2-word combinations, or utterances at least 50% understood by unfamiliar adults, according to the Stanford University School of Medicine guidelines.

When should you worry if your 18 month old isn’t talking?

It is a cause for concern if your child shows the following red flags according to the Stanford University School of Medicine guidelines published in Pediatrics in Review, an American Academy of Pediatrics (AAP) publication.​1​

  • They cannot participate freely and frequently in social interactions at any age.
  • By 6 months, they cannot laugh, vocalize, respond to sounds, or participate in vocal interactions.
  • By 9 months, they cannot respond differentially to names or to produce babble, such as baba or dada.
  • By 12 months, they cannot point to objects or actions, use gestures such as shaking their head, participate in verbal routines like “wave bye-bye,” or use mama or dada specifically for a parent.
  • By 18 months, they cannot say at least 5 words beyond mama and dada or follow simple commands with gestures.
  • By 24 months, they cannot say at least 50 words, 2-word combinations, or utterances at least 50% understood by unfamiliar adults.
  • By 36 months, they cannot follow simple directions without gestures, say word combinations of more than 2 words, or say utterances at least 75% understood by unfamiliar adults.
  • When older than 36 months, they cannot talk.
speech milestones newborn to 5 year olds

What are the speech milestones?

Here are the key speech milestones in children from birth to 84 months.

AGEEXPRESSIVE SKILLSRECEPTIVE SKILLSSPEECH
NewbornCriesAttends to voice
Regards face
3 month– Differentiates cry
– Coos
– Coos reciprocally with an adult
Smiles when spoken to
6 month– BabblesTurns when their name is called
9 month– Points to objects or actions
– Says mama or dada
– Stops when told “no”
– Learns routines, such as “wave bye-bye”
12 month– Says mama or dada
– Babbles
– Says first words
Follows simple instructions with gestures
15-18 month– Acquires words slowly
– Uses simple words
– Participates in conversations
– Points to body parts
– Follows a command without gesture
18-24 month– Says at least 50 words
– Learns new vocabulary quickly
– Uses 2-word phrases
Understands sentences50% correctly use p, m, h, n, w, b
24-36 month– Uses phrases more than 2 words
– Uses complex grammar
– Follows 2 and 3-step commands
– Answers simple questions
50% correctly use k, g, d, t, ng, f, y
36-48 month– Combines 3–4 words in a sentence
– Uses conjunctions, such as and, or, but
– Understands plurals, pronouns, and possessives
– Understands questions
– 90% correctly use p, m, h, n, w, b
– 50% correctly use r, l, s, ch, sh, z
– Able to produce final consonants in
words such as bus
– No longer replaces sound made in the back of the mouth (g, k) with sounds made in the front of the mouth (d, t)
48-60 month– Uses mature grammar at near-adult levels
– Constructs narrative discourse, such as tells or retells stories, makes explanations
Understands concepts, such as
same/different
– 50% correctly use j, v, voiceless th
(thing)
– 90% correctly use k, g, d, t, ng, f, y
– Correct production of consonant
clusters, such as st in stop
– No longer deletes weak and unstressed syllables, such as in banana
60-84 month– Mature language constructions
– Increasing use of sophisticated vocabulary and complex gramma
– Limited by the child’s conceptual knowledge, not language skills
– Understands humor, metaphor
– 90% correctly use r, l, s, ch, sh, z, j, v, th
– No longer substitutes liquids (r, l) with glides (w, j)
– Can correctly use fricatives, such as
voiceless th

How can parents help if their 18-month-olds are not talking?

Here are 4 ways parents can help if their 18-month-olds are not talking.

  1. Keep talking: The more your child is exposed to the language, the more words they’ll likely pick up. Engage your child in conversations during daily activities to expose them to language and enhance their brain development. Use “baby talk,” which aids in language and vocabulary development. Communicate as if having a conversation with your child. Participate in “conversational duets,” which studies have found to significantly enhance speech development.
  2. Facilitate peer pretend play: Proven to aid language development in preschoolers. Arrange playdates with other families or enroll your child in a daycare that offers plenty of free time for kids to play.
  3. Encourage imitation of sounds: Research suggests children learn to speak by imitating others’ speech. Provide positive reinforcement through praise for their efforts.
  4. Use gestures: Encourage your child to use gestures, which are positive indicators for language recovery and cognitive change in children, providing building blocks for language construction.

At what age do late talkers talk?

By age 3, approximately half of late talkers exhibit age-appropriate expressive language skills, with the majority catching up to normal language development by age 5.

Studies have consistently shown that most late talkers reach language milestones within typical ranges during early childhood and school age, indicating a positive trajectory in language development despite initial delays.

Who are more likely to be late talkers?

Children with the following 11 factors are more likely to be late talkers.

  1. Family history: A family history of early language delay.
  2. Gender: Male.
  3. Birth characteristics: Born at less than 85% of optimal birth weight or before 37 weeks gestation.
  4. Socioeconomic status: Lower socioeconomic status.
  5. Singleton status: Part of the twins, triplets, quadruplets, etc.
  6. Maternal age: Older maternal age at birth.
  7. Birth weight: Moderately low birth weight.
  8. Parenting quality: Lower-quality parenting, such as less reading to the child, telling stories, toys, or books.
  9. Daycare attendance: Receiving less than 10 hours per week of child care.
  10. Attention problems: Have problems focusing.
  11. Additional associations: Preterm birth, younger siblings, hearing impairments, and other developmental delays.

Do late talkers catch up?

Yes, many late talkers catch up on their own, with approximately 70 to 80% reaching language skills on par with their peers by school age, though 20 to 30% may continue to face challenges with reading, writing, and language. However, if a child’s speech delay is related to neurological differences, intervention and treatment should be applied immediately to prevent further language difficulties.​2​

Is late talker autism?

No, although a speech delay can be a characteristic of autism spectrum disorder, it doesn’t necessarily indicate autism, though it may signal broader developmental issues. Expressive language delays, common in late talkers, can also be associated with intellectual disability, hearing loss, or other syndromes, not exclusively autism.​3​

While speech delays in autism are common, they occur alongside a range of issues with communication, social behaviors, play skills, and behavioral differences, making a comprehensive assessment essential for accurate diagnosis. It’s important to consider your child’s overall development, and if concerns persist, consult healthcare professionals for a thorough evaluation.

Are gifted kids late talkers?

Some gifted kids are late talkers, while others begin talking as early as 6 to 9 months. When late-talking gifted children start talking, their speech is often advanced, reflecting a broader cognitive development that includes exceptional memory, advanced vocabulary, and an early appreciation for nuances and abstract concepts.​4,5​

Does late talking run in families?

Yes, late talking can run in families, with a significant association between a family history of language delay or communication disorders and the likelihood of a child experiencing language delays. Studies indicate that having relatives with specific language impairment (SLI) or speech-reading disorders increases the risk of late talking.​6,7​

What famous people are late talkers?

Here are 8 famous people who were late talkers.

  • Albert Einstein: Despite his speech delay until age 3, Einstein is considered one of the greatest scientific minds in history, famous for developing the theory of relativity.
  • Srinivasa Ramanujan: An Indian mathematician whose substantial contributions to mathematical analysis, number theory, and continued fractions profoundly impacted various branches of mathematics.
  • Gary Becker: An American economist who received the Nobel Prize in Economic Sciences for contributing to human capital theory and economic analysis of discrimination.
  • G. Gordon Liddy: A former FBI agent and political operative who became known for his involvement in the Watergate scandal during the Nixon administration.
  • Richard Feynman: An American physicist who received the Nobel Prize in Physics in 1965, known for his contributions to quantum mechanics and quantum electrodynamics.
  • Edward Teller: A Hungarian-American theoretical physicist known as the “father of the hydrogen bomb” for his crucial role in developing the first thermonuclear weapon.
  • Arthur Rubinstein: A renowned Polish-American classical pianist regarded as one of the greatest pianists of the 20th century.
  • Clara Schumann: A German pianist and composer of the Romantic era. She was one of the most distinguished pianists of her time and a prominent figure in the European musical scene.

What is the Einstein syndrome?

Einstein Syndrome is a pattern where children experience a delayed onset in speech development but demonstrate strong analytic skills and memory abilities. This term, coined by economist Thomas Sowell in his 1997 book Late Talking Children, is not a medically recognized diagnosis. It describes late talkers, typically around 3 to 4 years old, with no other developmental delays, and often have advanced analytical and reasoning abilities.​8​

What is a speech delay?

A speech delay occurs when a child fails to acquire speech and language skills at the expected rate, with their development significantly lagging behind peers of the same age. Although the language skills these children acquire typically follow the normal progression, they do so at a slower pace.

What is considered a speech delay?

A child’s language or speech development falling below 75% of the expected rate for their age is considered a speech delay. Therefore, if a child at 18 months does not meet the speech or language milestones expected at 13.5 months (18×0.75 = 13.5), it is considered a speech delay.​1​

An accurate diagnosis of speech delay requires the expertise of a trained professional. If you have concerns about your child’s speech development, consult a specialist promptly.

What causes speech delay in toddlers?

Here are 9 causes of speech delay in toddlers that are commonly found. Note that speech delay can be caused by various factors unique to each child.​1​

  1. Maturation Delay: Delays in speech production maturation occur when the central neurologic process required for producing speech develops slower than expected. This is more common in boys and families with late bloomers and often resolves by school age. The majority of these children do not ultimately have language disorders.
  2. Hearing Loss: Impaired hearing, either congenital or temporary, impacts speech development and a child’s ability to speak and understand others. Auditory processing disorder can also cause some children to struggle with understanding speech in noisy environments.
  3. Intellectual Disability: Approximately 50% of speech delays are linked to intellectual disabilities in a research study. A general learning disability can significantly impair a child’s cognitive skills and adaptive functions, affecting speech development.
  4. Neurological Differences: Autism, ADHD, and cerebral palsy can contribute to speech difficulties, affecting language development due to impulse, attention, or coordination challenges.
  5. Receptive Aphasia: Difficulties comprehending spoken language can lead to speech delay.
  6. Expressive Aphasia: Brain dysfunction can hinder a child’s translation of ideas into speech and is a less common disorder causing late language emergence in children.
  7. Psychosocial Deprivation: Physical and social deprivation, such as poverty and neglect, adversely affect speech development during the sensitive period for language development in early childhood. Children living in abusive conditions tend to develop speech/language disorders and lack any verbal communication skills.
  8. Elective Mutism: Children selectively do not speak in specific environments due to anxiety. For example, a child speaks at home but not at school or only with familiar people.
  9. Bilingual Environment: Children in bilingual households can experience temporary language delays in hlearning both languages, but they will usually become proficient in both languages before they are 5.

Can too much TV cause speech delay?

Yes, research indicates a correlation between excessive TV exposure in early childhood, especially before age 2, and language development delays. Children exposed to more than 4 hours of screen time per day at age 1 showed significant delays in communication and problem-solving skills at ages 2 and 4. Watching television before 12 months and exceeding 2 hours of screen time daily was associated with a six-fold increase in language delays.​9,10​

Can parenting cause speech delay?

Yes, research has found that lower parenting quality can cause speech delay. The absence of parenting activities such as reading to the child, telling stories, and singing is associated with delayed speech. Other parenting-related causes include the lack of toys, books, safety, or supportiveness in the home environment.​1​

Will speech therapy help an 18-month-old who’s not talking?

Yes, according to studies, speech therapy will help an 18-month-old who’s not talking, especially when initiated early. Consult with your child’s pediatrician and a language therapist to determine the most appropriate type of therapy based on the specific cause of the speech delay. Once identified, seek a speech therapist specializing in that area for intervention.

What are the statistics on speech and language delay?


Here are 5 key statistics on speech and language delay.​11​

  • The global prevalence of speech-language delay in developed countries ranges from 2% to 8%.
  • One study identified a prevalence of 2.53% among children attending a pediatric outpatient department.
  • Speech delays affect 3% to 10% of preschool children, making them a common developmental concern.
  • Speech and language delays are 1-4 times more common in boys than girls.
  • 40% to 75% of children with language disorders display challenging behaviors stemming from frustration due to difficulty expressing their needs or desires.

What are the risk factors for speech and language delay?

Here are 3 risk factors for speech and language delay.

  • Low maternal education
  • Male gender
  • A family history of developmental communication disorders

Children with all three risk factors face a 7.7 times higher risk of language delays than children without.

What is the difference between speech and language delay?

The main difference between speech and language delay is that speech delay involves challenges in articulating sounds and words, while language delay involves a broader range of communication skills, including vocabulary, grammar, and understanding language rules. A speech delay is a condition in which a child has difficulty producing speech, while a language delay occurs when a child has difficulty understanding or expressing language.

What is the difference between speech and language?

The main difference between speech and language is that speech is the motor act of articulating verbal expressions, while language encompasses the use of symbols for communication in spoken, written, or visual forms (e.g., sign language), including both understanding (receptive language) and expression (expressive language).

Speech is a subset of language, emphasizing the physical act of speaking, while language encompasses various aspects of communication.

References

  1. 1.
    Feldman HM. How Young Children Learn Language and Speech. Pediatrics In Review. Published online August 1, 2019:398-411. doi:10.1542/pir.2017-0325
  2. 2.
    Roos EM, Weismer SE. Language Outcomes of Late Talking Toddlers at Preschool and Beyond. Perspect Lang Learn Educ. Published online October 2008:119-126. doi:10.1044/lle15.3.119
  3. 3.
    Hawa VV, Spanoudis G. Toddlers with delayed expressive language: An overview of the characteristics, risk factors and language outcomes. Research in Developmental Disabilities. Published online February 2014:400-407. doi:10.1016/j.ridd.2013.10.027
  4. 4.
    Hammer CS, Morgan P, Farkas G, Hillemeier M, Bitetti D, Maczuga S. Late Talkers: A Population-Based Study of Risk Factors and School Readiness Consequences. J Speech Lang Hear Res. Published online March 2017:607-626. doi:10.1044/2016_jslhr-l-15-0417
  5. 5.
    Renati R, Bonfiglio NS, Dilda M, Mascia ML, Penna MP. Gifted Children through the Eyes of Their Parents:Talents, Social-Emotional Challenges, and Educational Strategies from Preschool through Middle School. Children. Published online December 25, 2022:42. doi:10.3390/children10010042
  6. 6.
    Bishop DV, Holt G, Line E, McDonald D, McDonald S, Watt H. Parental phonological memory contributes to prediction of outcome of late talkers from 20 months to 4 years: a longitudinal study of precursors of specific language impairment. J Neurodevelop Disord. Published online February 8, 2012. doi:10.1186/1866-1955-4-3
  7. 7.
    Kanhere S, Sunderajan T. Speech and language delay in children: Prevalence and risk factors. J Family Med Prim Care. Published online 2019:1642. doi:10.4103/jfmpc.jfmpc_162_19
  8. 8.
    Treffert DA. Savant Syndrome: Realities, Myths and Misconceptions. J Autism Dev Disord. Published online August 6, 2013:564-571. doi:10.1007/s10803-013-1906-8
  9. 9.
    Takahashi I, Obara T, Ishikuro M, et al. Screen Time at Age 1 Year and Communication and Problem-Solving Developmental Delay at 2 and 4 Years. JAMA Pediatr. Published online October 1, 2023:1039. doi:10.1001/jamapediatrics.2023.3057
  10. 10.
    Chonchaiya W, Pruksananonda C. Television viewing associates with delayed language development. Acta Paediatrica. Published online June 2, 2008:977-982. doi:10.1111/j.1651-2227.2008.00831.x
  11. 11.
    Sunderajan T, Kanhere S. Speech and language delay in children: Prevalence and risk factors. J Family Med Prim Care. 2019;8(5):1642-1646. doi:10.4103/jfmpc.jfmpc_162_19

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