Wednesday 15 April 2015

Another 2 year old not talking

This morning,  I went to the home of Fred, a lovely two year old who isn't talking. He did say some words but now doesn't. Understandably his parents are worried. When I first qualified, parents would have been a little concerned BUT there was no internet so they couldn't google their problem. (Let's face it we all do and  we could all convince ourselves that we have a terminal disease if we check our symptoms in this way!)

The same happens for parents: there's so much on the internet about Autism that parents are drawn to this as the only reason a child might not talk. However, there are several reasons why a 2 year old isn't talking, not just because they have ASD. They might just have a delay in the area of speech, language and communication (there might be a family history), it might reflect overall ability, they might not need to talk as everything is done for them or a combination of some of the above. We have had an influx of referrals for younger children who aren't developing language as they should be. We like to have referrals as young as possible so we can put plans into place to help. Early intervention is vital.

We're interested in:

  • Interaction skills, do they want to interact?
  • What is their eye contact and non-verbal ability like?
  • What is their attention and listening like?
  • What is the level of the child's play? This gives us a good idea of overall developmental levels
  • Do they understand what is said to them? We need to see if they understand word and phrases. There is a difference between situational understanding so of you have your car keys in your hand and you say 'Shall we go in the car?', they don't need to understand the words to be able to work out what's going on?
  • What are they communicating without words? 
  • How do they get their message across?
In Fred's case, his interaction and non-verbal ability is really good. His verbal understanding is age-appropriate. Play is developing well. He gets everything without needing to talk but is sensing the pressure to talk. There is also a family member who had language difficulties as a child. His functional communication is great!

We decided to do the following for 1 month:

1. To take the pressure off making him say things, so don't ask to repeat or ask too many questions in a story (handy rule 1 question to 4 comments). He is a very strong personality and knows whether the adult knows the answer so is unlikely to 'play the game'

2. Step up the opportunity for him to as make as many choices (non-verbal at the moment) see

3. Encourage non-speech noises e.g. animals, vehicles etc  

4. Keep adding language to his grunts/noises adding what you think he'd be saying if he could talk, children learn by echoing to start with so need a model to echo

5. Use repetitive rhymes to hesitate on words to give him chance to add the approximation of the word (don't care how he says it just that he has an opportunity).Work out which songs and words so  both parents do the same.  

6. Make a word book of Fred's things and people using photographs

I'm going into nursery to discuss Fred's communication skills with them and to see what help they might need. We'll review him at home in 4 weeks and I'll keep you posted on how he gets on!