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Delayed speech in three year old is a problem

Marilyn Heins, MD, is a pediatrician, parenting educator, writer, mother, step-mother and grandmother. She has written close to 600 parenting columns for the Arizona Daily Star, and her second parenting book, ParenTips, was published in ...

what they say & how they say it

How many words should a three-year-old have -- and when can you tell if he or she actually has delayed speech? A pediatrician offers some ideas here, and explains about a few things you can do to help your toddler or preschooler.

speech delay

The question:

My grandson, who turned 3 last March, is a happy, healthy, active child who appears on target for a three-year-old except he is behind in verbal skills. He "jabbers" a lot but other than a very few words his speech is not understandable. When I say a word and ask him to repeat it, he does, but it does not sound like what I have spoken. He seems to try very hard to speak clearly. Does he have a problem? - Concerned Grandmother

The physician answers:

Yes, there is a problem. The critical question to ask is: Will this problem go away by itself as he develops, or does he need intervention? Here are some things to consider:

What is normal speech for a 3 year old?

By three years of age, a child should have a vocabulary of 600 words with 80 percent intelligibility to a listener who does not know the child. This means that a person who has not previously listened to this child talk can understand 8 out of 10 words. (Parents can often understand what a child is communicating better than anyone else, in spite of any speech delay.)

  quotation mark openBy three years of age, a child should have a vocabulary of 600 words with 80 percent intelligibility to a listener who does not know the child. quotation mark close

When should a three-year-old be referred for speech evaluation? Evaluation is indicated if he or she has a vocabulary of 200 words or less, is not using short sentences, and has less than 50 percent intelligibility. This three-year-old has both limitation in vocabulary and few intelligible words, which means he should be evaluated.

Trust your instincts, Mama!

You are right in being concerned. In my practice I found that, for the most part, parents and other family members familiar with the child are pretty good developmental diagnosticians. When the family is worried about an aspect of development in a child, the pediatrician should pay attention to their concerns.

But sometimes the family is not aware of a speech delay or its potential significance. Pediatricians sometimes don't ask the right questions. For example, instead of "How many words does he have?" it's better to ask "How does he let you know what he wants?" (A 3-year-old should be using sentences) and "Can strangers understand most of what he says?" (By age 3, this answer should be yes.)

Does your child have a delay?

Developmental Language Disorder (DLD) is the term we use for selective impairment of speech and language development in children without other manifestations of developmental delay. These children generally have normal intelligence, and their hearing and social-emotional development are also normal. (Children with a speech delay due to something like an Autistic Spectrum Disorder would not be classified as DLD.)

Estimates of Developmental Language Disorders' incidence range from about 5 to 10% of preschool children, and boys are much more likely to be affected than girls are. Although DLD is associated with a variety of possible underlying factors, in most cases the etiology is unknown -- although there is a often a family history for speech delay so that genetic factors may be playing a role.

What happens next?

Children with a suspected Developmental Language Disorder should be thoroughly evaluated immediately. Such a child needs a complete physical and neurological examination as well as a psychological evaluation to determine the child's intelligence level. Hearing should also be carefully tested as the child could have a selective hearing loss which might not be noticed by the family.

If and when the diagnosis of DLD is made, the child should be referred for immediate speech and language therapy. He will do best in a preschool that is experienced in teaching children with speech problems.

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