Delayed speech in three year old is a problem

Jul 06, 2008 2:15 PM by Marilyn Heins, MD

Posted in Parenting / Age by Age / Preschoolers

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.)

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. 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.

Comments

Comments on "Delayed speech in three year old is a problem"

Also, it is important to remember that all things are relative to the child. My son has a vast vocabulary. When using an iPad app for articulation, he can correctly identify hundreds of pictures on "flashcards," and his articulation has improved greatly in just the past six months to the point where there are only a few sounds that give him any trouble at all. However, his expressive speech is at the "low end of normal" compared with his knowledge of vocabulary words, which is at the higher end of normal. Consequently, the gap we see between what we know he knows and what he can express is great, as are his temper tantrums when he can't get out his thoughts or feelings. He says plenty of sentences ranging from, "I want to go on the fire truck" to "Mom, can I have a powdered donut?" However, he cannot converse on the level of responding to open-ended questions like, "What did you do at school?" or "What should we name this new teddy bear?" He usually will just stare blankly and not answer the question, or he may say semi-related things like "I go to school" or "It's my teddy bear." Nor does he ever ask you a question like, "Where are we going?" or "What did you do today, Daddy?" Again, compared to some 36-month-olds, he is probably totally normal, but compared to his vocabulary, which is certainly in the hundreds of words, if not over 1000 words, his expression is behind. Therefore, we have him starting speech therapy to work on his expression and to bring it up to the level of his understanding and vocabulary. The therapist verified that I'm not crazy and that he is below the mean on expressing thoughts, and I'm glad that we're intervening early.

my son who is now 31/2 and when he was born we new he could not hear properly after many trips to doctors and hospital he had gromits after alot of ear infections we was told the gromits would help his speech improve they have a little a few months ago he had a hearing test which came bk as mild hearing loss and hes had another one and they passed him as he was doing all things before bhe said noise weve been told to learn makaton to help him but we feel like we banging our head against a brickwall he gets very frustrated getting himself over he got another hearing test nxt week but were do we go from here please help

is always a good idea and you could catleinry tell him a little story in return for the sweet one he just told you.One thing to remember is that there really is something to motherese. Motherese is that syrupy sweet way all of us (not just moms) talk to little ones we love. The sing songy and high pitched intonation of it and the way it's delivered, with smiles and affection, are all important to establishing strong connections in those language centers of the brain. So don't be afraid to baby talk. You can skip the sheepy for sleepy or the wawa for water but the aren't you just daddy's cutest little, sweetest little, boy in the whole world s are keepers.Kim recently posted..

my grandson seems to have his own vocabulary.he struggles to communicate with us.

My son is going to be 3 years in march. I expect that by now he should b constructing and speaking clearly relatively long sentences but he speaks just phrases. Do you think he has any impairment? Is there any thing he can take to correct this? Pls I will appreciate suggestions.

My daughter was born at eight months and since then her development has been slow but sure.She recently walked at three years and is now as fast as one can imagine. But speech is a little down.At 3years nine months, she gestures very well and utters noises to express herself. She likes going outside to play and really becomes agitated.We have seen a speech therapy and are currently taking therapy lessons. But what about speech-nutrients?

I am concern about my Grandson who was three in June. He started talking earlier about sixteen months and was make small statements like. "I know", "Oh No", and "You stop!" with the emotion tones. However, now he does not talk as much and I know he can because he made a statement about a month ago saying "I told you I be back in a minute,". He repeated this comment more than once. This let me to believe that he is capable of full sentences, however, he has just stop talking clearly most of the time he just won't say anything. We are training him to say when he has to go to the bathroom but he will not talk, he will sometime just take off his lower garments and you have to take him by the hand to the bathroom. Should his parents have him evaluated for DLD or is there something else causing his delay in speech?

My 3 year old grandson can communicate ok, but he seems to have lazy speech and doesn't pronounce his words correctly. He will make up words such as his favorite movie is Toy Story and he will call Woody Hidie.Is this normal?Will his speech improve?Is there a possibility he has a hearing problem?

I think my granddaughter my have this problem. I don't no were to take her. I live in Staten Island New York

What a load of rubbish! I hate these people who say your child should be doing this by then and this by that age. My son is coming up 3 he knows a lot of words and is picking up words everyday. He dosent use sentences yet but he will. Ive been told he slightly behind where he should be yet he was walking at 6 months he can count to 15! and can put a 10 piece puzzle together. He struggles with his knife and fork and cant quite grasp potty training. My point is every kid is different and should be treated as such dont follow these stupid guidlines that the so called experts tell us to because your child will be ahead on some and get no credit and behind on some when there then told there is something wrong. Trust your instinct if you child is piking something up thats all that matters it will take aslong as it takes just make sure you give them as much help as possible.

You have the right to be concerned for your child. Your Dr. should have referred you to an speech therapist or to your local elementary school for evaluation. They will test him and if he qualifies, they will refer him to a school in your district for help with his speech developement

my son is three and i noticed him not using more that two words at two years old. he don't conversate, he don't use sentences. for example, when kids play together they sometimes don't want a child playing with their favorite toy, they would say'"he got my car or be a tattle tale. my son don't commmunicate that way.

Thanks Dana, I will try that box and hope for the same result!

There was a lot of very good, specific information in this article, but I was surprised to see a very important piece of information left out at the end. A child with suspected speech-language difficulty should be evaluated by a speech-language pathologist (SLP). You can find an SLP by asking your pediatrician for referrals, contacting your state's speech-language-hearing association, or by contacting the national association, the American Speech-Language-Hearing Association, ASHA. You could contact a local Children's Hospital if you live near one or call your local elementary school or school district and ask for the Early Invention/Child Find contact information. There are federal funds to provide service to children younger than 3 years in county administered Early Intervention programs. If you are going the "private" route--clinic or hospital--check to see if your health insurance will cover the evaluation and whether you need an actual referral from your child's physician.

My son has verbal apraxia. I am constantly on the web doing research on the condition and trying to find new treatment methods that will help him. I came across a new product that is formulated by a pediatrician that has a child with Apraxia. The company is offering a free box to any family that would like to try it and see if their child responds. I thought those of you that are reading this blog might be interested. More info and the offer is available at speechnutrients. My son has been taking it for 3 months now, and there has been a great improvement in his speech as well as his gross motor skills. Even his SLP has noticed the improvement! Good luck to everyone! D

I have some concerns about my child's speaking ability. I appreciate the information in the article, but I am not sure WHERE to take him to have him evaluated. Is this something his pediatrician should handle, or make a referral for? I expressed the concern to her during his annual physical after he turned three and she said she doesn't think there is a problem. I would like a second opinion but I am not quite sure where to begin. Any suggestions?