Is it just a speech and language delay?

Toddlers often speak their first word around the age of one and experience a burst of language and new words by 18 months of age, pointing out things of interest in their immediate environment and naming them. It is typical for very young children to learn new words each week while also retaining the ones they have already acquired.  They begin to try and copy the words and sounds they hear others saying, after having already mastered imitating others’ actions, which typically comes first in the natural development of communication. Babies naturally copy others’ movements such as simple gestures or actions before they try and copy words or sounds. By 16 months of age children should have 16 different non-verbal gestures they use to communicate, such as waving, pointing, shrugging their shoulders as if to say “I don’t know”, or bringing their finger to their lips to say “shhhhh”.  By the age of two years, children have acquired a minimum of 50 spoken words, with many youngsters having well over 150. Current research supports the idea that being exposed to dual languages within the home, such as hearing both English and Spanish, does not often impact the ability to acquire spoken language and most young children will pick up both languages without difficulty. Being isolated due to the COVID-19 pandemic is also not a cause for young children to present with a delay in their communication.  Infants and toddlers are naturally meant to be home with their caregivers and natural patterns of communication will still form within the brain in these environments.

But what happens when a child is not saying words?  Or when they have lost the few words they had been previously saying? Any difficulties in attempting to say words or any regression in communication skills needs to be addressed by a professional. By not waiting, interventions can begin as soon as 12 months of age for the child and are often critical steps to take in assessing why the child is having difficulties with communication. If it is simply a ‘delay’ in speech and language, a toddler will often rely on their other means of non-verbal communication in an attempt to engage in reciprocal interactions with others. They will gesture, point, tap you to get your attention, sustain their eye gaze with you, and use every non-verbal communication means possible to try and tell you something. The logistics of communication are broken down into two main components: expressive language and receptive language.  Expressive language is what a child can say, or what they vocally produce. Receptive language is how they understand and respond to what others are saying. A child may be delayed in one or both of these areas.  When there is a delay in both expressive and receptive language, it can be an indication that there is something more going on than just a speech and language delay and a comprehensive evaluation is warranted.  Any child with less than 50 spontaneously spoken words by 24 months of age should undergo evaluation by a professional. Also of note, the child’s words should be used in a purposeful manner and across a variety of pragmatic contexts, such as calling out to someone, using words to request a drink or a snack, or labelling familiar items in their environment.  After 50 words are being consistently used, children will often begin putting two words together such as “Mama go”. A narrowed repetoire in the use of words, such as saying only letters or numbers or being able to sing songs but not ask for help is also of concern and may suggest that Autism Spectrum Disorder is playing a role in impeding the child’s functional language.

Above all, if your child is having difficulties acquiring language and using it in a functional manner, request an evaluation right away.  Ascertaining the reason for the communication delay it critical, as it drives the next steps for intervention and support. Speak to your pediatrician right away and request a formal assessment if your child is not speaking by 18 months of age and/or if he/she is not using gestures to try and communicate.  It is very important to know if it is just a speech and language delay or if something else may be going on, so that your child can then receive the correct support and intervention.

How much screentime should my child be getting?

This is a very difficult but increasingly researched topic in today’s world as we rely on electronics and technology far more than ever before.  But how is it affecting toddler brain development? And how much time should a child under the age of six spend looking at electronic devices? A landmark study in 2010 found that screen time for children 6 months of age is associated with poorer cognitive development. Other studies have supported this finding, stating that early screen time can increase the risk of cognitive and language delays by the age of two. The more time a child spends looking at screens, whether it be a television, ipad, phone, or other tablet (many of which are now manufactured especially for young children) the less time their brain spends gathering knowledge and information from experiences within the real world. And since children learn best through play, the brain is more developed and better able to learn and acquire knowledge when early exposures are multi-sensory. This means that young children learn best by touching, feeling, smelling, seeing, and exploring items that are 3-dimensional. It is very different to interact with wooden puzzle pieces than it is to slide objects into place on an electronic screen. The child with actual pieces that they can hold in their hands is learning about the texture, weight, size, and feel of objects while the child doing a puzzle on a “screen” does not obtain these benefits. The first child gains experiences with gravity and uses all of their senses while the completing the puzzle while the second child misses out of these aspects of learning. A young child’s primary occupation is PLAY and this play should be multi-faceted, with a variety of objects that are absent of batteries or flashing lights or screens.  The stores and media would prefer that you think otherwise as they heavily market the latest electronic devices to teach your children a wealth of knowledge.  But the young toddler brain acquires more concrete and solid foundational skills when three-dimensional toys are explored. Some research is also pointing to screen time as a reason for a child’s delay in their speech and language development.  We are seeing more and more children with both attention deficit disorder as well as a need for eye glasses by the age of entering school, and studies are beginning to directly attribute some of this increase this to screen time. The American Academy of Pediatrics recommends that young children be exposed to no more than one hour per day of screen time, including having a television on in the background. Children are less likely to vocalize or use their imaginations when an electronic device is providing entertainment for them. Many children cannot tolerate a short ride in the car without an electronic device to entertain them and as they head into the teen years, studies are showing that these same children are more moody, irritable, and depressed than other children when immersed in electronic devices for long periods of time. There are currently studies out of Denmark that are relating autism-like symptoms and poorer social skills in young children who are exposed to too much screen time, a phenomenon that has been identified as ‘virtual autism’. There are also studies around the world looking at the effects of the ‘blue light’ from screens and how it is adversely affecting young brains. In summary, young children’s exposure to screen time should be kept to a bare minimum. By restricting access to electronic devices from a very early age, children will learn to interact with their world in a more emotionally intelligent manner and their young brains will be better prepared for learning by the time they reach the age of entering formal school.