@andylondon Our trilingual toddler (35 months) has an expressive speech delay (about 1 year behind the milestones) and his pediatrician is exactly the same.
We oxcillated between worry (18 mo), the "let's wait it out" strategy (24-30 mo) and then back to "nobody's listening, but we need to do something". In my experience, the world isn't ready to accept the fact that some parents are capable of 1) realising their child struggles in an area of devlopment, 2) framing that as mere fact rather than a catastrophe/failure and 3) wanting to be calmly proactive about it. Blows my mind that as soon as I addressed my observatiuon, everyone suddenly became an expert telling me he just needs a little more time, he'll get there, their neighbour's cousin's ex-girlfriend's babysistter's nephew didn't speak before age 3 and now he's a rocket scientist. Oh and how I should chill and not stress him, I'm clearly anxious and transimitting my insecurities on him making it even harder for him to start speaking.
Right. So the world tells us that a) we don't need to intervene, becauser they'll stat speaking one day while b) whatever we're doing now will inevitably worsen things. Thanks a lot.
Back to the facts: 24 months with less than 50 words and no 2 -word combos has been commonly defined as a delay. That's just a fact. It doesn't mean your child has a language disorder,but he's - at the very least - a late talker. And that's fine. Another fact is that there are things you can do about.
Personally, our route was the following (I'm in Europe, so the healthcare system is different and the role of daycare might also differ):
- At 18 months we noticed he was lagging behind milestones
- At 20 months we spoke with his daycare (they agreed, phrasing it as part of character to be cautious and a perfectionist)
- At 25 months we contacted a University researcher specialising in language delay and multilingualism, who offers free online consultation for parents. She was great, because she was the first to ever explain to us WHY the prediatrician was chill and what exactly the "green flags" were (You mention some of them in your post, like receptive language and general (also non verbal) communication, but they're also glad to hear if there's pointing, eye contact, triangulation (looks at ball, looks to mum, looks at ball to indicate "give me the ball!")...)
- At 32 I finally convinced his pediatrician to prescribe an initial evaluation (phoniatric evaluation in our language) to rule out anatomic difficulties in his mouth/throat area and hearing difficulties [ruling out medical reasons of a language delay can be done before age 3!]
- At the same time, I privately contacted a speecha and language therapist, that was recommended to me by the researcher mentioned above and we did an initial assessment at age 33 months.
- At 34 months we had the phoniatric exam which (surprise) concluded that his hearing, receptive language, anatomy were fine, but that he indeed didn't meet production milestones and didn't imitate sounds when prompted (gasp!). This was crucial in our public health care journey, because they prescribed SLT which we immediately booked and they said we'd get and appointment 3-6 months later - therefore after his third birthday. Part of the packet for everyone with a suspected language disorder (there's no intevention packet for a language delay where we are, so we have to work with a suspected language disorder) is also an evaluation by a pediatric neuropsychiatrist, which I look forward to, even to we have no major concerns other than language.
- At the same time, we started working with the speech and language therapist, and here we finally get to the point that might be interesting to you. What we do is parent coaching for speech delay. Ours is called the Hanen program, but I assume all parent trainings work similarly.
PARENT COACHING FOR LANGUAGE DELAY
Is awesome for several reasons. It teaches the parents how to communicate with their child in order to facilitate their language acquisition. Unlike a therapist, the parents spend a lot of time with the child and therefore have many opportunities to interact with him. Unlike therapy, the parent training only involves the parents and doesn't require the child to go places or do any sort of exercises (as play-based and fun as they might be).
Our experience with Hanen is awesome and I recommend you to check out their website and specifically the "It takes two to talk" program. I'd just like to undelrine that I'm certain there are other parent training options just as valid and I don't intend to make advertisement, but Hanen is the only one I have experience with. If you can at all afford, consider taking the course. Other than teaching you the basics, they also make you do homework (personalised to your specific child's needs) and analyse videos that you take of yourself interacting with him. It's so useful. If your budget is very tight, consider buying the course book, which has lots of practical advise and is written in a very accessible language.
We're now half way through the program and so, so, so wish we had done it when we first started havingt doubts 17 months ago. He still uses toddler words and didn't have a word explosion yet, but he talks more, uses longer scentences, added proper words via copying them from us, modified a toddler word and turned it into a standard word (this was an absolute first for him - he used to say nana, now he says banana) and - most importantly - is so much more confident and excited about speaking!
Two things can be true at the same time: It might be early for therapy, but there are thing you can do, namely:
1.) Rule out medical causes
2.) Learn about how to interact with him to support his language development
All the best for you, your son and your language journey.
