24 months - when to intervene?

andylondon

New member
Hi all. I have a 24 month old and we practice OPOL (French and English). My child is very communicative, though mainly using toddler jargon. He has a limited vocabulary of around 40 words and has not yet started speaking in 2+ word phrases. His comprehension in both languages is very good.

It does appear he has a speech delay and I’m pro early intervention, but our pediatrician assures me the delay is due to the bilingualism, it’ll correct itself, and that he shouldn’t start speech therapy before 3 years (otherwise “too young”). This advice seems to go against what I have read.

My questions: What does speech therapy for a 2 year old look like? Are there any others here who are or have been in similar boats? Is the doctor correct that we should just let things develop on their own? I don’t want to do my child a disservice by not intervening if it’s actually necessary.
 
@andylondon 2 is young. I would wait. I don’t think multilingualism has anything to do with it though but some kids speak earlier or later. I won’t worry yet and see if it improves by 3. Between 2 and 3 vocabulary and speech improves a lot.
 
@andylondon I also panicked around that time. But he was above 50 words for his 2 year checkup, so he technically was on track.

Yeah, he's almost 6 now and speaking in endless sentences and both his languages are strong and ever growing. He was just more interested in gross and fine motor skills at the time. Rode a bike before his third birthday, loved building things like train tracks or stacking things. I know it's hard, but this whole parenting thing is mainly an excercise in patience, for the parents. The kids WILL get there (barring any major health or development problems), they just have their own timeline.
 
@andylondon If you can find a bilingual speech pathologist and even better, one that speaks French and English and is used to working with kids who uses these 2 languages, you can just get them to do an assessment and then they will tell you whether your son needs intervention or not.

Bilingualism doesn't cause speech delay. My son had a language explosion at 2 years old. So perhaps for your son, it's just around the corner. So maybe wait an extra month or two to see if it's just that.

But if you are going to get a speech pathologist to assess your son, you MUST find one that specializes in bilingual kids. Otherwise, your son will get misdiagnosed.

My son has pronunciation and articulation disorder/delay and we found a pathologist who specializes in English and Mandarin - exactly the languages my son speaks. She spent 3 sessions going through both English and Mandarin to assess my son so she can assess his entire language abilities and also, whether his issues are consistent across both languages (which it is).

And then with practices she gives us, she's able to tell us the sounds to practice in each language without it clashing with one another.

It makes a huge difference.
 
@andylondon I don’t know if it’s too young, but I know “caused by bilingualism” is wrong. If it’s worrying you, there’s nothing wrong with seeking a 2nd opinion. Have you watched Dr. Mary Pat O’Malley’s videos?

 
@andylondon So I've read and heard so much mixed stuff on whether multilingualism "causes" a "speech delay." I am a lay person, but from what I have seen talking to professionals and other parents it looks like multilingualism *looks like* a delay in speaking but not language. This is what I mean: apparently, toddlers are good at differentiating between this person speaks y language and this person speaks x language. So if you only know one language and only speak to your kid in one language, you will only hear half of your kid's words. Add to that the fact that your kid probably has at least another dozen words in either or both languages that you don't understand yet. As for putting words together in sentences, toddlers also don't tend to mix languages, so they have fewer words to put together a sentence with, so that won't come until their vocabulary is bigger. It seems like your kid is still understanding and communicating, which is part of language development, because it's more than just words. Word count is just the easiest way we can measure our kids' language development, but it's so imperfect.

My advice, if you want advice from a non-professional internet stranger, if you are worried, start with a hearing test. That will probably be the first step in speech therapy or a language evaluation anyway. My toddler just had his hearing test at around 28 months, and it was adorable! And he had his language explosion shortly before that, so we're not worried anymore. You can also look into an evaluation with a speech therapist. (and like others have said, one that knows about bilingual kids) I had one for my oldest (he's a teen now) when he was around 18 months with no words in any language. Interestingly, none of the evaluation required him to speak, and they told us he was right in the middle of what abilities kids have at his age. They asked him to do simple tasks, he did, so they knew he understood. They asked him to gesture or get an idea across (which toy do you want, for example) and he did. So yes, a delay in using words, but not a language delay. Also, try using sign language. This was a game changer for us and wish I had known about how awesome it was with my older two!!! I know a little ASL, so I taught my older kids and my husband and started using it with my kid for things like milk, more, all done, etc. Now it's amazing because so many of his toddler words sound similar, so he'll sign when he sees we're not understanding the mouth word. And I think being understood just encouraged him to speak more.
 
@andylondon Bilingualism does NOT cause delays. However, that doesn’t mean your child has/doesn’t have a delay. Some kids are just less verbal and will will catch up later.

I would insist on an assessment for your peace of mind and for you child just in case. The earlier the intervention the better. My nephew’s parents were worried about delay but pediatrician made them wait until 2 years. He has apraxia and is still in speech therapy at 4 years and only recently able to say a limited number of 2-3 word phrases and a lot of his words/speech still isn’t understandable. Listen to your gut feeling and get help asap even if to confirm no therapy is needed. They regret listening to pediatrician and wish they had gotten help at 18 months.

FWIW, my LO is 23 months and consistently speaks in 3-4 word sentences in both his languages. Bilingualism doesn’t cause delays.
 
@andylondon My son is just over 2 years, also 2 languages, and had maybe 25 words at 2 years. But he's now in the middle of his language explosion. I'd give it a few more months and if you're still worried, see a speech pathologist.
 
@andylondon 2y.o. is typically kind of the start of language explosion. Definitely seems a bit too early to worry about it.

At 2 ours had a decent command of ~50ish(?) words and some short phrases/sentences in both languages.

The difference from 2 to 3 is astounding.

As we approach 3y.o. we’ve already been getting full imaginative stories, past/present/future tense, cause & effect, generally correct conjugation/declension/articles, plus grammatically & situationally correct profanity we should’ve been more careful about, etc.

Our kid has 2 friends who are also being raised bilingual in other languages & who are slightly younger. One is only a few weeks younger & is at a similar place w/even better English pronunciation.

The other is maybe 2mo younger & just kinda barely mumbles and doesn’t really speak in sentences. But that kid’s languages are the most different (ours are very similar), and it’s truly only OPOL for them w/no family nearby, vs us & the other family whose parents both speak both languages fairly well/natively and who have a lot of contact w/relatives & community in both languages as well.
 
@andylondon Bilingual kids are often up to six months behind the usual milestones, and they could just be slow speakers on top of that.* My oldest didn't say anything until he was three. My youngest started talking at 18 months. Both of them are perfectly chatty bilingual kids.

I was a monolingual kid and didn't start speaking until I was almost four.

As long as they can understand and follow directions, there's no reason to think they have some difficulty processing language that needs to be addressed.

* The delays in bilingual kids disappear by kindergarten. I have been jumped on for saying that bilingual kids have temporary delays before, but the data is pretty clear on that.
 
@jmz bilingual kids have often no delay at all.

what I mean is that bilingualism is not the cause of speech delay.
bilingual children are not most often delayed than monolingual children.
 
@andylondon Ours (German and English) doesn’t have a speech delay but I follow zazi on instagram who is a speech and language therapist here in New Zealand and I have learned lots of little tricks from her 5o help my daughters language development so maybe you find some helpful content on her page as well
 
@andylondon We speak French and English at home as well. At my son's 24 month check up he was not speaking in two word sentences, so his doctor had us to go and audiologist to rule out hearing problems. His hearing is fine, and within a few weeks of his check up his language exploded.

He's 27 months now and speaks many 2 word phrases, has lots of words and sometimes now speaks 3 words phrases.

I think 24 months is still young. A lot of language develops between 2-3 years of age. We live in a French area and our pediatrician assures us that bilingualism has nothing to do with delays at all. I'd give it a bit of time before intervening.
 
@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.
 
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