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Speech/cognitive development in 4 year old
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Speech/cognitive development in 4 year old

My grandson is 4 years 5 months old and has an unusual problem with speech/cognitive development.  He talks, but in a monotone robot-like way with a pause between each word and an upward inflection at the end of each 4-5 word sentence.  He might say "I-go-pah-EE" for "I need to go potty." He asks questions but if you try to get him to reason out the answer, he is unable to (even simple questions,for example, I am pouring water from a big jug to our water bottles.  He says "What do-IN?" and I say, "what do YOU think I'm doing?  "I don't know."  "What is grandma pouring into the water bottles?" "I don't know." and so on).  

He was 6 weeks premature with minimal hypoxia, all tests in NICU normal, motor development normal but very slow language development (no babbling by 12 months, etc.)He seems to understand more than he can express, but it's hard to know how much he understands.  He cannot tell a simple story or joke, tell about an experience, name any colors (but he can count to three!)or verbally share feelings.  He seems to have normal emotions and is very well-behaved, potty trained, etc. His mouth muscles seem to be weak; he can't purse his lips to kiss or blow bubbles, he overstuffs his mouth at meals and chews in an unusual way, can drink with a straw but his cheeks cave in a lot more than other children's do.

He was evaluated (in our small town) at 18 months, and there was no real diagnosis; his parents were just given suggestions to improve speech skills.  They are not educated and now that he's talking at all--they feel like everything is fine!  Whereas I believe there's a severe problem here that needs early intervention (far sooner than now, actually).  They did apply for Head Start but were told that they make too much money.  

What do you think might be wrong and what's the best way to approach the parents?  I'm step-grandmom and I'm worried that they'll think I'm making unfavorable comparisons between their child and my other grandchild, who is a 3 year old male who is very bright and lives with me.
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It does sound prudent to obtain additional evaluation in light of the obvious deficit in relation to expressive speech and language and perhaps receptive language as well. Addressing the matter without any comparison with your other grandchild would make sense, and perhaps if you can enlist the help of an additional person the proposition would be more persuasive. Asking the local school district to do an evaluation would also be reasonable. Maybe the parents can accept such an evaluation because of the educational focus.
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