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Avatar universal

3 yr old language/conversation delays

Many thanks again for the guidance that I have received so far.  Now, I need to ask a new question.  My daughter, that I have been discussing previously, continues with her inability to answer open-ended questions and actively converse.  Is this something that can be addressed adequately through speech/language therapy?  Is there a larger problem that I am unaware of?  Is there some kind of processing problem? At this point, we have discussed Autism and Asbergers, both of which I do not feel are the issue, unless I am misinformed.  In all areas, beside conversation, she is a happy, healthy, loving little girl.  She is very active, and but does have a somewhat short attention span. She maintains good eye contact, does not care what she wears, eats pretty much anything (if we can get her to sit at the table long enough), is very loving & empathetic.  She doesn't have any unreasonable fears and is not a daredevil.  She can be somewhat shy around new people.  She does speak, answers most yes or no questions, sometimes she ignores us I think.  If someone appears to have hurt themselves, she will run over and say "OK, (name of person)?"  She uses please, thank you, and welcome at appropriate times.  "C'mon (name of person).", "Let's go.", "Gimme", "Hey wook (look).", "Wook at dat!", "Whatcha doing?"; if we are going somewhere its "Go School", "Go see cows?", "Go town" or "Go find Daddy" (fill in with where ever we are going).  She will sometimes speak to inanimate objects or toys..."Hi puzzle", "Hi rock." Generally though, she gets her needs/wants across through one or two word phrases. Instead of I want chocolate milk, its just "chocolate nilk (milk) please." Also at bedtime, its "Goodnite kiss."  Never "I want" or "I need" or "Can I have" I try to get her to mimick me in speaking the correct way and using sentences, but she just echoes the last one or two words.  She said, "Swing please." I said to her, "Audrey, say, I want to swing please."  Again it comes out "Swing please."  When I break it down into two words each: "I want" (she will repeat) "to swing please." (She will repeat.)  Then I will put the whole sentence together and it is still "Swing please."  If she is having a good time she will giggle and say "Hey this is fun."  But if you ask her if she had fun, she will not answer.  The doctor asked her questions like, "If you are hungry, what do you do?" (No answer.) "If you are cold, what do you do?" (No answer.)  I thought maybe she was being shy, so when we got home, I asked her the same questions.  No answer.  Today she got into my wallet and found a picture.  She looks down into my purse, "Hey its dark in dere."  Pulls out her sister's picture and says "Dat's sissy in dat picture." (That's quite good for her, especially if unsolicited.)  She likes doing flash cards, but again, it requires only a one word response.  I have scheduled the first meeting for her speech eval. with the school on 4/27.
41 Responses
242606 tn?1243786248
MEDICAL PROFESSIONAL
The very recent anecdote you described (with the wallet) indicates that she is developing this aspect of language. Developing language skills, as you know, is a process. And, like other aspects of development, children proceed at different paces. Your daughter happens to be slower in her development of language skills than she is in other areas of development. However, while it is not unusual for a child to display various rates of developemnt in the various spheres of development, it does make sense to pursue the Speech/Language evaluation and therapy. From your various very detailed descriptions of your daughter's progress in various areas, I do not see her language behavior as indicative of any serious emotional condition. Could it be symptomatic of some type of learning disability? Yes, it is possible, and this will become clearer as she continues to grow. You can also pursue a pre-school evaluation through your local school system, since she is now 'aging out' of Early Intervention.
Avatar universal
Our son started speech therapy, a few months before he turned 3.

You sound somewhat similar to me, because I was afraid that it could be more than just a speech delay--but my gut told me that is all it was.  (I was right, that is all it was)  
What does YOUR gut tell you?
With so much talk of Autism, it is hard not to worry about it--I was.  Your daughter is talking more than our son was at her age.

The progress he made in speech therapy was tremendous.  Perhaps your daughter does not answer, because her expressive delay is preventing her from anwsering.  Why say "I want milk please", when just saying "milk" gets results?

There a several kinds of delays:  the 2 I know about are:

expressive--trouble articulating
receptive--trouble understanding speech

We knew our son had an expressive delay.  But we could not tell if he had a receptive delay.  Can your daughter follow simple instructions? If she can, then she is understanding you.

With the help of our speech therapist, we began using some sign language as triggers for speech.  When he said "milk", we made the signs for 'I' 'want' and 'please'.  This triggered him to say 'I want milk please'  He had to say it before he got milk--and the next thing you know he started saying it on his own.

Had we not learned this from his speech therapist, we never could have come up with something so simple to help him.  Speech therapy helped him, but also gave US the tools to help him.
Over time, he made tremendous progress and any irrational fear I had about some other delay evaporated.

Right now, your daughter is saying more than our son said at that age--meaning he had alot of words, but was not putting them together.  What you describe sounds VERY similar to our son.  He had speech therapy for 1 1/2 years.  He did wonderfully, speaks beautifully now (alot better than some of his peers)--except he pronounces Kansas City as Cans of City...LOL

He is 6 years old and in kindergarten.  I think once you get the evaluation, you will feel alot better.

Jenny
Avatar universal
My daughter who is now nine started speech at three.  At the time she was diagnosed with adhd, severe seperation anxiety and developmental delay.  Now they have changed all of that and they say she has aspergers.  The sympoms she has now she didn't have at three.  The most noteworthy is her trouble with peers and understanding body language.  All I can advise you to do is to stick with the speech and keep your eyes out for your child.  If it's more than just speech it might not show up until later.  Good luck
Avatar universal
Jenny...Thank you so much for your kind words and encouragement.  With my first daughter, she was advanced on EVERYTHING, so now with Audrey, I have been sent into a tailspin.  Yes, she does understand everything we say, and can follow complex instructions as well.  It is just her ability to articulate and converse.  In most everything she is ahead, except for speech.  She can write her numbers to 10, identifies all of alphabet, can sing it, knows all colors (even some more difficult ones), all shapes (hexagon, octagon, etc.), has advanced art/drawing skills, is very social, loveable, athletic, and then there's the speech.  She can sing songs, like Twinkle, Twinkle, but can't tell me if something is wrong, or have even a small conversation.  My GUT tells me it's only a speech problem, but you know sometimes your mind can imagine the worst.  Thanks again for sharing with me and I am glad that your son is doing well...maybe there's hope for Audrey with speech therapy as well.  I LOVE Cans of City!!!  My favorite with Audrey is grasshopper (Gas ka pepper)!!!  Thanks again!  Amy
Avatar universal
I read your original post about the possible autism diagnosis after a 45 minute evaluation.

Our son had been in speech therapy for a few months and our therapist seemed to be frustrated with him.  She asked her boss to sit in on a session and give his opinion.  He felt our son needed a developmental evaluation--because of the 'way' he pronounced some words...

We refused.  We knew nothing was wrong--and just so you know--that will become more apparent as speech progressives. For us, his speech was improving, communication was improving, we were feeling relieved and any fears we had were dissapating(I should say me, my husband never felt anything else was wrong.  I was the only one worried).

We talked to our pediatrician about it and he told us to go with our gut.  If we really felt that nothing else was wrong, then we were probably right to turn down the developmental eval.

It turns out that we were right.  Nothing else was wrong.  Our son also knew his ABC's and counting etc.  He was very bright.  He had no other delays that we could see.  He did not fit into the autism symptoms--except his speech was delayed.

My point is that they had seen him for months and wanted a developmental evaluation and they were mistaken--how could anyone possibly diagnosis a child in 45 minutes?

For me, my husband was my anchor.  I was so worried about so many different things being wrong, that I was very easily influenced by any little comment by a therapist or dr, or a list of symptoms on the web, or any little odd thing our son would do.  My husband was the one telling me to calm down.  I think I was so worried about it that I conveyed it to others--There really must be something to worry about here if she is so worked up.

Your daughter sounds smart and kind and very aware of the world around her.  Just a little slow getting started talking.  Someone told me, that once our son starts talking the way kids do, I'll be sorry.  (they meant it jokingly in a nice way.)

I have never gotten tired of his little voice asking questions, telling me silly things...

Your evaluation is less than a week away.  I think you will find that with the start of speech therapy, alot of your fears will go away too.

Good Luck to you
Jenny
Avatar universal
From my understanding "true aspergers" dont have any type of speech delay, in fact they usually have very advanced speech. Who gave your child this diagnosis?
Avatar universal
Tomel, according to the DSM IV, Asperger's is characterized by no clinically significant delay in language at this age (3-4).  My son certainly fits that category as do most of the children being discussed on this board.  However, his autism is pretty apparent for the casually informed.  Asperger's kids do have problems with the pragmatics of speech as well as pronoun reversal.   Much of the information out there about Autism Spectrum Disorder and Asperger's Syndrome often times only contains "nuggets" of truth and not the full picture.  Some children with Asperger's do have advanced speech, but delayed or absent analytic and social language.  Social language is perhaps the most important of all speech because it helps us to learn to live and work with each other.  When Asperger's kids get into the workforce, this is where they often fail and their "language" becomes a very real and true disability.  Other Asperger's kids learn to adapt while others do not.  Early intervention is an important key.  If your child has a problem, do not try to talk yourself out of it but address it while they are young!
Avatar universal
I have had my son in early intervention since he was 19 months old. He is now 3 1/2 He was diagnosed for "at risk autism". When he turned 3 I was told that he no longer fit that category but was still probably ADHD and still "at risk for Autism",so in other words keep him in therapy and keep an eye on him. I was told by one of the best psychologists in the state where I live that "Aspergers" children dont have speech delay. I also know someome whose child has Aspergers and he never had a problem with speech. If there is a child that has the symptoms of austism with a speech delay that it is "High functioning autism", although I know that they are pretty much one in the same. I just think that there are alot of people out there that are trained to look for everything wrong with kids and a little to over zealous in giving them a label, which does no good unless it is needed for services.
Avatar universal
I also think (although in alot of cases with good cause)people are getting freaked out about the autism thing. Every little thing children a child does or doesnt do is under scrutiny.I was just reading something recently about sypmtoms to look for and one of them was "reading comprehension" and then after all of the noted symptoms to look for it said "onset prior to age 3" what the heck does that mean, a child is supposed to read before age 3. I do agree that there is alot of misinformation. One of the big ones is that "echolalia" is only a symptom of autism. Not true typical kids learn langauge thru echolalia as well. Also, that if a child doesnt like haircuts or doesnt eat certain foods, oops sensory problems must be autism. Or a child that likes everything in order in their bedroom, oops OCD. The reason I am giving all these examples is because I have seen them all in "typical" children. Some children might have a sensory problem, or a speech delay or lack of social skills. But there are other known and researched causes for some of these. Apraxia (which is a motor planning problem that affects speech and coordination) & Sensory Dysfunction are a couple of them. I do think people should keep and eye on their children, if I hadnt done so who knows how much progress my son would have made. But sometimes I think it goes a little overboard.
Avatar universal
Tomel, I agree with everything you wrote.  However, the psychologist you referred to is just plain wrong.  Some Asperger's kids do have "slight" delays in speech, most do not.  I also agree that untrained people are often looking for "red flags" in everything young children do.  We need to love our children for who they are, and at the same time help them along in areas where they need it.  I'm not sure where it was written that if a 3 year old can't read at an age appropriate level that is a sign of autism.  I've never heard of that and would have to say that it is also just plain wrong.  If a child can read before 3 then that might be a sign of autism/hyperlexia if other criteria in the DSM IV is met.  Autism is an uneveness in skills with some skills age advanced and some areas age regressed.  My son can read certain books and knows hundreds of words (he's most definately hyperlexic) but he can't learn to sit still for 1 minute.  He often doesn't say no, he just screams to get his objection out.  Sometimes he is just super smart and I think "how is this autism" but then I think, will this kid be able to learn in a mainstream setting and then I have my doubts because of his behavior is more like a 18 month old.  By the time he is in kindergarten, I expect he'll be reading like a 4th grader but he will have severe behavior problems that will interfer with learning.  HFA and AS are both just very frustrating nerological disorders because of the glimpes of brilliance followed by distressing behavior.
Avatar universal
I am familiar with hyperlexia.There are also some people who think that when a child memorizes the words in a book that this is reading. Well this is a pre-reading skill but not true reading(Im not saying your son is doing this). My sons preschool teacher encounters this alot, and when she tells the parents to open the book in the middle and ask them to read they cant do it. The other thing that I was just reading was if a child has an excellent rote memory that is a sign of Autism as well. Well that is how children learn letters numbers, colors etc. Any small child can learn these things if you show it to them enough. My son has memorized all of the above as well as some sight words, but that is because I showed them to him over and over.
Let me ask you this can your son understand body language? Like if someone gives him a mad face when he's doing something wrong, or a tickle gester etc.
Avatar universal
Tomel,

We've never taught our son to read, he just picked it up and the developmental pediatrician was the first one to really make note of it when he was 26 months old as he was reading road signs.  He can read no matter what the font size, rather capital letters or lowercase letters.  He reads from books he's never seen before.  I don't think he understands most of what he reads, but he does understand some of the more simple words.  His preschool teachers are flabbergasted at his reading abilities so maybe they've never seen something your child's preschool teachers apparently see routinely.  It's gotten to be a little disturbing to me because they want to see him read and now I'm starting to think that he is being treated as some sort of "freak".  

From my understanding of early learning, most all children learn in a rote fashion until about the 4th grade when more abstract learning begins.  Many autistic children do have excellent rote memory, you should see Kim Peek (the real rainmain).  He is exceptional.  However, he is severely autistic and not much like my son.  Autistic kids concentrate on the details and concrete thinking.  Whereas a normal child this age is more interested in other people than in things.  One way you can tell my son is autistic compared to normal children is when we are in the grocery store.  He doesn't look at other people but concentrates on the things on the shelves.  At times, he gets so wrapped up in the detail, that it is hard to distract him.  You can bounce a ball off his head and he wouldn't break his concentration on an object or toy of interest.

Another problem he has every once in a while is unusual fears.  For the longest time he was mortified everytime he saw a particular fuzzy soccer ball.  I eventually helped him overcome his fear of the ball and now he loves the ball and calls it "Mr. Soccerball".  He is currently afraid of public toilets and gets very panicky when he is near them.  He's still not potty trained.

He also has certain ways of touching objects.  For some reason, he likes to rub his fingernail across the plastic eyes of his toys.

Question:
"Let me ask you this can your son understand body language? Like if someone gives him a mad face when he's doing something wrong, or a tickle gester etc."

Yes, he understands when someone is mad.  When he is doing something wrong, usually all I have to do is give him a look and he will stop.  He lies too.  For instance, we have this full length mirror in the hallway which he knows he is not suppose to touch.  While sitting in the living room, I could hear him run down the hall and slap the mirror (he knew he wasnt suppose to touch it).  He turns back around and runs into the room I'm in and I sternly asked him if he touched the mirror.  He says "No".  
He loves to be tickled and understands the "tickle bug" gesture.  I'm not sure what this information is suppose to demonstrate though.  If your thinking "Theory of Mind" and Executive Function, he doesn't have much of a problem with theory of mind.  I have seen those issues with other children on the spectrum but that is generally not the case with my child.  He laughs at appropriate moments during his videos and is scared at appropriate moments.  I remember when he was about 16 months old and he was watching Monster's Inc. and in the beginning, it showed a child sleeping in the bed.  The child becomes scared during the scene.  When I looked at my son, he was shaking because he recognized that the other child was scared.  I don't think he relates to people with quite the same empathy, unless the feeling being expressed is very obvious.

He's a great kid, but very difficult for non family members to like because of his egocentric behavior.  Also, some of the more advanced children in his preschool I fear are starting to notice that he is a little different.  He's making great strides but I fear he will always be a little behind in a lot of areas.  Much like his father (me).  I'm most likely on the spectrum and I'm sure that I would have gotten the diagnosis if I was a child today.  Many times, I'm the only one who seems to "get it" when it comes to his behavior because I have this deja vu of "been there, done that".
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