The first few years as a parent are hard, and there are very few supports in place to help parents know what to expect, especially in terms of communication. Yes, parents know about babbling or that baby's first word will probably be "dada" but there is a lot of uncertainty around whether it is all going right!
One things that is pretty common are the many doctor visits. There are generally seven wellness visits in the first year alone, which then begin to spread out to biannual and finally annual visits by around 3 years of age. These visits are essential for keeping up with immunizations and checking on growth and development.
However, these visits often lead to parents to wait to seek services when development is delayed. In addition, there is a cultural mindset in today's society -- perpetuated by providers and other parents -- that can often (wrongly) encourage parents to wait when instead they should be proactive.
Today, I want to talk more about why I absolute hate hate hate the concept of "wait and see" and why this is never something I advise as a professional speech language pathologist. I also want to look at the hurdles that parents face when seeking support.
And then what we at Talk Time suggest instead.
Medical Model
Medical care in America generally operates on reactive care. This means we generally wait until a problem occurs, and then we treat it. Preventative care does exist -- mainly in the form of immunizations, routine blood work, and screening procedures like mammograms or colonoscopies.
However, in the pediatric world and when it comes to development, many doctors use the "wait and see" approach. The idea is that development is a wide range, so why worry about something if it might get better on its own.
BUT -- The "wait and see" approach is outdated -- current speech language research does NOT support this approach. Getting support early from a professional can never hurt and is crucial for helping little ones who may not catch up to peers on their own.
NOTE: While I know that other professionals (OTs, PTs, etc) agree with this opinion, I want to make it clear that my expertise is in communication only. I am speaking here only about the "wait and see" approach to communication delays.
What's Holding Parents Back
To begin, I want to outline some major problems parents face when determining whether or not to seek support for their child.
1. Milestone Mistakes
Most parents know about milestones. Some parents are trackers, reading up on all the skills and ages to see if their child is "on track" while other parents take a more relaxed approach.
But what are milestones anyways? And why are they important?
Milestones are markers for what the average neurotypical child does at a certain age. They are used as benchmarks by clinicians to help them determine whether a child might need support and whether further testing might be needed.
Some parents might know that CDC milestones were updated in 2022 and currently describe what 75% of children can do at a certain age. This was a shift away from milestones that marked the average (50th percentile).
So why 75?%
Typical development is a range. Clinicians consider the average range to be between 25th and 75th percentile. So, capturing this in milestones is a good idea.
Okay, so what's the problem?
Some of the new CDC guidelines for language are not backed by research, and they did not consult an SLP when revising these milestones! This has led to parents and other providers (like pediatricians) waiting rather than referring to speech pathologists or early intervention to support communication.
These are the two big ones that do not match SLP research:
The CDC says that the milestone at 18 months is "three or more words besides “mama” or “dada”" but speech research says 75% of children have 10 words or more.
The CDC says that saying 50 words is a 30 month milestone while speech research says this happens by 24 months for 75% of children.
Children who do not reach these milestones typically need specialized support. Having milestones that are not backed in actual data and research is frustrating for us as clinicians and confusing for parents. It suggests that we should wait longer than we should, and research shows that this is not helpful.
NOTE: Not every child learns skills at the same pace or in the same order. These milestones are often not appropriate for neurodiverse populations
2. Getting From A to B
Another problem beyond simply the milestones is that parents often do not have a clear idea of what to look for in terms of communication progress (precursors to expressive language, signs of receptive language) or signs support is need (i.e. "red flags" or concerns). They often don't know how to get from A to B and simply "wait and see."
Parents often rely on the limited questions at their wellness visits with pediatricians, which are often insufficient and only provide a small snapshot into your child's current communication profile. Or they focus on the big milestones only, missing the steps along the way to more advanced communication skills.
The biggest problem we see as SLPs is that society (and therefore parents) are too focused on words and less focused on how we actually get there. Most parents and pediatricians don't talk about the precursors for strong receptive language or emerging expressive language. They don't have a plan for reaching the next milestone ... they are just waiting for it to occur.
Parent education around communication is often limited unless they are actively seeking knowledge or currently receiving support. But knowing how to support your child's communication at home is so important, making this another hurdle for families.
3. Survivor's Bias
The final hurdle for parents is what we like to call survivor's bias. This is when people use anecdotal data (rather than actual research) in an attempt to normalize, validate, or comfort others.
For example:
You tell your mother that you are concerned that your son isn't saying any words yet at 18 months old. Your mother says "Oh, he's a boy. They always talk late."
Or perhaps you tell your friend that you aren't sure if your child needs early intervention. They reply, "Kids develop at different paces. I'm sure he'll be fine. My brother didn't have any words until 3 years old and then he just started talking in full sentences."
Or of course, the dreaded response from your pediatrician, "Well, let's just wait and see. Sometimes kids just talk a bit late."
Have you heard any of these before?
All of these responses are an attempt to make the parent "feel better" about their child's progress. But what this really does is delay parents from getting the early support they need for their child. Anecdotal data and survivor's bias may also prevent professionals from referring their clients, especially if they are not up-to-date on current speech and language research.
Needless to say ... this is a problem! And parents face this all the time in all aspects of parenthood. And of course there is a place for emotional support and parenting advice in parenting groups.
But I urge all parents to think about their responses when posting on facebook or talking to other parents. Try to clarify whether your information is research-backed or anecdotal. Encourage them to seek support to find out more. It may make a difference for a parent who isn't sure.
And for providers and professionals, I would argue there is never a time where anecdotal data should be used in your practice. As a professional, when you speak to a certain topic, parents assume that you have clinical, research-backed knowledge around your statement. So think about your scope-of-practice and your expertise. If you don't know the answer, it's perfectly okay to say so -- or look it up later!
Why Start Early?
Does waiting three months or six months or a year actually make a difference?
Yes.
And no, that's not anecdotal data.
We know that earlier IS better for progress and waiting DOES have worse outcomes. This is especially true for our little language learners.
Why?
1. Help Is Never Bad
It's true that there are children who will catch up to their peers without specialized support. And approximately 70-80% of late talkers catch up to peers by school age (although some do go on to have some challenges with higher level language or literacy skills).
However, approximately 20-30% of kids who will not outgrow their delay. They may need specialized support throughout school to help them with language, literacy, speech, and other communication skills.
The problem is we do not know which kids are which!
The good news is that communication support will never hurt. And it's possible that, for some children, given just a little bit of specialized speech therapy, it will all "click" and they will graduate in three or six months time.
But for others who need more help -- earlier truly is better.
2. The Delay Grows as Time Goes On
Waiting can actually make it harder to catch up because the expectations change and grow as your child does.
For example, if your child is 24 months old and has 10 words, they have about a 6 month delay. But if your child is now 30 months old and has only 14 words, they have nearly a 12 month delay.
This is because children with a language disorder are not simply behind in age, they also tend to learn language at a slower rate (or they might stagnate or regress!). So while typical kids are learning language quickly and gaining new skills every day, a child with a language disorder will learn slowly, falling further and further behind as time passes.
What To Do Instead?
If you have a child that needs support, we at Talk Time highly recommend that you seek out a trained speech language pathologist for a screen or an evaluation depending on your child's case.
A communication professional will be able to assess your child's entire communication profile, including their strengths, their precursor skills, and their challenges. They will identify how your child learns best and whether or not your child presents with a neurodiverse profile that requires an alternative approach to neurotypical milestones.
REMEMBER -- Early intervention is free in MA and we are lucky to have tons of private practices and outpatient hospitals in the area as well.
Talk Time recommends that you "Check and See":
We conduct screens and evaluations to be certain about your child's strengths and areas that may be at risk. If skilled therapy is recommended, we will write a treatment plan which will be a combination of weekly sessions and parent education/coaching sessions.
If your child shows some risk factors but is not yet a candidate for skilled weekly therapy, we will come up with a specific plan for monitoring. This includes providing you a few strategies to use at home, skills to look for as your child develops, and a plan to come back and check in with a professional after a certain amount of time.
Talk Time also provides parent education offerings (parent coaching, playgroups) as an option in between skilled speech and monitoring. We hope to empower parents to help them what to expect and to understand how to support their child at home.
If you want to reach out to us at Talk Time, please email us at info@talktimeboston.com. You can also check out our other blog posts on How to Choose Your SLP.
We love to help parents navigate their options to support their child.
Resources
Hawa, V. V. & Spanoudis, G. (2014). Toddlers with delayed expressive language: An overview of the characteristics, risk factors and language outcomes. Researchers in Developmental Disabilities, 35, 400-407.
Capone Singleton, N. (2018). Late talkers: Why the wait-and-see approach is outdated. Pediatric Clinics of North America, 65(1), 13-29.