Should I be concerned?

Should I be concerned that my 2-year-old, Kymee, doesn’t say many words and is hard to understand?

http://www.mayoclinic.com/health/toddler-speech-development/AN01940

Not when she’s this cute


But …
Sometimes it’s so hard to know if Kymee’s speech is “normal” 2 almost 3 year old, or if there really is a problem. I listen to her every day – so I probably understand her more than others do. So, I decided to research it. 

Answer

from Jay L. Hoecker, M.D.
If you’re unable to understand any of your 2-year-old’s words, talk to your child’s doctor about scheduling an evaluation. Done Speech delay can be an early sign of other developmental issues.So true
Although every child grows and develops at his or her own pace, toddler speech development tends to follow a fairly predictable path. For example, the average 2-year-old:
  • Speaks at least 50 words Yes, but not necessarily understandable words
  • Links two words together, such as “my cup” or “no juice”, Yes
  • Speaks clearly enough for parents to understand some of the words Yes – well maybe me more than Nelson, then again Nelson doesn’t always understand what our 15 year old is saying
      The average 3-year-old:
  • Speaks 250 to 500 or more words Not there yet – but somewhere between 50 and 250
  • Speaks in three- and four-word sentences Just starting this
  • Correctly uses pronouns (I, me, you, mine) Uses all of these, but not correctly
  • States first name Sometimes, sometimes when we ask “What is your name?” She answers “Two” and holds up two fingers
  • Speaks clearly enough for strangers to understand much of the time NO In fact, I can’t understand her most of the time if she’s sitting in the car seat and it isn’t in context
So, I think speech therapy and age has brought Kymee more into “normal” range, but I don’t think she is quite there yet. There are still letters she doesn’t say, and strangers who don’t understand her – but she’s not supposed to speak to strangers anyway. 

So my question is  should I be concerned? 

Progress Report

Kymee has made so much progress in her speech this last semester. A week before she began speech she had her ear tubes replaced. I believe that the combination of hearing clearly, speech therapy, and age appropriate behavior has made all the difference. For those of you who are fascinated by technicalities of evaluations and therapy, like I am, this post is for you. This is a summery of Kymee’s latest evaluation.










Before
Language:
1. Lack of verbal reasoning
2. Little to no knowledge of animals or household objects
3. Little use of social behaviors such as greetings or sharing
4. Identifies colors but unable to verbalize names
5. Unable to produce names of immediate family
6. Struggles with bilabial sounds, fricatives and glottal stops
(Googling this helped me understand Kymee could not make sounds which used both lips, or make sounds in which the airflow must be stopped to produce the sound)

Behavior:
1. Adapted to being with therapist away from Mom
2. 3 minute attention span
3. If more than one toy available for play – she struggles to choose and becomes upset
4. Is upset when asked to share (isn’t this normal for a 2 1/2 year old?)
5. Throws toys when finished
6. Throws things at therapist instead of verbalizing her needs
7. Noises outside room distract her
8. Strikes the therapist wen doesn’t want to participate in planned activity (I can vouch for this one personally)

Therapy Goals 
1. Repeat verbal commands 80% of time
Initial: 20%
Final: 100%
2. Verbally request items to play when prompted 80% of time
Initial: 40%
Final:90%
3. Verbally request items to play without prompting 80% of time in 2 sessions
Initial:40%
Final:90%
4. Repeat animal names 80% of time
Initial: 20%
Final:85%
5. Use 2 word phrases in structured play by modeling
Initial:25%
Final:90%
6. Repeat family names
Initial: 25%
Final: 85%
7. Repeat common household item names
Initial: 20%
Final:80%
8. verbally identify household objects
Initial:25%
Final: 75%


After
1. Says “all done” when finished with toys instead of throwing them
2. Verbalizes names of colors, animals and family member most of the time without prompting
3. Could play for 10 minutes without frustration
4. Could greet and share more age appropriately
5. Kymee no longer hits her therapist (now if we could figure out how to make her stop hitting Elijah)

Recommendations
1. Increse 2 word phrases
2. Increase age-appropriate vocabulary
3. Improve verbal identification of family members
4. Monitor Kymee’s articulation production for further assessment and remediation 
(I’m ready to move on to this part – but it may be a while)

Flower Fairy Kymee and the Evil Speech Stealing Monster

Once upon a time there was a Flower Fairy named Kymee.

An evil speech monster stole all Kymee’s words. Kymee couldn’t use her words to name all the beautiful flowers around her. 
Then all of a sudden, a Fairy Speech-mother appeared. She played and sang to Fairy Kymee and tried to help her find the words which the monster had stolen. But she couldn’t do it alone. 

So the Fairy Speech-mother placed a spell on each of those Kymee loved. She shrunk the Fairy Family down and turned them into a village of beautiful popcycle people. The Fairy Speech-mother hoped that if the Flower Fairy could hold them then the power of their love could overcome the monster’s spell. 

Each pop-cycle person, agreed to give Kymee one word or two. 
Kymee dressed Grandma popcycle person on her magnetic puzzle, and Grandma gave  her the words “shirt” and “skirt” and “shoes”

As the popcylcle people rested on lily pads, magical frogs transported Kymee from pad to pad.  And each gave her a new word.
She hopped from Grandpa and Grandma, Abuelo and Abuela to Daddy, Mommy and Yaya. She rode on the frogs back as she visited the lily pad of Baba, Mimi and Eli. She leaped to Carlos, Lydia, and J then to Kenny, Sissy and Trent, and finally she came to land on the pad of Uncle Mark and Auntie Kim.
With each new hop, the magic of the monster began to wear out and the Flower Fairy began to find her words.

 The Fairy Speech-mother put Kymee into a deep sleep, and returned the popcycle people to their rightful place among the flowers. The monster was overcome for another day.

When Flower Fairy Kymee awoke, she had new words to use and was happier then ever before.

The end, until the Speech Monster roars again.

Say "Moooo"

Amanda, “What does the cow say?”

 “The cow says moooo”
“Say ‘moooo'”

 “What does the lion say”
Kymee, “Grrrrrrrr”
Amanda, “Grr, good”

                                              

I watched on a TV monitor from a cubby-hole in the video observation room as Kymee and her new speech therapist played alone in a therapy room. I realized I was paying $25/hr for a graduate student to sit on the floor and name objects, a task I perform daily for free.

I have no idea why, but watching Kymee interact with the therapist, was spell-binding. Best TV I’ve seen for a while. Don’t ask me why it was entertaining to watch when she shook her head and said “no” when asked to exchange her plastic lion for a red fire truck, but it was. Even Andres couldn’t keep his eyes off the monitor and read his book, and laughed out loud as Kymee loaded her baskets with the four-legged creatures instead of willingly being redirected by Amanda. She enjoyed loading and unloading these small critters into the baskets, and when forced to play with the “red fire truck” and “yellow school bus” (as Amanda labeled them) she insisted on lining the vehicles up perfectly on the table. Slightly OCD, or maybe just a melancholy.

I prided myself on the fact that she never once threw a fit, or screamed in frustration, and only hit Amanda twice. I almost feel sorry for Amanda, after one hour of Kymee time, she believes her to be a “quiet” little girl whose one true love in life is manufactured barnyard animals. But, as far as first impressions go, Kymee made a good one. Hope the graduate student isn’t too disillusioned when the real Kymee shows up.

Scream and Point

Kymee was evaluated by ECI (a state funded program run by the school district for kids too young to go to school) to see if she qualified for Speech Therapy.

This is what 19 month-olds are supposed to be saying:
“The vocabulary of a typical 19-month-old toddler may consist of as few as ten words or as many as 50. Yours may be able to link two or more words together, and is starting to use more “action” words. Verbs like “go” and “jump” are common, and so is linking a verb with her name (or pronoun), as in “Come me,” meaning “Come with me.” (It will be some months before she inserts the preposition.) Many 19-month-olds are also well-versed in direction words such as “up,” “down,” “under,” “out,” and “in.”

This is what Kymee is doing at 19 months: 
“Kymberlee is waving bye-bye and uses signs and gestures to request what she wants. She is imitating several sounds: h,m,n and vowels. She can vary her voice to use inflections, and uses 5 verbal words and 4 signs consistently. Her sound repertoire is still limited related to her cleft palate. She is not eligible for therapy.” 

This is what they really mean:
Kymberlee uses signs and gestures to request what she wants = She smacks you to get your attention
She is imitating several sounds = she growls like a lion, and barks like a dog
She can vary her voice = she screams loudly
She uses 5 verbal words = that are only understood by over-compensation, over-zealous loved ones
Her sound repertoire is still limited = she can’t speak
She is not eligible for therapy = Because she can point and scream, we don’t have to spend money on her therapy, you do!