Is your child a late talker?

Don’t be too quick to

blame autism. It’s probably this.

When your child is slower to talk than your friends’ kids, it’s natural to worry: What’s wrong,
and how can you fix it?
More often than not, late talking is just a temporary stage, not a sign of a problem. But
increasingly, late talkers are being wrongly labeled as having autism.
“Almost all kids with autism are late talkers—but not all late talkers have autism,” says Stephen
Camarata, professor of hearing and speech science at Vanderbilt School of Medicine and author
of Late Talking Children: A Symptom or a Stage?
Too many late talkers are winding up in “the wrong clinical bin” as a result of the push for early
screenings and early interventions, he told me.
Rather than being on the spectrum, many of them simply have a different learning style.
What’s most helpful to you and your late-talker:
First, don’t panic: Late talking has MANY explanations.
That first cherished mama, dada, or other first word typically shows up around 12 months. But
(big, important BUT) there’s wide variation in when kids start to talk. First words before the first
birthday, or after the second, aren’t uncommon.
About one in every 9 or 10 kids starts talking late. “More than half the time, nothing is wrong
and late talking is just a stage,” Camarata told me. If you follow a group of 2- and 3-year olds
who have language delays, as many as 60 percent will be speaking just fine a year or two
later. (In addition to his 30 years of clinical experience, he knows firsthand the angst involved:
He was told that his late-talking 3-year-old, one of his seven children, was “mentally retarded,”
the label used then, and bound for a life of special-ed. Instead, he finished college, on
scholarship.)
For just under half of late talkers, something is going on, and it’s important to figure out what.
Among the possibilities:
 An expressive language disorder, meaning some kind of trouble learning to speak (the
most common reason)
 An intellectual disability
 Autism (fewer than one in five cases of late talking, says Camarata, and one in 50 of all
children)
 A physical problem, such as a hearing problem or a neurological disorder (like epilepsy)
 A speech disorder, meaning an inability to pronounce words so as to be understood
If your child still isn’t saying words at 18 months, be sure to bring it up with his or her doctor.
Don’t just assume your child will simply grow out of it. A physical exam and a hearing test to
rule out problems is always the best first step, Camarata says. Then a speech pathologist can
check for language disorders.
Worth mentioning here: Don’t let your mother-in-law, neighbor, or anybody else tell you that
this is a problem linked to poor parenting, vaccines, a nutrient deficiency, or environmental
toxins. None are true, says Camarata.
Pay attention to more than your child’s language.
Besides language, other behaviors can provide important clues to what’s wrong (or not). For
example, can your child understand what’s said to him? Follow some simple directions? Do
pretend play? Communicate with gestures? Make sounds? Kids with these “receptive language
skills” tend to be smart and do talk eventually—just not on time with their peers.
All kids learn at different paces. Some are more verbal and social. About 15 percent learn in a
more visual-spatial-analytical way. And these kids—much more often boys—tend to also
be late talkers.
They often share other traits too:
 Good at puzzles
 Little “escape artists” (good at getting out of cribs, rooms)
 Curious about how things are put together
 Like hands-on learning
 Clever problem solvers
 Slow to potty-train (ages 3 or 4, rather than 2 or 3)
 Strong-willed
 Left-handed
Many of these kids later prove extra-proficient at math and science; some become early readers.
(Camarata’s own son, in third grade, was doing fourth- and fifth-grade math but first-grade
reading.)
At the extreme end of the spectrum of this learning style is what’s been dubbed “the Einstein
syndrome.” The name comes from the famed physicist, who didn’t speak ’til age 3 and still
wasn’t fluent at 9 but proved no slouch in the smarts department. There seems to be a trade-off in
the brains of these precocious kids: less verbal focus but amazing reasoning and analytical
abilities. Other famous “Einsteins” include Nobel winners Richard Feynman and Gary Becker,
pianists Arthur Rubenstein and Clara Schumann, Virginia Woolf, and Winston Churchill.
Beware of “Silicon Valley syndrome.”
“Most kids with this more visual-spatial-analytical learning style aren’t necessarily geniuses;
they’re in the middle,” Camarata told me. “But because they’re late talkers, some people may
assume there’s something wrong with their thinking ability.”
A new wrinkle he’s been seeing is what might be called “Silicon Valley syndrome.” Many late
talkers’ parents are engineers, computer scientists, accountants, and others in similar analytical
professions. (In one of his studies, more than half the dads of late talkers had analytical
occupations, compared to less than 13 percent of the total labor force.) Music and medicine are
over-represented too.
Living in affluent areas, these families tend to be quick to access help (a good thing). But they
get caught up in the rush to diagnosis and steered to early intervention programs for problems
like ASD—which aren’t good for kids who don’t really have autism, which is itself often an
unreliable diagnosis in toddlerhood.
A 2007 University of North Carolina study found that almost one in three kids who had been
diagnosed with autism at age 2 did not fit that diagnosis at age 4.
“My big fear is that we’re making that whole learning style—kids with a visual-spatial-analytical
learning style—into something kids need to be treated or medicated for, that’s not really
clinical,” Camarata says. He’s seen a “huge change” toward this over the three decades he’s been
practicing.
“Early intervention is good if it’s for the right problem.” he adds. “But if not, it can deflect
or derail the natural development for that child. It’s not easy—we don’t have good answers.”
If you’re given a diagnosis, ask HOW it was made.
Given how often late talking is misidentified as something else—and the perils of treating the
wrong thing—it’s really important to understand the process used to diagnose your kid.
Too often, Camarata says, clinicians make a confirmatory diagnosis. It goes like this: Not talking
at 2 is a flag for autism. What are other signs of autism? Tantrums, ignoring parents, being shy of
strangers, a toe walk. Check, check, check. The problem is that these things are common in all
toddlers. They don’t necessarily confirm being on the spectrum. A differential diagnosis, teasing
out the cause from other possible causes, is more time consuming but critical.
In the past, autism wasn’t identified until kindergarten, by which point tantrums and anti-social
behaviors would stand out as being developmentally unusual. But since the American Academy
of Pediatrics began recommending autism screenings for all toddlers at 2, more false-positives
are turning up, Camarata says.
What helps:
 Ask if the label would apply if the child were not a late talker.
 Ask what other explanations have been ruled out. Beware that late talking also tends
to get mis-labeled apraxia (a very rare condition) and hyperlexia (basically, early
reading).
 Encourage experts to use plain English. When you hear terms like “pervasive
developmental disorder” or “social deficits,” say: “Are you saying my child has
intellectual disabilities?” “Are you saying my child has autism?”
 Don’t let yourself be talked into (or bullied into) an explanation or a treatment plan.
Keep asking questions.
 Get a second or third opinion—from practitioners who don’t work together. Experts
who can help include developmental-behavioral pediatricians, neurologists, child
psychologists, and speech-language pathologists.
 Ask the practitioner what percent of kids that he or she sees are diagnosed with
autism or apraxia. If it’s almost all of them, be sure to get another opinion.
Be sure you’re getting the right early intervention.
Clearly, identifying autism or other disorders early is useful. But a big problem with a wrong
diagnosis of late talking is that it sets your child down the wrong path for treatment.
New findings on early brain development seem to show that the brains of some late talkers, who
are otherwise normal, may just be organized differently. Forcing them to talk before their brains
are ready—or just as bad, treating problems that don’t have anything to do with their actual
needs—can set them back.
If the cause for late talking isn’t certain at age 2 or 2 and a half, treatment should focus on
teaching the child how to talk, Camarata says. (If it’s really autism, other features will become
more apparent with time.) He recommends avoiding oral muscle exercises (like stimulating the
tongue with an electric toothbrush), rubbing brushes on the arm, chelation therapy, blowing
bubbles, wearing headphones, brain-training computer games, special diets, or other treatments
that are either disproven or irrelevant to talking. And parents should always be invited to be part
of any treatment, never excluded.
Remember also that half of late talkers will start talking on their own. Ever hear of kids who
“outgrew” or “aged out of” autism? Camarata told me he wonders whether these were kids who
were misdiagnosed in the first place. “You can improve autism, but the core features stay there,”
he notes.
Trust your gut
What if you’re told it’s autism but you don’t believe it? What if you’re told it’s nothing but have
a lingering sense that something isn’t right? Keep asking a lot of questions, advises Camarata.
Especially with autism, you want to be sure the clinician is using the latest diagnostic language,
which was revised in 2013. Asperger’s syndrome, processing disorder, and sensory integration
deficit are no longer widely accepted, he says.
Sometimes it simply takes time to figure out if late talking is a symptom of a problem or just a
stage. As your child grows older, a diagnosis will become clearer.
If your late talker is among the majority who eventually wind up speaking normally—and on
some days, never stop talking—you may marvel that you ever worried so. It’s always right to be
concerned and to seek the right explanation, Camarata says. Just don’t let your understandable
concerns rob you of the present moments with your child. Late talking may be a phase, or not,
but your child is only a toddler and a preschooler once.
About the Author: Paula Spencer Scott
Paula Spencer Scott is a mom of 4 and step-mom of 2—and the author or co-author of more than
a dozen books about parenting, health, and eldercare, including Bright From the Start; The
Happiest Toddler on the Block; Like Mother, Like Daughter; and Surviving Alzheimer’s.
NOTE: This article was originally published on Kinstantly.
Photo: Timothée thinking/Flickr