On your first visit you ask, “Is Tyler saying any words?”
“Oh sure, Tyler has lots of words! He can say ball, mama, doggie, outside. He probably says 20-30 words!” his mother replies.
When you ask for more information, you realize that Tyler’s words are almost exclusively said in imitation after his mom prompts him. He only has 2 words that he actually uses: mama and doggie. Tyler is 18 months old.
Have you ever been in this situation? Families don’t always understand that when we (or the pediatrician) ask about how many words a toddler has, that we mean how many words the child spontaneously USES to communicate, comment, get his needs met. There is a huge difference!
Why the Answer Matters
For Tyler, if we use his mother’s estimate without gathering more information, we might conclude that Tyler is on target for his communication development. However, if we dig deeper, we will see that he actually only uses 2 words, which would be considered a developmental delay. This distinction isn’t always made during well-child check-ups at the pediatrician’s office either where the screening often relies on parent report. Relying on parent report can be a great thing; in fact, some studies have found that parent report is typically pretty accurate. The key here is asking the right question to help the parent understand what we are asking so that he or she can give us accurate information.
Knowing a child’s word count really isn’t all that helpful by itself, though. Sure, it can inform us about sounds the child is able to make and maybe even words he can understand. It also helps us identify whether or not the child has a variety of words that include nouns, verbs, and adjectives which are needed before the child begins combining words into phrases. In addition to knowing which words a child SAYS, we really need to know which words a child USES.
How Do You Help Families Understand the Difference?
Here are a few ideas:
Use specific language – Rather than asking the vague question above about whether Tyler is saying many words, a better, more specific question might be “What words does Tyler use to tell you what he wants?” Think about how you phrase questions so that your intent is clear.
Ask the next question – You might ask Tyler’s mother to tell you how he uses his words. You could ask a clarifying question like “How does Tyler use his words to talk to you?” or “Are these words that Tyler repeats or do you hear him use them on his own?”
Ask for an example – Ask Tyler’s mother for an example of when she hears Tyler use his words, like during a daily routine or activity. You can also ask about routines or activities that are a source of frustration for Tyler or his mother because he is not able to use his words.
Give pragmatic examples – You might provide Tyler’s mother with a specific example to put using words in context, like asking if Tyler uses “outside” to say that he wants to go outside to play. You could ask if he calls their family pet by saying “doggie” or says the word when he sees a picture of a dog.
Observe – Observation is always a good option when you have a child who is comfortable talking in front of or to you. We all know, though, that many toddlers are quiet when they first meet us. In that case, we must rely on what the parent tells us.
Specifically explain the difference and why it’s important – Be specific and talk about how developmentally, we want toddlers to move from imitating words to using them. Once a child can spontaneously use a word to get a need met, label something or make a comment, he or she really “has” that word. Imitating is the first step. This is especially important for children with echolalia, who often need extra help to get past the imitation stage.
Ask the parent to make a two-column list – Work with the parent to make a list of the child’s words. Divide the paper in half and list the imitated words on the left and the spontaneously used words on the right. Explain to the parent that the goal is for the words on the left to eventually move to the right. This list provides a visual example of the difference between the types of words. It’s also a great way to track progress.
What are other ways you help families understand the difference between imitated and spontaneously used words? How do you gather this information at intake and assessment?
Share your insights by leaving a comment below!
For more information about expressive and receptive communication development, visit the VA Early Intervention Professional Development Center to find these resources:
Speech and Language Resource Landing Pad (PDF, New Window)
Communication Delays & Disabilities topic page (articles, handouts, archived webinars and more)
If you know of other great resources, please share them in the comments too!