Realizing early that your toddler may have a speech-language or developmental delay is key in increasing the chances for improving communication skills down the line, preventing him from falling further behind.

"[Find out] as early possible because you don’t have to play so much catch up. You avoid problems with frustration and further delay," says Frances Grahamjones, a certified speech-language pathologist from Berkeley, Calif. Grahamjones urges parents to take action as soon as they think their child may not be talking properly or may be exhibiting signs of a development problem.

"If they have delays it will affect how they learn," says Grahamjones. "Early intervention addresses all the areas of a child’s development, not just speech and language but social, gross motor [skills] ... and emotional."

According to the American Speech-Language-Hearing Association (ASHA) in Rockville, Md., if a child doesn’t talk by age 1, the speech is not clear or if speech or language is different from that of other children of the same age, there may be cause for concern.

It’s estimated that 2 percent of all children born each year will have a disabling condition, including speech or language delays, ASHA reports. While many may believe speech-language treatment cannot and should not begin until a child begins to talk, ASHA says children know a great deal about their language even before the first word is said.

The first thing to look for – even before children become toddlers – is eye contact and strong social skills, from age 3 months on, Grahamjones says. By the age of 6 months, a baby should be babbling, carrying on and having conversations in "baby talk."

But by 9 months, parents should hear the changing consonants in the baby’s speech, she says.

Early identification of problems includes an evaluation and treatment provided to families and their children younger than age 3 who have, or are at risk of having, a disability or delay in speech, language or hearing.

Mindy Hudon, a Massachusetts certified speech-language pathologist, encourages parents to listen to their own instincts and to seek help if they have a concern, even if their child’s doctor says the child will "grow out of it" or says that some children simply talk late.

"Doctors who are saying wait till [the child] is 3 – that’s the old school,” says Hudon, who often works with infants and toddlers. “You don’t want to do that. You want to get to them as soon as possible. I don’t think a child’s ever too young to get going if there’s a problem. I would encourage parents just to get them evaluated. ... If they take care of it now it’s not going to affect them when they get to school. ... The sooner you get to them, the better."

Hudon says children should be talking by 18 months and should be able to follow directions, such as "get the ball," even before they start talking. If not, they may not be hearing well or it could be a sign of a developmental delay.

According to the U.S. Department of Education, many toddlers express the following language skills at specific ages:

12 to 18 months – They say their first words. They understand a few words and simple directions. They know their own names. They will give you a toy if you ask for it. They create long babbling sentences and look at a picture book with interest. Contact a professional if your toddler at this age does not say more than a few words clearly.

18 to 24 months – Toddlers put two or more words together to make short sentences such as "want juice" or "car go." They learn words quickly and can copy adult sounds, words and motions. They ask and answer simple questions. Contact a professional if your child at about 20 months cannot follow a simple request, such as "Come to Mommy," or if your 24-month-old does not use two words together.

24 to 36 months – They listen to stories and like to play pretend games. They ask "why" questions and use "no" and "not" a lot. They enjoy looking at picture books, turning pages and naming objects they see. Contact a professional if your 2-year-old does not ask questions or respond to simple questions with "yes" or "no."

Who Should Be Evaluated?
ASHA recommends children identified as at-risk or high risk, such as those from neonatal intensive care units, should be tested early and regularly.

Other risk factors include children who have had chronic ear infections, or who have been diagnosed with Fetal Alcohol Syndrome, genetic defects such as Down syndrome, neurological defects such as cerebral palsy or developmental disorders.

"With toddlers, the first thing to look at is [if they are] hearing," Hudon says. "Are they startling to sounds? Are they looking toward sounds? Are they hearing your voice? Are there a lot of ear infections? Frequent ear infections can actually make your child hear [like he’s] under water. It does and can affect speech development and sound productions."

Children with no high-risk factors should be evaluated if their speech and language is not similar to other children of the same age, ASHA recommends.

What Is an Evaluation?
Evaluations may include a number of tests, observation of the child at play and a collection of speech samples, if the child talks. Several sessions may be needed to obtain enough information to make a diagnosis by professionals such as speech-language pathologists, audiologists, psychologists and neurologists.

What Is Speech-Language Treatment?
It depends on the diagnosis. Remediation efforts, however, increase function in areas identified as delayed or disabling and may prevent other related problems, according to ASHA. For instance, the remediation of a language disorder can help offset learning difficulties.

Most often, treatment takes place in a natural setting and is presented at the child’s developmental level. Play may be used to teach communication, language models or rules of conversation, such as turn taking.

Where to Get Help
ASHA recommends that parents concerned about a possible speech-language delay or disability consult a speech-language pathologist.

The organization also recommends that parents ask the following questions when seeking treatment:

• Are you licensed?
• What age groups do you work with?
• Do you primarily work with particular speech, language or hearing disorders? What are they?
• How soon can my child be seen for an evaluation?
• Once evaluated, is there a waiting list for treatment? If so, how long is it?
• Do I need to be referred to your program by a particular source such as a community agency?
• Once evaluated, will you be able to anticipate the amount of time needed for treatment?
• How much do you charge?
• Will my insurance pay for the evaluation and for some or all of the treatment?
• If you cannot work with me, whom would you suggest I contact?

Some Tips for Parents
Hudon recommends that parents continually talk to their toddlers, pointing out planes and cars as they pass by, or talking to the child as they prepare to cook in the kitchen, such as saying, "Mommy’s getting an egg out of the refrigerator," as she does so.

"Always talk about what you are doing, the sounds you hear," she says.

Sometimes older siblings of toddlers will often speak for the younger child. Hudon says parents should discourage this and try to get the information the toddler is trying to communicate from him directly.

She also recommends that parents use verbal communication at all times to "talk" with their toddlers. For example, if the toddler walks up to the parent and hands the parent a cup without saying anything, the parent should ask what the child wants, not assume the child wants more milk.

"If they say ‘more,’ say, ‘Tell Mommy more milk,'" Hudon says.

She also recommends correcting a child’s pronunciation, such as if a child says they want a "tookie," to say, "Oh, you want a COOKIE," carefully enunciating the word "cookie."

Programs for Parents and Their Toddlers
While there are several programs in public schools where school-age children can get help, parents who want to intervene early may look at programs like Parents as Teachers (PAT).

PAT is an early childhood parent education and family support program for parents of children from birth to age 5. PAT provides parents not only with information on child development but with parental involvement in parent-child activities that encourage language development and intellectual growth as well as social development and motor skills, according to the St. Louis-based organization. PAT offers programs in cities throughout the country.

The program works with parents through certified parent educators who make home visits as well as encourage parents and their children to participate in the program’s group meetings and playgroups. Parent educators also help parents understand appropriate expectations for each stage of their child’s development and offer ideas to encourage learning.

"Parents as Teachers educators are not diagnosticians – we leave that to physicians or specialists," says Jenni Loynd, who coordinates training for PAT educators. "However, because we talk to parents about their child's typical development and meet with parents every two weeks to every two months, we often notice atypical changes or lags in a child's development. When we have concerns, typically we will ask the parents how they feel, do they have any concerns about anything, have they noticed such and such, what does their doctor say, will they observe and take notes on a specific aspect of development."

Loynd says PAT educators observe, listen, share information and gently guide parents to specialists or community resources when there is a concern.

"We also provide annual developmental screenings if the parents desire this," Loynd says.

One parent, Sue, whose name was changed to protect the identity of her child, noticed a change in her child when he was 18 months old.

"He stopped talking. He had had 10 words or so," says Sue, a St. Louis physician. "Then he stopped making good eye contact with us and it seemed hard to get his attention."

Sue, who already was involved with PAT, says at the time, she had just had another baby and her pediatrician said her son probably regressed in his development because of the arrival of the new baby and to wait it out.

"[The doctor] ... kind of blew me off," she says.

By the time her son, now 3, was 20 months old, her PAT parent educator recommended the child be evaluated for developmental delays. He was later diagnosed to be autistic, a syndrome where children often have the inability to relate or communicate and may have many language disturbances.

"I ended up getting him speech therapy and developmental therapy by the time he was 2 years old," says Sue.

She said she believes PAT was able to help her recognize that there was a problem because the parent educators work every day with children and are looking for specific developmental benchmarks at certain ages.

"It’s just nice to have another pair of eyes look at them and say, ‘Yeah this looks normal’ or ‘this doesn’t look normal,’" Sue says. "Early intervention is the key. A lot of these kids can be normal but intervention needs to be early."

For a list of certified speech-language pathologists in your area, call ASHA’s toll-free helpline at (800) 638-8255. For a Parents as Teachers program in your area, call the PAT National Center at (314) 432-4330 or visit www.patnc.org/findaprogram.asp.

Want to see more?

• Toddlers Today Expert Q&A
• Preschoolers Today Expert Q&A
• Preschoolers Today Expert Q&A
• Talk about it!

About the author: Jennifer Newton Reents is an iParenting.com assistant editor.