Speech and Language Concerns

I would definitely recommend that you contact your local early intervention provider and ask for a speech evaluation for your daughter. Expressive speech delays are very common in toddlers and many of these children are understanding language at an age appropriate level, but without therapy they begin to get frustrated by not being able to express themselves and be understood by adults. The earlier you seek speech therapy the quicker she can make progress and be on the road to age appropriate expressive language skills.

I would recommend to you and her grandmother's that you try to set up situations within her daily routine where she has to use a word or make an attempt at using a word. For example, instead of having her cup where she can always reach it, place it out of reach and when she points to it ask "what do you want?", "Do you want your cup/juice/milk?" "Tell me cup/juice/milk". Or when getting dressed "Do you want to wear the red or the pink dress?" Praise her for any attempt and don't withhold items if she cannot say the word or becomes overly upset or frustrated, but do give her ample to time to attempt a verbal response. Give her choices whenever possible, such as "Do you want to read the book or play with the baby?" If she points to the baby, re-phrase it for her and say "Oh, you want to play with the baby!" "Use your words, tell me baby" and again praise for any attempts even if she only makes a "b" or "ba" sound. Be a good speech role model and put all her single words back into sentences for her. If she says "ball" you say "Yes, you are playing with the red ball".

Keep a word list on your frig and share it with her grandmothers, so they can encourage her to use the words she currently has and do not accept pointing if she can say "book" she needs to use the word book before getting it. For words she already knows you can be a bit more persistent in with-holding items until she uses the word. Sing songs and leave words off, such as "Twinkle Twinkle" and sing "Twinkle, twinkle little ___" and see if she will attempt to sing "star" to fill in the missing word. Use books and name pictures for her and say "I see an AP-PLE" exaggerate words and sounds for her and allow her to look at your lips/mouth as you form words or use a mirror and have her look at her own lips/mouth as she attempts to make sounds. You can play silly word games such as only repeating sounds "la" "ma" "ba" "ta" or break words apart and have her repeat each syllable and then try to put the word together such as "Ca-at"= cat or "p- ig"=pig. Encourage her to repeat fun sounds like animal and environmental sounds "woof woof" "meow" or "beep beep" "whooo whoooo". To strengthen muscles needed for speech you can encourage her to drink from a straw rather than a sipper cup or use an open cup. Blowing bubbles or blowing a piece of paper across a table using a straw is also good oral motor play. This is the link for contacting Early Intervention Services in your state.

I am also happy to hear that you do have the option of enrolling him in a special education preschool and obtaining therapy for him, which is great and what I would recommend. I would definitely say that if you cannot find an English speaking speech therapist than do continue with his speech therapy in German. At home you can continue to speak English to him and benefit him by being a good English speech role model, pronouncing words and sentences clearly for him, expanding single words into sentences for him, etc. I would also suggest that perhaps you and your husband look into finding some German language tutoring for yourselves so that you can help your son with learning German as well. You don't need to be fluent in a language to help a young child, since you will simply be naming simple pictures in book for him or objects around the house for him. It might help you at home if he is mixing languages and for example says the German word for "help" so that you know what he is trying to tell you. Ask your child's teacher for a list of the German words or phrases they use commonly at school, see if they can help you out with some phonetic pronunciation and hang it on your refrigerator for easy access. If your son is having difficulty with articulation in English, you can check out this article for help on our website. This is also a great article on early bilingualism that may give you some tips. It will be beneficial for your son in the long run to know two languages even if it takes him longer to learn both.

In the meantime you can continue to be a good speech role model for your daughter, expanding on any single words she says by putting them into a sentence for her. For example, if she says "ball", you can say "Yes, you found your red ball". You can break words apart and see if she will make attempts to repeat them, for example "ba-by", see if she will attempt single syllables, then have fun putting the word together. Make sure you gain her eye contact when speaking to her, so she can watch your lips and mouth as you form words. You can give her choices during playtime or meals instead of always asking yes/no questions and hold the toys or food items by your face to encourage her to watch your face/mouth as you speak, such as "Do you want juice or milk in your cup?" or "Do you want to play with the dolls or bike?". Do encourage her to imitate fun sounds such as animal sounds and environmental sounds, such as the car goes "beep, beep" and the cow says "moo". Sometimes kids will imitate fun exclamatory sounds such as those more readily than nouns like cup or ball. Also use music and familiar songs like Wheels on the Bus to motivate her. Use mirror play so she can watch her own lips and tongue move during speaking. You can play games making funny faces and sounds in the mirror with her to encourage imitation. You will find more ideas and suggestions at these links on our Early Intervention Support web page: Speech - 24/36 months and Speech.

Also, many two year old and older children continue to have articulation errors that are expected and considered "normal" since production of speech sounds is developmental in nature and many children continue to work on more difficult sounds and blends up until age 8. Enlarged adenoids often cause nasal blockage and in turn children will mouth breathe excessively, often snore at night and may have trouble smelling or even breathing properly. Enlarged adenoids and tonsils can even be related to sleep apnea in some cases. Because of the nasal blockage, enlarged adenoids can cause children's speech to sound as if they have a cold all the time, which could be why your son's speech is sounding "muffled" since you went through this experience with your other child. I would definitely discuss your options with your physician, mention your concern about his speech and see what he/she recommends. If you do not have his adenoids removed or even if you do and you still have concerns about your son's articulation skills at age 3, then you might choose to contact your local preschool early intervention provider or a local speech clinic to have your son's articulation skills assessed. You can check our speech and language page for what is typical for a child of 2.5. This is also a link for a 0-3 Early Intervention Program in your area if you choose to contact someone before your son turns 3.

In the meantime you and your family can continue to be good speech models for your son by pronouncing words correctly for him. Don't draw attention when he mispronounces a word, but simply pronounce it correctly for him in a sentence back to him so he hears it correctly i.e., "Yes, you are eating SPAghetti". You can exaggerate initial sounds for him or make silly games of making sounds back and forth such as "PA, PA PA", "TI, TI, TI", or the snakes goes "ssssssss" etc. You can use his books or cut out pictures from magazines to make matching games of pictures with similar sounds. Blowing bubbles is a great oral motor strengthening activity and if you are using sipper cups, switch to a straw cup whenever possible, since sucking through a straw is a much more mature oral motor movement than suckling through a sipper spout (which is more like a bottle).

Before age 3 we do not look at articulation or how clearly words are pronounced. So for example, if your son is saying "gog" for dog or "paghetti" for spaghetti and using the same word approximations for the same objects this is still within the norm, as many toddlers are still having trouble blending sounds together and may leave consonants off the beginning or ends of some words. If your son is using only "no" and "uh-oh" consistently and not imitating new words or combining 2 words together within the next month or so you may want to schedule a speech evaluation from early intervention just to rule out any problems. Your doctor should be able to give you information on how to access your local early intervention provider. You can also check the Speech 12-24 months link on our website for more speech tips/red flags.

Also be aware that the "r" and "s" sounds are not addressed until around age 8 and should not be a reason for speech therapy at the preschool age. If you daughter has not had her hearing tested it is always a good idea to see your pediatrician to rule out that her hearing has any impact on her articulation skills.

You can also help her with pronunciation by playing games that involve breaking words apart and slowing them down for her, if she has trouble saying "Sam", but can say "ssss" and "am" separately, let her practice that way. You can use similar words such as "Sad" or "Sat" and break them down for her, asking her to repeat "ssss" then "ad" and finally the full word. When your daughter says a sound incorrectly you should repeat the word using the correct pronunciation, but do not force her to say a sound or word she is not ready to produce. You can also blow bubbles with her using a bubble pipe and encourage drinking from a straw (not a cup with a spout type lid) to strengthen muscles needed for speech. You can cut pictures from magazines to make games using pictures with similar sounds as well.

If you are still concerned in the next few months or if your child's preschool is concerned and your daughter is becoming increasingly frustrated by not being understood, you may wish to contact a licensed speech therapist for an evaluation of her articulation skills to see if she is eligible for therapy.

Hopefully these resources will get you started in the right direction for helping your son acquire a means of communication.

You can also read more about typical speech skills for 2-3 year olds here: http://www.earlyinterventionsupport.com/development/speech/24-36months.aspx If after reading these articles you have further questions regarding your son's speech and language skills please contact us again and we will try to help.

You may also wish to consult your pediatrician and have her hearing re-checked to rule out any impact on her speaking so loudly. You can search for a private speech therapist in your area by entering your information at this link: http://www.asha.org/findpro/ They will provide you with a list of licensed therapists in your area. Since our therapists work primarily with the birth to three population, I can't give you specifics on what the therapy would entail, but I hope the above information is helpful.

Since your son is not quite two, you may want to give him a bit more time to progress with his speech skills, but if by 25-26 months your son is still using a lot of jargon (babbling things you don't understand, but using the inflection of speech), has not increased his single word vocabulary to 50+ words and is not starting to combine words into two word phrases you may wish to have him evaluated by a speech and language pathologist. This may be a link to services in your area: http://www.alphavistausa.com/earlyintervention You can review our sections on speech skills for 12-24 months and 24-36 months for ideas and tips to enhance speech development, as well as red flags: http://www.earlyinterventionsupport.com/development/speech/12-24months.aspx http://www.earlyinterventionsupport.com/development/speech/24-36months.aspx

Many toddlers still have difficulty with initial or ending sounds or even pronouncing words that have more than one syllable such as banana as you mentioned. You will often hear toddlers say "nana" for banana or "paghetti" or just "ghetti" for spaghetti, but by being a good language role model you are always pronouncing the word correctly for them, so they can see and hear you say it. When your son says "nana" you reply "Yes, you want a BAnana" stressing the initial sound for him, but there is not need to correct him or point out that he is saying it incorrectly as this may only frustrate him. You can even break the words down and practice beginning, middle and ending sounds with your son for words with more than two syllables,by having him repeat after you as a game "ba", "na", "na". You may    also hear toddlers say "boo" for blue or "cacker" for cracker or "scare" for square and this is also typical since many toddlers will particularly have difficulty with words which involve blends such as "bl, pl, cr, sp, fr, pr, sq, and st". It is helpful again for you to slow down and let your son watch your lips and hear you say these sounds as he attempts to imitate you. You can also use a mirror during speech play so he can see his own lips, tongue and mouth form the sounds and words. As your son approaches age three, if you are not seeing improvement in his ability to pronounce beginning sounds of words or you or the day care staff are still concerned with the clarity of his speech, then you may want to seek an evaluation from a licensed speech pathologist to look at his articulation.

They should be using gestures to communicate as well, such a pointing or gesturing to get wants/needs met. For example, if your son's cup is on the table and he can't reach it, he should be gesturing or pointing to it and vocalizing (even if not using true words) to get your attention that he wants his cup. He should also be following a few simple commands such as "Get your ball" or "give me the book". I am glad your son enjoys books and this is a wonderful way to encourage language with him simply by letting him turn pages and having you identify pictures for him. Encourage him to point to or pat pictures as you name them and be a good language role model for him by expanding on any sounds or words he may say. For example, if he says "ba" when he sees a ball, you can say "You found the red ball!". You can also use music and finger plays to encourage speech, such as singing "Itsy Bitsy Spider" or "Wheels on the Bus" using hand gestures.

I would also recommend to start moving away from the bottle and teaching him to drink from a non-spill straw cup to help with speech production (it's also better for his teeth). If your child has mastered using a regular sippy cup with a spout lid, then speech therapists recommend using a straw cup and eventually moving to an open cup rather than always relying on sipper/spout cups. Drinking from a straw or open cup is a much more mature oral motor movement and is more beneficial for speech production than sucking from a bottle or spouted cup. When a child constantly uses a regular sippy cup their tongue tends to rest under the spout, which promotes tongue thrust, which can sometimes have adverse effects on speech or articulation skills. A straw cup promotes lip closure, oral moto control and strength. If you would like more suggestions on how to promote independent walking skills you can refer to this link, where we have answered several recent questions on the topic: http://www.earlyinterventionsupport.com/commonquestions/asktherapist-development.aspx.    If your son is soon walking independently and by 17-18 months you    have not seen any increase in his single word vocabulary, you may    wish to have a speech therapy evaluation through your local early    intervention provider. Here is a link to services in your area: http://www.therapycenterforchildren.com/parents-rights.html

Many toddlers still have difficulty with initial or ending sounds or even pronouncing words that have more than one syllable such as banana as you mentioned. You will often hear toddlers say "nana" for banana or "paghetti" or just "ghetti" for spaghetti, but by being a good language role model you are always pronouncing the word correctly for them, so they can see and hear you say it. When your son says "nana" you reply "Yes, you want a BAnana" stressing the initial sound for him, but there is not need to correct him or point out that he is saying it incorrectly as this may only frustrate him. You can even break the words down and practice beginning, middle and ending sounds with your son for words with more than two syllables, by having having him repeat after you as a game "ba", "na", "na". You may also hear toddlers say "boo" for blue or "cacker" for cracker or "scare" for square and this is also typical since many toddlers will particularly have difficulty with words which involve blends such as "bl, pl, cr, sp, fr, pr, sq, and st". It is helpful again for you to slow down and let your son watch your lips and hear you say these sounds as he attempts to imitate you. You can also use a mirror during speech play so he can see his own lips, tongue and mouth form the sounds and words. As your son approaches age three, if you are not seeing improvement in his ability to pronounce beginning sounds of words or you or the day care staff are still concerned with the clarity of his speech, then you may want to seek an evaluation from a licensed speech pathologist to look at his articulation. Hopefully this information was helpful to you.

The child may also have non-speech characteristics such as feeding difficulties, drooling, and oral motor (mouth/tongue movement) is not coordinated. CAS occurs when the brain tries to tell the mouth parts needed for speech to move certain ways but the brain signal is interrupted and the accurate movement does not occur.

Often CAS is not diagnosed when the child is very young (usually 3 years or younger) because of the developmental level needed for evaluation. The speech language pathologist should conduct an oral motor assessment where the child imitates or follows a request for mouth movements and how the mouth moves with specific sounds asked. The therapist also examines the child's melody of speech and how the child produces single sounds, sound combinations, words, phrases and sentences. There are formal tests that the therapist may also use.

I would take your child to a certified (CCC-SLP) speech language pathologist who specializes in apraxia and childhood speech/language disorders for a re-evaluation. He is at an age that he should be able to participate in the evaluation.

I found a website that lists therapists in your area and several note apraxia and childhood speech/language. Go to www.asha.org. Scroll down to Quick links, Click on "Find a Professional Near You" Type in your city and state and you will see therapists pop up. Click on the therapist's name or company's name and it will list the areas they specialize in. When you find a location you like request a therapist that has experience with apraxia if you feel your child fits this description.

I would continue to encourage your child to point to items to get his needs met. I would try to use any form of communication to keep him from being frustrated and to be able to get his point across. You can also use sign language, pictures and augmentative communication systems are sometimes used to assist with speech/language while the child is working on oral language.

Since your son was an early reader, he may have begun his reading skills by recognizing site words. Preschool level books are more concrete and word use is common. While reading to your son, you may have pointed to words as you spoke which could have helped him begin to recognize those words. It maybe he is seeing a site word within word he is reading and saying site word instead of actual word. Example of this would be recognizing "cat" within word "catch". Seek advise and counsel from your son's teacher and school reading specialist to determine if he is reading phonetically. Good foundation of reading skills are crucial at this time in his education.

In regard to rocking self to sleep at night and humming during test taking, these are common behaviors used to self-regulate, calm, and/or organize. We use self-regulation in order to attend and /or adapt to demands of our day whether that maybe to find strategies to relax a busy mind for sleep or to rev up to the challenges of testing. If these behaviors do not interfere with daily activities, routines, or cause disruptions in group activities, I would not be concerned. However, if you feel it is causing disruption speak with an Occupational Therapist. Pediatric therapy clinics will be a good resource within your community.

Some possible reasons for a mild low frequency hearing loss could be hereditary/genetic or viral infections. You noted she is having difficulty with k, g and ch sounds. These sounds are not considered low frequency sounds, vowel sounds are in the lower frequency. A common difficulty for children with mild to moderate hearing loss is leaving end sounds off words (final consonant deletion) and omission/distortion of blends, fricatives (f,th,s,v,sh,z) and affricates (ch,j). If your daughter has not had an evaluation by a certified speech language pathologist I would recommend that also. The speech pathologist and audiologist would work well together to determine a plan that is most appropriate for your daughter.

When children have an older sibling, it is common for speech to be delayed, especially if the older child talks a lot. The older child will often talk for the younger child when the child wants or needs something. This can delay the younger child's speech. Several suggestions for this situation: 1) Try to set aside specific time every day (15-30 minutes 1 or 2 times a day - or more if possible) when you can have focused time with your younger child; 2) Interact with your child in an activity he enjoys, such as playing with a ball or trucks. Model one word for your child and encourage him to imitate the simple word. If he is unable to imitate the word, encourage him to produce a sound related to the activity. Praise him for any sound or attempt he makes; 3) Encourage your older child to help in "teaching" the younger child. If the older child is old enough, have him try to help the younger one make sounds, say simple words or perform oral motor activities such as sticking out his tongue, blowing raspberries, etc. You can also explain to the older child that the younger child has his special times to "talk."

With regard to the pacifier, I would suggest stopping/reducing the time your child is using it. If your child is using the pacifier throughout the day, I would suggest reducing the use to only sleep times, and eventually weaning off the pacifier altogether. If the child has the pacifier during wake times, it does hinder speech production and oral motor movements.

It is very positive that he is pointing to objects/things he wants. This is a form of communication because he is exchanging with you. When he points to the object, you should name it and encourage him to imitate the word/sound. It is very easy to give the child what he wants without encouraging this, but really focus on having him make an attempt to "tell" you with a sound, a head nod (yes/no), a word, or simple sign language.

These are some suggestions for you to try. If you continue to have concerns, you should address them with your child's pediatrician and schedule a speech and language evaluation with a speech-language pathologist, who can determine if there's a need for therapy.

Just as his sitting eventually developed, often we see the same with language. It may take a little longer, but he will continue to make gains. I know you are concerned about his lower receptive language score (5 months delayed) but one positive is that he is still above his expressive language score (10 months delayed). We (SLPs) do show concern when the expressive language score is above the receptive language score because all through life we know more than what is expressed so the receptive score should remain above the expressive score.

If he is not receiving speech and language therapy, I do recommend it. Also, if you begin to see any regression, please speak with your doctor and neurologist.

It sounds like you have been trying to work with your son's teacher, which is the key first step. Positive collaboration with his teacher and other school personnel is crucial in shaping your son's behavior. Has your son's teacher shared with you what interventions they are trying at school with your son? Is a record kept of when and how often these behaviors occur throughout the day and what happens directly before and after each behavior that may be a trigger or a clue as to why he is behaving in this manner? Have you had contact with other professionals or counselor's at his school for advice? I would suggest talking to your son's guidance counselor or the principal if you feel you are not getting your son's challenges appropriately addressed by his classroom teacher and see if together you can create a plan to modify your son's behavior so that his classroom experience is more productive and positive. Switching schools would indeed be a last resort, but if the personnel at the current school are not willing to work with your son for a positive outcome, you may want to seek out one that will.

Secondly, I would suggest conferring with your son's pediatrician for a referral for a behavioral/psychological evaluation for your son to rule out any underlying issues that may contribute to your son's behavior at school, especially if you are seeing the same behaviors occurring in your home as well.

Be aware that many, many things can affect a child's behavior such as a specific learning disability or diagnosis, as well as changes in the home environment (moving, divorce, death in the family, marital tension), lack of sleep, diet, bullying by classmates, even temperament (shyness, fear). Sometimes behaviors such as the ones you report (lying, using bad language, acting out) are a way to get attention because the child does not have the social skills necessary to gain attention in an appropriate way and has learned through repetition that these behaviors get adult and peer attention quickly, even if it is negative attention. Sometimes children need social skills training so they can learn what is and is not appropriate for their age and grade level.

In any case, a system of consistent rules with rewards and consequences both at home and at school may be helpful for your son. Let him earn rewards for doing positive tasks, so that he can build some self-esteem and feel good about himself. But, when a rule is broken (such as he is caught in a lie or says a bad word) stick to your guns and a reward or privilege should be taken away. Make things fun, use charts for chores or homework or to target a specific behavior and at the end of the week if all requirements are met reward him with something special (going for ice cream, playing a video game for an extra 1/2 hr, etc). Try to praise him anytime he is being "good" or speaking positively so that he learns to associate attention for positive behaviors, not negative behaviors. Role play can be affective with elementary age kids, meaning you pretend to be your son and he can pretend to be you or his teacher...you tell a lie or act out as he does and then have him tell you how that makes him feel. Many young kids are not aware how their behavior affects others and role playing can make them more aware of other people's feelings, as well as their own. Also, if your son is able, have him keep a journal each day, encourage him to write about things he did and how he felt when things happened to him...it can be a way for him to reflect on his actions and a way for you to gain insight into why he acts the way he does.

Here is a link you can use to print a free behavior/reward chart (on the left side of the page there are links to many other charts that may be helpful to you).

Assuming that the pediatrician has been addressed, there are no other medical complications, and a speech and language evaluation has been recommended, you can choose which provider you want and what fits your income/insurance/needs. You need to be sure that the therapist is licensed (CCC-SLP) or is a clinical fellow with a supervisor (CFY-SLP). There are also therapists who specialize in bilingual therapy (English and Spanish especially).
These children do have several factors that could put them at risk for being slightly delayed: twins, boys, and prematurity. Not all twins, boys, and premature children are delayed, but they can be at risk.

Also, with two or more languages spoken in the home, the children's brains are working harder to distinguish and learn the languages (both in comprehension of words and how to use the words). With children who are learning two languages, it is fine for the parents to use both of the languages. When children seem to be having a difficult time learning either of the languages, usually therapists recommend that one parent speaks one language while the other parent uses the other language with the child. This allows the child to focus on one language at a time. Once the languages begin to be easier for the child, the parents can begin to use both of the languages again.

I am familiar with the Baby Bumble Bee series and think they are a good series. I have worked with several families who have really enjoyed them.

Some ideas for activities for the parents/caregivers are:

• Each parent plays the same activity with the children but at different times. (Example: In the morning, Mom plays ball or trucks with the boys using language 1. In the evening, Dad does the same activity using language 2. The kids will hear the same words but in different languages (Ball: bounce, throw, hit, big, little, etc. Trucks: big, go, fast, slow, colors, etc.)
• Each caregiver reads the same book in their language at different times ' you do not always have to only read the words in the books. Look at pictures and name the objects, actions, and emotions in each language. c. One caregiver helps kids get ready for breakfast using their language to name/describe the items (cup, drink, plate, fork, spoon, food types, etc). The other caregiver uses their language during supper.
• One caregiver helps kids get ready for breakfast using their language to name/describe the items (cup, drink, plate, fork, spoon, food types, etc). The other caregiver uses their language during supper.

These are just several suggestions. Your speech pathologist will be able to provide more.

I once saw a single mother who did not want to speak English in the home but wanted the kids to learn from other examples. In this situation, be sure to have the child involved in play groups, a preschool group, a library story time, etc. If it is a single-parent home, try to find a friend or another family member who can help.

These are some recommendations for your family. Please be sure to talk with your doctor and speech/language pathologist regarding your concerns. Thanks again for your question.

There are several books I can recommend for bilingual language:

• 7 Steps to Raising a Bilingual Child- by Naomi Steiner and Susan Hayes
• Raising a Bilingual Child-  Barbara Zurer Pearson, Living Language
• There is also a general article on line at http://iteslj.org/articles/rosenberg-bilingual.html

If you do have concerns regarding the language development of your children please speak to your child's doctor and have an evaluation by a speech pathologist.

The speech language pathologist will be able to evaluate your child to determine if there are expressive language delays, receptive language delays, oral motor delays and/or feeding delays. They can also observe play skills and social skills to determine if they are within normal limits. If your child is showing delays in an area a plan will be developed to determine what goals should be addressed to advance his/her skills.

To examine expressive language the therapist will observe how the child communicates his wants/needs (pointing, sounds, words etc.) If a delay is found the therapist could focus on improving oral communication, gestures/sign language, simple communication devices or other methods of communication depending on the child's needs.

Receptive language is what the child understands is being communicated to him/her. Examples of this are (following simple directions, identifying specific people/objects, identifying simple body parts etc.) The speech therapist should identify if the child is delayed and work on improving comprehension through play and various activities.

Oral motor skills are needed for sound production and feeding skills. There are many techniques to improve these skills such as increasing tongue mobility, lip closure, chewing, moving through textures etc. depending on the problem areas.

You noted your child is not playing with toys. I would focus on increasing his/her interactions with you. Have him make sounds with you, play patty cake, peek-a-boo etc. If he participates in these games incorporate a ball or car into the play. You lead play with the toy and see if he will imitate. If his motor skills are effected you can help move his/her hands/feet so your child is able to experience the action for play.

We recommend talking with your child's doctor and a pediatric speech language pathologist (SLP) regarding your concerns and having a speech language evaluation. If speech therapy is recommended the SLP should be able to provide suggestions regarding what toys/activities would be appropriate for your child to improve development in areas of delay.

By age 2 1/2 we generally like to see a vocabulary of at least 50 words, and that list should increase weekly, so that by age three a child has 100 or more words. Saying "no" to most questions is fairly typical for children at your son's age, even if he really means yes. He should also have begun to ask you some "wh" questions such as "where go?", "what that?" etc. It sounds like your son is extremely active and since speech is also a motor task involving complex movements of the tongue, lips and jaw, sometimes children who are putting all their energy into gross motor activities (running, jumping, climbing) are quieter during play or talk less or later because all their motor energy is going to one place-physical activity.

You can start offering him choices during meals and playtime to encourage him to use words instead of just babbling or pointing to get wants and needs met. For example, at dinner ask "Do you want juice or milk to drink?" If he is not yet saying either juice or milk, you can accept him pointing to one or the other and then put it back into a sentence for him "You want milk to drink for dinner tonight". Whenever your son says a single word, always expand on that word for him so he can hear it in a simple sentence. For example if he says "ball", you say "You threw your red ball". Being a good speech role model is always helpful.

If there are words your son cannot yet say, and you see him pointing or gesturing for things, you may want to think about building in a few simple sign language signs into his vocabulary, especially if he gets frustrated by not being able to tell you what he wants. Using signs paired with a word helps young children learn new vocabulary words before they can physically say them. Once children have mastered the spoken word the sign typically fades away. A speech therapist can teach you a few simple signs if this would be helpful to your son. If he is not yet pointing to body parts or following through with simple directions such as "Bring me your shoes" or "get the book and put it on the table" then your son may also be having some difficulty with receptive language-either understanding it or processing what is said to him. We do not start to look at articulation (clarity of speech) until a child turns 3, but by age 3 we like to see children be understandable by adults and other children at least 80% of the time.

Since your son is already nearing preschool age, I would definitely try to get an early intervention speech evaluation or a private speech evaluation set up for your son as soon as possible to assess his expressive and receptive language skills and determine if he is eligible for therapy.