When A Child's Silence Isn't Golden

MALINDA Boyd is increasingly worried about her 18-month-old son, Ryan. At 15 months, Ryan said absolutely nothing. Now he has a handful of words--"mama," "dada," "duck," "ball"-but far fewer than the norm for his age. Ryan's pediatrician has suggested that he be tested for a speech delay, but Boyd has resisted, concerned that her son will be labeled developmentally impaired simply because he's not talking as much as his playmates. "I think he'll talk when he's ready," she says. "You've got to give kids a little room to grow and be themselves."

Not long ago, giving children like Ryan a little room would have been routine. Parents of 2-year-olds who were barely saying single words, let alone simple two-word sentences, were reassured that the child would "outgrow it." Speech therapy was reserved for severely disabled children, such as those with autism or cerebral palsy. But today toddlers who have what developmental specialists call "expressive language delay" are at the center of a heated debate over whether they need speech therapy. Research has shown that early speech and language disorders can lead to later difficulties learning to read, write and spell. As a result, some pediatricians and preschools have abandoned the wait-and-see attitudes and are recommending intervention for children whose language development raises red flags (page 21). "Now if we see a child faltering at all," says Jean Mandelbaum, director of All Souls, a Manhattan nursery school, "we recommend an evaluation." But others see speech-language therapy as unwarranted treatment for a problem that will likely clear up on its own. "It can get them talking a lot faster," says Grover Whitehurst, a specialist in language delays, "but after a couple of years you can't tell the difference between kids who had early intervention and kids who did not."

No one knows why children like Ryan (the majority of late talkers are boys) don't speak. "It's often a big mystery," says Patricia Walsh Kaye, a Manhattan speech-language pathologist. Hearing is an obvious suspect: even mild loss from ear infections can slow comprehension and thus the ability to speak. High-risk pregnancies involving drugs or alcohol interfere with normal brain development. Environment may play a role, too: some children do not speak because nobody speaks to them.

For parents, the mystery is less what caused the problem than how to know when it's serious. There can be huge variability in speech and language development. By 18 months most children have a vocabulary of about 20 words. By 2 they're forming two-word sentences ("Mommy juice"). What if the child is nowhere close to passing these milestones? If she shows good comprehension and uses gestures to communicate, she is probably still on target for language development, lack of words notwithstanding. Talking will almost certainly come soon. Doctors' real concern centers on toddlers who do not understand simple questions or instructions.

Proponents of early intervention worry that kids who appear to be just delayed speakers may end up having more severe speech and language problems later. They're also concerned that toddlers who are frustrated at not being able to express themselves could develop behavior problems. Denying treatment, they say, is not the answer. "I'd rather err on the side of putting a kid in therapy who might outgrow it," says Pamela Rollins of the Callier Center for Communication Disorders in Dallas, Texas.

Not all would agree. It is difficult to tell, argue researchers, whether in the long run speech therapy actively helps or simply goes along for the developmental ride. One speech and language specialist, Rhea Paul at Portland State University in Oregon, found that of children under 2 who were not talking, about two thirds showed continued delays at 3. At 4, half did. But by kindergarten 75 percent of the children had caught up with their peers, scoring within the normal range-albeit at the low end-for language expression. "They are making slow progress all along," says Paul. "It's likely they will be able to function more or less OK by the time they get to kindergarten--even without intervention."

The debate is far from over. In the meantime, Malinda Boyd is hoping Ryan will outgrow his problem--and that soon enough he'll be talking her ear off.