My child isn’t talking: where to start

Your child is 2, 3 or 4 and isn’t talking, or hardly at all, and you are wondering whether to worry. Here are the warning signs, who to see in the UK and what to do this week. The main message: don’t wait for words, or for a diagnosis, before giving your child a way to communicate.

Markers: what to expect, what should alert you

Every child develops at their own pace, and language doesn’t follow an exact timetable. There are markers all the same. In typical development, first words arrive at around 12 months (Bloom, 2000, cited in Beukelman and Light, 2020). Children start putting two words together once they know about fifty, usually between 18 and 24 months (Owens, 2005). At around 3, short three-word sentences appear.

A checklist for spotting unusual development in children under 7 lists, among others, these warning signs for language:

not saying five words spontaneously at 18 months;
not saying more than ten words, or not putting two words together (‘Daddy gone’, ‘more cake’), at 24 months;
not making short three-word sentences, or not understanding a simple instruction without gestures, at 3;
speech that people outside the family can’t understand at 4;
and, at any age, a regression: words or gestures that disappear.

Whatever the age, your concern as a parent is reason enough to have your child’s development looked at carefully, and so is any regression or lack of progress. In other words, you don’t need to ‘be sure’ to ask for advice.

Who to see, and in what order?

Here are the most common first steps in the UK.

The first steps. Specialist services (child development teams, community paediatricians) come next if needed.

Your GP or health visitor. Tell them what you have noticed, with concrete examples and, if possible, short videos.
A hearing test. Deafness, even partial or fluctuating, can hold back language. It is a test to do early.
A speech and language therapy assessment. The speech and language therapist assesses understanding, expression and non-verbal communication, and can offer therapy and AAC. In many areas you can refer your child to the NHS service yourself; otherwise, ask your GP or health visitor. Waiting times are often long: get on the waiting list straight away.
Specialist services: child development teams, community paediatricians, child and adolescent mental health services (CAMHS), autism assessment teams. Your GP, health visitor or speech and language therapist will refer you if needed.
Later, support and funding: support at nursery or school, and help with equipment. The guide Funding AAC: how to prepare a funding request explains the steps.

If a diagnosis is made, carry on with Autism and AAC or Down syndrome and AAC.

Don’t wait for a diagnosis to communicate

Assessments take months. Meanwhile, your child has things to say: they’re hungry, something hurts, they want to play, they want you to look at them. Augmentative and alternative communication (AAC) gives them a way to say it today, with symbols, photos, gestures or an app that speaks (What is AAC?). Support can start before any diagnosis is confirmed.

‘They’re too little, they’re not ready.’ There are no prerequisites, and toddlers benefit too: see Myths about AAC.
‘If they have pictures, they won’t make the effort to talk.’ Studies show that AAC does not hold back speech and often supports it: see AAC and speech.

This week at home: the checklist

Print a few symbols. You don’t need an expensive device to start: a few printed, laminated symbols, placed where things happen (table, bathroom, front door), are enough for the first few weeks. ARASAAC symbols are free.
Choose words that matter to your child (family names, their comforter, favourite foods, with photos of your things and your family), plus a few little words that work everywhere: more, all done, stop, help, want, no. It’s the mix of both that works (Laubscher and Light, 2018). List and explanations: Which words to put in the tool.
Show the way. When you talk to your child, touch the matching symbols on their board (‘more bubbles!’): this is modelling, the strategy with the strongest research support. How to do it: Model, wait, respond.
Wait, then respond. Leave a real silence of 5 to 10 seconds while looking at them, then react to any attempt: a look, a gesture, a symbol touched ‘by chance’.
Not just requests. Give them ways to say ‘no’, to comment (‘yuck’, ‘wow’) or to call someone: Beyond requests.
Show what comes next in pictures. A simple ‘first / then’ (first shoes, then the park) often eases anxiety at transitions: Visual supports: schedule, sequences, timer.

An app on a phone or tablet adds a voice that everyone can hear, even from a distance: see Choosing a tool: paper, tablet, trial. Pictalk’s free vocabularies (Essential 24, Springboard 48, Horizon 80) are presented on their page.

Always keep the tool within reach

A child can’t say ‘I’m thirsty’ if their board is shut away in a cupboard: the tool goes everywhere with them, like their voice.

A fixed spot in each room where you spend time, at hand height.
A laminated paper version for times when the tablet isn’t practical: bath time, the swimming pool, play dough, the car.

Bring AAC into your routines

No need for sessions: routines come round every day, in the same order, with the same words, which is ideal for learning. Young children in fact organise their words by situation rather than by category (Fallon, Light and Achenbach, 2003). Choose one or two routines to start with, not all of them at once.

Routine	Words to model	Example sentence
Getting up and dressed	put on, take off, help, more, all done, cold	‘Shall we put on your jumper?’
Mealtimes	eat, drink, more, all done, good, not good, want	‘Do you want more?’
Bath time	water, hot, cold, open, close, stop, play	‘Is the water too hot?’
Play	play, my turn, your turn, more, look, fall	‘Your turn to throw!’
Bedtime	read, book, sleep, cuddle, light, all done	‘Shall we read one more page?’

Some words come up everywhere: more, all done, help, want. These are core vocabulary words; always keep them in the same place, so that the movement becomes automatic (Organising the grid). Add personal words to them: their little sister’s name, the dog’s name, their favourite brand of cereal. To create real reasons to communicate (a small portion to ask for more, a jar shut a little too tight to ask for help), see the ideas in Model, wait, respond.

Four symbols side by side: more, all done, help, want. — **more**, **all done**, **help**, **want**: the little words that come up in every routine, always in the same place.

A sheet for grandparents, the childminder and family

The more people use the tool, the more your child sees it working. Prepare a one-page sheet for the people who look after them:

Where their tool is, and where the important words are (more, all done, help, no, their favourite words).
How to show: talk normally, in full sentences, and touch one or two key words at the same time.
How to wait: 5 to 10 seconds, looking at them, without finishing their sentence for them.
How to respond: react to any attempt, even an approximate one, without demanding a spoken word.
The rule: the tool is never put away, and never taken away as a punishment.

Brothers and sisters are often excellent models, especially if you make it a game. To explain your child’s own gestures and reactions, add a communication dictionary: see the ‘How to talk to me’ card. For printable materials, see the resources page.

Keep the vocabulary alive

A vocabulary that never changes ends up in a drawer: lack of updates is one of the main reasons tools are abandoned (Johnson et al., 2006). Add words when they become useful: the new friend, Saturday’s trip to the zoo, the cartoon of the moment. A photo taken on your phone is enough. In Pictalk vocabularies, empty and hidden cells are built in so the vocabulary can grow without moving anything.

What to avoid

Waiting ‘to see’. Time spent without a way to communicate is hard to make up.
Testing (‘Show me the dog’) instead of having real conversations.
Putting the tool away so it doesn’t get damaged, or taking it away as a punishment: it is their voice.
Demanding a spoken word before responding to a symbol. All forms of communication count.

Frequently asked questions

My 2-year-old isn’t talking: is it necessarily serious?

No, not necessarily. Some children talk late and then catch up, but there is no way of knowing in advance: talking to your GP or health visitor is always justified, and starting AAC carries no risk for speech.

My child doesn’t touch their board: what should I do?

Keep showing the way without demanding anything, check that the words on offer really interest them, and respond to any attempt. Learning starts with watching.

Who can help me set up AAC?

The speech and language therapist is the key professional, but you can start on your own with a few symbols and modelling, then build the plan with the team that supports your child: see Setting up AAC as a team.

Pictalk Buddy brings together AAC boards, a visual schedule, guided sequences and notebooks, with the same symbols, on Android, iOS, the web and the watch. A pay-what-you-want app, developed by a non-profit association. Discover Buddy

Sources

Beukelman, D. R. & Light, J. C. (2020). Augmentative & Alternative Communication (5th ed.). Brookes. Studies cited: Bloom, 2000; Fallon, Light & Achenbach, 2003; Johnson et al., 2006; Laubscher & Light, 2018.
Owens, R. E. (2005). Language Development: An Introduction. Allyn & Bacon.
Checklist ‘Détecter les signes d’un développement inhabituel chez les enfants de moins de 7 ans’.