Expert: Dr. Sharon A. Mitchell - 6/20/2008

Question
Long story short, I have a 19 month old that has a ST, OT, and Dietician and is going to start with a Developemental Interventionist.  She is currently 19 pounds (very small) and is just now starting to eat food normally, but still has texture, sesory issues with food. At her last evaulations, by a team of experts, they said she has the comprehension of a 15 month old and the verbal skill of a 9 month old.  She say no words and really connects very few words to objects.  She knows what a ball is, but not daddy or mommy.  She knows what about 5 things are.  They reasured me that she is not on the autistric spectrum but her neurologist thinks she has PDD maybe. Here current therapist seem to think she has significant delays.  I am gettin very conflicted opinions from a lot of doctors.  She is very loving and does listen to simple command and follows them.  But she says no words and never has.  Her hearing is fine.  Im at a loss at what to do now.  Do I need to seek more opinions or is it normal for a 18 month old to not know the word mommy and daddy??

Answer
No, you're right that most kids at a year and a half know the words mommy and daddy and have at least a few words in their vocabulary. On the plus side though, your daughter is very lucky to have a mom so on the ball that she's involved an assortment of professionals already.

Here are a couple websites where you can see what is considered the norm for toddlers your daughter's age:

http://www.ldonline.org/article/6313

http://www.asha.org/public/speech/development/chart.htm

But you already have concerns and it sounds like you've done all the right things. Your child is still very young and already you've connected with a number of professionals who can provide early intervention. The ST, OT and dietician were excellent starting points. A Developmental Interventionist can help integrate these therapies and hopefully show you even more things that you can do in your home with your daughter.

While all kids develop at their own pace, there's generally a certain progression they go through when learning to talk. It's encouraging that the evaluation team said your little girl comprehends at a 15 month level (that's not that far behind her chronological age). Having verbal skills at a nine month level indicates that your child must be showing some babbling, some imitation of sounds, all precursors to speech.

Sometimes when children are delaying in their speech, they show behavioral difficulties (more than the "terrible two's") because of their frustrations in being unable to communicate their wants and needs. No matter how attentive and attuned you are to your baby, it's just not possible to anticipate or guess everything she wants, especially as she begins to develop her own mind. A couple ways of helping children communicate are through pictures or signs.

Here's some information on signing:

http://www.handspeak.com/index.php?home=babysign

http://www.signingbaby.com/main/

http://www.handsfirst.ca/

These sites will give you information on why and how to use pictures:

http://www.do2learn.com

http://usevisualstrategies.com/pictures.html

http://autism.healingthresholds.com/therapy/visual-schedules

http://card.ufl.edu/visual.htm

http://lindahodgdon.com/newsletters.html

http://pdictionary.com/

There are pros and cons with each system. Some children catch on to the idea that pictures represent actual objects more readily than they grasp the meaning of hand positions. For kids who have trouble with black and white line drawings, you can use actual photographs you take with your camera. Then the child can touch the picture of what she wants, choose between two pictures you show her, etc.

A drawback with pictures is that you or your child may have to hunt through a stack of pictures to find the one you want. You may not always have the correct picture with you. But with signing, you always have your hands.

Before using either methods, you might want to get your speech/language therapist's recommendations.

I'm not sure at this point if an exact diagnosis is critical. You're already accessing a nice array of help. The assistance and finding strategies that work are key; a label is often just a way to get those services. Here's a definition of PDD:

http://www.autismresourceconnection.com/documents/PDD_NOS.pdf

Whether or not your little girl has PDD may become clearer as she gets older. If you're interested, here are a couple online checklists that look at characteristics of PDD and autism spectrum disorders:

http://depts.washington.edu/dataproj/chat.html

http://www.childbrain.com/pddassess.html

http://www.brookespublishing.com/store/books/wetherby-csbsdp/checklist.htm

I'm glad that you're working with an OT and a dietician. I understand how worrying it can be when your child is very small. Our son hit the twenty-five mark when he was in kindergarten - we had a party! (He's 5'10" now.)

Although you're worried about your child, it sounds like you're doing all the right things to help her.

Best of  luck,

Sharon A. Mitchell, B.A., B.Ed., M.A.
www.autismsite.ca