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Question from a concerned grandmother: My grandson, who was 3 last March, is a happy, healthy, active child who appears on target for a 3-year-old except he is behind in verbal skills. He “jabbers” a lot but other than a very few words his speech is not understandable. When I say a word and ask him to repeat it, he does but it does not sound like what I have spoken. He appears to try very hard to speak clearly. Does he have a problem?

Yes, there is a problem. The critical question to ask is: will it go away by itself as he develops or does he need intervention.


By 3 years of age a child should have a vocabulary of 600 words with 80% intelligibility to a listener who does not know the child. This means that a person who has not previously listened to this child talk can understand 8 out of 10 words.

When should a 3-year-old be referred for speech evaluation? Evaluation is indicated if he or she has a vocabulary of 200 words or less, is not using short sentences, and has less than 50% intelligibility.

This 3-year-old has both limitation in vocabulary and few intelligible words which means he should be evaluated.


You are right in being concerned. In my practice I found that, for the most part, parents and other family members familiar with the child are pretty good developmental diagnosticians. When the family is worried about an aspect of development in a child, the pediatrician should pay attention to their concerns.

But sometimes the family is not aware of a speech delay or its potential significance. Pediatricians sometimes don’t ask the right questions. Instead of “How many words does he have?” it’s better to ask “How does he let you know what he wants?” (The answer in a 3-year-old is by using sentences) and “Can strangers understand most of what he says?” (By 3 the answer should be yes.)


Developmental Language Disorder (DLD) is the term we use for selective impairment of speech and language development in children without other manifestations of developmental delay. These children generally have normal intelligence. Hearing and social-emotional development are also normal.

Estimates of DLD incidence range from about 5 to 10% of preschool children, and boys are much more likely to be affected than girls are. Although DLD is associated with a variety of possible underlying factors, in most cases the etiology is unknown; although there is a often a family history for speech delay so that genetic factors may be playing a role.


Children with suspected DLD should immediately be thoroughly evaluated. Such a child needs a complete physical and neurological examination as well as a psychological evaluation to determine the child’s intelligence level. Hearing should also be carefully tested as the child could have a selective hearing loss which might not be noticed by the family.

When the diagnosis of DLD is made the child should be referred for immediate speech and language therapy. He will do best in a preschool that is experienced in teaching children with speech problems.

The prognosis or outcome is pretty good. Most of these children, through a combination of speech therapy, preschool exposure to other children, family understanding and involvement, as well as the process of ongoing development, will speak intelligibly by the time they enter elementary school. Some may have difficulty later with written language but this too can be diagnosed and appropriately treated.

If this were my child, I would want him immediately seen by his pediatrician who can make the appropriate referrals for testing and therapy.

Note that I have used the word “immediate.” No, delayed language is not a medical emergency like severe asthma that would require a trip to the ER. But because we are a social mammal living in a highly technological society, language is the basis for virtually everything we do.

The child who has trouble expressing himself or being understood is affected in just about all activities. Kids may not want to play with him, he may get teased, and worst of all he gets frustrated in trying to talk and be understood, so he stops trying. It’s hard to grow up human in silence.

In the old days many doctors told parents, “Yes his speech is delayed but he is a boy — just wait for him to grow out of it.” We know better now because EARLY INTERVENTION has proven to be effective.