Expressive and Receptive Delays in Speech

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My 3 yo has expressive and receptive delays with his speech. We haven't started ST yet and by the looks of it, services wont start until Sept, when he starts school. I have been working with him based off everything I can absorb so I am do not have a professional to give some feedback. He has made progress in the 2 months we are working with him. He is in this label phase now where he realize everything has a name and either names it himself or ask what the name is. The problem I am having is, I indulged him a lot, especially when he asks for things because I wanted him to learn that when he uses his words and asks for what he wants (instead of just crying) he will get what he asks for.

This has worked too well. Now, he will ask for junk food (too much in my opinion) and when he doesn't get it, it's all tears. I am constantly redirecting him. When he cries, he will lay on the ground in a ball and suck his thumb. Sometimes, he will even hit his head on the ground. The first time he did it, I was so scared, I freaked out and gave in. I have since realized that it is a ploy. First, he doesn't hit his head hard enough to really hurt and then right after he hits his head, he will say "Ouch, I hit my head" and then come to me to hug him and hold him and even pick it him up. He realize that when he does it, I get freaked out and give in, so I have unwittenly taught him another cause and effect. These episodes usually lasts anywhere from 5-15 minutes.

I don't want to spoil him and I want him to learn how to speak, but I feel like I am confusing him and in some way messing him up. It's hard to reason with him beacause of the language barrier. I don't know how much he understands and he can express to me how much he understands. Plus, he is only 3 so he is still fairly young. I was able to redirect him from cookies to cheese today but that took about 15 minutes.

With my eldest son, I could put him in time one but with my 3 yo, timeout turns into him just laying around where he is, which he does anyway when he is stressed or bored so there is no really punishment there. I don't even think I punish him for bad behavior, I just tell him no, he shouldn't do X and then redirect. I honestly have no idea how I should be discipling him. The only 2 things I know is timeout and redirecting. I take away privalidges with my now 6yo but that wouldn't work with my 3yo.

Sorry for the ramble, but how can I reason with my 3yo who has delay in expressive and recptive language?

My son turned 3 in March, and has very little language. I'm only getting his diagnosis on Monday, so I'm not really able to specify 'expressive and receptive' language like you have, but I'm pretty sure we'll be given similar jargon! The interesting difference is that we have had services since he was about 2, when he was saying nothing at all. First he was given ST, but it didn't work very well. After a few months, she said he wasn't playing like other kids and referred him to the County Early Intervention Team. They brought him in very quickly and assessed him. They said he was too young to diagnose, but mentioned they suspected Aspergers quite early on. A play therapist and speech therapist started visiting our home in October every 2-5 weeks and try things out with him, and supply us with picture cards and things like that. Then in January, they gave us a 6 week session with a trained childcare worker, and a week later he said his first words. This term, they've given us another 6 weeks again. He still mainly uses single or double words, with very few longer phrases. His speech is also very unclear, and he's bad at copying noises we make.

Their whole system is based on the fact that the earlier the intervention, the less trouble he will have later - I find it amazing that you aren't entitled to anything until September. Surely they realise that an effort now means a kid with fewer symptoms later. I suppose different countries do things differently (I'm in Ireland), but that sounds a bit silly of them. Also, I have access to them if I need to ask them anything. I can leave a message with the receptionist and one of them will contact me within a day or two with advice.

I'm not sure if any of my experience could be of use to you, since your son already sounds like he's ahead of mine. I certainly understand the difficulty in redirecting him. They advised me to send him to a playschool nearby, and I believe they use timeout there, but I've not bothered much with it myself, as they usually only use it when he has pushed or thumped someone. What really has made a big difference with him and his behaviour is the picture systems, but if your boy is already vocal, it probably wouldn't help so much.

Thanks for your response. My son does a lot of echolalia (he is down to about 50% of his words) but he is able to ask for what he wants verbally. His speech really picked up since we started working with him 2 months ago. He was evaluated 2 months ago and this was the results that they gave us. I am trying to get summer in home ST for him. I am still waiting to hear from the Dept of Ed on this.

My problem is how to explain limits to him, when we encouraged him to ask for anything he wanted, just to get him to ask for it in words. He knows that I don't want him to have X, but he wants it still which ordinarily would not be an issue with most other children. I just need to know that he wont regress if all of a sudden we stop indulging all his wishes.

When it comes to regressing, I don't know enough to say if it's a risk. But I do know that what got my son talking was that we finally got it through to him that it was worth talking - that there were rewards in store if you communicate. In his case, the first rewards were nursery rhymes, and he told us which one he wanted using the picture cards. It took a lot longer to get vocal communication going, but it came eventually. Could you figure out some set of new rewards perhaps? Something wholesome to replace whatever things you don't want him to get. Maybe non-food, like our rhymes, or some storybooks. Another picture card they gave us later was for a variety of activities - bubbles, swing him, tickles, chasing, cars, books, balloons, etc. Maybe you could tutor him into asking for these kinds of things - a positive choice, from his point of view, instead of being denied something that you previously were happy to give him. I don't have high hopes of explaining limits to my little guy at the moment - he seems to me to be at least a year behind in speech and emotions. I would not get much across to an actual 2 yr old, after all! I would just stop him physically and redirect him firmly, so that's what I try to do, I suppose with my 3 yr old - treat him like a 2 yr old, while expecting him to become more than that eventually too, of course.

You might try to find a Hanen program to enroll in. hanen.org They are in many countries, and work with parents on how to help their children's language development. It's expensive, but I've heard from a couple of parents that it was a huge help with language delays. They also have some good books and DVD's (but apparently the class is much more than just going over the material in the books):

It Takes Two to Talk -- the very earliest stages of communication to those who have begun to talk in short sentences
More Than Words -- show parents how to turn everyday activities with their child into opportunities for interaction and communication
TalkAbility -- understand the meaning behind the words by tuning in to the thoughts and feelings of other people

I wanted to enroll in a TalkAbility course, but my husband balked at committing to a 12 week program that cost $1400.

I would say now that he has some language, it would be good to introduce some limits. If he asks for cookies, I would say, "I know you want cookies, but its time for lunch!" or if that is too complex for his age, then maybe "cookies after lunch!"

Good luck, and I agree, why are they waiting for Sept to start speech therapy? Are you in the USA?

Thanks so much for your replies. We have been working on turn taking and so to entice him to eat dinner he gets to sip some water after a couple bites. He loves to read and be read to and understands enough to bring his book, etc for us to read to him. But he likes his snacks too much so it's a fight to redirect him. Sometimes you think he forgets but then he comes back for his snacks. We have never used picture cards because books seemed to have been the thing to get him talking. That and letting him know everything has a name. Now he can name most things but I have to ask him questions in yes or no or multiple choice format. He cannot answer open ended question.

Sometimes when I speak to him I don't know if what I am saying is getting through to him. There seems to be a delay, sometimes for days, before something sinks in. And then there are times he just gets it. I just need to know how to work with him. Should I treat him the way I treated my eldest son, where I say no and that's it, or should I keep trying to explain to my 3 year old why he cannot have his way all the time.

I am in nyc which is in the USA. We have the meeting next week to sign the papers. At that point we will know if we have services over the summer. He was approved for year long preschool however the school I chose does not have any openings until Sept. So I am now trying to get the home services.

I can understand your mixed feelings about saying No when you have been encouraging him to talk but you have to set limits with him just like with any child. When it comes to limits, I think all kids need consistency but ASD kids need consistency even more. My DS would bang his head on the ground at that age too, (my NT DS did that too but at a younger age and he only did it a few times). If he is doing this in the common "I'm not getting my way" kind of tantrum, ignoring it is often the best way to stop it. Freaking out and gving in to what he is demanding is likely to make it happen more. You do need to be careful though and be sure it really is a tantrum and not something more serious he is trying to communicate. That can be the tricky part with our kids.

Also, if he has receptive language delay then trying to reason with him is not likely to be all that effective. Fewer words will probably be more effective than more words.

I am in NY too...you CAN get home services until school starts. Fight for it...waiting till sept is WAY TOO LONG in my opinion!

Yes, give limits, and agree with PP, fewer words might be best. Good luck!

Thank you for your responses. Regarding the services, I have already started writing letters. citing the recommendation of any and everyone that I came across, that he should have services. the admin is a horrible woman, but she seems to be relenting a little since I have been calling her and also writing her so much. She actually pushed up the paper signing from June to next week. She also asked me what I want and I told her speach (we are working on OT and PT at home and he is picking up everything so fast that I don't want the therapist to go back and report that he needs anything less than he was approved for). I know once he starts school, the school will fight to keep his services at the levels they are now since it is more money for them.

When he hits his head, he is not doing it hard. I see that he slows down right before he hits. Just to be on the safe side, I put a rug under his head (we have hardwood floors). He also will hit, then look at me with his puppy dog eyes and tell me "I bumped my head". I am so week because I then instinctly hug him which is exactly what he wants. He then asks for X and I say no and cycle repeats. It stops when I give him something else he likes (but not as bad as X). Should just be able to say no? I think when he starts school, he will hear a lot of "No"s so he should get used to hearing it from me. Prior to the last 2 months, I was more harsh. I said no and if he didn't do it, I would put him on the sofa in time out and we would both be on time out for 2-3 minutes. But then, he wasn't as happy, was more aloof and spoke mostly in echolalia. Maybe that's why I feel reluctant to dicipline him. I feel like I need to make it up to him for not noticing he needed help earlier and that he wasn't doing any real talking.

So, you say I should use a few words to explain why he cannot have X and then mean it. I do not need to give him something else in order to say no?

Talk to your OT about what to do when he starts hitting his head on the floor. She might have some ways to redirect that behavior. I'd be tempted to grab a pillow and say he can hit his head on the pillow until he's done, but I don't have direct experience to say whether this is the best approach. You might want to look for a behaviorist to help you as well.

The OT and Pt that we have been doing is based off what we have read. He will start real OT and PT in September. The head hitting is usually about 1-3 times he will hit his head and so there isn't much time to get a pillow under there. Usually after the first one, I will grap whatever I can reach and stuff it under his head. He doesn't do it open either, it's usally when I say no to his something he really really wants. It's more of a part of a tantrum. It freaks me out even though I see that he controls his neck so it doesn't hit as hard. Right after he does it, he looks at me for my response. Unfortunately I inadvertently taught him this by picking him up and hugging him when he does it.

I am so worried about how he will be when he starts school, based off all the bad behaviors I think I taught him.

This sounds a lot like my son. When he first started to verbally ask for things we'd give them to him but it got to the point where if he got cookies, ice cream, etc every time he said it he'd weigh 300 pounds by now.

At first we'd always try to redirect but eventually I'd just say "No" or "You had enough already."

He is 4 now and pretty much seems to be growing out of the problem.

Don't beat yourself up. That isn't good for either one of you . It really sounds like you might want to try ignoring the head banging all together. From your description it sounds like he is purposefully yanking your chain. Ignoring unacceptable behavior is a common practice and often effective as long as there is no danger in ignoring. I mean if he was banging his head to the point of really hurting himself then ignoring would not be a wise choice. Be aware that there can be nuances to this type of behavior and sometimes when you start ignoring an attention seeking behavior, it may be worse before it gets better. In that time you need to be aware that it doesn't change from attention seeking to self-harming behavior. So you kinda have to ignore while looking out the corner of your eye!

"So, you say I should use a few words to explain why he cannot have X and then mean it. I do not need to give him something else in order to say no?"
Giving him something else that is an acceptable choice is a good option. When my DS wants something that is NOT acceptable or possible in that moment, I try to offer 2 other options that are usually appealing to him. For example, "No you can't play in big brother's room right now he is doing his homework. You can play Legos or color."

Changes in behavior must be learned. You will need to keep repeating instructions over and over again to make him stop. Even if you don't see immediate results he will change.

The process is quickened if you use a strategy such as deprive him of his favorite toy etc. Eventually the 3 yr old associates the banging on head with time out/loss of privileges.

This is the fundamental rule of ABA and parents can employ these strategies. An OT will deploy similar tactics but include visual imagery such as pictures of a boy choosing to eat a carrot/fruit rather than junk food.

Eventually the kid realises happiness will be associated avoiding dangerous self stimulating behavior.

The downside is often the child swaps....head banging for teeth grinding to lip pulling etc...the triggers still induce a response - we need to work out ways to transfer the response in a positive way.

Is there a reason you are not using a combination of words and pictures (PECS) for communication? This can help with the more complex.

I could imagine having a schedule with a time for a snacks like cookies and when he asks for cookies, pick the cookies picture and put it in the snack time spot, with a picture of him where you are on the schedule now.

If he learns the picture schedule that can help him to understand what "not now, later" means. Someone who has used something like this may explain it better. If you were in front of me, I could show you, but I am having a difficult time putting my thoughts into coherent words.