Speech Comes First... Or does it?

On average, most doctors, SLP’s, and other healthcare professionals subscribe to the known milestone of children getting their first word around the age of one. All children are on their own timeline, whether they are neurotypical or neurodivergent, so not having a word at one isn’t necessarily a cause for panic. Developmental milestones let us know what tends to happen, but doesn’t always indicate a problem if the timing is “off”. There are other things that we look at, too! Can they recognize familiar people and objects? Do they imitate your actions and facial expressions? Do they participate in the reciprocal nature of communication? Are they using gestures to communicate? These are all very important preverbal skills, many of which are also coming online leading up to this one year mark. 

But first–shameless plug: if you ARE worried, SLPs everywhere are ready and willing to help you support your child. Speech and language therapy inhibits nothing and early intervention is beneficial for everyone regardless of your child’s place on the developmental milestone timeline.

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Back to your regularly scheduled program: I hear the phrase “speech comes first” often. Usually it has good intentions behind it, a deep desire to understand and communicate with a child who is having a hard time getting their needs met. What is often forgotten is that speech is largely a cognitive process. There is a lot of thinking involved in speech and communication, not to mention the background knowledge to know what to say when and for what, and also the muscle memory required for correct productions. It seems like the easiest thing because we, as adults, have become experts in communication. In most cases, communication is effortless, save the public speaking event or neurodivergent experience that does not always easily or comfortably navigate socializing. But, generally speaking, communicating our basic wants and needs as adults is usually not as stressful as it is for the child who has no words at all. Which is exactly why everyone wants speech to come first. As a speech therapist, I believed it did, too. Until I didn’t.

In my first outpatient clinic position, I had a client who was on the schedule to receive speech and occupational therapy (a co-treatment). I still remember his name, but we’ll call him Arlo because I like that name. And HIPAA. Arlo was extremely dysregulated and did little more than cry and scream at the top of his lungs in response to any interaction from myself or the OT. He was somewhere between 12 and 18 months old (my memory has never been fantastic). As a newer SLP, I was doing my thing. Talking. My colleague, and the OT in the session, turned to me and said that I couldn’t talk, that it was too much right now. I didn’t understand at that moment because how could I possibly be a speech therapist and not TALK? Feeling defeated, I heeded her advice because I didn’t know what words to say anymore anyways. After a few pushes on the swing, her to me to her and back again, Arlo stopped crying. He looked around the room, looked at each of us. He smiled. He pointed. Arlo took a deep breath. I learned a huge lesson that day and I’m so grateful she was brave enough to kindly tell me to be quiet. Talking doesn’t come first. Regulation comes first. Connection comes first. Trust comes first. 

When we have these things–regulation, connection, trust–then we can access our cognitive skills. Language is a cognitive skill and talking won’t always come first. Check this post out to learn about supporting language development so it's less like searching words on an I-Spy chaos board in your child's brain: https://www.cradletotable.com/post/template-how-to-write-a-tips-blog-post

If you have any questions or comments, leave them below or send me an email at kknowsley@cradletotable.com