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How James (3) Learned to Say Three Magic Words




The gift of speech is one that we often take for granted. Being unable to truly express ourselves, especially as children, can make us feel disconnected from the outside world.


Meet James


This is what it must have felt like for James, who was a 2 ½-year-old boy when he came to one of our Rite Care Centers in September. When our licensed, board-certified speech-language pathologists examined him for the first time, they found that his vocabulary was severely limited for his age.


He was only using about 100 words. And James had not yet been able to string two of those words together. Instead, James would mostly communicate by pointing or leading a family member to show (instead of speak) what he wanted. His mother believed that he seemed to understand everything, but that he just could not vocalize himself!


James was falling behind on some of the normal milestones for kids his age. Take a look at these common childhood milestones for children between the ages of 2 and 3:


  • They should understand the differences in meaning (“go – stop”, “up–down”).

  • They should be able to follow two-step commands (“Get your cup and put it on the table”).

  • They should have a word for almost everything.

  • They should be able to use two- or three-word sentences (“Mommy go bye-bye”).

  • They should be able to name objects to ask for them or to direct attention to them.

  • Their speech is understood by familiar listeners most of the time.

  • They should be able to produce the speech sounds “h,” “w,” “m,” “n,” “p,” “b,” “t,” and “d”.



At 2 ½, this could be an indication of a more serious disorder that is impairing James’ ability to speak. When we look at the childhood milestones of children his age, he is well below average compared to his peers. Children at the age of 2 ½ should have a vocabulary extending to about 450 words. They should also at least be able to string 2 to 3 words together.


Children with a speech delay like James has could be caused by things like:


  • Limited exposure to words: If a child is not surrounded by a variety of words as they are developing, this could have a serious impact on their speech. Since they are not hearing the words daily, they will never learn them. This includes both spoken and written words.


  • Physical impairments: There may be problems with the physical structure of the child’s speech production centers. For instance, a cleft palate or a short frenulum can affect speech. However, these issues are usually diagnosed by a pediatrician before a child begins to speak.


  • Childhood apraxia of speech (CAS): This speech disorder is caused by malfunctions in the area of the brain responsible for speech production. The child may have trouble controlling their lips, tongue, or jaw.


  • A language disorder: The child may be suffering from a receptive, expressive, or mixed language disorder. A receptive language disorder may be present if the child has trouble understanding what they are hearing or reading. An expressive language disorder is when the child struggles to express their thoughts and ideas through spoken or written words. It is also possible the child has a mix of both disorders.


  • A developmental delay: The problem may simply be a developmental delay. This means the child is continually behind in learning compared to other children his or her age.


  • Hearing problems: Suffering from hearing loss could delay speech. The child should see a qualified audiologist if this is suspected.


  • Ear infections: Chronic infections can cause a speech delay since the middle ear is constantly inflamed and irritated. The child would need to see a qualified Ear, Nose, and Throat (ENT) specialist to determine if this is causing the delay.


Since the cause of James’ speech delay can come from a variety of different directions, he needed to see a licensed speech-language practitioner to understand and diagnose his condition. And that’s what our speech-language pathologists did!


James progresses:


Fast forward to the present today. Since his first exam, James has been going to individual therapy sessions twice a week for a half hour each. It is no mystery whether he enjoys these sessions; we find him anxiously waiting for his therapist’s arrival, peeking his head out as he sits in his waiting room chair. He cannot contain his excitement!


And for a good reason. His speech skills are quickly progressing in the right direction, and his family has noticed a big difference in the way he communicates. Even though his first visit was not that long ago, James has already increased his vocabulary from 100 to over 300 words! He is also able to join two words together, and sometimes even three!


And speaking of joining three words, James has learned three of the most magical words that will melt any heart: “I LOVE YOU!” He now leaves every session with a friendly wave of goodbye and these three oh-so-precious words filled with gratitude.


Help Children Blast Through Speech Impairments


If you’d like to help children like James blast through their speech impairments and start communicating more functionally, consider donating to CASRF. These donations will go straight to our many speech-language programs, including the Rite Care Center James went to! There is nothing more rewarding than seeing the difference these services make in a child’s life. Donate today!


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