When a child does not use spoken words to communicate, it can be a source of deep concern for parents. The term “non-verbal” in child development refers to a child who is not primarily using spoken language, which is distinct from a speech delay where a child might use words but struggles with articulation or language structure. It is important to understand that a non-verbal child is still communicating, often through gestures, facial expressions, or sounds. Early identification and understanding of the underlying reasons are important steps in supporting a child’s communication journey.
Understanding Typical Language Development
Children typically progress through a series of communication milestones as they grow. From birth to around 3 months, infants usually quiet or smile when spoken to, make pleasure sounds like cooing, and cry differently for various needs. Between 4 and 6 months, babies often turn towards sounds and begin to babble, repeating sounds such as “ba-ba” or “ma-ma” by 7 to 11 months. During this period, they also start to respond to their own name and may try to communicate using actions or gestures, enjoying games like peek-a-boo.
As children approach 12 to 17 months, they often understand simple commands and questions, like “Roll the ball,” and can point to a few body parts when asked. They may use one- or two-word questions and acquire a vocabulary of around four to six words, attempting to imitate simple words. Between 18 and 23 months, a child’s vocabulary typically expands to about 50 words, and they begin combining words into two-word phrases, such as “more milk.” By 2 to 3 years, children usually understand differences in meaning (e.g., go/stop) and use three-word sentences. Their speech becomes more accurate, though strangers may still find it somewhat difficult to understand. By 4 years old, most children are largely understood by non-family members.
Common Causes for Non-Verbal Communication
Several factors can contribute to a child being non-verbal. Autism Spectrum Disorder (ASD) is a common cause, where children may have significant difficulties with social communication and interaction. Around 25% to 30% of autistic children are non-verbal, and while some may develop functional language later, others remain minimally verbal. Their brains process social cues and language differently, impacting their ability to use and interpret nonverbal cues like eye contact. Difficulties with joint attention, a crucial skill for language development, may also hinder their social interactions and verbal communication.
Hearing impairment is another significant cause, as the ability to hear is fundamental for speech and language development. If a child cannot properly hear sounds or words, learning to replicate them becomes incredibly challenging. Research suggests that even non-verbal communication, like pointing, can be affected in infants with hearing loss.
Childhood Apraxia of Speech (CAS) is a motor speech disorder where the brain struggles to coordinate the complex muscle movements needed for speech. Children with CAS know what they want to say, but their brains have difficulty planning and producing the sounds, syllables, and words consistently. This results in inconsistent errors in speech production, making it hard for others to understand them.
Selective Mutism, an anxiety disorder, causes a child to be consistently unable to speak in specific social situations, such as at school, despite being fully capable of speaking in other environments like home. This condition is distinct from a general inability to speak, as it is situation-specific.
Global developmental delay (GDD) and intellectual disability can also lead to non-verbal communication. GDD involves significant delays across multiple areas of development, including speech and language, and may be linked to cognitive impairments or genetic syndromes. Intellectual disability also impacts cognitive functioning, which can affect language acquisition and the ability to express thoughts and needs verbally. Neurological conditions, such as cerebral palsy or certain genetic disorders, can affect brain areas responsible for speech production, further contributing to a child being non-verbal.
The Diagnostic Process
When parents notice their child is not meeting communication milestones, the first step often involves consulting with a pediatrician. The pediatrician will typically conduct an initial assessment and may then refer the child to specialists for a comprehensive evaluation. This evaluation often involves a multidisciplinary team, which can include a speech-language pathologist, audiologist, developmental pediatrician, and sometimes a neurologist or psychologist.
A hearing test by an audiologist is crucial to rule out or identify any hearing impairment. Speech and language evaluations by a speech-language pathologist assess both receptive language (what the child understands) and expressive language (how the child communicates). Developmental assessments, such as the Bayley Scales of Infant and Toddler Development, can measure cognitive, motor, and language abilities, along with social-emotional and adaptive behavior. For suspected Autism Spectrum Disorder, specific diagnostic tools like the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), are often used. These assessments involve structured observations of the child’s communication, social interaction, and play. When a child is non-verbal, non-verbal assessments that do not rely on spoken language, such as puzzles or drawing tasks, can be utilized to assess cognitive functioning. The diagnostic process also involves gathering detailed information from parents about the child’s developmental history and current behaviors.
Supporting Your Child’s Communication
Supporting a non-verbal child’s communication involves a combination of home-based strategies and professional interventions.
Home-Based Strategies
At home, parents can encourage communication by creating opportunities for their child to express needs and wants. This includes responsive communication, where parents pay close attention to gestures, eye contact, and sounds their child makes, and respond in ways that validate these attempts. Modeling language by narrating daily activities and using simple, clear phrases can also be beneficial. Encouraging gestures, such as pointing or reaching, and using visual supports like picture exchange communication systems (PECS) or communication boards can provide alternative ways for children to express themselves.
Professional Interventions
Speech-Language Therapy (SLT) is a primary intervention, where therapists use various techniques, including visual supports, modeling, and imitation, to enhance both verbal and non-verbal communication. They may also employ Augmentative and Alternative Communication (AAC) devices, which are tools like tablet-based apps that use images or icons for communication. Occupational Therapy (OT) can help children develop daily living skills and enhance social interactions, often integrating play to encourage communication in a natural setting. Applied Behavior Analysis (ABA) therapy is another structured approach, particularly beneficial for children with Autism Spectrum Disorder. ABA uses positive reinforcement to encourage desired behaviors, including communication attempts, and can involve techniques like Discrete Trial Training (DTT) and visual supports. Early Intervention programs, which are multidisciplinary, provide comprehensive support tailored to a child’s specific needs, often incorporating speech therapy, occupational therapy, and behavioral interventions to foster development during crucial early years.