Even after Emilie Montgomery's three-year-old son, Fraser, was diagnosed with a language disorder, the comments kept on coming: Boys are late talkers. Why bother with a special preschool? He's just a late bloomer.
But a decade later, when her two-year-old started having similar speech problems, Ms. Montgomery got her daughter therapy almost immediately after she was diagnosed. And nobody tried to tell the Vancouver mother that Elise was just a late bloomer. "Parents today are so much more informed," Ms. Montgomery says.
Early screening and testing efforts for speech and language disorders aimed at much younger children have increased dramatically in recent years, fuelled in part by a wealth of information for parents available on the Web or at the pediatrician's office. At the same time, researchers have targeted the mental and physical development of children less than two-years-old as a fertile area of study, largely because of the potential for effective early intervention.
Up to 15 per cent of Canadian children have developmental or behavioural problems, says speech and language pathologist Shirley Leew, who has been conducting research on the subject with the Calgary Health Region. But only 20 to 30 per cent of those children are being identified before they start school.
For parents, the emphasis on early testing can be daunting, heightening the natural anxiety they feel when their child is not the first baby on the block to walk and talk. "Even by 3, a child can be behind," Dr. Leew says. "There's so much competition between parents - 'My child's talking.' If yours isn't, you don't want to talk about it."
Some parents, especially new ones, remain unconvinced of the benefits of testing, Dr. Leew says. "They think, 'I don't want to know. I'll just wait a little longer to see. If there's something wrong, it's my fault.' "
Efforts to root out and treat developmental problems earlier in childhood have proliferated. In Vancouver, a program to remind pediatricians to watch for red flags resulted in a 200-per-cent increase in the number of referrals to the public health agency Vancouver Coastal Health, says Sue Wastie, a speech and language pathologist.
"We're getting children referred at a year or 18 months," Ms. Wastie says. "When I first started 20 years ago, it was wait and see and they'd be ready for kindergarten and not talking."
Some health clinics are using a detailed developmental questionnaire that parents can complete at a computer terminal, print out and take to regular appointments with a public health nurse. The goal is to involve parents in better identifying struggling children early on.
Dr. Leew is overseeing a pilot project with two such computers at Calgary health clinics. "Research shows that parents know," she says. "They can, in a reliable way and valid way, tell you when something's wrong."
Public health officials in New Brunswick have rolled out an initiative with similar goals. Parlez-Moi/Talk to Me, which started in 2004, consists of educational workshops about early language skills in venues such as daycares, seniors' residences, community kitchens and shopping malls - not just places where children would be.
"We're not fishing in the ocean for the 10 per cent of children with problems," says John Serkiz, a health care consultant with New Brunswick's Department of Health. "We want to reach everyone."
The next wave of testing could target children at even younger ages. Researchers are seeking to develop tests for children as young as 1, says Shula Chiat, a psycholinguistics professor at the City University, London.
"The earlier the better so that the repercussions for their later language development can be reduced," Dr. Chiat says.
She and colleague Penny Roy created four new play-based tests for preschoolers as part of an effort to recognize problems with "very early processing skills." These include activities that don't actually involve speaking but underpin communication.
Some researchers working in the field caution against anointing any one test as the magic answer to figuring out whether your child is hitting important milestones - if only to lessen parents' anxiety.
But despite increased efforts, experts worry they're not identifying enough children who have speech and language disorders. Diagnosing autism or other severe syndromes has taken the focus away from these more common and subtle conditions, Dr. Leew says. "It's the mild to moderate kids who aren't getting identified."
For Ms. Montgomery's children, diagnosis has meant getting a head start before reaching school age. Fraser and Elise have attended the Small Talk Centre for Language Development preschool in Vancouver to work with speech and language pathologists. Fraser, now 13, struggled with verbal apraxia - his mouth couldn't form words - and Elise, 3½, was diagnosed with word retrieval disorder.
Fraser benefited from visual therapy, such as creating the alphabet out of clay, whereas Elise is being treated with music therapy and movement to trigger language skills.
In the decade that spanned their diagnoses, Ms. Montgomery says she noticed a shifting acceptance in her community for earlier diagnosis and treatment. "If your teenager was struggling with math, you'd get a tutor. Why is it different for a toddler? It works."
Five ways to raise a smooth talker
Kristina Greig, a Toronto occupational therapist, teaches classes in sensory motor learning for parents and babies. These are a few of her tips for healthy speech and language development.
Start the conversation
Even for preverbal babies, there are ways to suggest a conversation. Rolling a ball back and forth lays the groundwork for understanding how conversations work.
Keep a running commentary to help children understand the connection between language and action. Explain emotions, too: "Mommy's frustrated right now because she dropped a glass."
When your baby makes a noise, make it a conversation. Make the noise or sound back. Don't push for "mama" or "papa." Ask for sounds he or she can pull off, such as "ah."
Once you know children have a word, try not to let them off the hook. If they know how to say milk, encourage them to use the word instead of, say, banging on the fridge door. And try to take it to the next level. When they say, "I want milk," say, "You want a glass of milk?" back to them.
Give children time to answer a question. When you ask what they'd like to drink, for example, don't jump in with a list of possible drinks. Ms. Greig says children's brains are still busy trying to process the original question, and new bits of information can be confusing.