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From the Baby's Point of View

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Tantrums and Speech Problems

My youngest son (27 months) has always been behind in speech. A few months ago I realized that he only used about 10 words. Twice Early Childhood Intervention has evaluated him and they said that his communication is much improved...he is up to 20 words now (which don't include basics like bye-bye, milk, juice, and water). I worry that he can’t yet put two words together.  We’ve tried signing but with little luck (he finally signs “please”). The ECI team will reevaluate him in a month. We’ve also met with the apraxia specialist who will reevaluate him at 21/2. Our family doctor is supportive and willing to refer us to in-house speech therapy. I just don't want to waste their time if my son is simply a late talker.

I am most concerned about his temper tantrums. He has 5-6 per day, some of which last over an hour. My gut tells me the tantrums are related to his communication problems: he knows exactly what is going on he just can't express it. Our doctor also just attended a presentation of yours and thought you might have some good suggestions.

Should I continue to pursue interventions or does it make more sense to see what happens at 2 1/2? How can we manage the temper tantrums and restore some calm in our home?

Your concerns are not wasting anyone’s time when your child and family are in distress!

Some of your ambivalence may stem from the mixed messages you receive: school districts are extremely restricted as to whom they can serve. By (frustrating) design, “best practices” compete with the district’s financial incentive to limit its exposure to the costs of our country’s under-funded mandate for special education.

I encourage you to get a referral for a speech therapist while you wait for the next apraxia evaluation. The individualized attention and strategies your family will gain from this will also build your knowledge and ability to observe your son, which will be useful in that evaluation. Meanwhile, you might also consider:

• Helping him communicate with a photo board of common items and feelings.
• Reducing the number of words you use when speaking to him. For example: “Shoes off.” “Want cookie.” Or “So mad.”
• Continuing to use basic sign language.

For many toddlers, their frustrations of not being able to communicate can escalate into tantrums.  And, while helpful growth spurt or period of developmental equilibrium might be just around the corner,  tantrums that consume the majority of your time merit prompt attention. 

Working with your primary doctor is a great first step. Consider your son’s medical history, any changes in his environment, and his ability to regulate sleep, eating, his social engagement skills, and problem solving abilities.  It might be helpful to gather some of this information by using a screen measure like the Ages and Stages Questionnaire - Social Emotional.

It’s easier said than done, I know, but the key to managing tantrums is to prevent yourself from getting too engaged while keeping your child safe. Does he like to be held when he’s upset? Either way, stay close and calm, and decrease stimulation like light and sound. Reduce your words. “I am here.” “You’re mad.” Acknowledge that he can have and is done with the tantrum “All done mad.” Having a parenting partner at these times can really help. Keep us posted.