Learning to speak is a complex journey, and parents often feel concern when a child’s communication development appears delayed. Understanding when a lack of spoken words becomes a clinical concern requires knowledge of typical milestones. The designation of a child as nonverbal is a clinical description used to guide intervention and ensure appropriate support is provided early in life. This designation accounts for both spoken language and other forms of expression.
Defining the Spectrum of Nonverbal Communication
In a developmental context, “nonverbal” describes a child who does not use spoken language to communicate their needs or ideas. This clinical distinction focuses on the output of speech, not a child’s intelligence or ability to connect with others. The term is part of a spectrum that clarifies a child’s specific communication profile.
Children under 18 months are generally considered pre-verbal, as they are still developing their first words. A child over 18 months who uses no words at all is often classified as nonverbal. Minimally verbal applies to children who use some spoken words, but significantly fewer than expected for their age. For instance, a child over 30 months who speaks fewer than 50 words falls into this category. Importantly, a child who is nonverbal is not non-communicative; they may use gestures, eye contact, or sounds to express themselves.
Typical Verbal Milestones and Red Flags by Age
Failure to meet specific speech milestones is the first indication that nonverbal status may be a concern. By 12 months old, a child should be attempting to copy speech sounds and may say a few words, such as “mama” or “dada.” A red flag at this age is a lack of babbling or a failure to use gestures like pointing or waving to communicate.
The period between 12 and 24 months is when expressive language rapidly expands, making 18 months a critical checkpoint. By 18 months, a toddler should have a vocabulary of at least 6 to 10 recognizable words and be able to follow simple commands when paired with a gesture. A significant delay is signaled if the child has fewer than six words or is not spontaneously learning new words.
The 24-month milestone is often the most significant marker for determining a potential nonverbal concern. At this age, children are expected to speak 50 or more words and begin combining two words into simple phrases like “more juice” or “go out.” The absence of these spontaneous two-word combinations is a major red flag, signaling a delay in developing foundational language skills.
Key Developmental Conditions Associated with Nonverbal Status
When a child consistently misses these milestones, a professional evaluation often points to an underlying developmental condition affecting speech production. The most common cause of functional nonverbal status past the age of two is Autism Spectrum Disorder (ASD). ASD is a neurodevelopmental condition characterized by challenges in social interaction and communication, which can manifest as delayed onset of speech, reliance on scripted speech, or a complete lack of spoken words.
Another prominent cause is Childhood Apraxia of Speech (CAS), which is a motor speech disorder. Children with CAS have difficulty planning and executing the precise movements of the tongue, lips, and jaw necessary for clear speech production. Unlike delays stemming from language comprehension issues, CAS is a motor planning problem that causes inconsistent errors and difficulty sequencing sounds, even if the child understands language well.
A high percentage of children with ASD also display signs of apraxia, which complicates the diagnostic process and can further limit verbal output. Severe global developmental delays, which affect multiple areas of development, including cognitive and fine motor skills, can also result in nonverbal status. Pinpointing the specific cause is necessary because the intervention strategies for a motor planning issue like CAS are different from those addressing the social-communication challenges of ASD.
Next Steps: Evaluation and Alternative Communication
If a child exhibits consistent red flags, the first step is to consult with a pediatrician for a referral to a speech-language pathologist (SLP) or a developmental specialist. A comprehensive evaluation by an SLP is necessary to determine the specific nature of the communication delay, assessing whether it relates to speech production, language comprehension, or both. Early intervention is strongly supported by research, as it can significantly improve long-term outcomes.
For children who are nonverbal or minimally verbal, Augmentative and Alternative Communication (AAC) methods are immediately considered. AAC can be augmentative, adding to a child’s existing speech, or alternative, used instead of speech. This approach provides an immediate, reliable means of communication and does not prevent a child from developing spoken language.
AAC methods range from low-tech options like sign language or picture-based systems (e.g., PECS) to high-tech devices like specialized tablets that generate speech. These tools allow children to express their wants, needs, and thoughts. Providing this reliable communication helps reduce frustration and offers a foundation for language development while the child continues therapy.