"He understands everything, he just won't talk"
This is the sentence we hear most often, and it is usually only half right. A child who follows instructions is clearly understanding something, but often less than the family thinks, because so much can be worked out from tone, gesture, routine and context without processing the words at all. Part of the first assessment is finding out how much language is actually going in, because that changes everything about what we do next.
The other thing families tell us is that everyone said to wait. Sometimes waiting is right; children do develop at different rates. But "wait and see" costs a child the years when language develops most readily, and if there is a difficulty underneath it, those are the years you most wanted. A speech assessment costs you one appointment. It is worth having.
Speech, language, and communication are three different things
Speech is the physical production of sounds: whether a child can make the sounds their language needs, clearly enough for others to understand. A child whose speech is unclear may have a full vocabulary trapped behind sounds nobody can decode.
Language is the system underneath: understanding what words mean, putting them in order, following instructions, answering a question rather than repeating it. A child can have perfectly clear speech and significant language difficulty.
Communication is broader than either. It is the intention to reach another person and the means to do it: pointing, showing, leading you by the hand, using a picture, using a device. A child who has no words yet can be a strong communicator, and building that intention is often the fastest route to speech rather than a detour from it.
Because of this, therapy for a child with no words looks very different from therapy for a child with plenty of words that nobody can understand. Both are speech and language therapy. The assessment is what tells us which one your child needs.
Working in Urdu, Pashto, Balochi and Brahui
Most children in Quetta grow up hearing more than one language, and families often worry that this is what caused the delay. It did not. Growing up multilingual does not cause speech delay, and dropping a language does not fix one. What it does mean is that a child's skills have to be understood across the languages they actually live in, not just the one used in the therapy room.
We work with families in the language of the home. Practice at home in the language you are most fluent and most natural in is far more valuable than stilted practice in a language chosen because it seemed more useful.
In practice
What a session looks like
A short settling activity your child already enjoys, so the room becomes somewhere they want to be. A child who dreads the door will not talk once through it.
Play-based work on the current target: a specific sound, a sentence structure, a way of asking. For a young child this genuinely looks like playing, because that is the condition under which children produce language.
Modelling and gentle prompting rather than drilling. We give the word, put it in a place where your child wants it, and wait. The waiting is the technique.
Where speech is not yet available, work on an alternative: pictures, signs or a communication board. These support speech; a large body of evidence indicates they do not replace or delay it.
Five minutes with you at the end, showing you exactly what we did and what to practise. Twenty minutes a week in a therapy room cannot compete with the hours a child spends with their family, which is why the handover matters as much as the session.
What progress looks like
Every child moves at their own pace, and none of this is a timetable or a promise. These are the changes families most often notice first.
- More attempts to communicate, before any of them are words: pointing, bringing things to you, meeting your eye when they want something.
- Understanding widening: following a two-step instruction where one used to be the limit.
- Single words appearing, then two words together. The jump from one to two is a bigger milestone than it looks.
- Speech becoming clearer to people outside the family, the real test of intelligibility.
- Frustration and its behaviours easing, because being understood is the thing that was missing.