Should I Be Concerned About My Child’s Speech and Language Development?
By Cari Ebert, M.S., CCC-SLP
Having children and watching them develop new skills is as rewarding as anything else we do as parents. We cherish our children’s achievement of milestones from their first tooth to their first step, but hearing a child speak his first word is like music to our ears!
What should we do if those first words don’t come or if our child’s speech is difficult to understand? Do we take the “wait and see” approach, or do we seek answers to our questions? Many of us turn to the Internet to try to find information about our concerns and answers to our questions. However, that can be an overwhelming experience for concerned parents. While the Internet may provide some answers, it often creates more confusion and more questions because of the over-abundance of information available.
I would like to speak directly to parents who are concerned about their child’s development of communication skills and provide you with some information regarding communication milestones, red flags, and strategies to enhance your child’s speech and language development.
It is important for parents to be aware of general time frames for communication milestones. Remember that skills are developed in age ranges and that all children develop skills at different rates. If your child is missing one or two skills in an age range, it does not necessarily imply that a delay is present. Consulting with a pediatric Speech-Language Pathologist (sometimes called a speech therapist) is the best way to determine if there is reason to be concerned.
Speech and Language Developmental Milestones
Birth to 6 Months
Makes cooing sounds
Makes eye contact with adult
Smiles and laughs
Expresses pleasure and displeasure by vocalizing
Makes sounds when talked to
6 to 12 Months
Says 1–2 words by first birthday
Babbles many different sounds
Participates in speech games such as “pat-a-cake” and “peek-a-boo”
Responds to own name
Says “mama” or “dada”
Shouts or vocalizes to gain attention
Understands the names of familiar objects
Says 5–15 words
Imitates new words
Indicates wants and needs primarily by pointing or grunting, but words are emerging
May leave off the final sounds of words (says “ca” for “cat”)
Imitates several animal sounds
Follows simple one-step commands
Can point to 3–4 body parts on self
Understands at least 50 words
Says 50 words by 24 months of age
Understands at least 300 words
Speech is about 60% intelligible by 24 months of age
Speech is more intelligible to parents than to less familiar listeners
Imitates animal sounds, car sounds, and other noises during playtime
Starting to put the sounds on the ends of words (now says “cat” instead of “ca”)
Imitates two-and three-word phrases
Points to 5 body parts
Says 200 words by 30 months of age
Understands about 500 words
Speech is 70% intelligible
Starting to combine 2 words together frequently
Names pictures in books
Understands and uses action words
Says 500 words by 36 months of age
Understands about 900 words
Speech is 80% intelligible
Asks and answers simple “wh” questions (e.g., where, why, when)
Talks in two-to three-word phrases consistently
Can count to 3
Says first name
Speech is easily understood by all listeners
Talks in complete sentences
Says first and last name
Asks and answers a wide variety of questions
Can now carry on simple conversation with others
Speaks in complex sentences using phrases, such as “If . . . then” and “. . . because . . .”
Can speak of imaginary conditions, such as “I hope . . . ”
Understands common opposites (hot/cold, up/down)
Carries on elaborate conversations
Tells jokes that may not make any sense to adults
Now that you have a basic knowledge of communication milestones, let me provide you with some warning signs about when to be concerned about your child’s speech and language development.
When to Be Concerned . . .
• No back and forth sharing of sounds and smiles by 6 months of age
• No babbling by 9 months of age
• No true words by 12–15 months of age
• Limited eye contact at any age
• No pointing to request something or identify things of interest by 15 months of age
• Does not follow simple one-step commands by 18 months of age
• Does not verbally imitate the names of familiar objects by 18 months of age
• Uses mostly vowel sounds and very few consonant sounds after 18 months of age
• Relies primarily on gestures and grunting to communicate after 18 months of age
• Does not say at least 25–50 words by age 2
• No two-word meaningful phrases by age 2
• Excessive drooling even when not teething
• Leaves off many sounds at the beginnings or ends of words after age 3
• Not using three-word phrases by age 3
• Does not ask or answer “wh” questions by age 4
• Not using complete sentences by age 4
• Stuttering after age 4
• Voice quality is always hoarse, even when not sick
• Consistently sounds as if talking through the nose (hyper-nasal)
• Child is frustrated, embarrassed, or disturbed by own speech at any age
If you suspect a speech and language delay, there are two initial steps you should take. First, it is always a good idea to have your child’s hearing formally evaluated by a pediatric audiologist. If your child has a history of frequent ear infections or fluid in the middle ear, this can contribute to speech and language delays.
Second, if you have significant concerns about your child’s speech and language development, it may be beneficial to have an evaluation completed by an ASHA (American Speech-Language-Hearing Association) certified Speech-Language Pathologist (SLP). Every state has an early intervention program for infants and toddlers (ages birth to 3), and every school district has an early childhood program for 3-to 5-year-old children. You also can contact your local hospital or a private speech therapy clinic in your area for an evaluation.
As a parent and your child’s primary teacher, there are many things you can do to help your child learn to communicate more effectively. Below are ten strategies you can use to stimulate your child’s speech and language development. The main goal of these strategies is to instill in your child the need and the desire to talk. Many children can make their wants and needs known by pointing and grunting. They need to be shown that language is a critical component in influencing the actions of others.
Language Stimulation Strategies
• Don’t anticipate your child’s needs. Wait for him to communicate to you that he wants something. When your child walks into the kitchen, don’t automatically assume he wants a drink.
• Be a good language model. Modeling is the most important strategy that we use to help children learn to talk. We need to model language that is easy for young children to understand and imitate. To become a good language model, try using the following techniques when you talk to your child:
—Use short, simple phrases.
—Speak slowly and deliberately.
—Repeat words and phrases frequently.
—Get down to your child’s eye level so he can see how you move your tongue and lips.
—Use an animated voice with lots of inflection.
—Pair words with what your child is seeing or doing.
—Avoid asking “What’s that?” or instructing your child to say words.
—Praise your child for trying to say new words, but don’t put pressure on him to perform.
—Do not withhold things from your child if he doesn’t say the words you want him to say.
• Encourage your child to imitate actions and sounds. Imitation skills are crucial for the development of speech and language.
• Expand on your child’s words. When your child says something, repeat back what he said, adding one or more words. Like building with blocks, build on his original words.
• Name objects in your child’s world to help expand his vocabulary.
• Sing with your child. Singing facilitates good listening and imitation skills, which are necessary for the development of language. The key is to slow down; use a reduced tempo when you sing, which will help your child to be successful.
• Model for correction. When your child says a word or phrase that is incorrect, repeat what he said, using the correct form. Do not expect your child to say it again. Just model the correction for him (e.g., child says “Look at the wabbit” and adult says “I see the rabbit”).
• Prolong difficult sounds. When your child has difficulty producing certain sounds, prolong those sounds when you say words, both to draw attention to them and to increase his auditory awareness (e.g., child says “Big nake” while pointing to a snake and adult then says “Yes, big ssssssnake”).
• Pause and wait. Once you have modeled a word for your child, you should pause, wait, and look expectantly at your child to give him an opportunity to talk.
• Give choices. Avoid asking too many questions that can be answered with a “yes” or “no” response. Instead, give your child choices between two items to encourage him to use his words (e.g., instead of “Do you want a cookie?” try “Do you want cookie or yogurt?”).
Effective communication equips us to interact, socialize, and learn. If you have concerns about your child’s speech and language development, I encourage you to follow your instinct and seek help to find some answers to your questions. As parents, we can easily be overcome with worry. The best advice I can give you is to stay positive and don’t get frustrated. Learning to talk is a marathon, not a sprint!
Cari Ebert is a pediatric Speech-Language Pathologist in private practice. She and her husband Jim homeschool their three children, and she is the author of the recently published small talk, a homeschool diagnostic and teaching curriculum for young children who demonstrate speech and language delays. For more information about Cari and small talk, please visit her website at www.homeschoolsmalltalk.com.
Copyright 2009. Originally appeared in The Old Schoolhouse Magazine, Summer 2009.
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