FAQs about Speech-Language Therapy and Disorders
Speech-Language Pathologists diagnose and provide treatment for children and adults with a variety of speech-language, cognitive, voice, and feeding-swallowing problems.
Speech and language disorders can affect the way children talk, understand, analyze or process information. Speech disorders include the clarity, voice quality, and fluency of a child’s spoken words. Language disorders include a child’s ability to hold meaningful conversations, understand others, problem solve, read and comprehend, and express thoughts through spoken or written words.
Cheryl works with children from infancy to adolescence. If you are concerned about your child’s communication skills, please call to find out if your child should be seen for a communication evaluation and/or consultation.
There are differences in the age at which an individual child understands or uses specific language skills. The following list provides information about general speech and language development. If your child is not doing 1 -2 of the skills in a particular age range, your child may have delayed hearing, speech, and language development. If your child is not doing 3 or more of the skills listed in a particular age range, please take action and contact Cheryl or another Speech-Language Pathologist and/or Audiologist to find out if an evaluation or consultation is necessary.
Birth – 3 Months
- Startles to loud sounds.
- Quiets or smiles when spoken to.
- Seems to recognize your voice and quiets if crying.
- Increases or decreases sucking behavior in response to sound.
- Makes pleasure sounds (cooing, gooing)
- Cries differently for different needs.
- Smiles when sees you.
4 – 6 Months
- Moves eyes in direction of sounds.
- Responds to changes in tone of your voice.
- Notices toys that make sounds
- Pays attention to music.
- Babbling sounds more speech-like with many different sounds, including, p, b, and m.
- Vocalizes excitement and displeasure.
- Makes gurgling sounds when left alone and when playing with you.
7 Months – 12 Months
- Enjoys games like peek-a-boo and pat-a-cake.
- Turns and looks in direction of sounds.
- Listens when spoken to.
- Recognizes words for common items like “cup”, “shoe,” “juice.”
- Begins to responds to requests (“Come here,” “Want more?”).
- Babbling has both long and short groups of sounds such as “tataupup bibibibibi.”
- Uses speech or non-crying sounds to get and keep attention.
- Imitates different speech sounds.
- Has 1 or 2 words.
12 Months
- Responds to their name
- Understands simple directions with gestures
- Uses a variety of sounds
- Plays social games like peek a boo
15 Months
- Uses a variety of sounds and gestures to communicate
- Uses some simple words to communicate
- Plays with different toys
- Understands simple directions
18 Months
- Understands several body parts
- Attempts to imitate words you say
- Uses at least 10 – 20 words
- Uses pretend play
24 Months
- Uses at least 50 words
- Recognizes pictures in books and listens to simple stories
- Begins to combine two words
- Uses many different sounds at the beginning of words.
2 to 3 Years
- Speech is understood by familiar listeners most of the time.
- Understands differences in meaning (go-stop, in-on, big-little, up-down)
- Follows two requests (“Get the book and put it on the table.”)
- Combines three or more words into sentences
- Understands simple questions
- Recognizes at least two colors
- Understands descriptive concepts
3 to 4 Years
- Uses sentences with 4 or more words.
- Talks about activities at school or at friends’ homes.
- People outside family usually understand child’s speech.
- Identifies colors
- Compares objects
- Answers questions logically
- Tells how objects are used
4 to 5 Years
- Answers simple questions about a story
- Voice sounds clear
- Tells stories that stay on topic.
- Communicates with other children and adults.
- Says most sounds correctly
- Can define some words
- Uses prepositions
- Answers why questions
- Understands more complex directions
Birth to Six Months
- Developmental or medical problems
- Lack of response to sound
- Lack of interest in speech
- Limited eye contact
- Feeding problems
- Very limited vocalizations
- Difficulties with attachment
- Lack of interest in socializing
Six to Twelve Months
- Limited sound production, lack of variety or amount.
- Groping movements when attempting to make or imitate sounds.
- Oral-motor problems such as excessive drooling, trouble with solid foods, intolerance to touch in and around the mouth.
- Lack of interest in sounds-making toys, radios, T.V., music, voices.
- Developmental or medical problems
- Lack of response to sound
- Lack of interest in speech
- Limited eye contact
- Feeding problems
- Very limited vocalizations
- Difficulties with attachment
- Lack of interest in socializing
Twelve to Eighteen Months
- Easily distractible.
- Does not understand any words or directions.
- Limited sound production, lack of variety or amount.
- Groping movements when attempting to make or imitate sounds.
- Oral-motor problems such as excessive drooling, trouble with solid foods, intolerance to touch in and around the mouth.
- Lack of interest in sounds-making toys, radios, T.V., music, voices.
Eighteen to Twenty-four Months
- Not using words some of the time to communicate.
- No interest in imitation.
- Won’t play games.
- No jargon.
- Grunting and pointing as primary means of communication.
- Easily distractible.
- Does not understand any words or directions.
- Limited sound production, lack of variety or amount.
- Groping movements when attempting to make or imitate sounds.
- Oral-motor problems such as excessive drooling, trouble with solid foods, intolerance to touch in and around the mouth.
- Lack of interest in sounds-making toys, radios, T.V., music, voices.
Two to Three Years Old
- Not combining words
- Must be told and retold to carry out simple directions (not just non-compliance)
- Using only nouns
- Poor eye contact
- No rapid increase in number of words understood and used
- Does not tolerate sitting for listening activity/looking at books, etc.
Three to Four Years Old
- Not speaking in full sentences (not necessarily correct grammar, but nice variety of word types
- Not using “I” to refer to self
- Cannot relate experiences, even in simple telegraph sentences
Receptive language includes the skills involved in understanding language. Receptive language disorders are difficulties in the ability to attend to, process, comprehend, and/or retain spoken language.
Some early signs and symptoms of a receptive language disorder include:
- Difficulty following directions
- Repeating back words or phrases either immediately or at a later time (echolalia).
- Difficulty with answering questions appropriately
- Use of jargon while talking
- Difficulty attending to spoken language
- High activity level
- Inappropriate and/or off topic responses to questions
Expressive language includes the skills involved in communicating one’s thoughts and feelings to others. An expressive language disorder concerns difficultly with verbal expression.
Some signs and symptoms of an expressive language disorder include:
- Omitting word endings, difficulty acquiring forms such as plurals, past tense verbs, complex verb forms, or other grammar forms
- Limited vocabulary
- Repetition of words or syllables
- Difficulty understanding words that describe position, time, quality or quantity
- Word retrieval difficulties
- Substituting one word for another or misnaming items
- Relying on non-verbal or limited means of communicating
Children with social pragmatic difficulties demonstrate deficits in social cognitive functioning. Diagnostic terms include: Asperger Syndrome, hyperlexia, High Functioning Autism, Semantic-Pragmatic Disorder, Pervasive Developmental Disorders-Not Otherwise Specified and Non-Verbal Learning Disabilities.
Persons with social-pragmatic deficits have significant difficulties in their ability to effectively communicate and problem solve. Some signs and symptoms may include:
- Difficulties with personal problem solving
- Literal/concrete understanding of language.
- Difficulty engaging in conversational exchange.
- Difficulty with active listening, including participating through observation of the context and making logical connections.
- Aggressive language.
- Decreased interest in other children.
- Difficulty with abstract and inferential language.
- Lack of eye contact.
- Difficulty interpreting nonverbal language.
Non-fluent speech is typical between the ages of two and six years. It is typical for non-fluent speech to last up to six months, improve then return. A speech-language evaluation may be in order if your child exhibits any other speech and language difficulties or was a late talker. Any child who is demonstrating any “struggle behaviors” (e.g., facial/bodily tension, breathing disruptions, blocks, grimacing) should be referred to a speech-language pathologist immediately.
- Slow down your own speech to a slow normal rate; slow down own actions and adopt a more relaxed, non-hurried atmosphere for your child. Build in more time for getting ready for activities and changing activities.
- Make sure your child has adequate rest and is healthy. Attend to allergies.
- Chart your child’s “stuttering” to see if a pattern can be determined. Videotape or audiotape your child once a month to obtain an objective assessment of disfluencies.
- Encourage conversation on a “good day”. On a day when your child shows many disfluencies, ask more “yes/no” questions which require shorter answers and direct your child to “quiet” activities if your child prefers not to talk.
- Listen patiently to your child and encourage other family members to refrain from interrupting.
- Do what works to encourage fluent speech. Don’t be afraid of the stuttering. Your attitude will be conveyed to your child. Fluent speech is like any other sill to be learned and can be encouraged. Contrary to popular belief, many things parents say naturally (e.g., slow down, start again) help their children. Sensitivity and patience is the best approach.
Articulation is the production of speech sounds. An articulation disorder is when a child does not make speech sounds correctly due to incorrect placement or movement of the lips, tongue, velum, and/or pharynx. It is important to recognize that there are differences in the age at which children produce specific speech sounds in all words and phrases. Mastering specific speech sounds may take place over several years.
Phonology refers to the speech sound system of language. A phonological disorder is when a child is not using speech sound patterns appropriately. A child whose sound structures are different from the speech typical for their stage of development, or who produce unusual simplifications of sound combinations may be demonstrating a phonological disorder.
Signs of a possible articulation/phonological disorder in a preschool child may include:
- Omits medial and final sounds
- Is difficult to understand
- Stops many consonants, little use of continuing consonants such as /w, s, n, f/
- Limited variety of speech sounds
- Omits initial consonants
- Asymmetrical tongue or jaw movement
- Tongue between teeth for many sounds
Signs of an articulation/phonological disorder in a school age child may include:
- Omissions/substitutions of speech sounds
- Difficulty with consonant blends
- Frontal and/or lateral lisps
- Difficulty producing consonant /s, r, l, th/
- Speak clearly and at a slow conversational rate.
- Know which sounds are expected to be pronounced correctly at your child’s age – encourage only the speech sounds which are appropriate.
- Model correct pronunciation at natural times during the day. Do not correct your child. For example, if your child says, ” I got a pish”, you could say, “Yes, you have a fish”. You may want to emphasize the target sound slightly.
- Play sounds games if your child is interested. This will increase his overall awareness and discrimination of sounds. You might play with magnetic letters, read rhyming books such as Dr. Seuss, say nursery rhymes or sing songs slowly. Many songs can encourage awareness of sounds through their words (Old MacDonald, Bingo, etc.)
The above was compiled from ASHA, “How Does Your Child Hear and Talk?”