"How do I know if my child needs speech/language therapy?"
Updated: Aug 7, 2019
The biggest indicator that your child might needs speech/language therapy is if they are not reaching typical milestones for their age. There are many different types of developmental milestones - physical, social, emotional, cognitive, and the big topic for today, communication. I feel like the most noticeable milestones are the physical milestones, like when your baby begins to walk. Your little one goes from crawling to taking their first steps to running around like crazy in a span of months. Just like there is a steady progression in your child walking, there is a a similar progression for communication or speech/language.
Speech/Language milestones are going to be the best indicator for parents if a child needs speech therapy. There are developmental steps in speech and language that a child should reach by a certain age. If your child is not reaching those milestones, he/she might benefit from speech therapy.
But what are those important early milestones? I'm glad you asked!
Adorable Things In Your Baby's First Year
It's difficult to think that even in your baby's first year that they have language milestones, but they do! All those super cute moments that have you reaching for the camera are actually important steps toward your little one talking. Here are some milestones that you can see in your baby's first year along with some video examples, because who doesn't love baby videos!
Phonation aka produce sound (e.g. cry, burp, sneeze)
Babbling aka repeating syllables (e.g. "mama", "baba")
Variegated Babbling aka uses different syllable shapes (e.g. "ba-doo")
12 months - 18 months
Around a year is when all of that babbling will turn into actual words. So, around this time, you should expect that your child says their first word. Sometimes that word is "mama", sometimes it's "no". It's hard to know what their first word will be. During this time, they will also start to imitate animals sounds (e.g. "moo", "oink, oink").
Says first word (e.g. "Mama")
Imitates animal sounds
18 months - 24 months
During this time, your child should start combining two words together and you'll notice that their vocabulary has increased. You should be hearing them say about 50 words. These will mostly be nouns -- food, animals, clothes (e.g. "more", "banana", "cow"). Typically, your baby's first 20 words are going to be slow and inconsistent. They will be words that they hear often and are easy to say, so don't be surprised if for a while your child says "nana" for 'banana'.
Beginning to put two words together (e.g. "milk, Mama")
Uses 50 words, mostly nouns
25% of speech understood by unfamiliar listeners and parents
24 months - 36 months
This is a time where your child will be learning more and more words very fast. They will have quite a few words in their vocabulary, approximately 200-300 words if you can believe that. This is also where you, as the parent, may be able to understand your child a little bit better than people who are not around them as much. Someone who doesn't know them as well as you do should still understand about 50% of what they say and look to you every once and a while to "translate".
Consistently uses two words together
Uses 200-300 words
50% of speech understood by others (unfamiliar listener)
50 - 75% of speech understood by parents
At 3 years old, or a little bit before, is around the age that the majority of parents report seeing signs of their child's not communicating the same as other children their age. At three years old, you'll see your kiddo using 3 word phrases maybe more, with a vocabulary of around 1000 words. They are starting to understand more complicated directions and new concepts (e.g. prepositions, opposites). They should also be understood better by unfamiliar listeners.
Uses mostly 3 word phrases.
1000 vocabulary words
Uses words like in, on, and under.
Understands opposites, like go–stop, big–little, and up–down.
Follows 2-part directions, like "Get the toy and put it in the box."
Has the following speech sounds: p, b, m, d, n, h, t, k, g, w, ng, f, y
75% of speech understood by others (unfamiliar listener)
75 - 100% of speech understood by parents
Your child is doing a lot at this age! At four years old, they will put four+ words together in a sentence. We will still see some occasional mistakes, usually on verbs (e.g. goed/went). They are answering simple Wh-questions and are learning new concepts (e.g. rhyming, plural words, colors, shapes). This is also where they should have the majority of their speech sounds. There are still some sounds that are not typical until 6 years old. See the chart below to see all the sounds from ages 2-6 years old.
Puts 4 words together. May make some mistakes, like “I goed to school.”
Answers simple who, what, and where questions.
Says rhyming words, like hat–cat
Uses pronouns, like I, you, me, we, and they.
Uses some plural words, like toys, birds, and buses.
Asks when and how questions.
Responds when you call from another room.
Understands words for some colors, like red, blue, and green.
Understands words for some shapes, like circle and square.
Has the following new speech sounds: l, j, ch, s, v, sh, z
100% of speech understood by others (unfamiliar listener) with some slight developmental errors
Here is a cute chart that I like to use to show the development of sounds from ages 2-6 years. This chart comes from a recent research article that you can find in the references section below.
The Importance of Milestones
Won't my child just eventually "catch up"? - Yes and no. Research shows that about 80% of children who are considered "late talkers", will "catch up" to their peers. However, the other 20% will not. They will have continued speech and language delays that will affect their academics in school (e.g. phonological awareness, grammatical and social skills). The difficulty is that currently there is not enough evidence to know whether your child will be in the 80% who "catch up" or the 20% who do not. This is why most Speech Language Pathologists recommend a proactive approach to therapy in your child's early years.
Other Signs/Risk Factors of Speech/Language Issues
Constant tantrums. This is a possible indication that your child is frustrated with their difficulty communicating.
Your child has a hearing impairment.
Medical or developmental conditions may also have speech/language disorders: Autism, ADHD, Cerebral Palsy.
Being born prematurely
Having a family history of speech and language problems
Paying attention to developmental speech/language milestones is a great way to see if my child might benefit from speech therapy.
There are times when my child does not need speech therapy. For example, if my 2- year old does not use the 'r' sound, there's no need to consider speech therapy until about 5- years old.
There's a difference between when my child should be understood by me (aka the parents) and someone they are not around as much. So if I'm getting more than the majority of what my two year old is saying, but my neighbor isn't, that's completely fine.
There is a wide range of "typical" when it comes to milestones. If your child is slightly delayed in a few areas above, that does not mean they necessarily have a communication disorder.
Still unsure if your child could benefit from speech therapy? - Ask me! I'd love to talk to you or answer any additional questions. Email: email@example.com.
I'm also still taking parents' questions to integrate it into the blog. Send me your questions!
McLeod, S. & Crowe, K. (2018). Children’s consonant acquisition in 27 languages: A cross-linguistic review. American Journal of Speech-Language Pathology. doi:10.1044/2018_AJSLP-17-0100. Available from: https://ajslp.pubs.asha.org/article.aspx?articleid=2701897
ASHA Website https://www.asha.org/public/speech/development/01/