frequently asked questions
There are differences in the age at which each child understands or uses specific language skills. The following list outlines the 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 a 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.
- Responds to their name
- Understands simple directions with gestures
- Uses a variety of sounds
- Plays social games like peek a boo
- Uses a variety of sounds and gestures to communicate
- Uses some simple words to communicate
- Plays with different toys
- Understands simple directions
- Understands several body parts
- Attempts to imitate words you say
- Uses at least 10 – 20 words
- Uses pretend play
- 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
Compiled from www.asha.org, “How Does Your Child Hear and Talk?”
Non-fluent speech and stuttering in children 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.
Stuttering affects the fluency of speech. It begins during childhood and, in some cases, lasts throughout life. The disorder is characterized by disruptions in the production of speech sounds, also called “disfluencies.” Most people produce brief disfluencies from time to time. For instance, some words are repeated and others are preceded by “um” or “uh.” Disfluencies are not necessarily a problem; however, they can impede communication when a person produces too many of them.
In most cases, stuttering has an impact on at least some daily activities. The specific activities that a person finds challenging to perform vary across individuals. For some people, communication difficulties only happen during specific activities, for example, talking on the telephone or talking before large groups. For most others, however, communication difficulties occur across a number of activities at home, school, or work.
Some people may limit their participation in certain activities. Such “participation restrictions” often occur because the person is concerned about how others might react to disfluent speech. Other people may try to hide their disfluent speech from others by rearranging the words in their sentence (circumlocution), pretending to forget what they wanted to say, or declining to speak. Other people may find that they are excluded from participating in certain activities because of stuttering. Clearly, the impact of stuttering on daily life can be affected by how the person and others react to the disorder.
Signs and Symptoms of Stuttering
Stuttered speech often includes repetitions of words or parts of words, as well as prolongations of speech sounds. These disfluencies occur more often in persons who stutter than they do in the general population. Some people who stutter appear very tense or “out of breath” when talking. Speech may become completely stopped or blocked. Blocked is when the mouth is positioned to say a sound, sometimes for several seconds, with little or no sound forthcoming. After some effort, the person may complete the word. Interjections such as “um” or “like” can occur, as well, particularly when they contain repeated (“u- um- um”) or prolonged (“uuuum”) speech sounds or when they are used intentionally to delay the initiation of a word the speaker expects to “get stuck on.”
Some examples of stuttering include:
- “W- W- W- Where are you going?” (Part-word repetition: The person is having difficulty moving from the “w” in “where” to the remaining sounds in the word. On the fourth attempt, he successfully completes the word.)
- “SSSS ave me a seat.” (Sound prolongation: The person is having difficulty moving from the “s” in “save” to the remaining sounds in the word. He continues to say the “s” sound until he is able to complete the word.)
- “I’ll meet you – um um you know like – around six o’clock.” (A series of interjections: The person expects to have difficulty smoothly joining the word “you” with the word “around.” In response to the anticipated difficulty, he produces several interjections until he is able to say the word “around” smoothly.)
Pay attention to your child’s environment and routine:
- Keep the environment predictable and familiar, and prepare your child for changes. For example, count down the time until a transition.
- Prime your child for new situations by explaining in advance what you expect will happen, and prepare them for the “what if’s.” For example, explain you are going to visit grandpa, but “what if” grandpa doesn’t answer the door.
- Provide consistent structure and routine.
- Many children respond well to visual supports, such as a daily schedule using pictures. Schedules help to give information about what is happening in the day and give a place for the child to check when needed (just like you might check your planner or shopping list).
- Pay attention to sensory input from the environment, like noise, temperature, smells, crowds, etc.
When you talk to your child:
- Don’t assume that your child understands what you are saying.
- Communicate clearly. Be logical, organized, clear, concise and concrete. Avoid jargon, double meanings, sarcasm, nicknames, and teasing.
- Explain abstract concepts in concrete terms.
- Don’t talk about your child in front of them, unless you include them in the conversation.
- Be sure to tell your child what you want him to do, rather than what you don’t want him to do. For example, say “put it on the table” rather than, “don’t throw it on the floor.”
To help your child improve their behavior:
- Help your child learn to communicate using gestures, sign language, picture boards, communication devices, and/or speech. Work on communication early, and be consistent to help your child improve more. Better communication will help relieve frustration and may lead to better behavior.
- Teach your child to make choices.
- Be consistent in rewarding positive behavior.
- Replace the unwanted behavior with a favorite activity. In other words, use distraction.
- Choose rewards you know your child will like.
Always remember to show love and caring for your child.
© copyright 2013 Regents of the University of Michigan
The Center for Disease Control and Prevention’s (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network released data in 2007 that found about 1 in 150 8-year-old children in the areas of the United States they monitor had an ASD1 For more on the numbers: Prevalence of ASDs, from the CDC.
Autism occurs throughout the world in families of all racial, ethnic and social backgrounds. Boys are four times more likely to have autism than girls2.
The MIND Institute in California found that the number of cases of autism is on the rise. This is probably a national trend.
© copyright 2013 Regents of the University of Michigan
Current research suggests that differences in the development of the brain and central nervous system cause autism. What causes these differences in brain development is not known for sure. However, a variety of factors are being investigated. These include infectious, metabolic, genetic, and environmental factors. A 1995 National Institutes of Health (NIH) working group reached a consensus that autism probably results from a genetic susceptibility that involves multiple genes. To date, genetic causes for one disorder commonly accompanied by autism (Fragile X) and one autism-spectrum disorder (Rett syndrome) have been identified and genetic “hotspots” for autism have been found. NIH research on possible genetic, infectious, immunological, and environmental causes and mechanisms of autism continues.
© copyright 2013 Regents of the University of Michigan
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.
Receptive language disorder means the child has difficulties with understanding what is said to them. The symptoms vary between individuals but, generally, problems with language comprehension usually begin before the age of four years.
Other names for receptive language disorder include central auditory processing disorder and comprehension deficit. In most cases the child also has an expressive language disorder, which means they have trouble using 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
Understanding spoken language is a complicated process. The child may have problems with one or more of the following skills:
- Hearing – a hearing loss can be the cause of language problems.
- Vision – understanding language involves visual cues, such as facial expression and gestures. A child with vision loss won’t have these additional cues, and may experience language problems.
- Attention – the child’s ability to pay attention and concentrate on what’s being said may be impaired.
- Speech sounds – there may be problems distinguishing between similar speech sounds.
- Memory – the brain has to remember all the words in a sentence in order to make sense of what has been said. The child may have difficulties with remembering the string of sounds that make up a sentence.
- Word and grammar knowledge – the child may not understand the meaning of words or sentence structure.
- Word processing – the child may have problems with processing or understanding what has been said to them.
Expressive language includes the skills involved in communicating one’s thoughts and feelings to others. An expressive language disorder concerns difficultly with verbal expression.
Expressive language disorder affects work and schooling in many ways. It is usually treated by specific speech therapy, and usually cannot be expected to go away on its own.
Speech therapy can vary from a short duration for something like an isolated tongue thrust or reverse swallow to a lengthy period of time for people that are deaf or have Down syndrome, autism, or cerebral palsy. Each case needs to be looked at individually and discussed with the professionals and family members within the context of the remediation process.
Signs of a possible Articulation and Phonological Disorders in a preschool child may include:
- Drooling, feeding concerns
- 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 Articulation and Phonological disorders 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/.
Children with social pragmatic language disorder demonstrate deficits in social cognitive functioning.
Individuals with SLD have particular trouble understanding the meaning of what others are saying, and they are challenged in using language appropriately to get their needs met and interact with others. Children with the disorder often exhibit:
- delayed language development
- difficulty understanding questions
- difficulty understanding choices and making decisions
- difficulty following conversations or stories. Conversations are “off topic” or “one sided”
- difficulty extracting the key points from a conversation or story; they tend to get lost in the details
- Stuttering or cluttering speech
- Repeating words or phrases
- difficulty with verb tenses
- difficulty with pronouns
- difficulty explaining or describing an event
- tendency to be concrete or prefer facts to stories
- have difficulty understanding satire or jokes
- have difficulty understanding contextual cues
- difficulty in reading comprehension
- difficulty with reading body language and reading/using nonverbal communication
- Problems with nonverbal cues such as personal space between others
- Difficulty with writing
- difficulty in making and maintaining friendships and relationships because of delayed language development
- difficulty in distinguishing offensive remarks
- difficulty with organizational skills
- difficuly telling left from right
Improving pronunciation in children begins at home.
- 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.)
- Tell your child when you don’t understand what she has said. Let her know that you will listen and try to understand. Have her gesture or show you what she is talking about if needed. Explain to her that sometimes you may not understand what she says and that you know this must be frustrating for her. Let her know you understand how she feels.
Developmental expressive language disorder is a condition in which a child has lower than normal ability in vocabulary, producing complex sentences, and remembering words. However, children with this disorder may have the normal language skills needed to understand verbal or written communication.
Some common expressive language disorder symptoms 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
If you are concerned about a child’s language development, have them tested.
Persons with social pragmatic language disorder 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.
- Difficulty with adequately expressing feelings.
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.
Commonly, children with this disorder have:
- Problems with words that begin with two consonants. “Friend” becomes “fiend” and “spoon” becomes “soon.”
- Problems with words that have a certain sound, such as words with “k,” “g,” or “r.” The child may either leave out these sounds, not pronounce them clearly, or use a different sound in their place. (Examples include: “boo” for “book,” “wabbit” for “rabbit,” “nana” for “banana,” “wed” for “red,” and making the “s” sound with a whistle.)
Milder forms of this disorder may disappear on their own by around age 6.
Speech therapy may be helpful for more severe symptoms or speech problems that do not get better. Therapy may help the child create the sound, for example by showing where to place the tongue or how to form the lips when making a sound.
There is definitely the possibility that impairment in the speech and language areas can have a detrimental effect on academics and social interactions. It is also known to have a very negative impact on self-esteem. These are all factors that can be addressed with treatment.
M.A. is an abbreviation for master of arts. M.S. is an abbreviation for master of sciences. Both graduate degrees have been used for students of Communication Disorders depending on the university attended and the year.
C.C.C. is an abbreviation for Certificate of Clinical Competence. Speech pathologists that have passed a national exam and did a clinical fellowship year with proper accreditation from the American Speech Language and Hearing Association will have those letters after their name.
S.L.P is an abbreviation for Speech-Language Pathologist, a certification awarded by the American Speech-Language-Hearing Association (ASHA)
One common speech problem that adults can have is apraxia or motor speech disorder. This condition is caused by damage to the speech-related areas of the brain.
Patients with apraxia have difficulty putting the sounds of syllables together to make words. Therapists engage patients in an activity that slows down the pace of speech and practices sounds over and over. The patient reads a list of simple sentences while a metronome taps out a slow pattern of speech. The patient repeats the first sentence over and over to the beat of the metronome. When the first sentence is mastered, he moves on the next sentence.
A speech therapy treatment plan is an individualized plan created by the Speech-Language Pathologist to address your child’s speech, language, cognitive, and/or voice needs.
The plan may include:
- Recommendations for therapy or re-screening/re-evaluation at a later time
- Initial goals to address during therapy
- Referrals to other professionals (i.e., audiologist, medical specialist, occupational/physical therapist, etc…)
- Referral to other community services, such as an early intervention program
- Suggestions for parents/caregivers and educators
Prior to the speech evaluation
Parents complete a questionnaire regarding their concerns and the child’s medical, developmental, and educational history.
We will request medical information from the child’s pediatrician, and may also request information from other medical or educational professionals who have evaluated the child.
During the speech evaluation
Your child’s medical, developmental, and educational history is carefully reviewed. Parents are interviewed regarding their concerns and the child’s history. This information helps the Speech-Language Pathologist identify areas to evaluate more closely.
A variety of methods, including formal and informal tests, observation, parent/caregiver interview, and play-based activities will be used to evaluate your child’s speech, language, cognition, and voice. Selection of testing methods is based on your child’s individual needs. Parents are encouraged to observe during the evaluation.
Following the speech evaluation
Initial results of the evaluation and recommendations are reviewed with you (and your child if age appropriate). A written report detailing evaluation results will be made available.
Speech-Language Pathologists specialize in treating a variety of speech-language, cognitive, voice, and feeding-swallowing problems.
Working with the full range of human communication and its disorders, speech-language pathologists:
- Evaluate and diagnose speech, language, cognitive-communication and swallowing disorders.
- Treat speech, language, cognitive-communication and swallowing disorders in individuals of all ages, from infants to the elderly.
The main components of speech production include: phonation, the process of sound production; resonance; intonation, the variation of pitch; and voice, including aeromechanical components of respiration.
The main components of language include:
- Phonology, the manipulation of sound according to the rules of the language
- Morphology, the understanding and use of the minimal units of meaning
- Syntax, the grammar rules for constructing sentences in language
- Semantics, the interpretation of meaning from the signs or symbols of communication
- Pragmatics, the social aspects of communication.
Speech and language disorders in children can affect the way they talk, understand, analyze or process information. Four major areas in which these impairments occur include:
- Articulation | speech impairments where the child produces sounds incorrectly (e.g., lisp, difficulty articulating certain sounds, such as “l” or “r”);
- Fluency | speech impairments where a child’s flow of speech is disrupted by sounds, syllables, and words that are repeated, prolonged, or avoided and where there may be silent blocks or inappropriate inhalation, exhalation, or phonation patterns;
- Voice | speech impairments where the child’s voice has an abnormal quality to its pitch, resonance, or loudness; and
- Language | language impairments where the child has problems expressing needs, ideas, or information, and/or in understanding what others say.
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.
Our Speech-Language Pathologists work 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. The early months of your baby’s life are of great importance for good social skills, emotional growth, and intelligence!
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.
An articulation disorder involves problems making sounds. Sounds can be substituted, left off, added or changed. These errors may make it hard for people to understand you.
Young children often make speech errors. For instance, many young children sound like they are making a “w” sound for an “r” sound (e.g., “wabbit” for “rabbit”) or may leave sounds out of words, such as “nana” for “banana.” The child may have an articulation disorder if these errors continue past the expected age.
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.