Frequently Asked Questions

We use language to share our thoughts, ideas, and feelings and to understand others.  Language is made up of rules that people agree on.  Rules that determine:

1. Word meaning (vocabulary)
2. How to make new words
3. How to put words together (grammar)
4. What word combinations are best for different situations (ask questions, make commands, and comment)

Speech is the spoken form of language.  Children can have difficulties pronouncing their words, and that is “speech”.

Generally, children learn language by listening and practicing what they hear.  That is why it is very critical to use whole sentences when talking to children with appropriate grammar.  It’s not learned all at once.  It is a continuum that happens over time and develops in a systematic way.  Milestones determine when a child should be learning a new language rule.

Children develop/learn across a developmental schedule and are compared with other children at their chronological age to determine “norms”.

i.e.  “At what age do 90% of children ___________” (use plurals, follow 2 step directions, etc.)

This determines the range of “Norms” or normal development.   A screening/consultation and then an evaluation is needed to determine if a child’s speech and language skills are developing “normally”.

• A research study done by Nelson, H.D., screening for speech and language delay in preschool children, showed that in severe cases, children with severe language difficulties are probably identified before they start school, but many may not be identified until they start formal education. Estimates of the prevalence of language difficulty in preschool children are between 2% and 19%.
• According to the U.S. Department of Education, almost 3 million school children (43.8%) ages 3 to 21 have some form of learning disability and receive special education in school.
• Incidence of childhood stuttering is highest between a child’s second and fourth birthdays, ultimately affecting 4% to 5% of the population.
• Specific Language Impairment (SLI) is one of the most common childhood disorders, affecting 7% of children.
• There is an observed relationship between early phonological disorders and subsequent reading, writing, spelling, and mathematical abilities.
• Children with early development language impairment demonstrate persistent impairments in developmental and functional skills at school entry not limited to language.

A speech-language pathologist, also referred to as a speech therapist, is a professional who specializes in working with individuals to improve their communication and feeding skills.  The role of a speech therapist is to identify, assess, treat and prevent communication disorders in all modalities (spoken, written, pictorial and manual) both receptively and expressively.  In pediatrics, a speech-language pathologist works to develop and maximize the child’s speech, language, and feeding skills in a motivating play setting with the goal of increasing their independence and ability to communicate. 

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.

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!

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 a Speech-Language Pathologist and/or Audiologist to find out if an evaluation or consultation is necessary. Compiled from www.asha.org, “How Does Your Child Hear and Talk?”

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 – 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

Here are some of the common warning signs by age range.

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 Year Olds

• 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 Year Olds

• 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

Signs of autism may begin to be detected as early as 12 months of age. Symptoms of autism can occur in isolation or in combination with other conditions. Some early indicators of autism spectrum disorder may include:

• Delayed development of the ability to draw the attention of parents and others to objects and events.
• Little or no use of pointing to encourage another person to look at what (s)he sees (i.e., “joint attention”).
• Little or no attempt to gain attention by bringing or showing toys/objects to others.
• Little or no eye contact.
• Participates in repetitive patterns of activities.
• Aloofness and indifference to other people.
• Lack of understanding that language is a tool for conveying information.
• Tendency to select for enjoyment trivial aspects of things in the environment (e.g., attending to a wheel on a toy car and not the whole car for imaginative play).
• Odd responses to sensory stimuli, such as hypersensitivity to sound, fascination with visual stimuli, dislike of gentle touch but enjoyment of firm pressure.
• Uses senses of taste and smell rather than hearing and vision.
• Poor coordination including clumsiness, odd gait and posture.
• Over or under activity.
• Abnormalities of mood, such as excitement, misery.
• Abnormalities of eating, drinking, and sleeping.

More Obvious Signs of Autism Spectrum Disorder

• Flicking fingers, objects, pieces of string
• Watching things that spin
• Tapping and scratching on surfaces
• Inspecting, walking along and tracing lines and angles
• Feeling special textures
• Rocking, especially standing up and jumping from back foot to front foot
• Tapping, scratching, or otherwise manipulating parts of the body
• Repetitive head banging or self injury
• Teeth grinding
• Repetitive grunting, screaming or other noises
• Arranging objects in a line
• Intense attachment to particular objects for no apparent reason
• A fascination with regular repeated patterns of objects, sounds

Red Flag Statements Often Heard by Caregivers

• ‘His speech is delayed, he’s not talking. He doesn’t respond to his name, could he be deaf?’
• ‘She’s not interested in playing with toys.’
• ‘At the playgroup he won’t have anything to do with the other children.’
• ‘She hits other children if they get in her way.’
• ‘He’s not very affectionate, he doesn’t like being touched and cuddled.’
• ‘She clings to me all the time and won’t let me out of her sight.’
• ‘He insists on the same routine and is very upset if this is changed.’
• ‘She seems very different from other children of her age.’
• ‘At school he says nothing and gives no problems. At home he just won’t fit in with family.’
• ‘He seems to have no idea of how to follow the social rules.

Compiled from: The National Autistic Society

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.
• Difficulty with adequately expressing feelings.

• 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.
• Come in for a consultation if you are very worried or upset.

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:

• 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 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/.

When children have ear infections (otitis media), fluid can build up in their middle ear. When this occurs, it can affect how they hear sounds. The sounds that they hear may seem distorted. For instance, imagine what it would sound like to hear someone talking while your head was under water. In order to learn to speak properly, children need to be able to hear speech sounds accurately and clearly. If they experience frequent ear infections while their language is developing, they may be at risk for speech and language problems.

Bilingual children develop speech and language normally. Typically, learning two languages can take a longer time. However, bilingual children should still reach developmental milestones such as producing their first word at 12 months and using two-word phrases by two years of age. The majority of these children will go through a period where they combine words and grammar from both languages in the same sentence. Additionally, once the second language is introduced, children may go through a stage where they do not speak as much. As their language skills develop, children will begin to produce more speech and language.

Children with feeding and swallowing disorders may present with a variety of symptoms including:

• Refusal of different textured foods
• Prolonged feeding times
• Excess drooling or spilling of food and liquids from the mouth
• Frequent spitting up
• Wet, gurgly voice or breathing
• Coughing or gagging during meals
• Recurrent pneumonia and/or respiratory infections
• Slow weight gain
• Younger children may demonstrate stiffening of body, irritability, and/or lack of alertness during feeding

Prior to the Evaluation:

Parents complete a questionnaire regarding their concerns and the child’s medical, developmental, and educational history. We may request medical information from your child’s pediatrician, and may also request information from other medical or educational professionals who have evaluated your child. You may be asked to keep a food diary for several days and bring this on the day of the evaluation.

 During the Evaluation:

Your child’s medical, developmental, and feeding 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.

Your child will be provided with an age-appropriate snack (you may be asked to bring in favorite foods and feeding utensils from home). The Speech-Language Pathologist will assess your child’s oral structures and movements, sensory responses to food and touch, posture and positioning, oral movements during eating and drinking, swallowing and behavioral responses.

Parents are encouraged to observe during the evaluation.

Following the 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 mailed to your home and to your child’s physician (if requested). The report will include a detailed analysis of your child’s feeding-swallowing behaviors.

If your child has indications of a feeding-swallowing disorder, an individualized plan of care will be developed with you, your child, and the physician. The plan may include recommendations for special instrumental diagnostic tests to further evaluate your child’s feeding-swallowing. Treatment varies greatly depending on the causes and symptoms of the feeding-swallowing problem.

• 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.

If you have concerns about your child’s speech and language development, do not hesitate to address your concerns with your pediatrician. Request a referral to have speech-language pathologist (SLP) evaluate your child to determine whether or not your child qualifies for services. If services are warranted, your SLP should present her findings and goals for treatment before beginning treatment.

Prior to the 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 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 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 mailed to your home and to your child’s physician (if requested).

A 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

Speech therapy may be covered as part of your child’s early intervention plan or as part of other education plans. You should check directly with your insurance company to determine what they will cover.

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The length of therapy depends on the severity of the problem and the rate of progress made in the therapy sessions and during reinforcement at home and in the community.

Many speech therapists have the credentials “CCC-SLP” after their names. This means that the therapist has been awarded their Certificate of Clinical Competence in Speech Language Pathology by ASHA.