8 Signs Your Child May Need a Speech Therapist
Editor's Note: The following post was written by Kelli Thompson, M.S., who holds a Certificate of Clinical Competence in Speech Language Pathology.
Whenever I meet parents of young children and they learn that I’m a speech language pathologist working with the preschool population, I’m immediately bombarded with questions about their children’s development. “My child’s been stuttering a lot later,” “My son can’t say his R’s,” or “My 3-year-old still isn’t combining words.” What does typical speech and language development look like, and when should you seek intervention?
Between articulation (aka sound production), language (think vocabulary size and variety, sentence structure, ability to understand spoken language), fluency (aka stuttering), voice (think hoarseness), and social communication skills, the number of areas we treat for within this field seem endless. In the following list, I’ll hone in on some of the most common indicators for seeking a speech and language evaluation for your young child.
Your child’s expressive vocabulary should grow rapidly from the time he or she says his or her first word (around 12 months) through first grade. By 18 months, your child should have an expressive vocabulary of 200 to 300 words, and by three years, your child’s expressive vocabulary should be approximately 1,000. If you’re concerned about your child’s vocabulary size, especially if he or she isn't articulating general verbs used frequently (e.g., "make," "go," "do"), spend a week keeping a list of the words you hear him say (and ask other caregivers to keep their own lists). You’ll be hard-pressed to list 1,000 words, but at the end of the week, your list should give you a better idea of the number of words in your child’s expressive vocabulary—pay special attention to those verbs!
In other words, how many words is your child combining? The general rule of thumb is that age is approximately commensurate with the number of words combined in each utterance. So at age 1, your child should be saying one word at a time; at age 2, two words; at age 3, three words; and so on. If your 3-year-old is still speaking at the one- to two-word level, I would recommend seeking an evaluation.
If your child is having a hard time understanding and processing simple directions, he may have a receptive language delay. Speech comprehension generally precedes speech production, and your child should be able to use your nonlinguistic cues, such as gestures and facial expressions, to understand a sentence even if he only truly knows the meaning of a few words in the sentence.
By age 2, your child should be understood about 25%-50% of the time, and by 3, your child should be understood about 75%-80% of the time. Pay attention to others’ ability to understand your child’s speech; as a parent, you learn to understand your child’s speech much better than a stranger does.
Vowels are the earliest sounds to develop and are produced rather easily, so most children do not have difficulties with vowels. Many kids follow the same general developmental sequence for consonants, and some are not developed until much later than others. For example, the “Late Eight”—S, Z, Sh, Zh as in the middle sound in “measure,” Th as in “think,” Th as in “that,” R, and l—aren’t expected to be mastered until about 7 1/2. If your preschooler is producing earlier-developing consonants (M, N, P, Y, H, B, D, and W) or the vowels erroneously, intervention may be warranted. In general, a toddler should produce about 50% of the consonants correctly.
Almost all children go through short periods of stuttering as they’re rapidly developing language between ages 2 and 6. You should have your child evaluated if he’s been stuttering for longer than six months, stutters on more than 10% of his speech, and/or if he shows frustration or tension when attempting to speak.
Limited play skills (e.g., primarily manipulating and grouping toys, little imaginative play); limited gestures, such as pointing and clapping; and limited social skills (e.g., few conversational initiations, interacting with adults more than peers) may all warrant intervention.
If your child is hoarse for more than 10 days in the absence of allergies or a cold, take your child to a medical doctor. If the cause is vocal abuse, voice therapy may be necessary to identify your child’s vocal behaviors and teach your child healthy voicing habits.
Keep in mind that many children who are slow to start talking eventually catch up, and not all would agree that an otherwise typical child of 18 to 36 months who fails to begin talking or who talks very little is significantly delayed. Intervention may hasten development that would eventually happen on its own. Therefore, deciding whether to intervene (particularly before the third birthday) can be difficult, even for us as speech therapists. Researchers believe that children with cognitive deficits, hearing impairments or chronic middle ear infections, dysfunctional families, social problems, risks associated with their birth histories, or family histories of language and reading problems should receive highest priority. In addition, males are more vulnerable to language delays than females.
The Individuals With Disabilities Education Act (IDEA) makes grants available to states to provide special education and related services to children with disabilities between ages 3 to 5. If you’re concerned about your child’s speech and language development, write a letter to your local school district administrator requesting an evaluation. In the state of California, the school district must give you an assessment plan within 15 days of receiving your written request; other states likely have similar guidelines. If your child doesn’t qualify for speech services through the school district, you can seek private speech therapy services (this may be out-of-pocket or covered by your insurance policy).
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