When is it Time to Go to a Speech-Language Pathologist?
Feb 4, 2022 A parent asked us: "My son is a very talkative 3-year-old, but I don't understand half of the things he says. Should I take him to speech-language pathologist?" Read more to learn how to solve this dilemma!
In This Article
Does My Child Need Speech Therapy?
First, let me tell you about speech-language pathologists (SLPs). These are the medical professionals that will evaluate, assess, diagnose, and treat your child.
A SLP has a master’s or doctorate degree in the area of communication disorders, and must hold a state and national license in order to practice. Most likely, your child will see an SLP from an early intervention agency (if your child is 0-3-years-old), or with a SLP in the school setting.
To know when to start speech therapy for your toddler, there are certain milestones that SLPs look for when trying to identify if a communication disorder is present. These milestones may also be discussed at your child’s regularly scheduled pediatrician’s office (typically every 3-6 months).
So, it’s very important to bring up anything you are seeing or worried about when you see the pediatrician. If they are aware of the issues, they may refer you to a SLP sooner rather than later. This will help your child develop and learn skills quicker than if there is a delayed intervention.
Check the table below for a comparison between normal language milestones and clues for possible speech disorders. When in doubt, always talk to your pediatrician!
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Normal Language Milestones and Clinical Clues of a Possible Communication Disorder
0-3-month-old baby
| Normal Language Milestones | Clinical Clues/Causes for Concern |
| – Looks at caregiver/others – Becomes quiet in response to sound (esp. speech) – Cries differently when tired, hungry, or in pain – Smiles or coos in response to another person’s smile or voice | – Lack of responsiveness – Lack of awareness of sound – Lack of awareness of environment – Cry is no different if tired, hungry, or in pain – Problems sucking/swallowing |
3-6-month-old baby
| Normal Language Milestones | Clinical Clues/Causes for Concern |
| – Fixes gaze on faces – Responds to name by looking for the voice – Regularly localizes sound source/speaker – Cooing, gurgling, chuckling, laughing | – Cannot focus, easily overstimulated – Lack of awareness of sound, no localizing toward the source of the sound/speaker – Lack of awareness of people and objects in the environment |
6-9-month-old baby
| Normal Language Milestones | Clinical Clues/Causes for Concern |
| – Imitates vocalizing to another – Enjoys reciprocal social games structured by adult (peekaboo, pat-a-cake) – Has different vocalizations for different states – Recognizes familiar people. Imitates familiar sounds and actions – Reduplicative babbling (babba, mama-mama), vocal play with intentional patterns, lots of sounds that take on the sound of words – Cries when parent leaves the room (9 months) – Responds consistently to soft speech and environmental sounds – Reaches to request object | – Does not appear to understand or enjoy the social rewards of interaction – Lack of connection with adult (such as lack of eye contact, reciprocal eye gaze, vocal turn-taking, reciprocal social games) – No babbling or babbling with few or no consonants |
9-12-month-old baby
| Normal Language Milestones | Clinical Clues/Causes for Concern |
| – Attracts attention (vocalizing, coughing) – Shakes head “no,” pushes undesired objects away – Waves “bye,” indicates requests clearly; directs others’ behavior (shows objects), gives objects to adults, pats, pulls, tugs on adult, points to objects of desire – Coordinates actions between objects and adult (looks back and forth between adult and object of desire) – Imitates new sounds/actions – Shows consistent patterns of reduplicative babbling, produces vocalizations that sound like first words (mama, dada) | – Is easily upset by sounds that would not be upsetting to others – Does not clearly indicate request for object while focusing on object – Does not coordinate action between objects and adults. Lacks consistent patterns of reduplicative babbling – Lacks responses indicating comprehension of words or communicative gestures – Relies exclusively on context for language understanding |
12-18-month-old toddler
| Normal Language Milestones | Clinical Clues/Causes for Concern |
| – Begins single-word productions – Requires objects: Points, vocalizes, may use word approximations – Gets attention: Vocally, physically, maybe by using words (mommy) – Understands that an adult can do things for him/her (activate a wind-up toy) – Uses ritual words (bye, hi, thank you, please). Protests: Says “no,” shakes head, moves away, pushes objects away – Comments: Points to objects, vocalizes, or uses word approximation – Acknowledges: Eye contact, vocal response, repetition of words | – Lack of communication gestures – Does not attempt to imitate or spontaneously produce single words to convey meaning – Does not persist in communication (hand object to adult for help, but then gives up if adult does not respond immediately) – Limited comprehension vocabulary (understands fewer than 50 words or phrases without gesture or context cues) – Limited production vocabulary (speaks fewer than 10 words) – Lack of growth in production vocabulary of 6-month period from 12 to 18 months |
18-24-month-old toddler
| Normal Language Milestones | Clinical Clues/Causes for Concern |
| – Uses mostly words to communicate – Begins to use 2-word combinations, first combinations are usually memorized forms and used in 1 to 2 contexts – By 24 months, uses combinations with relational meanings (“more cookie,” “daddy shoe”), more flexible in use – By 24 months, has at least 50 words, which can be approximations of adult form | – Reliance on gestures without verbalization – Limited production vocabulary (speaks fewer than 50 word) – Does not use any 2-word combinations – Limited consonant production. Largely unintelligible speech – Compulsively labels objects in place of commenting or requesting – Regression in language development, stops talking, or begins echoing phrases he/she hears, often inappropriately |
24-36-month-old toddler
| Normal Language Milestones | Clinical Clues/Causes for Concern |
| – Engages in short dialogues and expresses emotion – Begins using language in imaginative ways – Begins providing descriptive details to facilitate listener’s comprehension – Uses attention-getting devices (hey) – Able to link unrelated ideas and story elements – Begins to include article (a, the) and word endings (adding -ing to verbs), regular plural -s (cats), is + adjective (ball is red), and regular past tense -ed | – Words limited to single syllables with no final consonants – Few or no multiword utterances – Does not demand a response from listeners – Asks no questions – Poor speech intelligibility – Frequent tantrums when not understood – Echoing or “parroting” of speech without communicative intent |
Please remember: not all children develop at the same rate. For example, boys develop motor skills faster than girls, but girls (typically) develop speech and language skills faster than boys.
HOWEVER, if your child is not being understood at least 50-75% of the time at age 3.5, then you definitely need to seek out a SLP. Studies have shown that the earlier a child receives necessary services, the more successful they will become at catching up to their age-related peers.
Why is an Early Diagnosis Important?
An early diagnosis is important because children need to be able to communicate with unfamiliar listeners, or with people they haven’t been around their whole lives. They will have problems if they can’t tell them when they need to go to the bathroom or that they don’t feel well. This can lead to:
- An increasingly frustrated child,
- Acting out because they aren’t getting what they need,
- Falling behind academically because they can’t communicate when they don’t understand information,
- Social isolation because children may not understand the delayed child and will shy away from communication opportunities.
To sum up, please look at the chart that I’ve included on this blog.
If your child is more than one age group behind, make sure that you seek out a speech-language pathologist and get a proper evaluation.
As always, please feel free to ask any additional questions! For practicing speech and language, download Speech Blubs!