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When Is It Time to Go to a Speech-Language Pathologist?

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Parents question: "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?"

About Speech-Pathologists and Speech Therapy

First of all, let me tell you about a speech-language pathologist (SLP). These are the medical professionals that will evaluate, assess, diagnose and treat your child.

A speech language pathologist has their masters, or doctorate degree in the area of communication disorders. They must also 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 through and SLP at the school setting. 

There are certain milestones that we as speech pathologists will look for when identifying if there is a communication disorder present. These milestones may also be discussed at your child’s regularly scheduled pediatrician’s office (typically every 3-6 months).

This is why it’s very important to discuss anything you are seeing or worried about when the doctor examines your child. If they are aware, they may refer you to a speech pathologist sooner rather than later, which will help your child develop and learn skills quicker than if there is delayed intervention.

Take a look at the table bellow to the comparison between normal language milestones and clinical clues for possible speech disorder. When in doubt, always talk to your pediatrician!

Normal Language Milestones and Clinical Clues of a Possible Communication Disorder

0-3 months old baby

Normal Language MilestonesClinical Clues / Cause 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 months old baby

Normal Language MilestonesClinical Clues / Cause for Concern
– Fixes gaze on face
– Responds to name by looking for 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 sound/speaker
– Lack of awareness of people and objects in the environment

6-9 months old baby

Normal Language MilestonesClinical Clues / Cause 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 peopleImitates familiar sounds and actions
– Reduplicative babbling (babba, mama-mama), vocal play with intontional 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 months old baby

Normal Language MilestonesClinical Clues / Cause 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 adultsLacks consistent patterns of reduplicative babbling
– Lacks responses indicating comprehension of words or communicative gestures
– Relies exclusively on context for language understanding

12-18 months old toddler

Normal Language MilestonesClinical Clues / Cause 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 months old toddler

Normal Language MilestonesClinical Clues / Cause 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 productionLargely 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 months old toddler

Normal Language MilestonesClinical Clues / Cause 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

It is important to remember that not all children develop at the same rate of speed. For example, boys develop motor skills faster than girls, but girls (typically) develop speech and language skills quicker than boys.

HOWEVER, if your child is not being understood at least 50-75% of the time at age 3.5, then you most definitely need to seek out a speech-language pathologist. Studies have shown that the earlier a child receives necessary services, the more successful they will become at catching up to the age-related peers. 

Why Is an Early Diagnosis Important?

This is important because when children enter the school systems, they need to be able to communicate with people that are unfamiliar listeners, or people they haven’t been around their whole lives. If they can’t tell those people when they need to go to the bathroom or that they don’t feel well, this is a problem. It may lead to:

  • Increased frustration from your 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.

In summary, please look at the chart that I’ve included on this blog.

If your child is more than one age group behind, it is very important 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 SpeechBlubs!

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