Speech-language pathology is a health profession aimed at helping individuals develop effective communication skills. Professionals in this field are educated and trained to evaluate and treat children and adults with speech, language and swallowing problems.

A speech-language evaluation at Metro Speech Therapy is performed by a speech-language pathologist to gain insight into a child’s developing speech, language, communication, feeding, and oral function skills. A speech-language pathologist will obtain a variety of scores from the tests utilized in the evaluation. These scores (standard scores, age equivalents and percentile ranks), as well as information from other types of tests, help the speech-language pathologist determine if a child has delayed or disordered language.  In addition to determining if a language delay or disorder is present, speech-language pathologists at Metro Speech Therapy may give informal/formal assessments, observational scales and parent report measures to gather information about social, play, communicative, feeding and behavioral patterns. A report is generated that uses this information to help other professionals make diagnostic decisions and to make recommendations for intervention.

Formal/standardized test can be administered to evaluate a child’s comprehension of language, expressive language, articulation, and receptive and expressive vocabulary skills. Informal tests may include an oral-motor examination, feeding assessment, language samples, some structural play interactions, caregiver questionnaires and checklists that will help provide additional information to supplement the formal tests administered.

The recommendation from a speech-language assessment may address:

  • Social skills, social language and social interaction treatment goals
  • Provide educational recommendations (i.e., class size, level of structure, etc.)
  • Ideas for activities at home that will help facilitate language/communication/play/social skills/feeding skills
  • Linguistic, oral-motor, gesture and related communication treatment goals
  • Feeding/oral function skills

Speech-language treatment plans and goals are created and implemented based on the child’s individual needs. Individual therapy may address:

  • Opportunities to develop more appropriate play skills
  • Social skill development as appropriate and driven by the desire of the child, as well as self-awareness and self-advocacy skills in social situations.
  • Language comprehension and expression
  • Development of augmentative communication skills
  • Literacy skills

No…it means that she did not meet the criteria required for the public school system.  The state has specific requirements that children must meet to receive speech or language therapy in school.  Additionally, the disability must have a negative impact on the student’s education. Therefore a student who has a lisp that does not affect her ability to spell or discourage her from participating in class may not qualify for services.

It is fine to work with two speech-language pathologists. The two professionals may collaborate throughout the year, discussing the student’s goals and progress.  Parents must give their consent before professionals can speak about a student. Private speech-language pathologists usually work with students individually. This is typically not the case in a public school setting due to limited state funding and high student caseloads.  

When you make the initial contact with your speech-language pathologist, background information will be requested. The type of information requested will depend on what your concerns are regarding your child. A review of your child’s health and development will be needed. This helps identify any potential clinical markers, such as delayed milestones for walking, a family history of language or learning problems, complications at birth, frequent ear infections, allergies, or other pertinent concerns that may signal a problem. After gathering information, the evaluation process will begin with your child. An evaluation of your child’s skills will be conducted through formal and informal testing. Formal testing will be conducted with the use of standardized tests and informal testing will include activities initiated by the speech-language pathologist for a specific purpose.

The areas addressed during the evaluation will depend on what your primary concerns are regarding your child. Following the evaluation, a report will be provided. The results of the testing and recommendations will be discussed between you and the speech-language pathologist. Areas include:

  • Receptive Language Skills: what a child is able to understand.
  • Expressive Language Skills: a child’s spoken language.
  • Auditory Processing Skills: how a child hears what is said.  This may include auditory vigilance (the awareness of and response to sound, e.g. knowing that your name has been called and giving a response to it), auditory discrimination, auditory memory, and phonological awareness skills as they relate to language, reading and spelling skills.
  • Pragmatic Skills: the use of language that is appropriate to the situation (social skills).
  • Articulation and Phonology: how a child pronounces words.
  • Oral-Motor Function/Feeding Skills:  the ability of the tongue, lips, and other muscles to move adequately for good speech production and feeding/swallowing.
  • Voice Quality: the quality of a child’s voice (i.e. loudness, clarity).
  • Fluency: refers to stuttering.
  • Critical Thinking and Reasoning Skills: a child’s ability to find and explain solutions to problems.

A speech and language evaluation will address issues related to speech, language, auditory processing, articulation/phonology, oral-motor function, pragmatics, fluency, voice, and critical thinking and reasoning skills as described above. A complete educational evaluation addresses cognitive ability and achievement through verbal and nonverbal measures. Achievement testing addresses reading, mathematics, written language, and general knowledge. Cognitive testing addresses broad ability, cognitive factors such as short-term memory, visual processing, processing speed, and scholastic aptitudes such as reading, writing, written language, and knowledge. The type of evaluation that will be conducted will depend on what your primary concerns are regarding your child. Whether you choose a speech and language evaluation or complete educational evaluation, it will be necessary to determine this prior to scheduling your appointment.

Listening is an active process of hearing and comprehending what is said. Auditory processing is what we do with what we hear. An auditory processing disorder (APD) is a difficulty in processing auditory information although hearing and intellectual ability are unimpaired.  Areas that may be affected by an auditory processing disorder are:

  • Receptive language and vocabulary
  • Auditory memory for meaningful and non-meaningful information of increasing length and complexity: Meaningful information involves the ability to recall directions and interpret them. Non-meaningful information is the ability to recall unrelated words and numbers.
  • Phonological awareness skills: That is, an individual’s explicit knowledge of the sound segments (phonemes) which form words.  These skills consist of being able to blend, delete, substitute, rhyme, segment and isolate sounds.  Difficulties in the area of phonological skills may precede difficulties in reading and spelling.
  • Thinking and reasoning: the ability to use common sense and ingenuity to solve common thought problems.
  • Auditory vigilance: the awareness of and response to sound. For example, knowing that your name was called and giving a response to the fact that your name was called.
  • Auditory discrimination:  the ability to discriminate paired words with phonemically similar consonants, cognates and vowel differences.
  • Not listening carefully to instructions.
  • Being easily distracted by background noises.
  • Difficulty with phonics or speech sounds, spelling and/or reading.
  • Poor learning through the auditory or hearing channel.
  • Behavioral challenges.
  • Below average academic performance.

Fluent speech is produced with ease. It is flowing, smooth, continuous, and relatively rapid, and normally rhythmic. Fluent speech is free from an excessive amount or duration of dysfluencies. Stuttering is called dysfluency by professionals in the field of speech-language pathology. Dysfluent speech is an excessive amount and duration of dysfluencies. It is halting, discontinuous, not smooth, and not rhythmic because of the dysfluencies. There are many forms of dysfluencies such as:

  • Repetitions: Part -word ( e.g. dddd dog), whole-word ( e.g.,“How How How How; are you”?), phrase (e.g.“My name is.. My name is .. My name is…Bob.”)
  • Prolongations: Silent prolongations known as “blocks”.
  • Sound prolongations ( e.g.“sssssomebody”.)
  • Interjections: Sound /syllable ( e.g.“I go to um.. um .. um high school.”)
  • Word (e.g.“ I want uh like like like go home.”)
  • Phrase (e.g.“ This is um like um like um like my friend.”)
  • Pauses
  • Broken Words
  • Incomplete Sentences
  • Revisions

There may be other behaviors associated with stuttering such as motor behaviors (rapid eye blinks, lip pursing, knitting of eyebrows) and abnormal breathing (talking on inhalation, tensed breathing, speaking without first inhaling a sufficient amount of air).

Important : Remember, stuttering is the occurrence of the above listed dysfluencies in excessive amount and excessive duration. Some children go through a normal period of dysfluency during the preschool years which usually “peaks” at about 3½ years of age and consists of “easy” whole word and phrase repetitions ( e.g.“mommy, mommy, mommy what is what is what is that?)

The term apraxia (dyspraxia) is used to describe a child who is exhibiting difficulty with praxis (performing an action). Childhood Apraxia of Speech is a label/category of a speech sound disorder that is explained by difficulties with planning and/or programming of the motor movements that result in speech. Our speech-language pathologists have received training in Dynamic Temporal and Tactile Cueing (DTTC) for Childhood Apraxia of Speech.

Answer: This depends on what you are noticing in the home.  A young child (9 months) who is not responding to sounds, alerting to his/her name, showing comprehension of simple words, or pointing to call attention to interesting objects, may be showing early signs of a hearing loss or language disorder.  Other general guidelines:

  • First words by 12-15 months
  • Frequent two-word combinations heard by 36 months
  • Intelligible speech in conversation 90% of the time by age 5 years.
  • Grammatically complete sentences most of the time by kindergarten age.

This is highly dependent on the individual. Each case needs to be looked at individually and discussed with the professionals, family members, and patients involved.

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.

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.

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 of a communication disorder 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

Some early signs and symptoms of a receptive language disorder include:

  • Difficulty following directions
  • Difficulty with answering questions appropriately
  • Use of jargon while talking
  • Difficulty attending to spoken language
  • Inappropriate and/or off topic responses to questions

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.

What we’ve traditionally thought about regarding Autism is constantly evolving. Autism is a spectrum for a reason. If we’ve met one Autistic child, we’ve met one Autistic child! For more information on Autism and neurodivergence, please see this link: https://my.clevelandclinic.org/health/symptoms/23154-neurodivergent. Your therapist is more than willing to discuss this in-depth with you regarding your individual child.

It is important to note that there are two different ways children can learn language: analytical language processing and gestalt language processing. Analytical language processors learn language in what is accepted as a more traditional way. This is the way in which language development milestones are often based: starting with one word, progressing to two-­word combinations, and growing to original, flexible language composed of complex sentences. However, gestalt language processors naturally process language as whole, intonational chunks, or gestalts, rather than as individual words.

There are four main stages of gestalt language processing, referred to as Natural Language Acquisition, that gestalt language processors move through. Stage 1 is known as echolalia or scripting. In this stage, gestalt processors often imitate the language they hear, such as “Let’s go outside!”. We cannot take gestalts literally at this stage; however, they are intentional and carry meaning for your child. At this stage, their utterances may sound unintelligible or only be identified by consistent, intentional intonation. In Stage 2, or mitigated gestalts, the gestalt language processor starts to change, or mitigate, those original gestalts, such as “Let’s go + home!” instead of the original “Let’s go outside!”. In Stage 3, the gestalt language processor starts to acknowledge the value of the single word as they isolate single words and produce two​​​­-word combinations. Finally, in Stage 4, there is the emergence of beginning grammar, ultimately resulting in the same original, flexible language that analytical language processors also achieve. Stage 4 is also where gestalt language learners have acquired the foundational language skills necessary to begin answering wh-­questions functionally, rather than as a rote skill. Language learners can be gestalt language processors, analytical language processors, or a combination, known as dual language processors.

Your speech-language pathologist will do the detective work with you to determine how your child primarily processes language and adjust goals as appropriate. For more information, please refer to: https://communicationdevelopmentcenter.com/

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.

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 (e.g., “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.

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.

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
  • Omissions/substitutions of speech sounds
  • Difficulty with consonant blends
  • Frontal and/or lateral lisps
  • Difficulty producing consonant /s, r, l, th/.
  • 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.

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, feeding, oral function 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 provided to you and to your child’s physician (if requested).

A child does not get a language disorder from learning a second language. It won’t confuse your child to speak more than one language in the home. Speak to your child in the language that you know best. Children with language disorders will have problems with both languages.

Speech-language pathologists, also called SLPs, usually are part of a team. The team includes you, the child’s teacher, and other professionals. The team can see if your child’s language skills are at age level. SLPs evaluate children while they play. They want to know:

  • Does your child know what to do with toys?
  • Does your child use pretend play?

For understanding and talking, the SLP will see if your child:

  • Follows directions
  • Names common objects and actions
  • Knows colors, numbers, and letters
  • Follows routines like putting his coat away or sitting during circle time
  • Sings songs or repeats nursery rhymes
  • Gets needs met at home, during play, and at preschool

SLPs will see if your child’s speech is easy to understand. They will see how your child uses his/her lips, tongue, and teeth to make sounds. They will have your child imitate sounds or words.

For early reading and writing, the SLP will see if your child:

  • Looks at and talks about pictures in books
  • Recognizes familiar signs and logos
  • Holds a book correctly and turns the pages
  • Recognizes and writes his or her own name
  • Tries to write letters and numbers

Here are some language tips:

  • Talk a lot to your child. This will help your child learn new words.
  • Read to your child every day.
  • Point out words you see. Point to signs in the grocery store, at school, and outside.
  • Speak to your child in the language you know best.
  • Listen and respond when your child talks.
  • Encourage your child to ask you questions.
  • Give your child time to answer questions.
  • Set limits for watching TV and using electronic media. Use the time for talking and reading together.

Speech-language pathology is the study of communication disorders. Communication disorders can include, but are not limited to: apraxiaarticulation disorderslanguage-based learning disabilitieslanguage processing disordersspeech and language delays in young children, stuttering and/or voice disorders.  A speech-language pathologist (SLP), also known as a speech therapist, works with individuals who experience difficulties with their speech, language, feeding., oral function, or voice. Pediatric speech-language pathologists specialize in working with children who have speech, language, feeding, oral function difficulties. There are also speech therapists that specialize in working with adults. Speech therapists assess, diagnose, and provide therapy to assist these individuals. Speech therapists must be licensed to practice by the state that they are working in, and many speech therapists are also certified by the American Speech-Language-Hearing Association (ASHA). ASHA is a professional organization that oversees speech-language pathologists within the United States.

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.

In general, speech therapists aim to improve both their client’s “Expressive” and “Receptive” language skills. Receptive language refers to the ability to understand spoken language and follow directions. For example, a child’s ability to listen to and follow the directions, “point to your shoe,” relies on their receptive language. Typically, children are able to understand language prior to being able to produce it, themselves. A child who is unable to comprehend language may have receptive language difficulties. In contrast, expressive language refers to the ability to communicate verbally or with written words. Children that have difficulty communicating their wants and needs may have expressive language difficulties. For example, children might be experiencing expressive language difficulties if they are unable to inform their caregivers that they are hungry. It is important to note that this is just one example of an expressive language difficulty. If you have concerns about your child’s speech and/or language development, you should consult with a pediatric speech-language pathologist.

Pediatric speech-language pathologists work with children exhibiting either or both receptive and expressive language difficulties. Receptive and expressive language can be improved by providing language stimulation. Parents of young children (ages 1-3) can improve their children’s receptive and expressive language by repeating what their children says, and expanding on those utterances. If the child says, “Ball,” the parent can then expand on that utterance by saying something like, “Yes, you have a big ball.” The child will then begin to learn from their caregiver’s model, and should gradually begin to combine multiple words together to form phrases.

The sequence in which children reach their speech and language milestones is fairly consistent; however, the age at which children reach these milestones can vary based on a number of factors. Accordingly, it isn’t necessarily alarming that your child isn’t speaking yet, but it’s important that you begin to work with him.

  • There are several warning signs that parents can look for to determine whether their child has a language problem.
  • Parents should be able to notice some development in their child’s speech and language abilities each month.
  • Even if your child is not verbally speaking, he/she may rely on hand and body gestures to communicate wants and needs.
  • If your child’s speech and language is not developing, and/or you haven’t noticed gestures being used, you should consider seeking a speech and language evaluation.

Hearing & Understanding Milestones

  • Child points to a few body parts when prompted.
  • Child follows simple commands and understands simple questions (e.g., “Roll the ball,” “Kiss the baby,” “Where’s your shoe?”).
  • Child listens to simple stories, songs, and rhymes.
  • Child points pictures in a book when they’re mentioned.


Talking Milestones

  • Child’s vocabulary grows every month.
  • Child begins using some one- or two- word questions (e.g., “Where kitty?”, “Go bye-bye?”, “What’s that?”).
  • Child puts two words together (e.g., “More cookie,” “No juice,” “Mommy book”.)
  • Child uses many different consonant sounds at the beginning of words.
  • For a complete guide to children’s milestones, visit:


  • The frequency that adults communicate with their children, and the quality of their responses to their children greatly influences speech and language development. Parents & caregivers should talk to their children as much as possible. When adults talk with children, they provide a good model for children to emulate. Kids can learn about language, intonation and speech patterns when they listen to adults’ voices.
  • There are many opportunities for parents to help stimulate their children’s language and speech development every day.
  • Parents should make a concerted effort to narrate their family’s daily routines to stimulate their children’s speech and language development. Such occasions include, but are not limited to feeding, dressing, playtime, and bath-time.
  • Counting steps as you walk up and down them is an easy way to begin to teach your child how to count.
  • Singing songs, finger play, and traditional games like peek-a-boo teach children both language skills and appropriate social interactions (e.g., eye contact and turn-taking).

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.

Motor speech disorders can make it very difficult for individuals to clearly and effectively express themselves, which can be very frustrating. People with motor speech disorders know what they want to say, but cannot get it out. The two types of motor speech disorders are:

  • Dysarthria:  This is when the muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all. Sometimes people refer to dysarthric speech as “slurred” speech.
  • Apraxia:  People with apraxia of speech have trouble sequencing the sounds in syllables and words. Sometimes a person cannot say a word, and then later they can say the same word without any difficulty. People with apraxia have problems imitating words but often can produce “automatic speech” without any problem (for example, saying “hello”, “I’m fine”, “OK”, etc.)

Aphasia is a language disorder, usually caused by damage to the left side of the brain. There are different types of aphasia that affect people in various ways. Aphasia can make it difficult for a person to understand spoken or written information. It can also affect a person’s ability to speak or write. Sometimes an individual can have impairments in all of these areas to some degree. The different types of aphasia are known as global, Broca’s, transcortical motor, conduction, anomic, transcortical sensory and Wernicke’s aphasia.

Dysarthria is a condition where muscle weakness in the jaw and mouth area cause problems with speaking. Dysarthria is often the result of a disease like cerebral palsy, multiple sclerosis, Lou Gehrig’s Disease or a stroke or accident causing damage to the brain.One way to improve the muscle movements is an activity that uses oral motor therapy. The instructor asks the patient to pretend he is a mirror. The patient is to mimic the movements the instructor makes. These movements include making silly faces, smiling and frowning, blowing kisses and using the tongue to lick all the way around the lips. This is a fun activity that exercises necessary mouth muscles to improve speech function.

Voice is the sound produced by vibration of the vocal cords (vocal folds) in the larynx (voice box). A voice disorder occurs when the vocal folds do not vibrate effectively to produce a clear sound.

Common Causes:

Causes of voice disorders can include abuse or misuse of the voice, such as yelling, excessive throat clearing, or speaking too loudly. These types of behaviors result in excessive hard closure of the vocal folds causing blister-like bruises that can harden into callous-like lesions called vocal fold nodules. Other causes of voice disorders can include Laryngo-Pharyngeal Reflux (excessive stomach acid backing into the larynx), vocal fold polyps, vocal fold paralysis, vocal fold cysts, etc.

Symptoms of Voice Disorders:

  • Voice quality disturbance: breathiness, raspiness, harshness
  • Voice pitch disturbance: pitch too high for age and gender, pitch too low for age and gender, pitch fluctuates excessively, pitch is monotone
  • Voice volume is too low or too loud
  • Vocal fatigue (decreased stamina, increased hoarseness following speaking)
  • Effortful voice use (having to use too much effort to speak)

Evaluation of Voice Disorders:

Voice evaluations are conducted by Speech-language pathologists who are experts in the area of voice. Evaluations include non-instrumental assessment and instrumental assessment. These assessments allow the Speech-language pathologist to measure the voice objectively, determine patterns that suggest how the larynx is functioning physically, and determine whether there is a hyper functional or hypo functional component present. Voice disorders are complex and this type of evaluation helps determine whether behavioral voice therapy, surgery or a combination of approaches would best serve the patient.

Treatment Options:

Types of voice treatment may include:

  • Vocal strengthening- exercises that can improve voice quality and stamina and can also reduce symptoms of vocal effort and fatigue. Examples of exercises are repetitions of high speech sounds, pitch glides, or glottal closure. These exercises are often used with singers.
  • Reduction of vocally abusive behaviors- During the evaluation and interview, vocally abusive behaviors are often identified. Some examples include:  talking in competition with background noise, yelling, throat clearing, loud cell phone use, not using a microphone, etc. In the treatment session, goals can be made to improve or eliminate these behaviors and provide strategies for care of the voice.
  • Improvement in vocal technique- improving respiratory support for proper voice use, reducing hard glottal attack, and improving vocal resonance. Goals are created during voice therapy sessions and home exercises are provided for continued practice. Carryover of these techniques into everyday situations is also expected.

Pre and Post surgical treatment- Counseling of proper voice care before and/or after vocal fold surgery can significantly improve surgical outcomes and assist patients in healthy return to voice use following surgery. Patients can expect gradual return to voice use following surgery.

Dysphagia is the medical term for the symptom of difficulty in swallowing. Dysphagia can occur at different stages:

  • Oral Phase – sucking, chewing, and moving food or liquid into the throat
  • Pharyngeal Phase – starting the swallowing reflex, squeezing food down the throat, and closing off the airway to prevent choking
  • Esophageal phase – squeezing food through the esophagus into the stomach

Some patients have limited awareness of their dysphagia, so lack of the symptom does not exclude an underlying disease. When dysphagia goes undiagnosed or untreated, patients are at a high risk of pulmonary aspiration and subsequent aspiration pneumonia secondary to food or liquids going the wrong way into the lungs. Some people present with “silent aspiration” and do not cough or show outward signs of aspiration. Undiagnosed dysphagia can also result in dehydration, malnutrition, and renal failure.

Some signs and symptoms of oropharyngeal dysphagia include difficulty controlling food in the mouth, inability to control food or saliva in the mouth, difficulty initiating a swallow, coughing, choking, frequent pneumonia, unexplained weight loss, gurgly or wet voice after swallowing, nasal regurgitation, and dysphagia (patient complaint of swallowing difficulty). When asked where the food is getting stuck, patients will often point to the cervical (neck) region as the site of the obstruction. The actual site of obstruction is always at or below the level at which the level of obstruction is perceived.

The most common symptom of esophageal dysphagia is the inability to swallow solid food, which the patient will describe as ‘becoming stuck’ or ‘held up’ before it either passes into the stomach or is regurgitated.

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.

Health insurance may sometimes cover speech and language therapy. There are variations in coverage based on carriers, individual’s policy and diagnosis. Be aware of restrictions, deductibles and co-payments.