How do I know if my child has a speech disorder?

Parents should pay attention to these developmental milestones

About five percent of children have noticeable speech disorders by the first grade, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). However, a parent can track numerous indicators in their child from birth through 5 years to help determine if an evaluation and/or an intervention is needed.

“Children acquire language skills within general ranges of time,” said Lisa Minahan, owner of Premier Speech Therapy in Londonderry (see sidebar). “If a developmental milestone is not reached on time, I do not consider that a delay — it is a disorder.”

Evaluations and interventions

If a toddler is not reaching these milestones, Tiffany Strazze, speech language pathologist at Swing for the Stars Pediatric Therapy Center in Concord, said an evaluation can help determine if there are underlying speech or language difficulties.

“We look at variety of areas — articulation skills, how their language is developing, their comprehension, and how well they can put words together to express themselves,” she said.

She said they also look for other presenting symptoms, which include stuttering or pacing, resonance and voice issues, feeding difficulties or swallowing, social skills, and how well children interact with their peers.

“Articulation and language issues are the biggest ones for us,” she said. “Kids will come in at 3 or 4 and they will be hard to understand. They struggle to express themselves in a way that allows them to get their needs met.”

Jodie Heath, owner and executive director of Swing for the Stars Pediatric Therapy Center, said they also provide speech therapy services to children on the autism spectrum.

“We help them develop the ability to express their wants and needs as well as improve interactions with their family members and caregivers,” she said.

Minahan said parents should trust their instincts when seeking help for their child. She said the first red flag is when a parent simply starts to wonder if there is indeed “something going on.” She said this often happens with a second child or with other kids in their playgroup as parents will often make comparisons to their child’s respective skills.

“Get a second opinion until you are satisfied with an answer,” she said. “If you are just going to your school system, for instance, they have different norms than we do in a private practice. Kids in schools must be 33 percent behind in an area in order to be picked up and receive help there.”

When interventions are deemed necessary, Heath said they tend to work with a child/family once each week. She said the majority of the work, however, takes place at home, which sometimes surprises families.

“We see them for a small snapshot of their entire lives,” she said. “We send families home with programs that they will do at home — that catches some parents off-guard. This is not a ‘drop them off and fix them’ model. It is a lot of work with the family doing a lot of it at home.”

Acknowledging that some interventions take quite some time before improvements may be seen, Strazze said success they have seen in some children is nothing short of remarkable.

“Those slower successes are very rewarding and exciting,” said Strazze, who noted a large majority of services are covered by insurance plans. “They come to us nonverbal — and when they are discharged, they can communicate and interact with their peers. Interventions can be very successful.”

Minahan agrees and said parents can serve as their child’s strongest advocate.

“You know best,” she said. “Schools, sometimes even doctors will say nothing is wrong, or ‘let’s wait, they will grow out of it.’ Parents are usually pretty intuitive, so follow your instincts.”  

Speech and language milestones

Experts break down developmental language/speech milestones by age ranges. According to Lisa Minahan, owner of Premier Speech Therapy, some of these milestones include the following:

Birth to 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)

4 to 6 months

• Moves eyes in direction to 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

7 to 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”, or “juice”

• Begins to respond to requests (i.e., “Come here” or “Want more?”)

12 to 18 months

• Recognizes their name

• Uses 3 to 20 words

• Understands simple instructions

• Recognizes words as symbols for objects

• Points to a few body parts when asked

18 to 24 months

• Uses 10-20 words but says more words every month

• Understands “no”

• Recognizes pictures of familiar persons and objects

• Uses words to make wants known, such as “more,” “up”

• Points to a few body parts when asked

2 to 2½ years

• Understands differences in meaning (“go-stop,” “in-on,” “big-little,” “up-down”)

• Follows two requests (“Get the book and put it on the table”)

• Has a word for almost everything

• Uses two- or three-word “sentences” to talk about and ask for things

• Answers simple questions and commands

2½ to 3 years

• Has a 450-word vocabulary

• Gives first name

• Uses past tense and plurals, and combines nouns and verbs

• Understands simple time concepts: “last night,” “tomorrow”

• Refers to self as “me” rather than by name

3 to 4 years

• Hears you when you call from another room

• Hears television or radio at the same loudness level as other family members

• Understands simple “wh” (who, what, where, why) questions

• Talks about activities at school or at friends’ homes

• Speaks clearly enough that people outside the family usually understand their speech

4 to 5 years

• Pays attention to a short story and answers simple questions about it

• Hears and understands most of what is said at home and in school

• Makes voice sounds clear like other children’s

• Uses sentences that give lots of details (i.e., “I like to read my books”)

• Tells stories that stick to the topic


Rob Levey is a freelance writer for numerous publications including Parenting NH.

Categories: Behavior and Learning