Speech and Language

Developmental Milestones

Speech and Language development varies from one child to another. However, there is a typical progression for mastery of these skills. The developmental milestones are identifiable skills that can serve as a guide to normal development. Basic skills usually develop before more complex skills and there is a general age when most children attain these skills.

If your child is not at age level in the speech and language milestones or if you have any questions regarding their skills, we recommend that you make an appointment for an initial assessment at TALK. A licensed Speech-Language Pathologist can determine whether treatment is needed and/or provide you with suggestions which may prevent a communication problem from developing.

Download a pdf file of the developmental milestones.

Speech and Language Deficits

We treat a variety of deficits at TALK. Some children only have one of the issues describe below, while other may have combinations with varying severity. The following provides a brief overview of the most common types of communication disorders targeted at TALK:

1. Speech/language Delay and/or Disorder

Speech/language delays and disorders are the most common developmental problem among preschool children. It affects 5 -10% of preschool children. Child development research has shown that the first three years are critical for learning language. Numerous studies have identified that through early identification and appropriate treatment, children can develop to their potential.

Speech and Language Delays are characterized by a typical development sequence, but at a slower rate. On the other hand, Speech and Language Disorder is characterized by an abnormal language development sequence.

Speech and/or language deficits can be identified and treated as young as 12 months of age.

2. Receptive/Expressive Language Deficit

It is estimated that between three and five per cent of children have a receptive or expressive language disorder, or a mixture of both.

Children need to understand language before they can use language effectively. A receptive language deficit is characterized by a child who has difficulty understanding what is said to them. The symptoms vary between individuals but, generally, problems with language comprehension usually begin before the age of four years. Very often a child with receptive language deficits will have difficulty remembering things. This memory problem is only apparent in speech; non-verbal or non-linguistically based memory will be unimpaired. In most cases, the child with a receptive language problem also has an expressive language disorder, which means they have trouble using spoken language.

Expressive language disorder is characterized by having a limited vocabulary and grasp of grammar (especially with tense and time words). It is a general language impairment that puts the person out of the general level for his/her age and onto the level of a younger or less linguistically developed person. There must be a gap between their receptive (understanding, listening and writing) functioning and their expressive functioning, that is they have more difficulty speaking and writing than the average person their age and general developmental level. Expressive language disorder affects work and schooling in many ways. It is usually treated by specific speech therapy, and usually cannot be expected to go away on its own.

3. Autism Spectrum Disorder

Autism is a developmental disability that affects, often severely, a person’s ability to communicate and socially interact with others. It is four times more prevalent in males than females. Currently, autism is believed to affect 1 in every 166 people. The rate of people being diagnosed with autism has increased substantially over the past two decades. Although this may be in part due to improved diagnostic techniques and to changes in the criteria for Autism spectrum disorders, the majority of experts agree these changes are not enough to explain the epidemic rates at which autism is being diagnosed.

Autism Spectrum Disorder (ASD) is an umbrella term that includes classic autism (also known as Kanner’s autism or Kanner’s syndrome), Asperger’s syndrome, and pervasive developmental disorder (PDD). Autism is considered a spectrum disorder because the number and intensity of the symptoms people with autism display may vary widely. However, all people with autism demonstrate impairments in the following three areas: communication, social relationships and restricted patterns of behavior. The spectrum ranges from those who are severely affected, less able, and dependent on others to those who are of above-average intelligence and independent, yet lacking in social skills.

4. Apraxia of Speech

Childhood Apraxia of Speech (CAS) is a deficit in the ability to plan the motor movements for speech and is considered an oral motor planning disorder. Children with CAS have difficulties transmitting the speech message from their brain to their mouths. symptoms of CAS include consonant and vowel distortions, distorted sound substitutions, errors inconsistent in type and place, and prosodic errors (prosody refers to pitch, rate, and rhythmic features of speech). Some other behaviors seen in CAS include groping, perseverative errors, and increasing errors as the length of utterance increases.

5. Auditory Processing Disorder

Auditory processing is a term used to describe what happens when your brain recognizes and interprets the sounds around you. Humans hear when energy that we recognize as sound travels through the ear and is changed into electrical information that can be interpreted by the brain. The "disorder" part of auditory processing disorder (APD) means that something is adversely affecting the processing or interpretation of the information. Children with APD often do not recognize subtle differences between sounds in words, even though the sounds themselves are loud and clear. For example, the request "Tell me how a chair and a couch are alike" may sound to a child with APD like "Tell me how a couch and a chair are alike." It can even be understood by the child as "Tell me how a cow and a hair are alike." These kinds of problems are more likely to occur when a person with APD is in a noisy environment or when he or she is listening to complex information. APD goes by many other names: central auditory processing disorder (CAPD), auditory perception problem, auditory comprehension deficit, central auditory dysfunction, central deafness, and so-called "word deafness."

6. Articulation Disorder

Articulation refers to the manner in which a child produces a sound and the placement of the tongue, lips, and teeth. Traditional thinking has been that some articulation errors are developmental in nature and that children may not be ready to address them in therapy until a specific age (typically 7 or 8). However, current research suggests beginning articulation treatment with the most difficult sounds is just as effective, and often more effective, than following the developmental norms for articulation. Research is now finding that the earlier therapy begins, the more successful it will be.

7. Phonological Disorder

Phonology is the sound system of language. The phonology of language tells us how sounds fit together in words. Children who have phonology disorders have not learned the rules for how sounds fit together to make words, and use certain processes to simplify words. Phonology disorders are related to language and reading and are now seen as a language-based disorder. Children with phonology disorders are frequently unintelligible; often, their parents are the only ones who can understand them, and even they have difficulties. Children with these disorders are at high risk for later reading and learning disabilities.

8. Social/pragmatic disorders

Pragmatics is the area of language function that embraces the use of language in social contexts (knowing what to say, how to say it, and when to say it - and how to "be" with other people). Children with pragmatic difficulties have great trouble using language socially in ways that are appropriate or typical of children of their age. They often do not understand that we take turns to talk, and they will "talk over the top of you" at times, or, at other times respond to what you say with inappropriate silences, or in a voice that is too quiet. They may interrupt excessively and talk irrelevantly or about things the in which the listener shows no interest. Their communicative behavior often appears rude and inconsiderate. Children with social/pragmatic deficits may have difficulty playing with other children, whether it be one-on-one or in a group/classroom setting. Social skill intervention is often targeted in small group settings, with peers, and is relevant to the child’s everyday routine for immediate carry-over and generalization.

9. Oral/Feeding Disorders

Oral Motor deficits may affect Speech and Feeding skills. Signs of oral motor deficits include:

Oral Motor programs are designed to improve jaw strength, stability and movement. Additionally, coordination and sequencing of articulators are also targeted. Specific oral postures paired with sound and word production typically show the best results. Our therapists employ a combination approach using muscle- based therapy, such as Talk Tools and the PROMPT tactile cueing system.

10. Stuttering

Stuttering is a communication disorder involving disruptions in the forward flow of speech. These speech disfluencies are moments when a child has difficulty "getting his words out." As a result, he/she may repeat parts of word (li-li-like this), stretch out sounds (llllike this), or experience a complete blockage of speech when no sound comes out at all (l---ike this).

Many times, young children are not aware of their speech disruptions at all, they simply repeat parts of words or prolong sounds until they are able to continue speaking. Other times, children become frustrated, frightened, or confused because of their speaking difficulties. This may lead them to try to do different things to "fix" their speech, such as tensing the muscles in their mouth in an attempt to "push" words out, tapping their mouth with their hand, or simply giving up and not talking at all. Although all of these behaviors can be considered part of the child’s overall stuttering pattern, they vary from child to child.

All children exhibit disfluencies in their speech — making mistakes is a normal part of learning to talk. Furthermore, some types of disfluencies are actually a normal part of the communication process. We all occasionally produce interjections, such as "um" or "uh", while we are thinking about what we want to say. Similarly, we sometimes make changes in what we want to say, and then revise our speech accordingly (e.g., "I want- I need that"). These examples of "normal" or "typical" types of disfluencies are different from stuttering, which involves a seemingly involuntary interruption in speech or a moment when the child knows what she wants to say but has difficulty saying it.

11. Voice disorders

Most changes in the voice result from a medical disorder. Failure to seek a physician’s care can lead to hoarseness and more serious problems. The most common voice disorders in children are: laryngitis, vocal cord lesions, poor speaking technique and vocal cord paralysis.

12. Literacy and writing delays

Research indicates that 17-20% of our nation’s children experience substantial difficulties in learning to read, and that more than a third of students in fourth grade (and nearly 70% in some low-income urban schools) read below the basic level. Children who are not fluent readers by fourth grade are likely to continue struggling with reading into adulthood, making early identification and intervention of reading problems essential to a child’s success in both school and society. Spoken language provides the foundation for the development of reading and writing. In fact, spoken and written language share a reciprocal relationship, building on each other to result in general language and literacy competence. Children who have problems with spoken language frequently experience difficulties learning to read and write, and children with reading and writing problems often experience difficulties using language to communicate, think and learn. Similarly, instruction in spoken language often results in growth in written language.