What are speech and language difficulties?
Speech and language difficulties can include delays or difficulties in any of the three main parts of speech:
- Articulation: How we shape and pronounce words.
- Fluency: How smoothly and naturally we speak.
- Voice and resonance quality: The quality, pitch and volume of our voice. This could include sounding too nasal (hypernasality) or having an unusual voice.
Language difficulties include challenges in speaking using words and/or gestures (expressive language). It can also include challenges in understanding language commands and questions (receptive language).
There is a wide range of speech and language milestones, which can vary from child to child, but there is an expected age range of onset. To learn about speech and language milestones in younger children, please see Speech and language development from ages 0 to 3.
Signs of speech and language problems
While each child develops at a different rate, there are certain signs that their speech and language are developing properly.
- vocabulary increases to 1,000 words at 3 years and 5,000 words by 5 years
- uses full sentences
- retells stories
- turn taking and conversational skills develop
- speech is 100% intelligible at 4 years
- links ideas in sentences using "and", "because", "what", "when", "but", "that", "if", "so"
- adjusts order of words in sentences ("What is he doing?" instead of "What he is doing?")
- uses pronouns correctly (I, she, he, her, him, me, mine, they)
- uses more advanced, contracted forms of negatives (e.g., from "no", "not" to "didn't", "wasn't")
- uses plurals but may make some errors ("two gooses") and overgeneralizes some rules ("I runned")
Between 3 and 5 years, pronunciation improves, and children use more blended letters. Children are able to produce the following specific sounds:
- at 4 years: w, b, t, f, g, ng, n
- at 5 years: l, sh, ch, s, j
- at 6 years: z, r
Some stuttering (normal non-fluency) is common when children are learning to talk. This can include repeating sounds, syllables, words or phrases, as well as sound prolongations (i.e., stretching out sounds) or silent blocks. If these disfluencies persist for more than six months or seem to get getting worse, it is a good idea to consult a speech-language pathologist. They will assess whether the stuttering is typical developmental stuttering or if it might require more specialized intervention. Early assessment and intervention can be helpful in managing stuttering effectively.
These are some additional markers you can watch for to help make decisions about whether to seek a professional opinion about your child's language development:
- very few words by 2 years corrected age or all of the words are from one category, such as labels for objects
- indistinct, garbled speech after 3 years of age
- trouble learning words to songs and nursery rhymes in preschool
- difficulty expressing thoughts after 3 years of age
- limited vocabulary: trouble finding exact labels (e.g., says "thing" a lot)
- uses immature forms of grammar longer than expected (e.g., "I goed to the park") in kindergarten; often mixes up word order in a sentence)
- trouble answering "why" questions in kindergarten
- trouble retelling a familiar story in kindergarten
What are some strategies I can use to support my child's speech and language development?
There are several things you can do to help encourage language development in your toddler. The following recommendations can be used throughout your daily interactions with your child.
Model two- to three-word sentences
By the age of 3, your child will typically have a vocabulary of around 900 to 1,000 words. They may use sentences with two to three words (e.g., "I want more").
When speaking to your child, use clear, simple language that is easy to imitate. When your child speaks to you, imitate what they say as a way of showing them you understand them and then build on it. For example, if your child says, "Want more milk", you can respond by saying, "You want more milk. I'll pour some milk in your cup."
Read books with simple phrases many times until your child can say part or all of the words on each page. For example:
- Parent: Where's Spot? … Spot is in the box.
- Parent: Where's Spot?
- Child: In the box!
Building vocabulary (numbers, colours, names)
There are many different activities you can do with your child to help expand their vocabulary:
- Practise counting. Count toes and fingers. Count steps as you go down them.
- Cut out pictures from magazines and make a scrapbook of familiar things (food, toys, people). Help your child glue the pictures into the scrapbook. Practise naming the pictures, using gestures and speech to show how you use the items.
- Create your own photo album while naming and describing people (Grandpa is fishing, Mommy is on the beach).
- Singing is a great way to develop words and sentences. Try nursery rhymes and songs such as “The itsy-bitsy spider”, “Twinkle, twinkle little star” and “Row your boat”.
- Let your child fill in the blank while singing:
- Parent: Mary had a …. (pause)
- Child: Little lamb, little lamb.
- Introduce adjectives: furry bunny, green peas, fast car. This is something you can do while playing “I spy”.
Using plurals
Read books that have multiple examples of plural nouns, such as Goldilocks and the Three Bears, which uses plural nouns such as "beds", "bowls" and "chairs".
Talk about the pictures and count the objects in the pictures.
Stress the 's' sound at the end of words or when they come up in conversation.
Count body parts (e.g., one hand, two hands) or sing "Head and shoulders".
Asking "wh' questions
Use everyday activities to model 'wh' questions:
- Who is at the door?
- What goes in the basket?
When reading books, ask about the pictures:
- Where's the doggy? (searching through a flipbook)
- Who's in the car? (while playing with a toy car and small dolls)
- What is her name?
Following two- and three-step commands
Use commands with simple words, such as "Get a spoon."
Break longer commands into smaller parts, for example, "Put on your socks," then, "Put on your running shoes."
Have your child repeat the command and then do it to verify they understood you.
Use numbering to preface each step, for example, "First find your doll, then put it in the bin."
Playing games such as "Simon says", baking and doing crafts are good opportunities to practise following simple instructions.
Storytelling
Expand on social communication and storytelling skills by acting out typical scenarios (e.g., cooking food, going to sleep or going to the doctor) with a dollhouse and its props. Do the same type of role-playing activity when playing dress-up. Repeat what your child has said, even if you do not understand it completely. This shows that what they say is important to you.
What should I do if I have concerns about my child's speech, language or quality of their voice?
If you are concerned about your child's speech or language development, get in touch with your local Preschool Speech & Language Program (PSL) to access a speech-language pathology assessment. If you live in Ontario, visit https://www.ontario.ca/page/preschool-speech-and-language-program to find your local PSL and for information on how to self-refer. You do not need a health-care provider's referral to access your local PSL—families can refer themselves online. If your child attends day care or a preschool program, speak with your child's educator to share your concerns. Referrals to the PSL are considered up until the spring of when your child enters junior kindergarten.
Private speech-language pathology services
Some families will consider getting an assessment with a private speech-language pathologist (SLP). Some insurance companies may pay for part of these costs. A registry of private SLPs can be found through the College of Audiologists and Speech-Language Pathologists of Ontario. You can search under "Find a Registered Professional" by visiting www.caslpo.com.
Speak with your child's health-care provider
You can also speak with your child's health-care provider if you are concerned your child's communication difficulties might be related to an underlying medical or psychosocial cause. Your health-care provider may refer your child for a hearing test. They may also refer to specialty clinics that assess specific speech and voice concerns. If the speech and language difficulty is suspected to be part of another condition (e.g., autism spectrum disorder), then this should be evaluated, and a referral to a specialist may be needed. All children with significant speech and language problems should be seen by an SLP.