The areas of children's communication skills that are evaluated and may require treatment for infants, toddlers and preschoolers include:

Language Comprehension

Children typically understand more language than they are yet using.  They may understand many words that they have within their own expressive vocabulary.  They also usually understand sentences and ideas beyond what they can express.

Children learn to listen and pay attention to other people and to figure out what our words, sentence structure and intonation mean.  By age one, children typically understand names of family members, a few familiar items, and social words such as "bye".  By two, they are answering simple questions, have a large number of words they understand, and can follow instructions they have never heard before.  By age three, children can understand stories and participate in conversations about prior or remote events.  Children's comprehension of vocabulary, concepts, verb tense, and sentence structure continue to expand throughout childhood.

An SLP referral may be appropriate if your child...

  • Does not listen to what people say.
  • Cannot understand questions, comments or instructions as well as other children.

Language Expression

This area encompasses the gestures, words, and sentences children use.  Babies often have their first word around 1 year of age.  At this time, they are experimenting with their voice and are learning many gestures, including waving "bye" and pointing.  By 1 1/2, children have a small but consistent vocabulary and they begin use sounds and words more than gestures.   By 2, children generally have a vocabulary of 200 words and combine 2 words together.  By age 3, children usually have a large vocabulary of approximately 800 words; they now combine words into short sentences and use early developing grammar.  Preschoolers continue to make advances in vocabulary, grammar and sentence structure.  By age 5, they make few errors in language use but all areas of expressive language will continue to develop through their school-aged years and hopefully through their lives.

 Refer if your child...

  • Has a smaller vocabulary than expected.
  • Is not able to combine words by age 2 or form sentences by age 3.
  • Cannot tell simple stories by age 4.

Speech Production or Articulation

This refers to how well children can pronounce sounds and words.  Before age 3, children generally have developed all the vowels and are using early developing consonants including M, B, P, N, D, T, W, and H.  Between age 3 and 4, they usually add further sounds including S, K, G, and Y.  Later sounds that emerge by 4 and are consistent by 5 include SH, L, CH, J, and blends of 2 sounds such as ST.  The latest sounds to develop, which may not be acquired until age 6 or 7, are TH and R; the S sound may also be refined at this period if it was originally learned in a lisped manner.

Refer if your child...

  • has a limited number of vowels and consonants at age 2
  • is less than 95% understandable by age 3
  • is less clear than other children
  • continues to make speech errors beyond the typical age of mastery

Fluency

When children speak fluently, their words come out smoothly and easily in conversation.  It is common for children under age 4 to go through a period of dysfluency, or stuttering.  They often repeat words, syllables, or sounds.   When stuttering becomes more severe, we might observe "blocks", where children cannot get a sound out.  They may also begin to prolong and get stuck on sounds.

Refer if your child...

  • has been stuttering for at least a few weeks
  • is becoming withdrawn or upset by the stuttering
  • struggles to get words out; shows signs of tension
  • or anytime you are concerned and have questions about stuttering

Social Interaction

Communication occurs within social interactions.  Children with good social interaction skills show interest in what their parents, siblings and others are doing and saying.  They listen to people and also communicate their own desires and ideas with others.  They make eye contact while they listen and speak and smile to indicate they enjoy social interaction.   With good social skills, children make friends easily and like to co-operate with others.

Children with Autism Spectrum Disorders (ASD) experience significant difficulties in their ability to respond to others and to initiate appropriate communication.  Children and youth with Asperger's Syndrome usually show strengths in vocabulary and sentence structure yet are challenged with the back-and-forth of conversations.

Refer if your child...

  • avoids interacting with you or with other children
  • does not make eye contact 
  • engages in repetitive questions or conversations

Play Skills & Attention

Play skills are closely tied with language development and are of particular concern at an early age when play and language are rapidly developing.  By six months of age, infants are expected to show an interest in objects and begin to grasp, hold, mouth, shake, bang and drop them.  At one year, they typically enjoy putting objects into places, such as into a box or cupboard, and then taking them out again.  In the second year, they are learning a variety of appropriate actions to do with toys, such as pushing toy cars, stacking blocks, putting pieces into puzzles, hugging a doll, feeding a puppet, and "pouring" tea into cups.  Young children learn what to do both with their toys and with real-life objects Children also learn to look at pages in books, turn the page, open flaps, and hold a book up the right way.  They also enjoy songs, rhymes, and interactive play with people.

Refer if your child...

  • does not know what to do with toys; may throw or bite them past the age when this is appropriate
  • prefers a limited number of toys while not tolerating new ones
  • demonstrates a short attention span for activities

Behaviour

Difficulties with behaviour may co-occur with a child's language or speech delay.  Children may have trouble expressing what they want or need.  They may not understand people's language so can become frustrated when others behave in ways they do not understand.  They may have difficulty playing appropriately and develop patterns of negative behaviour instead.  Children with challenges of behaviour may need immediate assistance before patterns become more ingrained or escalate further beyond their control.

Refer if your child...

  • becomes upset easily
  • hits you or other people

Emerging Reading Skills

From about age 3 onward, children are learning the names of letters and also the sounds that letters make.  Preschool children develop skills of "Phonological Awareness", or the understanding that words are made up of sounds, or phonemes, that may be combined and manipulated in various ways. Children are able to rhyme words, combine words or syllable to make words (e.g., "cow" + "boy" --> "cowboy"), and identify the first sound in words.  Young children are also gaining important skills with print and books; they know how to hold a book upright, know that pages turn from right to left, and can recognize letters within words they see in the world around them.

Refer if your child...

  • has difficulty learning letter names and sounds during kindergarten
  • cannot rhyme words by age 5


Additional Resources -- Milestones & Tips

The Ontario Ministry of Child & Youth Services has the following lists of developmental speech-language milestones: