When Your Child Should See a Speech-Language Pathologist

Concerned about your child meeting speech-language milestones when they should? Wonder when you should take your child to a speech-language pathologist? Betty Aboff, MA., CCC-SLP, answers your questions.

My child is 2½ years old and can’t say s and th sounds. Should I be concerned?
Not yet. A child at age 2½ is only expected to be approximately 65-70 percent intelligible when speaking. We are not concerned with difficulties in articulation (the production of certain sounds) until a child is at least 3 years old, unless it’s severe. Even at age 3, it depends upon which sounds he is having difficulty with. At age 3, he should be able to say sounds produced using his lips, including b, p, and m, and the tongue, including t, d, n. At age 4, he should be able say the r sound and “back sounds” such as the k and g. At age 4½, he should be able to say the s, sh, and ch. At age 6-7, he should be able say “later sounds,” including v, th, j, and z, and blends (two consonants together).

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My child is age 3½ and lately stutters a lot. I keep trying to correct her, and tell her to “slow down and think.” What else can I do?
Stuttering among children ages 2½-5, when they are still learning how to speak, is very common, and is not a cause for concern. It is called “developmental dysfluency,” which appears in approximately 25 percent of all children at that stage, and will usually disappear if left alone over time. As therapists we don’t address it, and we discourage parents from telling their child to “slow down” or “think about what you want to say.” We don’t want to call attention to the dysfluencies. Never finish a child’s sentences for her. Act as if you plenty of time to hear what she has to say. Model slower speech for her. When at home, insert extra pauses, simplify your own language, and maintain normal eye contact with her. Reassure her that talking can sometimes be hard for everyone. If your child develops what we call “secondary characteristics” such as eye-blinking, foot stamping or facial grimaces or if the stuttering gets worse, the dysfluencies should be addressed by a speech therapist.

My child just turned 2 and is only saying a few words. Should I be concerned?
No. Normal speech and language development can proceed at very different rates. It is common for 2-year-olds to have a 40- to 50-word vocabulary and to be just starting to put two words together. Some children develop language skills faster, and can manage to conduct a conversation at that age. However, if a 2-year-old only has a few words, isn’t imitating words, and is having trouble understanding language and commands addressed to him, I would suggest having the child’s hearing tested, and a speech and language evaluation is recommended.

My child is 4 years old and I have to tell him something at least 10-20 times before he follows what I say to him. He has trouble with answering questions and usually repeats exactly what I ask him rather than giving me an appropriate response. His teacher says he does the same thing in class in school. Should I be concerned?
If he has not been already, your child should be tested for auditory processing (the ability to understand spoken language) difficulties, as part of a complete audiological evaluation, to discover if the source of the difficulty is behavioral, processing, or a combination of both. In the meantime, before giving your child directions, make sure you have gained his complete attention. Speak slowly and clearly, but don’t over-exaggerate your speech. Your directions should be simple and brief. Try to use visual aids such as pictures or actual objects and written instructions to supplement your spoken words. While speaking to your child, emphasize key words, and ask him to repeat your instructions back to you, to make sure that he understood what you told him. Next year in kindergarten, he will be expected to follow directions and answer questions. If he has auditory processing difficulties, it will become more apparent in the classroom setting. This is the time to work try to give him compensatory strategies in order to function better in the classroom setting.

I am a parent of three children younger than 5. Are there any therapist techniques that I can use at home to help my children develop their language skills?
Below are some recommended techniques:

Expansion: Expand what your child says. If your child says “Mommy,” you say, “Where is Mommy’s car?”
Modeling: Provide a good model for the child to follow. If your child says, “baby hurt,” you say, “put Band-Aid on it.”
Parallel talk: Comment on the actions of yourself or your child, with the hope that she will begin to do the same.
Imitation: Have the child imitate your words after you, to hopefully begin to use them spontaneously.
Association: When a child comes across a new experience or word, you supply additional vocabulary words. If your child says, “car,” you say, “It is a car, and it has wheels like Daddy’s car.”
Repetition: Repeat the same new words over again in front of your child in many different contexts. Eventually, he will begin to use the words himself.

Try these techniques at home and keep praising your child each time she tries to use a new word. Encourage him to want to learn new words and use them.