The document discusses a common scenario where parents notice their young child is slow to start talking compared to peers and hesitate to seek professional advice. It provides developmental milestones for speech and language from infancy through age 3 to help parents determine if a child's development is normal or warrants concern. Potential causes of delayed speech are discussed, as well as the role of speech-language pathologists in evaluating children and developing treatment plans when needed. The importance of early intervention and parent involvement are also highlighted.

1. our son is 2 years old and still isn't talking. He says a few words, but compared with his peers
you think he's way behind. You remember that his sister could put whole sentences together at
the same age. Hoping he will catch up, you postpone seeking professional advice. Some kids are
early walkers and some are early talkers, you tell yourself. Nothing to worry about...
This scenario is common among parents of kids who are slow to speak. Unless they observe
other areas of "slowness" during early development, parents may hesitate to seek advice. Some
may excuse the lack of talking by reassuring themselves that "he'll outgrow it" or "she's just
more interested in physical things."
Knowing what's "normal" and what's not in speech and language development can help you
figure out if you should be concerned or if your child is right on schedule.
Understanding Normal Speech and Language Development
It's important to discuss early speech and language development, as well as other developmental
concerns, with your doctor at every routine well-child visit. It can be difficult to tell whether a
child is just immature in his or her ability to communicate or has a problem that requires
professional attention.
These developmental norms may provide clues:
Before 12 Months
It's important for kids this age to be watched for signs that they're using their voices to relate to
their environment. Cooing and babbling are early stages of speech development. As babies get
older (often around 9 months), they begin to string sounds together, incorporate the different
tones of speech, and say words like "mama" and "dada" (without really understanding what those
words mean).
Before 12 months, children should also be attentive to sound and begin to recognize names of
common objects (for example bottle, binky, etc.). Babies who watch intently but don't react to
sound may be showing signs of hearing loss.
By 12 to 15 Months
Kids this age should have a wide range of speech sounds in their babbling (like p, b, m, d, or n),
begin to imitate and approximate sounds and words modeled by family members, and typically
say one or more words (not including "mama" and "dada") spontaneously. Nouns usually come
first, like "baby" and "ball." Your child should also be able to understand and follow simple one-
step directions ("Please give me the toy," for example).
From 18 to 24 Months
Though there is a lot of variability, most toddlers are saying about 20 words by 18 months and
50 or more words by the time they turn 2. By age 2, kids are starting to combine two words to

2. make simple sentences, such as "baby crying" or "Daddy big." A 2-year-old should also be able
to identify common objects, common pictured objects, indicate body parts on self when labeled,
and follow two-step commands (such as "Please pick up the toy and give it to me").
From 2 to 3 Years
Parents often witness an "explosion" in their child's speech. Your toddler's vocabulary should
increase (to too many words to count) and he or she should routinely combine three or more
words into sentences.
Comprehension also should increase — by 3 years of age, a child should begin to understand
what it means to "put it on the table" or "put it under the bed." Your child also should begin to
identify colors and comprehend descriptive concepts (big versus little, for example).
Continue
The Difference Between Speech and Language
Speech and language are often confused, but there is a distinction between the two:
Speech is the verbal expression of language and includes articulation, which is the way
sounds and words are formed.
Language is much broader and refers to the entire system of expressing and receiving
information in a way that's meaningful. It's understanding and being understood through
communication — verbal, nonverbal, and written.
Although problems in speech and language differ, they often overlap. A child with a language
problem may be able to pronounce words well but be unable to put more than two words
together. Another child's speech may be difficult to understand, but he or she may use words and
phrases to express ideas. And another child may speak well but have difficulty following
directions.
Warning Signs of a Possible Problem
If you're concerned about your child's speech and language development, there are some things
to watch for.
An infant who isn't responding to sound or who isn't vocalizing is of particular concern. Between
12 and 24 months, reasons for concern include a child who:
isn't using gestures, such as pointing or waving bye-bye by 12 months
prefers gestures over vocalizations to communicate by 18 months
has trouble imitating sounds by 18 months
has difficulty understanding simple verbal requests
Seek an evaluation if a child over 2 years old:

3. can only imitate speech or actions and doesn't produce words or phrases spontaneously
says only certain sounds or words repeatedly and can't use oral language to communicate
more than his or her immediate needs
can't follow simple directions
has an unusual tone of voice (such as raspy or nasal sounding)
is more difficult to understand than expected for his or her age. Parents and regular
caregivers should understand about half of a child's speech at 2 years and about three
quarters at 3 years. By 4 years old, a child should be mostly understood, even by people
who don't know the child.
auses of Delayed Speech or Language
Many things can cause delays in speech and language development. Speech delays in an
otherwise normally developing child can sometimes be caused by oral impairments, like
problems with the tongue or palate (the roof of the mouth). A short frenulum (the fold beneath
the tongue) can limit tongue movement for speech production.
Many kids with speech delays have oral-motor problems, meaning there's inefficient
communication in the areas of the brain responsible for speech production. The child encounters
difficulty using and coordinating the lips, tongue, and jaw to produce speech sounds. Speech
may be the only problem or may be accompanied by other oral-motor problems such as feeding
difficulties. A speech delay may also be a part of (instead of indicate) a more "global" (or
general) developmental delay.
Hearing problems are also commonly related to delayed speech, which is why a child's hearing
should be tested by an audiologist whenever there's a speech concern. A child who has trouble
hearing may have trouble articulating as well as understanding, imitating, and using language.
Ear infections, especially chronic infections, can affect hearing ability. Simple ear infections that
have been adequately treated, though, should have no effect on speech.
What Speech-Language Pathologists Do
If you or your doctor suspect that your child has a problem, early evaluation by a speech-
language pathologist is crucial. Of course, if there turns out to be no problem after all, an
evaluation can ease your fears.
Although you can seek out a speech-language pathologist on your own, your primary care doctor
can refer you to one.
In conducting an evaluation, a speech-language pathologist will look at a child's speech and
language skills within the context of total development. Besides observing your child, the
speech-language pathologist will conduct standardized tests and scales, and look for milestones
in speech and language development.
The speech-language pathologist will also assess:

4. what your child understands (called receptive language)
what your child can say (called expressive language)
if your child is attempting to communicate in other ways, such as pointing, head shaking,
gesturing, etc.
sound development and clarity of speech.
your child's oral-motor status (how a child's mouth, tongue, palate, etc., work together for
speech as well as eating and swallowing)
If the speech-language pathologist finds that your child needs speech therapy, your involvement
will be very important. You can observe therapy sessions and learn to participate in the process.
The speech therapist will show you how you can work with your child at home to improve
speech and language skills.
Evaluation by a speech-language pathologist may find that your expectations are simply too
high. Educational materials that outline developmental stages and milestones may help you look
at your child more realistically.
What Parents Can Do
Like so many other things, speech development is a mixture of nature and nurture. Genetic
makeup will, in part, determine intelligence and speech and language development. However, a
lot of it depends on environment. Is a child adequately stimulated at home or at childcare? Are
there opportunities for communication exchange and participation? What kind of feedback does
the child get?
When speech, language, hearing, or developmental problems do exist, early intervention can
provide the help a child needs. And when you have a better understanding of why your child isn't
talking, you can learn ways to encourage speech development.
Here are a few general tips to use at home:
Spend a lot of time communicating with your child, even during infancy — talk, sing,
and encourage imitation of sounds and gestures.
Read to your child, starting as early as 6 months. You don't have to finish a whole book,
but look for age-appropriate soft or board books or picture books that encourage kids to
look while you name the pictures. Try starting with a classic book (such as Pat the
Bunny) in which the child imitates the patting motion, or books with textures that kids
can touch. Later, let your child point to recognizable pictures and try to name them. Then
move on to nursery rhymes, which have rhythmic appeal. Progress to predictable books
(such as Eric Carle's Brown Bear, Brown Bear) that let kids anticipate what happens.
Your little one may even start to memorize favorite stories.
Use everyday situations to reinforce your child's speech and language. In other words,
talk your way through the day. For example, name foods at the grocery store, explain
what you're doing as you cook a meal or clean a room, point out objects around the
house, and as you drive, point out sounds you hear. Ask questions and acknowledge your

5. child's responses (even when they're hard to understand). Keep things simple, but never
use "baby talk."
Whatever your child's age, recognizing and treating problems early on is the best approach to
help with speech and language delays. With proper therapy and time, your child will likely be
better able to communicate with you and the rest of the world.
http://kidshealth.org/parent/emotions/behavior/not_talk.html#
for children with speech and language difficulties
Speaking, listening, reading and writing are four aspects of language development that are at the
core of the school curriculum. There is evidence that children with speech and language
difficulties suffer difficulties with all four skills that adversely affect their educational progress
and vocational prospects.
The project evaluated two theoretically motivated interventions for young children with speech
and language difficulties. One intervention involved training phonological skills in the context of
structured literacy teaching. A second intervention involved training children’s receptive and
expressive oral language skills.
It was predicted that the phonological intervention would primarily facilitate children’s
phonological and phonic (reading and spelling accuracy) skills, while the language intervention
should have improved children’s receptive and expressive oral language skills.
How to Help Overcome Speech-Language Difficulties in the
Homeschooled Child
Dateline: 2/19/09
By Dr. Linda Kennedy MS SLP ND
ver 1 ½ million children in the United States alone are homeschooled, this represents 2.9% of all
school-age children in the U.S. According to the National Center for Education Statistics, the
three main reasons parents give for homeschooling include concern about the public school
environment, to provide religious and moral instruction and dissatisfaction with public school
academic instruction. Choosing to homeschool is an important decision. Children and their
families enjoy several distinct benefits: Homeschooled children score higher on standardized
tests than children educated in public schools, by large margins. Homeschooling allows a child to
learn at their own pace, rather than at the pre-determined pace that the public schools mandate.
Homeschooling also minimizes the impact of negative peer influences outside of the home.
Finally, recent studies show that homeschooled kids enjoy a similar number of social activities

6. outside of the house compared to children in public schools, thereby destroying the myth that
homeschooled children are socially isolated.
However, there are a few challenges that some homeschooled children and their parents must
cope with. Namely, the lack of taxpayer funded resources typically available to full time public
schooled children. For example, public schools often offer free tests for vision, hearing and
speech. Even in schools where these services are not offered, experienced teachers and nurses in
public schools usually have worked with enough children to have a good idea if a child may have
a learning or developmental problem, and they can make referrals to appropriate specialists for
further testing.
In the homeschool setting there are no such experts available on a day-to-day basis. Therefore,
you, as the parent and teacher, must be attentive to potential learning or developmental deficits in
your child. Speech-language disorders are common in children and are among the most difficult
problems to detect, especially in a homeschool setting. Most parents lack formal training in this
area and only have experience with teaching a few children with whom they are very familiar ...
so familiar in fact, that in many cases it is difficult to step back and evaluate the children
accurately, objectively and without bias.
Although this is by no means an exhaustive list, the following are possible symptoms of a child
that may be presenting with a speech-language disorder:
Trouble pronouncing sounds
Trouble understanding words
Trouble expressing thoughts in words
Difficulty with memory, reasoning, or imagination
Stuttering
Voice problems such as nasally speech, hoarseness, or excessively loud or soft
voice
There are several different types of speech and language disorders, each with different
symptoms. The main types of speech and language problems are briefly discussed below:
Receptive Language Disorder
Receptive language disorder is a learning disability that limits the child's understanding of
language. Common characteristics of this disorder are trouble following verbal directions and
understanding word problems. Children with receptive language disorder may also have poor
listening skills, low academic performance or behavior problems. There is no known cause for
this disorder, although some believe there may be a genetic link. This disorder may be related to
other conditions such as autism, attention deficit disorder or dyslexia. Receptive language
disorder does not affect intelligence since these children usually have average to above-average
IQ.
Expressive Language Disorder

7. Children with expressive language disorder have no problems understanding language, but they
have difficulty expressing themselves through speech and writing. These children often have an
abnormally small vocabulary and difficulty understanding the basics of grammar. These children
have the communication skills of children younger than themselves and they may not speak very
often because of their impairment. This disorder may cause difficulty with schoolwork,
especially writing and answering questions. As is true with receptive language disorders, there is
no known cause.
Motor Speech Disorder
Motor speech disorder is caused by poor muscle control of the muscles used in speaking. This
disorder makes it difficult to articulate sounds, resulting in slow, distorted or slurred speech.
However, there are no problems with understanding or expression. Motor speech disorders are
often a result of congenital neurological problems or from a prior stroke, traumatic injury or
infection.
Cognitive Disorder
A cognitive disorder describes the inability to communicate effectively because of damage to the
part of the brain that controls your ability to process language. This brain damage limits a child's
ability to express themselves in speech or writing. Depending on the exact location and extent of
the damage, the child may struggle to speak clearly, initiate a conversation and/or organize and
process language. In children, these disorders are usually caused by birth defects, prior infection
during infancy or traumatic brain injury.
Phonetic Disorder
Phonemic disorder describes a condition in which a child has difficulty articulating certain
sounds. This results in common enunciation errors such as omitting sounds from words,
distorting sounds or substituting one sound for another. Phonetic disorder may be the result of a
motor speech disorder or oral/dental problems.
Speech-language problems can be further described based on the cause and
severity:
The term acquired describes a problem that results from an event after birth such as illness or
trauma.
The term delayed implies that the child is developing the correct patterns of speech and
language, just at a slower rate than other children of their age.
The term disorder describes a condition where the child is not developing the correct speech
and language patterns, which results in an obvious deficit compared to their age-matched peers.
If it is suspected that a child may have a speech-language disorder, professional guidance is most
definitely in order. While the internet offers much information on speech language disorders, no
two cases are the same - each child and situation is unique and an evaluation from a health
professional is the only way to find out for sure. If, in fact, a child has a speech-language

8. disorder, early diagnosis and treatment results in a greater chance for long-term treatment
success.
One of the challenges of homeschooling is that parents may not have access to the free health
screening and treatment that is usually available in public schools. The guidelines vary from state
to state. Check to see if your local school district offers free or discounted services for your
homeschooled child. If the school district does not offer these services and insurance does not
cover the expense, the diagnostic testing and subsequent therapy required for a child with a
speech-language disorder can be a large out-of-pocket expense. Check to see if there is an
audiologist or speech language pathologist (SLP) in your area that offers discounted fees based
on income earned.
The initial step in diagnosing a speech-language disorder is to visit an audiologist to rule out a
hearing problem. Audiologists are trained professionals who specialize in diagnosing people with
suspected hearing loss and other hearing or balance disorders. Hearing problems are commonly
related to delayed speech, which is why a child's hearing should first be tested by an audiologist
whenever there is suspicion of a speech-language disorder. A child who has trouble hearing may
have trouble understanding, imitating and using language. If the audiologist detects a hearing
problem, he or she will determine an appropriate course of treatment. On the other hand, if there
is no hearing deficit, the next step is to visit an SLP. Speech language pathologists are highly
trained professionals with expertise in diagnosing and treating speech-language disorders. Most
have a graduate or doctoral degree.
The initial visit to the SLP will consist of a series of tests lasting from 2 to 8 hours, depending on
your child's unique situation. The SLP evaluation will include an assessment of your child's
speech and language skills with standardized tests that will compare them to their expected
developmental level. These tests will include language understanding, language expression,
speech clarity and identification of ways the child may compensate for lack of effective
communication, such as pointing and gesturing. If a speech delay or disorder is identified as a
result of the diagnostic procedure, the SLP will make a diagnosis and recommend an appropriate
treatment for your child, which may include speech therapy and daily home programs. Make sure
to tell the SLP that your child is homeschooled so that the SLP can be certain that you
understand how to administer your part of the daily curriculum. This is where parental
involvement in a homeschool situation is vital. A child's improvement will, in part, depend on
diligence in maintaining the daily therapeutic program prescribed by the SLP.
If efforts have been made for a formal evaluation and treatment plan, your SLP will periodically
monitor your child to make sure that the treatment protocol is indeed effective. The SLP will
collect data over subsequent therapy sessions and make changes to the treatment protocol as
needed. The SLP may also choose to administer testing again, as yet another means of cross
referencing data to insure progress for the child.
If a speech-language problem is suspected, quick and early intervention by a professional is the
key to helping a child overcome this issue and insure future scholastic success.

9. Dr. Linda Kennedy MS SLP ND: Has a graduate degree specializing in Communication Sciences
and Disorders. She owns a laboratory that specializes in the production of custom vitamins,
liquid vitamins and whole food vitamin supplements for health care professionals around the
globe. Contact her at: ezdoc26@bellsouth.net
Language Impairment Links
Apraxia Kids
Frequently asked questions answered about children who are slow to speak clearly, and what can
be done about it.
Can We Talk?
We specialize in free, quickly read and easily understood materials about working with speech
delayed children.
Carol's Speech and Language Disorders Professional Resources
These sites will give you information about specific speech and language disorders, articles you
might wish to use, such as lesson plans and reference materials.
Homeschooling Language Impaired Forum
Many of the people who belong to this list are homeschooling parents of language-impaired or
learning-disabled children.
http://homeschooling.gomilpitas.com/articles/021909.htm
Language Difficulties Associated with Specific Language Impairment
In addition to students with specific speech disorders, you will also find students who have
language disorders but no other disabilities. These students may be classified as having a
Specific Language Impairment (SLI). The table below lists some key facts about language
difficulties associated with Specific Language Impairment at different ages.
Age Language Difficulties
Late appearance of first word (average age of 23 months); delayed use of
present progressive (-ing), plural (s), and possessive ('s); late use of two-word
Infancy and combinations (average age of 37 months); less frequent use of verbs and less
toddlerhood variety in verbs; slow development of pronouns; longer reliance on gestures for
getting needs meet; difficulty initiating with peers; difficulty sustaining turns in
conversation
Use of grammar that resembles that of younger children (e.g., pronoun errors,
as in me want dolly); late use of verb markers (e.g., third person singular is as
Preschool
an auxiliary); frequent errors of omission (e.g., leaving out key elements of
syntax); shorter sentence length; problems forming questions with inverted

10. auxiliaries; difficulty with accurate use of be as an auxiliary or copular verb
form; slow development of pronouns; requests similar to those of younger
children; difficulty with group conversations (i.e., conversing with more than
one child); difficulty with verbal resolution of conflict
Word-finding problems accompanied by circumlocutions and pauses; naming
errors (e.g., shoes for pants); slower processing speed; use of earlier developing
Early and later
pronoun forms; low sensitivity to the speech of others (e.g., difficulty
elementary
responding to indirect requests); difficulty maintaining topics; difficulty
recognizing need for conversational repair
Difficulty expressing ideas about language; inappropriate responses to
questions and comments; poor social language; insufficient information for
Adolescence listeners; redundancy; inadequate sense of limits or boundaries; difficulty
expressing needs and ideas; difficulty initiating conversations with peers;
immature conversational participation
Source: From L. Justice, Communication Sciences and Disorders (2006), p. 224, published
by Merrill/Prentice Hall. Copyright © by Pearson Education. Reprinted with permission.
http://www.education.com/reference/article/difficulties-specific-language-impairment/
Top 10 Things You Should Know About Children With Specific Language
Impairment
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11. By Joy Simpson|Mabel L. Rice
Merrill Advanced Studies Center
Specific Language Impairment has been actively studied for more than 40 years. Language
acquisition is the primary area of concern as the child grows and develops. There are no obvious
related causes such as hearing loss or low IQ. The condition appears in young children and is
known to persist into adulthood. Although the causes are unknown, current research focuses on
possible inherited tendencies. Early identification and intervention are considered best practices,
in order to minimize possible academic risks.
1. Specific Language Impairment has many names and it is surprisingly common.
SLI is just one of the many communication disorders that affect more than 1 million students in
the public schools. If your child has been evaluated by a speech pathologist, you may have heard
its other names: developmental language disorder, language delay or developmental dysphasia.
Specific language impairment is the precise name that opens the door to research about how to
help a child grow and learn.
SLI is more common than you might think. Research over the past ten years has generated
accurate estimates of the numbers of young children that are affected by SLI. We now know it
could be as high as 7 to 8 percent of the children in kindergarten. In comparison, Down
syndrome or autism affects less than one percent of the five-year olds.
2. Late talking may be a sign of disability.
As they enter their two's and grow into three and four, children have a remarkable number of
ways to tell adults what they need. Even if the words don't all sound right, a normally
developing child will make many efforts to communicate and will make his point effectively.
Young children ask so many questions -- often exhausting their parents and care providers.
Children who don't ask questions or tell adults what they want may have a communication
disorder.
Children with SLI may not produce any words until they are nearly two years old. At age three,
they may talk, but can't be understood. As they grow, they will struggle to learn new words,
make conversation and sound coherent.
Today, research is underway to determine which children do not outgrow this pattern of
delayed speech. By age 4 to 5 years, SLI could be a signpost of a lasting disability that
persists throughout the school years.

12. 3. A child with SLI does not have a low IQ or poor hearing.
Several other disabilities involve difficulties communicating, but for these children the primary
diagnosis will be mental retardation, or autism, or hearing loss, or cerebral palsy. A child with SLI
scores within the normal range for nonverbal intelligence. Hearing loss is not present. Emerging
motor skills, social-emotional development and the child's neurological profile are all normal.
The only setback is with language. SLI is the primary diagnosis.
4. Speech impediments are different from language disorders.
A child with a speech disorder makes errors in pronouncing words, or may stutter. Recent
studies find that most children with SLI do not have a speech disorder. SLI is a language disorder.
This means that the child has difficulty understanding and using words in sentences. Both
receptive and expressive skills are typically affected.
5. An incomplete understanding of verbs is an indicator of SLI.
Five-year old children with SLI sound about two years younger than they are. Listen to the way a
child uses verbs. Typical errors include dropping the -s off present tense verbs and asking
questions without the usual "be" or "do" verbs. For example, instead of saying "She rides the
horse" the child will say "She ride the horse." Instead of saying "Does he like me?" the child will
ask "He like me?" Children with SLI also have trouble communicating that an action is complete
because they drop the past tense ending from verbs. They say, "She walk to my house
yesterday" instead of "she walked to my house."
6. Reading and learning will be affected by SLI.
SLI does affect a child's academic success, especially if left untreated. Forty to seventy-five
percent of the children have problems learning to read.
7. SLI can be diagnosed precisely and accurately.
In the last ten years, researchers have documented the ways that SLI occurs. Clinical practice is
catching up to these advances in research. In the past, SLI has not been included on educational
classification systems used by speech pathologists or psychologists, and when identified, it was
called a language delay.
In 2001, the Psychological Corporation released the first comprehensive test for SLI. The
Rice/Wexler Test of Early Grammatical Impairment is based on research funded by the National
Institutes of Health, and carried out at the University of Kansas and the Massachusetts Institute
of Technology. Speech pathologists and preschool educators can use this test with children ages
3 to 8. It will point to the specific gaps in a child's language abilities so that treatment can be
more effective. It is especially useful for identifying children with SLI at the time of school entry.
8. The condition may be genetic.
The genetic origin of SLI has not yet been proven, but studies show that fifty to seventy percent
of children with SLI have at least one other family member with the disorder. Several
researchers are studying twins, looking for the genetic link. In 2001, British researchers
successfully found the chromosome that affected 15 of 37 members of a London family with a
profound speech and language impairment.
9. The nature of the disability limits a child's exposure to language.
Children with SLI need extra opportunities to talk and to listen, but because of the disability,
they may actually have fewer chances. At a young age, curious children ask questions over and
over as they see, touch, and experience the world. The adults in their life respond, giving them
vocabulary and grammar in a spontaneous teaching format. A child with SLI has trouble asking
"Do you?" and says instead "You like ice cream?" This kind of question is easily misunderstood.
A child who cannot get the message across may simply stop trying. Interactions are especially
difficult with other children because they are less supportive and patient than adults.

13. 10. Early intervention can begin during preschool.
By age five, parents can secure a conclusive diagnosis, but being proactive in the preschool years
is often time well spent. Equipping a child for success at ages three and four will lead to positive
experiences in kindergarten -- and the signs of SLI are present by age three.
Some preschool programs are designed to enrich the language development of students with
disabilities. This classroom may include normally-developing children who will act unknowingly
as models. The focus of class activities may be role-playing, sharing time, or hands-on lessons
with new, interesting vocabulary. This kind of preschool will encourage interaction between
children, and will build rich layers of language experience. It may even include techniques from
speech pathology that solicit from children the kinds of practice they need to build their
language skills.
Parents can also send their preschool child to a speech or language pathologist in private
practice. This professional can assess the child's needs, engage in structured activities, and can
send home materials for enrichment.
This fact sheet was written by Joy Simpson in collaboration with Mabel L. Rice, an international
expert on language disabilities in children. Dr. Rice is the Fred and Virginia Merrill
Distinguished Professor of Advanced Studies at the University of Kansas. Queries may be
directed to the Merrill Center at merrillcenter@ku.edu.
http://www.education.com/reference/article/Ref_Top_10_Things_You/