Definition
Speech and language impairments include a variety of conditions that interfere with a person’s communication.
According to the Individuals with Disabilities Education Act, “Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.”
Speech is oral communication. Speech impairments, or speech disorders, happen when a person’s lip, tongue, jaw, and vocal tract do not work well together to produce or articulate certain sounds. Language deals with meaning. A person with a language impairment or a language disorder may have trouble understanding what is being said (receptive language disorder) and/or expressing thoughts (expressive language disorder).
Prevalence
According to the National Institute on Deafness and Other Communication Disorders, in the United States:
- Nearly 1 in 12 children ages 3-17 has had a disorder related to voice, speech, language, or swallowing in 2011.
- The prevalence of voice, speech, language, or swallowing disorders is highest among children ages 3-6 (11.0 percent), compared to children ages 7-10 (9.3 percent) and children ages 11-17 (4.9 percent).
- Over half (55.2 percent) of children ages 3-17 with a voice, speech, language, or swallowing disorder received intervention services in 2011.
- About 1 in 13 adults ages 18 or older report having had a problem with their voice in 2011.
- More than three million Americans (about one percent) stutter. Stuttering can affect individuals of all ages but occurs most frequently in young children ages 2-6.
- The first 6 months of life are the most crucial for a child to develop language skills. For a person to become fully competent in any language, exposure must begin as early as possible.
- About 1 million people currently have aphasia (losing the ability to use or understand language).
- Anyone can acquire aphasia, but most people with aphasia are in their middle or late years. Nearly 180,000 Americans acquire the disorder each year.
Speech and Language Impairments in Children
God created humans to be social beings. It comes as no surprise that children are born to learn language and communication. Babies start learning when they hear and respond to familiar sounds in the womb. The first three years of life is the fastest period to acquire speech and language skills.[i] These are critical periods to obtain and develop speech and language skills.
Communication disorders affect a person’s speaking, listening, understanding, reading, and writing. If not treated early, communication disorders can interfere with a person’s educational and social experiences later in life. Therefore, parents and caretakers must pay attention to the child’s communication development. If you suspect your child may have a speech and/or language impairment, it is essential to find help as soon as possible.
How do you gauge your child’s speech and language development, and where do you find help if you notice a problem?
Characteristics
The characteristics of speech and language impairments vary depending on the specific impairment or a combination of different impairments a person has. Moreover, children vary in their communication development. However, most children follow a certain progression in developing speech and language skills. Therefore, speech and language development milestones offer a helpful way to monitor a child’s communication development.
Speech and Language Development Milestones
Developmental milestones refer to specific skills a child is expected to master by a certain age. These milestones serve as markers for parents and caretakers to track the child’s developmental progress. Speech and language development milestones, therefore, are skills most children can achieve at a certain age.
The following chart highlights milestones for children from birth to five years old.[ii]
| Birth to 3 months |
| Seems to know your voice and quiets down if crying. |
| Reacts to loud sounds with a startle reflex. |
| Is awakened by loud voices and sounds. |
| Vocalizes pleasure and displeasure sounds differently (laughs, giggles, coos, cries, or fusses.) |
| Makes noise and smiles when spoken to. |
| Responds to the sound of a rattle. |
| 4 to 6 months |
| Looks or turns toward a new sound. |
| Responds to “no” and changes in tone of voice. |
| Enjoys rattles and other toys that make sounds. |
| Vocalizes back when talked to. |
| Begins to repeat sounds (such as “ooh,” “aah,” and “ba-ba”). |
| 7 to 11 months |
| Responds to his or her name, telephone ringing, or someone’s voice, even when not loud. |
| Knows words for familiar things (such as “cup” or “shoe”) and sayings (such as “bye-bye”). |
| Babbles (says “ba-ba-ba,” “ma-ma” or “da-da”). |
| Tries to communicate by actions or gestures. |
| Looks at things or pictures when someone talks about them. |
| Starts to respond to requests (such as, “come here”). |
| Enjoys games like peek-a-boo and pat-a-cake. |
| Makes babbling sounds, even when alone. |
| Imitates simple words and sounds; may use a few single words or baby signs meaningfully. |
| 12 to 17 months |
| Understands simple phrases (such as, “Put the ball in the box” or “Put the car on the table”). |
| Enjoys being read to. |
| Follows one-step commands when shown by a gesture. |
| Answers simple questions by shaking his/her head or going to get an item when asked. |
| Says two to three words to label a person or object (pronunciation may not be clear). |
| Tries to imitate simple words. |
| Vocabulary includes four to six words or more. |
| Says more words as each month passes. |
| 18 to 23 months |
| Understands the meaning of action words (such as clap, sit, or jump). |
| Points to some body parts when asked. |
| Understands and answers simple “yes-no” questions (such as, “Are you hungry?”). |
| Understands “not now” and “no more.” |
| Chooses things by size (such as “big” or “little”). |
| Uses a vocabulary of 50 words; pronunciation is often unclear. |
| Asks for common foods by name. |
| Makes animal sounds (such as “moo”). |
| Starts to combine words into 2- to 3-word phrases to talk about things or ask for things (such as “more milk”). |
| Begins to use pronouns (such as “mine”). |
| 2 to 3 years |
| Knows some spatial concepts (such as “in” or “on”). |
| Understands and uses more pronouns (such as “you,” “me,” or “her”). |
| Knows descriptive words (such as “big” or “happy”). |
| Answers many simple questions. |
| Follows two-step commands (such as, “Get your shoes and come here.”) |
| Uses three- to four-word sentences. |
| Uses at least 100 words by 2 years of age. |
| Uses question inflection to ask for something (such as, “My ball?”). |
| Begins to use plurals, such as “shoes” or “socks,” and regular past tense verbs (such as “jumped”). |
| Speech pronunciation is improving but may still leave off ending sounds; strangers may not be able to understand much of what is said. |
| 3 to 4 years |
| Answers simple questions (such as, “What do you do when you are hungry?”) |
| Groups objects into categories (such as foods or clothes). |
| Recognizes colors. |
| Uses 300 to 500 words by 3 years of age. |
| Describes the uses of objects (such as, “You eat with a fork”). |
| Has fun with language; enjoys poems and recognizes language absurdities such as, “Is that an elephant on your head?”) |
| Expresses ideas and feelings rather than just talking about the world around him. |
| Uses verbs that end in “ing” (such as “walking” or “talking”). |
| Uses most speech sounds but may distort some more difficult or later developing sounds (such as l, r, s, sh, ch, v, z, th). |
| Uses consonants in the beginning, middle, and end of words. Some of the more difficult consonants may be distorted but tries to say them. |
| Strangers can understand much of what is said. |
| 4 to 5 years |
| Answers “why” questions |
| Lists items that belong in a category (such as animals or vehicles) |
| Understands more abstract spatial concepts (such as “behind” or “next to”) |
| Understands complex questions |
| Uses some irregular past tense verbs (such as “ran” or “fell”) |
| Describes how to do things (such as painting a picture) |
| Speech is understandable but makes mistakes when pronouncing long, difficult, or complex words (such as “hippopotamus”). |
| 5 years |
| Understands time sequences (such as what happened first, second, or third). |
| Carries out a series of three directions. |
| Understands rhyming. |
| Engages in conversation. |
| Produces sentences that can be eight or more words in length. |
| Uses compound and complex sentences. |
| Describes objects. |
| Uses imagination to create stories. |
More on Speech and Language Milestones
Often, a child may not have a speech or language impairment but a hearing impairment that interferes with the child’s communication development. Therefore, it is crucial to have a child’s hearing checked regularly.
It is important to remember that every child develops and matures at different speeds. A child may reach a milestone sooner or later than his or her peers. A delay in language development is not the same as an impairment. A language delay happens when a child acquires language skills in the expected, typical sequence but at a slower speed. On the other hand, a language or speech impairment shows atypical language development. There is no easy way to distinguish between the two. The best and surest way is to consult a certified speech-language pathologist.
Diagnosis
Speech-language pathologists, or speech therapists, evaluate, diagnose, and treat people with communication disorders or swallowing issues.
In general, the diagnosis process includes the speech-language pathologist:
- Interviewing parents about the child’s health, communication development, and daily interactions with others. Finding out the parents’ concerns that lead them to seek professional help.
- Directly observing the child.
- Assessing the child’s level of communication difficulty.
- Identifying the treatment goal.
- Designing a treatment plan.
Intervention
Adults and children alike can benefit from professional help when having communication problems. However, children will benefit the most from early intervention when their young brains are still growing and maturing.
For Children Under Age 3
Early intervention refers to services and supports available to infants and toddlers who experience developmental delays, including delays in communication development. All 50 states offer early invention, but each state has its own rule for a child’s eligibility.
Parents can request an early speech evaluation for their child if they are concerned about the child’s speech and language development. If the child is eligible for early intervention service, a service coordinator will work with the child’s parents to develop an Individualized Family Service Plan.
For Children Aged 3 to 21
Children with a language or speech impairment eligible for special education and related services under the Individuals with Disabilities Education Act will receive an Individualized Education Program. The child’s family and school work together to create a program that best supports the child’s educational needs.
Communication is an essential life skill that will impact all aspects of life – relationships, education, career, etc. Being proactive in addressing speech and language concerns early in a child’s life will help the child get timely help, avoid further delay, and correct pertinent problems.
Resources
Many helpful resources are available for people with concerns about speech or language disorders in themselves or their loved ones. I encourage you to start with the articles and organizations in the following list. Then, from there, to expand your search and understanding.
Organizations
ASHA | American Speech-Language-Hearing Association
Information in Spanish | Información en español. 1.800.638.8255 |
actioncenter@asha.org | www.asha.org
NIDCD | National Institute on Deafness and Other Communication Disorders
1.800.241.1044 (Voice) | 1.800.241.1055 (TTY) nidcdinfo@nidcd.nih.gov | http://www.nidcd.nih.gov/
American Cleft Palate and Craniofacial Association (ACPA)
1.800.242.5338 | https://acpacares.org/
Childhood Apraxia of Speech Association of North America | CASANA
http://www.apraxia-kids.org
National Stuttering Foundation
1.800.937.8888 | info@WeStutter.org | http://www.nsastutter.org/
Stuttering Foundation
1.800.992.9392 | info@stutteringhelp.org | http://www.stuttersfa.org/
Articles
1. CDC. “What Is a Developmental Milestone?” Centers for Disease Control and Prevention, December 29, 2022. https://www.cdc.gov/ncbddd/actearly/milestones/index.html.
2. CDC. “What Is ‘Early Intervention’ and Is My Child Eligible?” Centers for Disease Control and Prevention, April 11, 2018. https://www.cdc.gov/ncbddd/actearly/parents/states.html.
3. CDC. “Language and Speech Disorders in Children.” Centers for Disease Control and Prevention, May 11, 2022. https://www.cdc.gov/ncbddd/developmentaldisabilities/language-disorders.html.
4. “Speech and Language Developmental Milestones | NIDCD,” October 13, 2022. https://www.nidcd.nih.gov/health/speech-and-language.
5. “Developmental Language Disorder | NIDCD.” Accessed August 21, 2023. https://www.nidcd.nih.gov/health/developmental-language-disorder.
6. “Voice, Speech, and Language | NIDCD.” Accessed September 18, 2023. https://www.nidcd.nih.gov/health/voice-speech-and-language.
7. “General Information About Speech and Language Disorders | LD OnLine.” Accessed September 11, 2023. https://www.ldonline.org/ld-topics/speech-language/general-information-about-speech-and-language-disorders.
8. @ASHA. “How Do You Know When It’s a Language Delay Versus a Disorder?,” April 13, 2015. https://leader.pubs.asha.org/do/10.1044/language-delay-versus-a-disorder/full/.
9. “Speech and Language Disorders – Symptoms and Causes.” Accessed August 21, 2023. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/speech-and-language-disorders.
10. Cleveland Clinic. “Speech Impediment: Definition, Causes, Types & Treatment.” Accessed September 11, 2023. https://my.clevelandclinic.org/health/diseases/21937-speech-impediment.
11. American Speech-Language-Hearing Association. “Late Blooming or Language Problem?” American Speech-Language-Hearing Association. Accessed September 18, 2023. https://www.asha.org/public/speech/disorders/late-blooming-or-language-problem/.
12. American Speech-Language-Hearing Association. “How Does Your Child Hear and Talk? Speech, Language, and Hearing Developmental Milestones From Birth to 5 Years.” American Speech-Language-Hearing Association. Accessed September 16, 2023. https://www.asha.org/public/speech/development/chart/.
13. American Speech-Language-Hearing Association. “Developmental Norms for Speech and Language.” American Speech-Language-Hearing Association. Accessed September 16, 2023. https://www.asha.org/slp/schools/prof-consult/norms/. 14. Individuals with Disabilities Education Act. “Sec. 300.8 Child with a Disability.” Accessed September 18, 2023. https://sites.ed.gov/idea/regs/b/a/300.8.
[i] Speech and Language Developmental Milestones | NIDCD. (2022, October 13). https://www.nidcd.nih.gov/health/speech-and-language
[ii] Philadelphia, T. C. H. of. (2014, August 23). Age-Appropriate Speech and Language Milestones. The Children’s Hospital of Philadelphia. https://www.chop.edu/health-resources/age-appropriate-speech-and-language-milestones