Frequently Asked Questions - Speech Development

Common concerns about speech and language development

My child is 2 years old and not talking.
While there is a wide range of variability in normal development, a 2-year-old should be using words and phrases to communicate his or her wants and needs. It would be a good idea to schedule a speech-language evaluation to assess your child's skills. A speech-language pathologist may provide suggestions and recommendations.

I have a hard time understanding my 2 year old.
A two year old should be understood approximately 50 percent of the time. It is common for children this age to mix nonsense words and real words. A two-year-old also does not say words as precisely and correctly as an adult.

My 4 year old can't say her "r" and "l" sounds correctly.
This is very common. A child is not expected to say these sounds correctly on a consistent basis until he or she is about 6 years old. If you are questioning whether your child's speech skills are appropriate for his or her age, a speech-language evaluation can help identify whether pronunciation skills are age-appropriate of if speech therapy may be needed.

My child is not responding to environmental noises or people's voices.
There are many reasons why a child may not be responding to people or noises. Consider scheduling a hearing evaluation for your child. If the hearing assessment shows that your child's hearing is normal, a speech-language evaluation may be recommended to ensure that the child understands what is being said.

My child is having difficulty paying attention.
Again, many different factors can result in a child not paying attention. Hearing problems and difficulties understanding language should be ruled out first.

My child is not interacting well with the other children.
Some children avoid interaction with other children because they are shy, have difficulties communicating or because of a limited set of interactive skills. A speech-language evaluation will assess the child's skill set to better evaluate the situation.

My child is having difficulty explaining his ideas or answering questions.
Children can have difficulties thinking of the word they want and/or have trouble putting their words into sentences. This may be a form of an expressive language delay. A comprehensive speech-language evaluation would need to be completed to get a good picture of the child's skills.

My child does not seem to follow directions.
A child may not be following directions because he or she has a difficult time understanding the words or the sentences used. The child may also be having a hard time hearing the instructions. A hearing assessment and speech-language evaluation would be needed to determine what is causing these difficulties.

My child is not eating the foods I would expect her to eat at her age.
Sometimes your child may have a problem with eating certain foods but cannot explain it to you. A feeding evaluation by a speech-language pathologist should be completed to determine the causes of the feeding problems and plan for how to help solve them.

My child is choking and gagging on what they eat.
Children occasionally choke on foods if they are eating rapidly or haven't chewed their food thoroughly. If this happens often, a speech-language pathologist should complete a feeding evaluation. The evaluation may include a swallow study to be sure that there is not a structural or functional problem causing your child to choke or gag.

My child's voice is very raspy.
While some children will have raspy voices from time to time, other children have this type of voice all the time. It may be from yelling or making noises/sounds. An assessment of the child's vocal cords and voice-use patterns should be completed. This includes an evaluation by a speech-language pathologist and an ear, nose and throat physician.

My child does not seem to be interested in communicating with me.
When children are younger, they often do not have the communication skills to verbalize everything they are thinking. Younger children often then use different ways to help communicate their message. This may include gestures or pulling you toward things. If the child is not using these other forms of communication, a speech-language evaluation is recommended.

My child is starting to stutter.
Repeating words, parts of words, or prolonging speech sounds, known as speech dysfluencies, occur naturally in everyone's speech. Most children between 2 and 6 years of age experience an increase in speech dysfluencies as they are learning new language skills and developing better control of the muscles of their mouth to produce speech. Normal dysfluency in children is usually characterized by repeating the first word in a sentence or phrase. There are several things a parent can do to minimize normal dysfluency so that this does not progress to a stuttering disorder. If you are concerned about your child's dysfluencies, consider scheduling a speech-language evaluation.

What occurs during a speech/language evaluation?
Parents will be asked to provide information about their child by filling out a case history form before the appointment. Parents should accompany the child to the evaluation.

The speech-language pathologist will present the child with tasks to assess various speech and language skills. Formal tests that may be completed involve things like having a child talk about pictures or situations, point to pictures, or respond to verbal requests or questions. The speech-language pathologist also will engage the child in interactions to assess his or her ability to use communication skills when talking with an unfamiliar adult and to determine if the child's speech clarity is age appropriate.

A brief examination of the structures of the mouth, including the lips, tongue, teeth and palate, also will be completed. Before you leave the appointment, the speech-language pathologist will discuss the findings with you and make suggestions and recommendations for improvement.