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How do you know if your child has speech and language difficulties?

We currently have family visiting from overseas (an in law) so for the last few weeks I have been acting as a tour guide.  We’ve been to Cambridge, Oxford, Stonehenge, Bath, Eton, Windsor, Dunkirk, Bruges and Brighton.  As we’ve travelled they have commented over and over again how beautiful everything looks and how quaint all of the old buildings are.  At first I thought they were being polite, but then I realised that they were sincere!  It made me ponder and I’ve realised that actually Great Britain is really beautiful.  We live in a lush, green country and there are stacks of gorgeous historic buildings around.  I’ve always known that they are there; it’s just that seeing them again through fresh eyes made me think about how much I have taken them for granted.  When you are around something every day you stop seeing it, or you don’t see it for what it is.

The school term has just started and many children are just starting school.  One of my colleagues over at Bridge Therapy (Stourbridge) recently posted an article on her facebook page about Head teachers reporting that the number of 4 year olds starting school without being about to speak properly is on the increase.  The original article was in The Telegraph newspaper (http://www.telegraph.co.uk/education/2017/09/06/cases-rour-year-olds-arriving-school-unable-speak-properly-rise/) and talks about how because of the pressures of modern family life many parents no longer have time to talk to their children, but instead leave them to play with ipads and other forms of technology.  They cite this as one of the factors that may be contributing to why there is an apparent increase in children nesnot being able to communicate properly.  I’m not going to bash parents here, most of the time they do the best they can with the tools and knowledge they have available to them at the time.

However, another potential reason they cite did resonate with me and that is “that there is a failure to identify and support additional needs early enough” was the most common reason given.  It’s a tough job being a parent!!!!  Most parents have to keep lots of balls balanced up in the air all at once, but I wonder if part of the problem is that we are so used to being with our children that we simply don’t notice that they are having difficulties (a bit like not seeing the green hills and historic buildings).  They are just our children and we are used to what they do and how they do it!  Now don’t get me wrong I’m not saying that parents are complacent or lazy, but how do you know what your child is supposed to do and at what age?

How do you know if their skills are delayed?  Speech and language therapists are highly skilled and have specialist knowledge.  Most parents do not have access to this knowledge.

So, how do you know whether you should be concerned about your child?

The following is a guide to the skills that they should have acquired by certain ages.

By 18 months you should see your child doing:


  1. Enjoy games like peek-a-boo and pat-a-cake and toys that make a noise.
  2. Start to understand a few simple words, like ‘drink’, ‘shoe’ and ‘car’. Also simple instructions like ‘kiss mummy’, ‘kick ball’ and ‘give me’.
  3. Point to things when asked, like familiar people and objects such as ‘book’ and ‘car’.
  4. Use up to 20 simple words, such as ‘cup’, ‘daddy’ and ‘dog’. These words may not always be easily recognised by unfamiliar adults.
  5. Gesture or point, often with words or sounds to show what they want.
  6. Copy lots of things that adults say and gestures that they make.
  7. Start to enjoy simple pretend play, for example pretending to talk on the phone.


By 24 months they should be:


  1. Concentrate on activities for longer, like playing with a particular toy.
  2. Sit and listen to simple stories with pictures.
  3. Understand between 200 and 500 words.
  4. Understand more simple questions and instructions. For example ‘where is your shoe?’ and ‘show me your nose’.
  5. Copy sounds and words a lot.
  6. Use 50 or more single words. These will also become more recognisable to others.
  7. Start to put short sentences together with 2-3 words, such as ‘more juice’ or ‘bye nanny’.
  8. Enjoy pretend play with their toys, such as feeding dolly.
  9. Use a limited number of sounds in their words – often these are p, b, t, d, m and w. Children will also often miss the ends off words at this stage. They can usually be understood about half of the time.


By 3 years they should be doing:


  1. Listen to and remember simple stories with pictures.
  2. Understand longer instructions, such as ‘make teddy jump’ or ‘where’s mummy’s coat?’
  3. Understand simple ‘who’, ‘what’ and ‘where’ questions.
  4. Use up to 300 words.
  5. Put 4 or 5 words together to make short sentences, such as ‘want more juice’ or ‘he took my ball’.
  6. Ask lots of questions. They will want to find out the name of things and learn new words.
  7. Use action words as well as nouns, such as ‘run’ and ‘fall’.
  8. Start to use simple plurals by adding ‘s’, for example ‘shoes’ or ‘cars’.
  9. Use a wider range of speech sounds. However, many children will shorten longer words, such as saying ‘nana’ instead of ‘banana’. They may also have difficulty where lots of sounds happen together in a word, e.g. they may say ‘pider’ instead of ‘spider.’
  10. Often have problems saying more difficult sounds like sh, ch, th and r. However, people that know them can mostly understand them.
  11. Now play more with other children and share things.
  12. Sometimes sound as if they are stammering or stuttering.  They are usually trying to share their ideas before their language skills are ready. This is perfectly normal, just show you are listening and give them plenty of time.


By 4 years you should expect:


  1. Listen to longer stories and answer questions about a storybook they have just read.
  2. Understand and often use colour, number and time related words, for example, ‘red’ car, ‘three’ fingers and ‘yesterday / tomorrow’.
  3. Be able to answer questions about ‘why’ something has happened.
  4. Use longer sentences and link sentences together.
  5. Describe events that have already happened e.g. ‘we went park.’
  6. Enjoy make-believe play.
  7. Start to like simple jokes.
  8. Ask many questions using words like ‘what’ ‘where’ and ‘why’.
  9. Still make mistakes with tense such as say ‘runned’ for ‘ran’ and ‘swimmed’ for ‘swam’.
  10. Have difficulties with a small number of sounds – for example r, w, l, f, th, sh, ch and dz.
  11. Start to be able to plan games with others.


By 5 years they should be:


  1. Understand spoken instructions without stopping what they are doing to look at the speaker.
  2. Choose their own friends and play mates.
  3. Take turns in much longer conversations.
  4. Understand more complicated language such as ‘first’, ‘last’, ‘might’, ‘may be’, ‘above’ and ‘in between’.
  5. Understand words that describe sequences such as “first we are going to the shop, next we will play in the park”.
  6. Use sentences that are well formed. However, they may still have some difficulties with grammar. For example, saying ‘sheeps’ instead of ‘sheep’ or ‘goed’ instead of ‘went’.
  7. Think more about the meanings of words, such as describing the meaning of simple words or asking what a new word means.
  8. Use most sounds effectively. However, they may have some difficulties with more difficult words such as ‘scribble’ or ‘elephant’.


Since children are different the milestones listed above are a general guide.  A skilled clinician will be able to ascertain whether there is cause for concern about a child’s development.

One of the most difficult aspects of being a speech and language therapist is that you sometimes have to break bad news to people.  Often, when children are diagnosed with language difficulties a lot of parents will report that they didn’t know what to look out for.

Here are some things to look out for that may indicate your child is having difficulties with language understanding and use:

  • Does not use gestures (e.g., waving, pointing) (7–12 months)
  • Doesn’t understand what others say (7 months–2 years)
  • Says only a few words (12–18 months)
  • Doesn’t put words together to make sentences (1½–2 years)
  • Says fewer than 50 words (2 years)
  • Has trouble playing and talking with other children (2–3 years)
  • Has problems with early reading and writing skills—for example, may not show an interest in books or drawing (2½–3 years)
  • Has a limited vocabulary compared to children the same age
  • Substitutes general words like “stuff” and “things” for more precise words
  • Has trouble learning new vocabulary words
  • Leaves out key words when talking.
  • Uses certain phrases over and over again when talking
  • Doesn’t talk much, although he understands what other people say
  • Uses short, simple sentences or speaks in phrases
  • Uses a limited variety of sentence structures when speaking
  • Has little interest in social interactions
  • Goes off-topic or monopolizes conversations
  • Doesn’t change his language for different listeners or situations
  • Has trouble understanding things that are implied and not stated directly
  • Doesn’t understand how to properly greet people or gain attention
  • Doesn’t understand riddles and sarcasm

Now, a friend jokingly commented to me that this sounds like the average teenager. My reply “ha ha, teenagers will mostly be doing this through choice and not inability”.  If your child has difficulties with understanding and using language you will see these signs well before they become teenagers.