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Does My Child Need Speech Therapy?

RED Flags for Toddlers and School-Age Children


ARTICULATION: A child’s speech should be 80% intelligible to the unfamiliar listener by 3 years of age(though most parents can understand what their child is saying, this refers to how well your child can communicate to the average person in your community)

RED flags:

  • Child starts talking, is hard to understand, then stops.
  • Child leaves the ending off of many words.
  • Child lacks of variety of sounds produced.
  • You are unable to understand even simple words.
  • Excessive drooling, difficulty eating, difficulty drinking from a straw, and difficulty imitating mouth postures (like sticking out his/her tongue or puckering lips).
  • Child stuffs food into their mouth or is a picky eater.
  • Child produces an s-sound with a lisp.

VOICE: This area of speech-language development refers to the pitch, intonation, quality and loudness of a child’s voice.

RED flags:

Recurrent -

  • Hoarseness
  • Breaks in voice while speaking
  • Loss of voice
  • Low pitch
  • Reflux or constant sore throat, especially in morning

EXPRESSIVE and RECEPTIVE LANGUAGE: Your child should be able to clearly communicate his/her ideas, wants and needs. Your child should be able to demonstrate an understanding of basic concepts, answer questions, and follow directions.

RED flags:

  • Child is not approximating words or imitating sounds by 18 months of age.
  • Child is not combining words at 2 1/2 years of age.
  • Child is difficult to understand, cannot express ideas logically or clearly.
  • Child cannot maintain a topic, even for a brief period of time.
  • Child starts talking about something, or sees something, and cannot move on to another topic.
  • Child has difficulty coming up with the names of items or people.
  • Child has difficulty answering “what,” “where,” “who,” and “why” questions.
  • Child has difficulty talking about events, people, or things that are not in the immediate environment.
  • Child uses physical body language, rather than speaking to communicate with peers.
  • Child has trouble following directions.
  • Child has difficulty completing tasks independently.
  • Child has trouble making friends, entering a play circle, or expressing feelings.

STUTTERING: This area of speech refers to the inability of a child to speak without getting stuck on his/her words. This is a coordination problem involving difficulty coordinating breathing, voice, rate, and articulation.

RED flags:

  • Prolongations – “Give me the sssscissors.”
  • Part-Word – “Give me the sci- sci- sci- scissors.”
  • Whole-Word – “Give Give Give me the scissors.”
  • Phrase repetitions – “Give me, Give me, Give me the scissors.”
  • Rate - child talks so fast that he/she exhibits the behaviors listed above.

AUDITORY PROCESSING: This area of speech-language development refers to the inability of a child to accurately detect and understand incoming auditory information- from simple sounds/noises to the speech of others (despite the fact that the child has normal hearing – normal audiograms/hearing check-ups).

RED flags:

  • Near average, average, or above average intelligence but still experiencing academic difficulties; may repeat a grade or be labeled a "slow learner."
  • Exhibits a short attention span and becomes easily fatigued; forgets what is said within a few minutes.
  • Unable to block out irrelevant stimuli (background noises like air conditioners or traffic).
  • Inability to detect where sound is coming from.
  • May listen attentively, but has difficulty following long or complicated directions.
  • A significant history of chronic middle ear infections or fluctuating hearing loss.
  • Slow to answer questions.
  • Difficulty in reading, writing, or spelling.
  • Appears pre-occupied; difficult to get their attention; daydreams.
  • Presence of hyperactivity, or Attention Deficit Disorder.
  • Limited abstract abilities and difficulty pretending in play situations.
  • Does not remember simple routine things from day to day.
  • Overreacts to loud noises or sounds.
  • May show need to “cock head” or extend neck to focus attention.
  • Always looks to see what others are doing before responding to verbal direction.
  • Verbalizes whatever comes to mind; responses may not be appropriate to questions, topics, or situations.