Language development and when to consult

By 1 year of age a child...

By 1 year of age a child...

  • starts to recognize names of objects and body parts (e.g., blanket, nose, toes);
  • starts to look for an object when asked where it is (e.g., “Where are your toes?”, “Where’s the cat?”);
  • likes people he knows - may move away from an unfamiliar person; - points and makes a sound to ask for something;
  • may start to use a few simple words;
  • imitates simple sounds; - waves “bye”;
  • shakes his head to say “no”;
  • does things to see how others will react (e.g., putting a blanket over his face);
  • tugs at parent or holds up his arms to be picked up. 
At 1 year of age, a child should be referred to speech-language pathology if he...

At 1 year of age, a child should be referred to speech-language pathology if he...

  • produces only a few sounds (little vocalizations or babbling)
  • does not respond to his name
  • does not recognize familiar objects when named (e.g. blanket, bottle)
  • does not point 
By 1 1⁄2 year of age a child...

By 1 1⁄2 year of age a child...

  • looks at pictures;
  • responds to “give me” command;
  • may point to one or a few body parts;
  • says three to ten words spontaneously;
  • mixes words with jargon;
  • may imitate animal sounds;
  • takes turns speaking;
At 1 1⁄2 year of age, a child should be referred to speech-language pathology if one of the following is present...

At 1 1⁄2 year of age, a child should be referred to speech-language pathology if one of the following is present...

  • does not respond to his name;
  • does not understand simple routine commands (e.g., “Sit down”);
  • produces only vowel sounds, communicates through gesture;
  • little variety of sounds produced in syllable strings (i.e. little jargon);
  • says no words, not even “Mommy” or “Daddy”;
  • does not imitate 
By 2 years of age a child...

By 2 years of age a child...

  • understands simple instructions (e.g., “Drink your juice”);
  • can identify body parts on himself;
  • listens to simple stories from a picture book;
  • says the names of things, actions, and people;
  • starts to put two words together (e.g., “more milk”, “car go”);
  • asks questions (e.g., “What’(s) that?”, “Where’(s) Daddy?”);
  • likes to pretend (e.g., imitates housework);
At 2 years of age, a child should be referred to speech-language pathology if one of the following is present...

At 2 years of age, a child should be referred to speech-language pathology if one of the following is present...

  • only understands few, if any, words (e.g., “bath”, “night-night”, “juice”, “outside”);
  • does not imitate sounds (e.g., animal sounds, sound of car, etc..) or words;
  • says fewer than 40 words - has few intelligible words.
  • does not combine two words together 
By 2 1⁄2 years of age a child...

By 2 1⁄2 years of age a child...

  • follows a two-step related command (e.g. take your coat off and put it on the chair);
  • identifies pictures when named;
  • produces two-word phrases frequently;
  • produces three-word phrases occasionally;
  • uses simple pronouns (e.g. “me”, “you”); 
At 2 1⁄2 years of age, a child should be referred to speech-language pathology if one of the following is present...

At 2 1⁄2 years of age, a child should be referred to speech-language pathology if one of the following is present...

  • does not understand choice questions (e.g., “Do you want milk or juice?”);
  • does not understand the question “What’s that?”;
  • is unable to follow simple instructions in context (e.g., “Go get your coat” when the parents are ready to go out);
  • is not understood by his parents;
  • says fewer than 100 words - rarely produces two-word phrases;
  • can only name a few objects 
By 3 years of age a child...

By 3 years of age a child...

  • understands many words, including those for actions (e.g., “run”, “jump”, “sit down”), location of an object (e.g., “in”, “under”), pronouns (e.g., “I”, “you”), and simple opposites (e.g., “big”, “little”);
  • uses short sentences (e.g., “Me do it”); - pronounces words clearly but not perfectly;
  • asks for things by name;
  • asks simple questions (e.g., “What’s that?”);
  • starts to tell simple stories;
At 3 years of age, a child should be referred to speech-language pathology if one of the following is present...

At 3 years of age, a child should be referred to speech-language pathology if one of the following is present...

  • does not seem to recognize the name of familiar objects;
  • does not understand simple questions (e.g., “who”, “where” questions);
  • does not understand simple instructions which are not accompanied by natural gesture (e.g., “Put your coat on the chair”); - does not understand basic concepts (e.g., “up/down”, “big/small”);
  • communicates non-verbally (i.e. uses gestures) or combines single words with gestures to express most of his ideas;
  • rarely produces phrases of three or more words;
  • is still unintelligible to his parents 
By 4 years of age a child...

By 4 years of age a child...

  • understands most of what is said to him; - understands words that express concepts of size, space, and quantity;
  • understands directions that have two or three actions (e.g., “Look on the table and find a story book that you would like to read”);
  • can identify colours when they are named;
  • is intelligible to most people;
  • uses sentences that have 4 to 5 words;
  • asks different questions (e.g., “how”, “why”, and “when”); 
  • an have long conversations with others;
  • uses language to joke, tease and pretend; 
At 4 years of age, a child should be referred to speech-language pathology if one of the following is present...

At 4 years of age, a child should be referred to speech-language pathology if one of the following is present...

  • repeats the question asked instead of answering it;
  • does not understand questions which refer to past events (e.g., ”How did you hurt yourself ?”);
  • seems to understand the object of the question but answers inappropriately (e.g., Question “Where is the cat?” Answer: “The cat is black”);
  • has difficulty differentiating prepositions related to spatial location (e.g., “on”, “in”, “under”, etc...) as well as naming and recognizing colours;
  • expresses himself using telegraphic phrases (e.g., “Mommy, want water”);
  • is always searching for his words;
  • often makes off-topic remarks. 
By 5 years of age a child...

By 5 years of age a child...

  • understands complex directions (e.g., “Please pick up your toys and wash your hands before dinner”);
  • understands and asks many questions, including questions that begin with “How”;
  • understands the difference between “full” and “empty”, “loud” and “soft”;
  • is readily intelligible;
  • uses complete sentences that have 4 to 8 words;
  • can talk about a long story that has been read or makes up his own stories; 
At 5 years of age, a child should be referred to speech-language pathology if one of the following is present...

At 5 years of age, a child should be referred to speech-language pathology if one of the following is present...

  • has difficulty answering open-ended questions (e.g., “Why is the boy crying?”);
  • has difficulty understanding two-part instructions (e.g., “Take off your coat and put it in the closet”);
  • has difficulty grasping abstract concepts (e.g., number concept, “first/next/last”);
  • is often off-topic, lack of coherence in discourse;
  • does not produce complex (two-part) sentences (e.g., “The boy is crying because he hurt himself”). 
Beyond age 5 years of age...

Beyond age 5 years of age...

Some children are not identified before age 5. When parents and teachers report difficulty following instructions, producing grammatically correct sentences, expressing ideas, and finding words in children beyond 5 years of age, these children should be referred to their school speech-language pathologist. 

Please refer to the Speech Language Pathology web page for more information regarding services offered in our department and the eligibility criteria. 

*In order to simplify the text, the masculine form has been used to refer to both genders. 

Patient
Montreal Children's Hospital

Speech-Language Pathology

Speech-Language Pathology is part of Brain Development & Behavior. New referrals must be processed via the Central Intake Service.

Please follow the instructions for referral on the Central Intake webpage and send it by:

  • Fax: (514) 412-4136
  • Email: bdbci@muhc.mcgill.ca