Language Difficulties in preschool children: When to worry and how to help

You should worry if a 1-year-old child...

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

Language Stimulation up to 1 Year of Age

Before 6 months

Talk about what you are doing
Repeat the sounds the child makes
Position yourself so that the child can see your face
Talk about the different sounds the child hears
Respond verbally when the child touches you, looks at you, or makes sounds
Exaggerate intonation; use facial expressions

Between 6 and 12 months

Speak in short sentences
Label what the child is pointing to
Play with sounds: repeat sounds that the child produces
Play simple games, e.g.“peek-a-boo” and “pat-a cake”

You should worry if a 1 1/2-year-old child...

Produces no words (even “mama”, “dada”)
Does not respond to his name
Only produces vowels
Communicates only with gestures
Produces little jargon
Does not imitate
Does not understand routine commands (e.g. “Sit down”, “Give me”)

You should worry if a 2-year-old child...

Understands few, if any words
Does not imitate sounds or words
Has few intelligible words
Does not combine two words together

Language Stimulation from 1 to 2 Years of Age

Use short sentences
“Read” a storybook in your own words
Pay attention to what the child is saying instead of how he is saying it
Don’t withhold objects and insist that the child speak
Don’t insist that the child speak perfectly Repeat his message yourself and correct the errors.
Do not use “baby talk”

You should worry if a 2 ½ year-old child…

Does not understand choice questions
Cannot follow simple commands in context
Is not understood by his parents
Can only name a few objects
Rarely produces 2-word combinations

You should worry if a 3-year-old child...

Does not recognize the name of familiar objects
Does not understand simple questions (ex. Who?, What?)
Does not understand two-step instructions without natural gestures (ex. “Take off your coat and put it on the chair”)
Does not understand basic concepts (ex. up/down, big/little)
Communicates non-verbally (i.e. gestures) or combines words with gestures to express most of his ideas
Rarely makes phrases of three or more words
Is still unintelligible to his parents

Language Stimulation from 2 to 3 Years of Age

Describe what you are doing
Listen when he speaks to you
Speak to him often
Produce words and sounds correctly, without asking him to repeat.
Add words to his sentences
Do not ask too many questions. Make comments instead.
Expose the child to rhymes and songs
Read/tell a story every day

You should worry if a 4-year-old child...

Repeats the question instead of answering it
Does not understand questions which refer to past events
Answers questions inappropriately
Has difficulty understanding spatial concepts (e.g. “under”) as well as colour concepts
Uses telegraphic phrases (ex. “Doggy running fast”)
Searches for words

Language Stimulation from 3 to 4 Years of Age

Let the child help you do things; talk about what you are doing
Encourage the child’s conversations by paying attention, showing that you are interested
Vary the topic of conversation
Let the child tell stories using books and pictures.
Let him play with other children

You should worry if a 5-year-old child...

Has difficulty answering open-ended questions (e.g. “Why is the boy crying?”)
Has difficulty understanding complex directions (e.g. “before/after” or several steps)
Has difficulty grasping abstract concepts (ex. time, first/next/last)
Is often off-topic
Does not produce complex sentences

Language Stimulation from 4 to 5 Years of Age

Talk about what you are doing together
Include the child in planning activities
Talk about the ideas in stories you read
Encourage imaginary play
Don’t expect perfectly clear speech
Do not insist that he repeat correctly of perform for others

A few definitions

Communication

used to interact with other people
verbal communication: words
non-verbal communication: gestures & facial expressions

Receptive language

verbal comprehension

Expressive language

why you talk: requesting, responding, describing
what you talk about: what has happened, where, why
how you talk: vocabulary, sentences

Speech

Articulation (pronunciation)
Voice (e.g. hoarse voice)
Fluency (stuttering)
Resonance (nasal speech)

Looking to learn more? Watch our video on stuttering, with Speech Language Pathologist, Lisa Massaro.

Caroline Erdos M.Sc.(A), S-LP(C)
Elaine-Pelland-Blais M.O.A,

Montreal Children's Hospital