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

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

Katrine Doucet, M.Sc.(A), S-LP(c)
Speech-Language Pathologist
The Montreal Children’s Hospital
McGill University Health Centre