Signs and Symptoms

Speech Development

The sound pattern of language that we call speech or articulation is made up of combinations of sounds that form words. Speech development is a gradual process. It begins in infancy and continues through a child’s seventh or eighth year. Children develop speech abilities at different rates and ages.

Milestones of Speech Development

  • Newborn–3 months

    First Sounds

    Newborns are limited to crying, which signals hunger or discomfort, and to other non-cry sounds such as burps, coughs and sneezes.
    Between two and three months of age your baby begins to laugh.

  • 4–6 months

    Vocal Play

    During the period of 4 – 6 months, babies can produce sounds that are more like speech. They begin to put sounds together, making syllables out of vowel and consonant-like sounds. They also make non-speech sounds like raspberries, squealing, yelling and growling. This experimentation with sound production is called vocal play.

  • 6–11 months


    Between 6 – 11 months of age, infants begin to babble. In babbling, a syllable is repeated two or more times in sequence, like ba-ba. Babbling is a way for your infant to practice the oral motor speech skills needed during actual speech.

  • 12–18 months

    First Words

    Between 12-18 months, babies begin to produce strings of sounds made up of different syllable combinations such as ba-da-na. These sequences are produced with adult-like speech patterns. Your baby seems to be really talking, asking questions, making statements or demanding action. However, when you listen closely to these combinations, you will find they are mostly jargon. Sometime around the babies first birthday, the child begins to produce some true words. However, babies are very limited in the consonants and vowels they use in these first words.

  • 18–36 months

    Rapid Speech Development

    Between 18 – 36 months children develop speech rapidly. They use a greater variety of sounds and sound combinations. When they encounter a word that is difficult to pronounce they usually simplify the pronunciation. A child might:
    - Leave off the final consonant of a word. Dog would be pronounced da.
    - Simplify the production of a consonant blend (two or more consonants in a sequence), so that plane would become pane.
    - Substitute one sound that is easier to make than another which is more difficult to make. For example, ring becomes wing.
    - one of the syllables in a word. For example water might become wa-wa.
    - Drop one of the syllables in a word so that telephone becomes tephone.


Apraxia of speech is a motor-speech programming disorder resulting in difficulty coordinating the oral-motor movements necessary to produce and combine speech sounds to form syllables, words, phrases and sentences.

Apraxia of speech is often treatable with the appropriate techniques. It is not just a simple articulation disorder, nor a phonological disorder but a motor-speech programming disorder. Traditional therapy as well as minimal pairs techniques are often unsuccessful.

Early signs and symptoms

Lack of cooing or babbling as an infant, first words may not appear at all, pointing and grunting may be all that is heard.

Delayed first words with many phonemes deleted or replaced with other easier phonemes.

Lack of a significant consonant repertoire: child may only be able to use /b,m,p,t,d,h/.

All phonemes may be imitated well in isolation, but any attempts to combine phonemes are unsuccessful.

Words may be simplified by deleting consonants or vowels, and/or replacing difficult phonemes with easier ones.

A syllable is favored, and used for all words.

A word (may be real or a nonsensical utterance) is used to convey other words.

Single words may be articulated well, but attempts at further sentence length becomes unintelligible.

Oral scanning or groping may occur with attempts at speaking.

A whole phrase may be clearly said and never heard again, or cannot be imitated.

Other fine-motor problems may be present.

Verbal preservation: getting stuck on a previously uttered word, or bringing oral-motor elements from a previous word into the next word uttered.

Receptive Language Disorder

Receptive language refers to the skills involved in understanding language. Difficulties in receptive language may be present in the ability to attend, process, comprehend, retain or integrate spoken language.

Early signs and symptoms

– Inability to follow directions
– Echolalia (repeating back words or phrases either immediately or at a later time.)
– Inappropriate, off-target responses to WH questions
– Repeating back a question first and then responding to it
– Difficulty responding appropriately to:

– WH questions
– Yes/No questions
– Either/Or questions
– Not attending to spoken language
– Jargon (sounds like unintelligible speech)
– Using memorized phrases and sentences

Expressive Language Disorder

Expressive language refers to the skills of being precise, complete and clear when expressing thoughts and feelings, answering questions, relating events, and carrying on a conversation.
– Word retrieval difficulties
– Dysnomia (misnaming items)
– Difficulty acquiring the rules of grammar
– Difficulty in verb tense changes
– Difficulty in word meaning

Milestones of Language Development

  • Birth

    - Listens to speech
    - Startles or cries at noises

  • 0–3 Months

    - Turns to you when you speak
    - Smiles when spoken to
    - Recognizes your voice and quiets down if crying
    - Can coo and goo
    - Cries differently for different needs

  • 4–6 months

    - Responds to no
    - Looks around for the source of a new sound
    - Babbles
    - Imitates different speech sounds

  • 7 months–1 year

    - Recognizes words for common items
    - Begins to respond to requests (Come here)
    - Has one or two words
    - Uses speech or non-crying sounds to gain attention

  • 1–2 years

    - Understands a variety of words and should be using a few single words.
    - Points to pictures in a book when named
    - Points to a few body parts
    - Follows simple commands
    - By age two, words should be combined into two and three-word phrases and sentences.

  • 2–3 years

    - Understands differences in some opposites
    - Follows two requests
    - Has a word for almost everything
    - Uses 2 – 3 word sentences

  • 3–4 years

    - Answers simple who, what, where and why questions
    - Uses sentences of 4 or more words in length

  • 4–5 years

    - Pays attention to a story and answers simple questions about it
    - Communicates easily with children and adults
    - Uses the same grammar as the rest of the family

Voice Disorders

During speech, the air stream passes through the larynx, causing the vocal cords to vibrate. The size and shape of a persons vocal cords, along with the size and shape of the mouth influences a persons voice. There are several aspects of voice:
– Loudness
– Quality (hoarse, weak, strident, husky or breathy)
– Resonance (vibration of air in the throat and nasal cavity during speech)

The child with a voice problem should always be seen by an ear, nose and throat doctor (Otolaryngologist). Any hoarseness or vocal strain that lasts for more than two weeks should be investigated. The most common voice disorder in children is vocal nodules. These are hard calluses that develop on the vocal cords due to harmful use of the voice. Nodules cause the child’s voice to be hoarse and/or sometimes weak and breathy if they are very large. Everyday misuse of the voice is a serious problem. The management of vocal nodules should always include voice therapy by a speech pathologist. Occasionally, vocal nodules require surgery.


Children seem to be most disfluent during the preschool years, particularly during the ages of 2 – 4. Generally, revisions, interjections, and word and phrase repetitions are very common in children’s speech. Sound and syllable repetition, sound prolongation, and broken words are less common. However, there is a wide range of behavior considered to be normal. Most children show each type of disfluency from time to time. This is considered to be normal disfluency.

While disfluency is common in most children, certain patterns of disfluent speech are not quite as typical. The presence of some of these behaviors may indicate that the child is having disfluency and beginning to react to the interruptions:
– Frequent sound and syllable repetition
– Syllable repetition in which an uh vowel replaces the correct vowel in the word (puh-puh-peach)
– Frequent prolongation of sounds that become longer in duration
– Tremors (trembling of the muscles) round the mouth or jaw during speech
– Rises in pitch or loudness of the voice during the prolongation of sounds
– Tension and struggle behavior while saying certain words
– A look of fear in the child’s face while saying a word
– Avoidance of or delay in saying certain words

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