The first step, as always, is determining whether there is a problem and what the nature of the problem might be. Several approaches can be used to help clarify whether an individual actually has a communication problem that warrants intervention or if, instead, the individual has an unusual, albeit strange at times, communication style.

For children, the three key ways to consider whether there is a significant problem or concern are:

• Checking developmental milestones
• Looking for Warning Signs or "high-risk" behaviors
• Considering "other" factors such as medical or environmental factors

How Do I Know If I Might Need Help For My Child?
As a parent, you know how well your child communicates and how his or her speech and language skills compare to those of siblings and other children the same age. If you suspect that your child’s developmental progress may be slow, the best step you can take is to arrange for a professional evaluation and get help sooner instead of later. Studies show that the younger children are when speech and language problems are diagnosed and treated, the more positive their outcomes will be.

Here are some developmental speech and language milestones to look for:

At 18 months your child should be able to:

• Use five to 20 words
• Point to at least 3 body parts
• Shake his or her head "no"
• Imitate 3 animal sounds
• When asked, find familiar objects that are not in sight

At 24 months your child should be able to:

• Put two words together
• Follow simple instructions
• Point to pictures in a book when they are named
• Enjoy listening to stories
• Understand prepositions like "in," "on," and "at"

Between ages 3 and 5 your child should be able to:

• Carry on a conversation
• Ask and answer questions
• Follow and give directions
• Speak alone in front of a group

Keep in mind that not all children reach these milestones at exactly the same age, but all must pass through them in order to develop successful speech and language skills. A delay of a year of more in reaching any of these milestones may indicate a problem.

Warning Signs
Here are some clues that your child may be having trouble with speech and language skills:

• Recurrent ear infections
• A hospital stay of six months or more
• Continuing frustration when trying to communicate, lasting for a month or more
• Poor response to speakers or environmental sounds
• Difficulty in following directions
• Limited speech
• Trouble getting words out
• Problems paying attention
• Difficulty interacting with others

Problems with language fundamentals

• Trouble with sucking, swallowing or chewing
• Limited skills in imitating speech sounds or behavior
• Difficulty focusing and maintaining attention
• Slow cognitive skills
• Slow processing of non-verbal cues (pictures or objects)
• Limited curiosity in exploring the environment
• Limited social responsiveness
• Poor responses to other speakers or environmental sounds
• Documented ear problems or hearing difficulties

Trouble understanding or formulating spoken language

• Difficulty in following directions
• Poor memory
• Slow processing of spoken information
• Little ability to understand spoken and implied relationships
• Limited verbal output
• Disorganized or inappropriate comments
• Trouble with grammar and word order

Difficulty with speech sound production and speech clarity (articulation)

• Speech that is hard to understand
• Speech that is noticeably different from that of other children the same age
• Excessive or poor management of saliva
• Tendency to thrust tongue forward for certain sounds
• Stuttering or cluttering
• Excessive hesitations and pauses
• Trouble getting words out

Problems with voice production

• Unusual voice quality without a clear medical cause
• Voice that is hoarse, nasal, too loud or soft
• Voice problems resulting from a significant medical condition

Problems in school achievement

• Problems with attention
• Problems in reading or reading comprehension
(dyslexia)
• Problems in spelling or written language
• Problems in math
• Difficulties in general organization or study skills

Difficulties in Social Language (or "Pragmatics")

• Socially inappropriate communicative behaviors
• Trouble interacting with others—not knowing what to say to whom, or when or how to say it
• Trouble recognizing communication signals from others (such as body language, facial expressions and situation cues)
• Trouble with self-control including verbal control

Other Communication Issues
The Clinic staff also provides help with a range of other communication issues and problems, including:

• Foreign accents that interfere with clear communication
• Questions about alternative, non-oral communication systems
• Communicating after laryngectomy
• Concerns or questions about child development
• Embarrassment about speech
• Feelings of limited effectiveness in public speaking or when communicating in a persuasive or instructional setting

Other Risk Factors
Medical factors

• History of chronic respiratory problems
• History of sucking, swallowing or chewing difficulty
• History of chronic ear infections, with or without hearing loss
• History of chronic illnesses which might limit experiences in learning
• Physical disabilities or differences in speech mechanism that directly impact speech production (examples: laryngectomy, tracheotomy, cleft lip, cleft palate)
• Sensory impairment (hearing, vision)
• Psychiatric and/or psychological issues
• Genetic disorders (Down’s Syndrome)
• Neuromuscular disorders
• Failure to thrive
• Atypical birth history, including prematurity

Environmental factors

• Unstable home situation or home location
• Over-stimulation or under-stimulation in caregiving setting
• Bilingual stimulation that may be confusing