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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:
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 childs
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 othersnot
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 (Downs
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

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