caused by hearing loss, while other times it may be dueto a speech or language disorder.
What is the difference between a speechdisorder and a language disorder?
Children who have trouble understanding what otherssay (receptive language) or difculty sharing theirthoughts (expressive language) may have a languagedisorder. Specifc language impairment (SLI) is a languagedisorder that delays the mastery o language skills. Somechildren with SLI may not begin to talk until their third orourth year.Children who have trouble producing speech soundscorrectly or who hesitate or stutter when talking mayhave a speech disorder. Apraxia o speech is a speechdisorder that makes it difcult to put sounds andsyllables together in the correct order to orm words.
How do speech and language develop?
The frst 3 years o lie, when the brain is developingand maturing, is the most intensive period or acquiringspeech and language skills. These skills develop best ina world that is rich with sounds, sights, and consistentexposure to the speech and language o others.There appear to be critical periods or speech andlanguage development in inants and young childrenwhen the brain is best able to absorb language. I thesecritical periods are allowed to pass without exposure tolanguage, it will be more difcult to learn.
What are the milestones for speech andlanguage development?
The frst signs o communication occur when aninant learns that a cry will bring ood, comort, andcompanionship. Newborns also begin to recognizeimportant sounds in their environment, such as thevoice o their mother or primary caretaker. As theygrow, babies begin to sort out the speech sounds thatcompose the words o their language. By 6 months oage, most babies recognize the basic sounds o theirnative language.Children vary in their development o speech andlanguage skills. However, they ollow a naturalprogression or timetable or mastering the skills olanguage. A checklist o milestones or the normaldevelopment o speech and language skills in childrenrom birth to 5 years o age is included on the ollowingpages. These milestones help doctors and other healthproessionals determine i a child is on track or i he orshe may need extra help. Sometimes a delay may be
NIDCD Fact Sheet
Speech and LanguageDevelopmental Milestones
.s. drtmt f lt & m srvs ∙ tl sttts f lt ∙ tl sttt dfss d tr mmt dsrdrs
l a n g u a g e v o i c e , s p e e c h , l a n g u a g e
What are voice, speech, and language?
Voice, speech, and language are the tools we use tocommunicate with each other.
voice
is the sound we make as air rom our lungs ispushed between vocal olds in our larynx, causingthem to vibrate.
speech
is talking, which is one way to express language.It involves the precisely coordinated muscle actions othe tongue, lips, jaw, and vocal tract to produce therecognizable sounds that make up language.
language
is a set o shared rules that allow people toexpress their ideas in a meaningul way. Language may beexpressed verbally or by writing, signing, or making othergestures, such as eye blinking or mouth movements.
Researchers sponsored by the NIDCD have discoveredone genetic variant, in particular, that is linked to SLI,a disorder that delays children’s use o words andslows their mastery o language skills throughout theirschool years. The fnding is the frst to tie the presenceo a distinct genetic mutation to any kind o inheritedlanguage impairment. Further research is exploring therole this genetic variant may also play in dyslexia, autism,and speech-sound disorders.A long-term study looking at how deaness impactsthe brain is exploring how the brain
“
rewires
”
itselto accommodate deaness. So ar, the research hasshown that adults who are dea react aster and moreaccurately than hearing adults when they observeobjects in motion. This ongoing research continues toexplore the concept o
“
brain plasticity
”
—the ways inwhich the brain is inuenced by health conditions or lieexperiences—and how it can be used to develop learningstrategies that encourage healthy language and speechdevelopment in early childhood.A recent workshop convened by the NIDCD drewtogether a group o experts to explore issues related toa subgroup o children with autism spectrum disorderswho do not have unctional verbal language by theage o 5. Because these children are so dierent romone another, with no set o defning characteristicsor patterns o cognitive strengths or weaknesses,development o standard assessment tests or eectivetreatments has been difcult. The workshop eatureda series o presentations to amiliarize participants withthe challenges acing these children and helped themto identiy a number o research gaps and opportunitiesthat could be addressed in uture research studies.
What should I do if my child’s speech orlanguage appears to be delayed?
Talk to your child’s doctor i you have any concerns. Yourdoctor may reer you to a speech-language pathologist,who is a health proessional trained to evaluate andtreat people with speech or language disorders. Thespeech-language pathologist will talk to you about yourchild’s communication and general development. He orshe will also use special spoken tests to evaluate yourchild. A hearing test is oten included in the evaluationbecause a hearing problem can aect speech andlanguage development. Depending on the result othe evaluation, the speech-language pathologist maysuggest activities you can do at home to stimulate yourchild’s development. They might also recommend groupor individual therapy or suggest urther evaluation byan audiologist (a health care proessional trained toidentiy and measure hearing loss), or a developmentalpsychologist (a health care proessional with specialexpertise in the psychological development o inantsand children).
What research is being conducted ondevelopmental speech and languageproblems?
The National Institute on Deaness and OtherCommunication Disorders (NIDCD) sponsors a broadrange o research to better understand the developmento speech and language disorders, improve diagnosticcapabilities, and fne-tune more eective treatments.An ongoing area o study is the search or better waysto diagnose and dierentiate among the various typeso speech delay. A large study ollowing approximately4,000 children is gathering data as the children grow toestablish reliable signs and symptoms or specifc speechdisorders, which can then be used to develop accuratediagnostic tests. Additional genetic studies are lookingor matches between dierent genetic variations andspecifc speech defcits.
Birth to 3 Months4 to 6 Months7 Months to 1 Year1 to 2 Years
YESNO
Knows a ew parts o the body and canpoint to them when asked
2 to 3 Years
NIDCD Fact Sheet
Speech and LanguageDevelopmental Milestones
l a n g u a g e v o i c e , s p e e c h
YESNO
Reacts to loud soundsCalms down or smiles when spoken toRecognizes your voice and calms downi cryingWhen eeding, starts or stops sucking inresponse to sound
Coos and makes pleasure sounds
Has a special way o crying ordierent needsSmiles when he or she sees you
YESNO
Enjoys playing peek-a-boo and pat-a-cakeTurns and looks in the direction o soundsListens when spoken toUnderstands words or common items such as
“
cup,
”
“
shoe,
”
or
“
juice
”
YESNO
Follows sounds with his or her eyesResponds to changes in the tone o your voiceNotices toys that make soundsPays attention to musicBabbles in a speech-like way and uses manydierent sounds, including sounds that beginwith p, b, and mLaughsBabbles when excited or unhappyMakes gurgling sounds when alone or playingwith you
YESNO
Has a word or almost everythingUses two- or three-word phrases to talkabout and ask or thingsUses k, g, , t, d, and n soundsSpeaks in a way that is understood by amilymembers and riendsNames objects to ask or them or to directattention to themFollows simple commands (
“
Roll the ball
”
)and understands simple questions (
“
Where’syour shoe?
”
)Enjoys simple stories, songs, and rhymesPoints to pictures, when named, in booksAcquires new words on a regular basisUses some one- or two-word questions(
“
Where kitty?
”
or
“
Go bye-bye?
”
)Puts two words together (
“
More cookie
”
or
“
No juice
”
)Uses many dierent consonant sounds at thebeginning o wordsResponds to requests (
“
Come here
”
or
“
Wantmore?
”
)Babbles using long and short groups o sounds(
“
tata, upup, bibibi
”
)Babbles to get and keep attentionCommunicates using gestures such as wavingor holding up armsImitates dierent speech soundsHas one or two words (
“
Hi,
”
“
dog,
”
“
Dada,
”
or
“
Mama
”
) by frst birthday
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