Speech acquisition: Key development stages for children

A child’s first word is an eagerly awaited milestone in most households and parents worry if there appears to be a delay in learning to talk.

Of the four child-development checks, the most crucial one for speech and language issues is probably the one scheduled for between 18 and 24 months. Although all the checks are important, the one coming up to two years of age is when concerning delays in speech and language are most likely to be flagged.

During this check, children’s understanding and expression of language is assessed, as is their ability in pretend play, says Dr Ciara O’Toole of the department of speech and hearing sciences at UCC. Questions around hearing and ear infections can come up at this point, which, if not picked up and addressed early, by an audiologist or area medical officer, can have long-term impacts on developing speech and language.

Early intervention

Through all the checks, public health nurses are on the lookout for early social interaction difficulties, which could be early signs of autism and/or language disorder and would need to be monitored and checked by an early-intervention team, she says. If they see early cognitive difficulties (for example not understanding words, lack of pretend play, or problem-solving difficulties), these too would need to be monitored and checked by an early intervention team.

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“They pick up early speech and language difficulties like signs of late talking, speech sound difficulties, stammering and lack of development and progress which need to be checked by a speech and language therapist.”

If your child has missed out on one or more development checks over the past year due to the pandemic, here O’Toole outlines some typical indications that a child may need to be checked by a speech and language therapist/early-intervention team. However, she stresses that parents should view milestones as “windows of development” as opposed to strict age cut-offs because all children develop at slightly different paces.

Three months

– Does not respond to environmental sounds or voices.
– Does not make sounds to indicate he/she wants you to do something.
– Has no interactive eye gaze.

Nine-11 months

– Does not follow simple commands or understand simple questions ("roll the ball", "kiss the doll", "where's your shoe?")
– Does not identify three body parts on self or doll.
– Does not point at objects or events as if they are "saying" to an adult "wow look at that!"
– A very "quiet" baby who is not making sounds or babbling.
– No pretend play.

18-24 months

– Does not use at least 50 understandable, different words.
– Does not use some two-word sentences ("where's kitty?"; "go bye-bye"; "what's that?'").
– Does not refer to self by name or pronoun (eg "me", "mine").
– Poorly developed pretend play skills.

Three years

– Does not understand differences in meaning (eg go/stop; in/on; big/small; up/down).
– Does not respond to wh-questions (eg who, what, where).
– Does not tell you about something in two- or three-word "sentences".
– Has difficulty learning new concepts and words.
– Has very unclear speech (to familiar adults).
– Stammers frequently with signs of distress.

In normal times, public health nurses are responsible for more than half of child referrals to speech and language therapists (SLTs). But concerned parents can always refer their own children to an SLT, either through the public system, where waiting lists were long even before the pandemic, or privately.

O’Toole suggests that parents start to keep a diary to take note of any words they hear their child say, or anything they notice about their understanding of language. This will help to form a view of how the child is learning.

“Don’t listen to people who say they will ‘grow out of it’ if you have particular concerns,” she adds. “Anything you can do to help the child as they are growing and learning language will help in the long term.”

For more information, see the Irish Association of Speech and Language Therapists and the Independent Speech-Language Therapists of Ireland. 

Read: Child development checks in a time of pandemic