Language Difficulties in preschool children: When to worry and how to help

You should worry if a 1-year-old child…

• Produces only a few sounds (little vocalizations or babbling)
• Does not respond to his name
• Does not recognize familiar objects when named (e.g. blanket, bottle)
• Does not point

Language Stimulation up to 1 Year of Age

Before 6 months

• Talk about what you are doing
• Repeat the sounds the child makes 
• Position yourself so that the child can see your face
• Talk about the different sounds the child hears
• Respond verbally when the child touches you, looks at you, or makes sounds
• Exaggerate intonation; use facial expressions

Between 6 and 12 months

• Speak in short sentences
• Label what the child is pointing to
• Play with sounds: repeat sounds that the child produces 
• Play simple games, e.g.“peek-a-boo” and “pat-a cake”

You should worry if a 1 1/2-year-old child…

• Produces no words (even “mama”, “dada”)
• Does not respond to his name
• Only produces vowels 
• Communicates only with gestures
• Produces little jargon
• Does not imitate
• Does not understand routine commands (e.g. “Sit down”, “Give me”)

You should worry if a 2-year-old child…

• Understands few, if any words
• Does not imitate sounds or words
• Has few intelligible words
• Does not combine two words together

Language Stimulation from 1 to 2 Years of Age

• Use short sentences
• “Read” a storybook in your own words
• Pay attention to what the child is saying instead of how he is saying it
• Don’t withhold objects and insist that the child speak
• Don’t insist that the child speak perfectly Repeat his message yourself and correct the errors.
• Do not use “baby talk”

You should worry if a 2 ½ year-old child…

• Does not understand choice questions
• Cannot follow simple commands in context
• Is not understood by his parents
• Can only name a few objects
• Rarely produces 2-word combinations

You should worry if a 3-year-old child…

• Does not recognize the name of familiar objects
• Does not understand simple questions (ex. Who?, What?)
• Does not understand two-step instructions without natural gestures (ex. “Take off your coat and put it on the chair”) 
• Does not understand basic concepts (ex. up/down, big/little)
• Communicates non-verbally (i.e. gestures) or combines words with gestures to express most of his ideas
• Rarely makes phrases of three or more words 
• Is still unintelligible to his parents

Language Stimulation from 2 to 3 Years of Age

• Describe what you are doing
• Listen when he speaks to you
• Speak to him often
• Produce words and sounds correctly, without asking him to repeat.
• Add words to his sentences
• Do not ask too many questions. Make comments instead.
• Expose the child to rhymes and songs
• Read/tell a story every day

You should worry if a 4-year-old child…

• Repeats the question instead of answering it
• Does not understand questions which refer to past events 
• Answers questions inappropriately
• Has difficulty understanding spatial concepts (e.g. “under”) as well as colour concepts
• Uses telegraphic phrases (ex. “Doggy running fast”)
• Searches for words

Language Stimulation from 3 to 4 Years of Age

• Let the child help you do things; talk about what you are doing
• Encourage the child’s conversations by paying attention, showing that you are interested
• Vary the topic of conversation
• Let the child tell stories using books and pictures. 
• Let him play with other children

You should worry if a 5-year-old child…

• Has difficulty answering open-ended questions  (e.g. “Why is the boy crying?”)
• Has difficulty understanding complex directions (e.g. “before/after” or several steps) 
• Has difficulty grasping abstract concepts (ex. time, first/next/last)
• Is often off-topic
• Does not produce complex sentences

Language Stimulation from 4 to 5 Years of Age

• Talk about what you are doing together
• Include the child in planning activities 
• Talk about the ideas in stories you read
• Encourage imaginary play
• Don’t expect perfectly clear speech
• Do not insist that he repeat correctly of perform for others

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A few definitions

Communication

• used to interact with other people
• verbal communication: words
• non-verbal communication: gestures & facial expressions

Receptive language

• verbal comprehension

Expressive language

• why you talk: requesting, responding, describing
• what you talk about: what has happened, where, why
• how you talk: vocabulary, sentences

Speech

• Articulation (pronunciation)
• Voice (e.g. hoarse voice)
• Fluency (stuttering)
• Resonance (nasal speech)

Caroline Erdos M.Sc.(A), S-LP(C) 
Elaine-Pelland-Blais M.O.A,

Montreal Children’s Hospital