Speech Development Milestones in Children, Stammering & When to refer

Comprehension Expressive language Speech-articulation phonology Fluency Play Attention
Birth-6 months Comprehension of tone of voice. Pre-linguistic babbling-intonation patterns. Exploratory eg mouthing, banging-hitting. Level 1

Fleeting attention, highly distractible.

6-9 months Comprehension of gesture eg waving bye-bye. Linguistic babbling ie consistent with meaning: laughs, chuckles. Frolic, rough and tumble.
9-12 months Situational understanding: “give mummy a kiss”, words have no individual meaning. First words (range 9-30 months). Relational.
12-18 months 12 months: object recognition

  • generalises labels
  • knows name

Beginning of symbolic understanding.

Two words (range 10-44  months) Symbolic play begins Level 2

Will attend to own choice of activities.

18-24 months
  • 14-15 months: comprehension of large doll play.
  • 18-21 months: comprehension of small doll play.
  • 24 months: comprehension of 2-dimensional representations – pictures.
18 months:

  • p
  • b
  • m
  • n
  • h
  • w
periods of normal non-fluency. Sequences

  • patterns
  • puzles.
24-30 months 24-27 months:

  • match small toys to pictures
  • one symbol to another
  • true verbal comprehension
  • relates 2 named objects – “put brush into box”.
  • Three words
  • Uses own name
24 months

  • k
  • g
  • d
  • t
  • ng
Level 3

  • Single channel attention
  • Will attend to adults choice of activity but difficult to control.
30-36 months
  • Comprehension of verbs increases
  • Relate 2 concepts
  • Comprehension by function eg “which do we cook with, which one barks?”
Four words + 30 months

  • f
  • y

36 months

  • r
  • l
  • s
  • Simple construction
  • Make-believe
36-48 months
  • Complex directions
  • adjectives
  • colour
  • size
  • prepositions
  • pronouns
  • negatives
  • Complex sentences
  • Language directs and integrates practical activities
Speech understood by family

42 months

  • ch
  • sh
  • Planning and organising
  • Role-play
Level 4

Single channel attention easily controlled.

48-54 months Language internalised and integrative.
  • Discussive style
  • Questions why/when.
48 months

  • z
  • j
  • v
  • blends

Speech generally clear, may  not use s clusters or k, g and th (fully developed by 7-8 years).

Fluency relapses due to sttress up to 6-7 years. Indoor games with complex rules. Level 5

Integrated for short spells

Level 6

5 years. Integrated attention, well controlled and sustained.

Children with communication disorders may have:

  • poor listening and attention
  • poor auditory memory
  • poor ability to organise themselves and their belongings
  • difficulty in concentrating in a group
  • difficulty in proceeding from one activity to another
  • difficulty with concept formation
  • difficulty with relating to other children

Older Children

  • delayed phonic skills
  • difficulty sequencing ideas
  • problems in generating ideas or constructing a narrative
  • problems with abstract thought
  • problems with problem solving

Uses of language


  • Commenting and directing
  • Initiation of conversation with familiar adults and children
  • Awareness of feelings/Awareness of social context
  • Use of questioning
  • Use of descriptive language
  • Reporting previous experience
  • Reasoning/explaining
  • Prediction of events
  • Planning
  • Imagining
  • Instructing
  • Awareness of language

  • Expression of feelings, needs and wants
  • Commenting and directing
  • Social greetings
  • Use of language in play
  • Response to and maintenance of conversation
  • Use of questioning
  • Use of descriptive language
  • Reporting previous experience
  • Reasoning
  • Prediction of events

  • Initiation of conversation with unfamiliar adults and children
  • Projection of thoughts and feelings
  • Instructing
  • Explaining Imaginative use of language
  • Extended use of questions
  • Planning
  • Hypothesising
  • Inferring and deducing
  • Reflecting on and exploring language
  • Presenting sequenced oral account
  • Giving and considering opinions

Referrals for speech therapy

  • Pre-school and school age children with speech and language disorders
  • Pre-school and school age children with developmental delay and/or learning difficulties
  • Children with communication difficulties due to physical disability
  • Children with delayed or disordered communication, social and play development due to autism
  • Children with deft/lip palate
  • Children with dysfluency
  • Children with feeding difficulties
  • Children with neurological dysfunction
  • Children with written language disorders

Stammering in early childhood

5% of children under five will experience dysfluent speech while learning to talk; about a third of these will not simply ‘grow out of it’. Early intervention by a speech and language therapist can prevent persistent stammering. Onset is commonly between two and five years3- the average being 32 months.

Stammering in young children is both fluctuating and episodic.

  • It varies in severity, according to the situation (for example with whom the child is talking, what he* wants to say, and how he is feeling).
  • A child may be fluent for days, weeks or months, and then become dysfluent again for a further period. Periodic dysfluency is a feature of early stammering.

Because stammering in young children is episodic and fluctuating, you may not observe stammering during a child’s visit. Therefore, you need to take note of parents’ concerns about their child’s speech. Facts about stammering Stammering is a communication difficulty, not just a speech problem – it can undermine a child’s confidence as well as affect social, educational and employment potentials. Boys are four times more likely to stammer than girls.

The exact cause of stammering is not yet known. It is likely that a combination of factors is involved.

There is a fine balance between what a child sable to do at a particular moment and what people or situations demand of him. Anything affecting this balance can increase dysfluency.

Modern approaches to stammering therapy are very effective in significantly reducing dysfluency in a young child’s speech. Research has shown that intervention close to the onset of stammering has a high success rate. Early referral and intervention reduces the need for prolonged and costly therapy later in the child’s life

By working together, speech and language therapists and primary healthcare professionals can move towards ensuring that all dysfluent children have the help they need to develop normally fluent speech.

When to refer

The following factors have been shown to be characteristic of those children at greater risk of developing a persistent stammer.

A child who has dysfluent speech, or if a parent reports hearing this, and one or more of the following factors are present:

  • a family history of stammering or speech or language problems
  • the child is finding learning to talk difficult in any way
  • the child shows signs of being frustrated or in any way upset by his speaking
  • the child is struggling when talking
  • the child is in a dual language situation and is stammering in his first language
  • parental concern or uneasiness
  • the child’s general behaviour is causing concern


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