Does my preschooler need Speech and Language Therapy?
When might a child benefit from Speech and Language Therapy?
2 Years Old
Red Flags:
Limited vocabulary (fewer than 50 words)
Not combining two words (e.g., “more milk”)
Difficulty following simple one-step instructions (e.g., “give me your ball”)
Lack of interest in social interaction or play with others
Limited use of gestures (pointing, waving, nodding)
Poor eye contact or response to name
Unclear speech (parents are the only ones who understand them)
Impact on Daily Living, Education, and Social Skills:
Difficulty expressing needs may lead to frustration and tantrums.
Struggles with understanding simple requests can impact safety and learning.
Limited social interaction skills may lead to isolation from peers.
Examples in Daily Life:
At daycare/preschool: Child cries or becomes frustrated when unable to request a toy or food.
At home: Parent struggles to understand what the child wants, leading to tantrums.
2 Years 6 Months
Red Flags:
Vocabulary fewer than 200 words
Not using two-word phrases consistently (e.g., "want cookie")
Difficulty following two-step directions (e.g., “Get your shoes and come to me”)
Limited engagement in pretend play (e.g., not feeding a doll or pretending to talk on a toy phone)
Speech is still very unclear, even to familiar listeners
Impact on Daily Living, Education, and Social Skills:
Struggles with understanding and following directions can affect participation in structured activities.
Poor speech clarity may lead to frustration and difficulty making needs known.
Reduced pretend play can indicate challenges with social interaction and cognitive development.
Examples in Daily Life:
At daycare/preschool: Child does not understand when the teacher says, "Put your hat away and come sit down."
At home: When asked, "Where is your teddy?" child does not respond appropriately.
3 Years Old
Red Flags:
Limited vocabulary (fewer than 500 words)
Not using three-word sentences consistently
Difficulty answering simple “what” and “who” questions
Struggles to understand prepositions (in, on, under)
Speech is still unclear to unfamiliar listeners
Difficulty engaging in back-and-forth conversation
Limited imaginative or role-play skills
Impact on Daily Living, Education, and Social Skills:
Difficulty expressing thoughts leads to frustration and avoidance of interactions.
Struggles with understanding basic concepts can impact learning.
Speech clarity issues may cause peers and teachers to misunderstand the child, leading to social isolation.
Examples in Daily Life:
At preschool: Struggles to join in pretend play or follow instructions in group activities.
At home: Cannot tell a parent what happened during the day in a meaningful way.
4 Years Old
Red Flags
Cannot retell simple events or stories
Difficulty forming longer sentences (4+ words)
Struggles with understanding and answering “why” and “how” questions
Poor speech clarity (unfamiliar listeners struggle to understand)
Does not use past tense (e.g., played) or plurals correctly (e.g., horses)
Difficulty taking turns in conversation or staying on topic
Does not play cooperatively with peers
Impact on Daily Living, Education, and Social Skills:
Difficulty expressing thoughts affects academic readiness (storytelling, comprehension).
Struggles to participate in classroom discussions or structured play.
Poor social communication may lead to frustration and being left out of peer interactions.
Examples in Daily Life:
At preschool: Cannot explain what happened when they fell, saying only “Me fall.”
At home: Does not engage in back-and-forth conversations, giving one or two-word answers.
5 Years Old
Red Flags:
Cannot tell a simple story with a clear sequence
Difficulty following multi-step instructions (e.g., “Put your book away, wash your hands, and sit at the table”)
Uses incorrect grammar frequently (e.g., “Him goed to the park”)
Difficulty identifying rhyming words (e.g., mat / cat / bat) or beginning sounds of words (e.g., the first sound in bat is ‘b’)
Struggles to initiate or maintain friendships
Often misunderstood by peers or teachers due to speech clarity issues
Impact on Daily Living, Education, and Social Skills:
Struggles with storytelling and comprehension impact early literacy and academic performance.
Poor grammar and speech clarity may result in difficulties expressing ideas.
Social challenges may lead to exclusion from group activities and friendships.
Examples in Daily Life:
At school: Cannot retell a simple story from a book, missing key details.
At home: Difficulty explaining what they did at school, saying only “play outside” without further details.
