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12-18 Spontaneously uses 40-80 words
Starts to use recognizable words "wawa" "babba" "dada"
Use sounds from the following sound families: /p, b, t, d, k, g, m, n, y, w/
Indicates wants and needs by pointing/gesturing and engages in pretend play
Produces subjective and objective pronouns (I, it)
Follows a 2-step direction without gestures "go get"
Answers yes/no questions, possibly with a head nod or shake
Refers to self by name, engages in parallel play, and exhibits verbal turn taking
Points to distant objects outside
Says social words like "hi, bye-bye, thank you, please."
Requests items by name "more milk" and protests by vocalizing "no!"
Asks and Answers "what's that" and "where" with rising intonation
Says "all gone" and asks for more
Points to 12 objects when named
Repeats actions that made someone laugh and imitates adult behaviors in play
Talks to self during play
18-24 Speaks 40-80 words
Use sounds from the following sound families: /p, b, t, d, k, g, m, n, y, w/
Produces personal pronouns (my, me, mine, you, your)
Points to familiar objects in a picture
Imitates gestures involving objects (rolls car)
Follows three directions "go upstairs, get your shoes and coat"
Names three pictures
Puts two words together "go car"
Verbally requests snacks and/or drinks "I want cookie"
Imitates animal or environmental sounds
Uses intelligible speech 50% of the time
Imitates a 4 word phrase
Asks what, where, who questions with rising intonation
2-3 yearsExpressive vocabulary of 200-300 words and combines 2 words together
Has approximately 75% intelligibility
Produces the pronouns: "your, she, he, yours, we"
Clearly produces /p, b, m, t, d, k, g, n, w, h, w/ in words
Rapid sound expansion. Say "cat" (not tat) "dog" (not gog)
Airflow sounds emerge: /s, z, sh, f, v, h/
Asks and answers who, what, and where questions
Uses early pronouns I, you, me, his, hers in speech
Vocalizes for all needs "I want more"
Says yes and no in speech
Understands in, out, on, under, one, many, together, away
Understands number concepts of one and two and size differences such as big/little.
Begins to understand time concepts of soon, later, wait
Demonstrates the use of an object's function
Points to and names 5 pictures when asked
Follows three step directions "go upstairs, get your shoes and coat"
Understands verbs and most adjectives color and size
Combines nouns and verbs "boy is running"
recites a few nursery rhymes and holds up fingers to tell age
Controls volume of voice and briefly joins in play
3-4 yearsExpressive vocabulary of 300-1000 words and combines 3 words together with 80% clarity
Separates from primary caregivers easily.
Understands quantity more, less, empty, a lot, big, tall
Understands directions same, both
Understands up, down, in, on next to, besides, between, behind, in front
Identifies all colors and 5 shapes
Points to an object that is different from the others
Follows two-step commands without cues.
Asks and answers why, how and where questions
Responds to "What do you see, hear, smell?" Expresses ideas and feelings.
Talks about recent experiences. Takes turns and plays cooperatively.
Clearly produces /p, b, m, t, d, k, g, n, w, h, w, f,ing/ in sentences
Adult like speech. Clusters are stabilized (spt, spr, str). Words should not be simplified.
4-5 yearsHas a 2500 expressive word vocabulary.
Final sounds acquisitions: /v, s, z, sh, ch, l, r, j/
Has approximately 90% intelligibility
Follows three-step directions without cues.
Uses 4-5 word sentences.. Uses imaginary conditions, such as "What if…" or "I hope."
Uses words to invite others to play.
Understands comparatives big, bigger, biggest and opposites
Understands time concepts first, then, days of the week
Asks and answers why and how questions
Asks "Do you want to..?" "Are we going to…?" "Can you…?"
Understands and expresses figurative language (idioms, jokes, humor)
Uses could, would, might, maybe, should in speech
Tells what common objects are made of and their functions
5-6 yearsUnderstands opposites including left/right
Understands numbers up to 20
Answers how and when questions
Uses adjectives for describing
Uses yesterday and tomorrow
Uses prepositions through, nearest, corner, middle
Names ordinal numbers such as first, second, third
Uses irregular plurals (feet, mice) and irregular past tense (ran, slept)
Describes common objects and events
Tells the weather
Uses complete, coherent sentences
Speaks audibly, sharing ideas and information
Stabilization of all sounds including /v, s, z, sh, ch, l, r, j, th/
Understands categories
Has approximately 100% intelligibility


Speech Sound Disorders

Q. What are speech sound disorders?

A. Most children make some mistakes as they learn to say new words. A speech sound disorder occurs when mistakes continue past a certain age. Every sound has a different range of ages when the child should make the sound correctly. Speech sound disorders include problems with articulation (making sounds) and phonological processes (sound patterns).

Q.  What are some signs of a speech sound disorder?

An articulation disorder involves problems making sounds. Sounds can be substituted, deleted, added or changed. The development of speech sound acquisition varies with each child.  However, the following sounds are typically the earliest developing phonemes children acquire: “p, b, m, n, h, w, t, d, k, and g.”  These sounds should be clearly produced in conversation by 4.5 years of age.  Most children acquire later developing phonemes including: “f, v, r, l, s, and z” between the ages of 5-6.  The latest developing phonemes: “j, ch, sh, th” are typically developed between 6-7 years of age.  The ultimate goal is for your child to be approximately 100% intelligible, to an unfamiliar listener, given the context, by 6 years of age.  The child may have an articulation disorder if these errors continue past the expected age.  It is important for children to clearly articulate most sounds prior to entering Kindergarten, to prevent academic delays in reading, writing, and spelling.

Q.  How will a Speech and Language Pathologist assess my child?

A.  A speech-language pathologist (SLP) will listen to your child and use a formal articulation test to record sound errors.  The SLP will tell you exactly what sounds your child is struggling with, in what position of the word (beginning, middle or ending), and what sound, if any, he is substituting it with.   The therapist will also determine if your child is stimulable for the correct sound.  A child is “stimulable” if he or she can say the sound in direct imitation of the therapist. An oral mechanism examination is also done to determine whether the muscles of the mouth are working properly and to ensure that she has good independent control of her lips, tongue and jaw, as well as good range of motion.  The SLP will also evaluate your child’s language development to determine overall communication functioning.  Whenever there is an articulation delay, it is always recommended to rule out a hearing impairment and/or fluid in the middle ear. 

Q.  What causes speech sound disorders?

Many speech sound disorders occur without a known cause. A child may not learn how to produce sounds correctly or may not learn the rules of speech sounds on his or her own. These children may have a problem with speech development, which does not always mean that they will simply outgrow it by themselves.   Children who experience frequent ear infections when they were young are at risk for speech sound disorders if the ear infections were accompanied by hearing loss.

Q.  What are some signs of a phonological disorder?

A phonological processing disorder involves patterns of sound errors that children use to simplify the sounds of speech.  While it is common for young children learning speech to leave one of the sounds out of the word, it is not expected as a child gets older.  Most phonological processing errors typically disappear by 3.0 years of age.  If they persist past 3.0 years of age and negatively affect intelligibility, therapy is typically recommended.  The following are common errors many children present with.

Pre-Vocalic Voicing: “Pigbig”

Word-Final de-voicing: “Pigpick”

Final Consonant Deletion: “catca”   This is the most common pattern that children present with.  The final consonant in a CVC word typically has less “stress” and therefore, is often difficult to hear in connected speech.  Since these sounds are difficult to hear, they are often deleted. 

Fronting: “titekite, doddog.” The “t/k” and “d/g” phonemes are often substituted for each other because they share the same manner of articulation with different tongue placements. 

Consonant Harmony: “gogdog,” Due to consonant assimilation, which is the propensity for one consonant to take on similar characteristics of another consonant in the same word, many children confuse k/g for t/d, especially when they are presented in the same word.  

Cluster reduction:  “coolschool”, “backblack, and booblue. Blends can be very difficult for children to produce because each consonant is difficult to perceptually discriminate when adjacent to each other. 

Syllable reduction: “nanabannana.”  As words increase in length and complexity, children often omit one or more syllables.

Stopping: /pf/, /ts/, /dth/.  Your child’s airflow is literally “stopped” and substituted with a plosive sound, typically the /t/, /d/, /p/ phonemes. 

Gliding:  /wr/ and /yl/.   The /r/ sound is the most frequently produced phoneme in the English Language, making it an important phoneme to acquire for improved overall intelligibility.


Q.  How can a Speech and Language Pathologist help my child?

Sound elicitation is the process we go through to teach the child how to say the targeted sound. For example, if your child cannot say the /th/ sound in imitation, your therapist will break down the process for him.   She might say, “Put your tongue between your teeth then blow.” After the sound is learned, then the sound(s) is practiced in isolation.

Isolation:  Practicing a sound in isolation means saying the sound all by itself without adding a vowel. For example, if you are practicing the /t/ sound you would practice saying /t/, /t/, /t/ multiple times in a row. When the child is 80% accurate producing the sound in isolation over three consecutive sessions, she is ready to move onto syllables.

Syllable Level:  Practicing sounds in syllables simply means adding each long and short vowel before, after, and in the middle of the target sound.

Word Level: At this point, your therapist has decided which position of the word she wants to target and will begin practicing words in the initial, medial or final position of the word. When your child is 80% accurate producing the target sound(s) in all positions at the word level, she will move on to the next step, which is using the word in sentences.

Sentence Level:  A great way to practice sounds in sentences is with a “rotating sentence”.  In a rotating sentence only one target word changes. For example, the sentence might say, “Put __ in pink purse.” Then the child rotates all the target words through the sentence. This is an especially great way to practice sentences for young children who can’t read yet.

Sounds in Stories:  For younger children, we prepare a story for them to practice using the sounds they have been practicing.  We try to include as many picture cues as possible so young children can retell the story without being able to read. 

Conversation:  The biggest leap in progression occurs from the sentence to conversational speech level.  This last stage of therapy typically takes the longest amount of time, as the child is required to produce the sound(s) with automatic, habitual, overlearned, effortless productions without using any mental effort.   

Q. What are different therapy approaches?

Core vocabulary approach: Focuses on whole-word production and is used for children with inconsistent speech sound production who may be resistant to more traditional therapy approaches. The words selected for practice are those that are used frequently in the child's functional communication system.

Cycles approach: Targets phonological pattern errors and is designed for highly unintelligible children who have extensive omissions, some substitutions, and a restricted use of consonants.  During each cycle, one or more phonological patterns are targeted rather than specific sounds.

Distinctive feature therapy:  This approach is typically used for children who primarily substitute one sound for another. This approach uses minimal pair contrasts that compare the target sound with the error sound (chip/ship).

Metaphon therapy:  Designed to teach metaphonological awareness, the awareness of the phonological structure of language. For example, for problems with voicing, the concept of "noisy" (voiced) versus "quiet" (voiceless) are taught.

Oral-motor therapy:  Involves the use of oral-motor training prior to teaching sounds or as a supplement to speech sound instruction. The rationale behind this approach is that immature or deficient oral-motor control or strength may be causing poor articulation and that it is necessary to teach control of the articulators before working on correct production of sounds.

Speech perception training:  Recommended procedures include auditory bombardment and identification tasks in which the child identifies correct and incorrect versions of the target through inter-auditory discrimination (e.g., "rat versus wat"). 

Q.  What are some things I can do at home to help my child?

There are many fun ways for your child to practice sounds outside of therapy! 

Ø  When you are driving, play the “Alliteration Game.”  For example, if your child is targeting the phoneme /r/ in therapy, see who can come up with more words that either start or end with the /r/ sound.

Ø  When you’re in a store with your child, ask your child to find as many products that include their target sound(s).  For example, if your child is working on clearly producing /s/ blends, he can find and say: “strawberries, spices, string cheese, snacks, and spaghetti.”

Ø  When your therapist provides you with pictures of the target sound(s), cut them out and tape the pictures above your child’s bed.  Every night, turn out the lights, focus a flashlight on each picture, and model the correct production of the word. You can also play a scavenger hunt game, producing the sound(s) each time a picture is found.

Ø  Buy a child’s magazine and cut out all the pictures that contain the target sound(s).  Make a collage of all the pictures and practice saying the sound.

Ø  When your child is brushing her teeth, practice the sound in isolation.  Ask your child to see what’s happening to their lips, tongue, and jaw when they produce the sound correctly. The mirror provides excellent visual feedback.

Ø  Instead of saying comments such as: “What did you say?” or “Say that again” try repeating everything that you heard your child say, but omit the word(s) that were unclear.   This will reduce your child’s frustration and improve their awareness of which sound(s) are mispronounced.

Ø  Feed your child’s speech cards to puppets after they have been said.

Ø  Once your child is aware of the correct production of a target sound, try saying a word incorrectly to see if your child corrects you.  

Ø  When your child is at the “generalization stage” of therapy and expected to say the sound(s) correctly in conversational speech, model a faster rate of speech when practicing their speech homework. 

Ø  If your child is learning to read, highlight the target sound in your books at home.  This visual prompt will remind them to produce the sound correctly while reading.

Additional resources:,


Red Flags to Look out for When suspecting Autism


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Here are resources to find out more information about Autism Spectrum Disorders :




  • –The materials exchange page has great handouts for teachers and parents to work on with students.

  • has great blogs that are supportive, informative, and helpful.  There are blogs and many topics from people, family, and friends living with autism spectrum disorders.

  • has great handouts that are informative for parent and teachers, not only of children with autism but with other disabilities.

Red Flags to Look Out For….

  • Lack of eye contact

  • Reduced receptive and  expressive language

  • No response to name being called, it could be as if the child is not listening or appears to be deaf

  • Flapping, rocking, or spinning especially when excited

  • Repetitive movements with body parts or objects such as shaking a hand in front of his/her face or waving a pencil in front of his/her face

  • Loss of speech after child has been talking

  • Lack of pretend skills 

  • Lack of interest or joint attention

  • Echolalia- repeating words or phrases 

  • Difficulty with transition from one activity to the next

  • Sensitive to sounds, tastes, and textures

  • Difficulty with social interactions with others including initiating and maintaining  conversations and play

  • Preoccupation of objects or parts of objects

  • Restricted interest in foods; “picky eaters”

  • Prefers to engage in solitary play with repetitive actions

  • Frequent tantrums

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A Brief Overview of Autism Spectrum Disorders

What you need to know…

Important information when interacting with children with ASD…From the perspective of the person living with ASD:

  • Eye contact can be over-stimulating for me.  Just because I am not making eye contact with you does not mean I am not listening. 

  • I thrive on routine and knowing what is going to happen ahead of time.

  • I might have a hard time transitioning from one place to the next so please be patient with me.

  • I like to play alone most of the time.  You might need to try and engage me in playing or talking with you.

  • My interests may be narrowed to only a few things.  Please try and introduce new toys and objects to me.

  • I have a hard time understanding figurative language and sarcasm.  I am very literal, so you will have to explain what you mean.

  • I might communicate better with pictures or using sign language such as, “more” and “all done.”

  • If you see me rocking or flapping my hands, I am either excited or trying to make myself feel better.  Try giving me a bear hug or deep squeezes.

  • Sometimes loud noises are too much for me and I will cover my ears.  If you see me cover my ears, try to turn the volume down or walk out of the room with me.

  • I like to talk about things that I like.  I might not let anyone talk about anything else and try to bring the conversation back to what I want to talk about. I need to be reminded to show interest in what other people want to talk about.

  • Holiday parties are really hard for me because I am out of my routine and it is very loud.

Tips, strategies, and ideas for relating to students with ASD….

Children with autism learn differently….

Children with autism benefit from learning through pictures. Teachers can have pictures of the steps to washing hands or the steps of a cutting and gluing activity posted for the student to look at as a reminder.  It is easier for students to learn through pictures because they are visual learners.  They also learn skills through modeling and repetition, rather than picking it up in the environment.  Applied Behavioral Analysis (ABA) is a very successful treatment approach combined with speech therapy.  

Children with autism like to know what is going on…

Having a consistent routine and/or a schedule helps reduce stress and anxiety from not knowing what is going to come next.  Using a picture schedule of what is going to happen throughout the day or letting the child know a head of time (with several reminders given) will help alleviate some of the anxiety.  Using the language, “First-then” helps reduce anxiety of the unexpected.

Children with autism have social deficits…

Children with autism might have difficulty starting or ending a conversation or they might have trouble with taking turns in a conversation.  Sometimes they engage in one sided conversations where the child with autism is doing all of the talking about a preferred item or topic.  A personalized social story

can be created to help teach the child how to interact in social situations.  The social story will be a short story that is about that child’s specific area of need. For example, the story could be about taking turns in conversation and giving the other person a chance to speak.  Your speech therapist can help you design this.

Children with autism have sensory problems…

Some students with autism are sensitive to clothing items, loud noises, and food items.  Children with autism may rock back and forth, spin, or hit themselves seeking sensory stimulation.  Deep pressure such as squeezing, massaging, or deep hugs helps to relax the child and helps in calming and allowing the child to regroup. 

Children with autism have difficulty with initiating…

A child with autism may have trouble initiating play or requesting basic wants and needs (i.e., “I want __.”).  A child with autism might not notice that another person is in the room and therefore will not say greetings or farewells.

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