East Cheshire Speech and Language Therapy Team

Stages of Normal Communication Development and When to Refer: 0 – 5 years

By 6 months / By 12 months
Play and Social Interaction /
  • Seeks and enjoys physical contact. Looks and smiles in response to being held and bounced.
  • Explores toys and objects by banging, feeling and mouthing.
  • Watches face when someone talks
  • May copy facial movements, e.g. sticking out your tongue
  • Laughs during play. Screams to show annoyance.
/
  • Uses noises, pointing and looking to get adult attention.
  • Smiles at people who smile at them
  • Enjoys ‘pat-a-cake’ (copies clapping), and gets excited when sung to
  • Lifts arms to be picked up.
  • Hold objects out for adults to take
  • Starting to take turns using babble sounds

Listening and Understanding /
  • Startled by loud noises
  • Turns head to sounds
  • Recognises parent / carer’s voice
  • Shows some awareness of their facial expressions and tones of voice, e.g. happy or fearful
  • Shows excitement when hears familiar voices.
/
  • Locates voices heard across a room
  • Responds to their name; stops and looks
  • Understands frequently used words especially when a gesture is used, e.g. ‘bye bye’ + waving, ‘up’ + arms out
  • Begins to recognise the names of family members and familiar objects, e.g. ‘mummy’, ‘car’.

Talking /
  • Frequently cries to show their needs, e.g. hunger, tiredness, attention
  • Makes cooing, gurgling and squealing noises to get your attention or to join the ‘conversation’
  • Begins by using vowel sounds, e.g. ‘oooh’, ‘aah’
  • Then starts to babble around 6 months, e.g. ‘ba’, ‘da’,‘muh’
/
  • Uses gestures such as waving and pointing to help them to communicate.
  • Shakes head for ‘no’
  • May say a couple of words by 12 months, e.g. ‘dada’ for daddy.

Speech Sounds /
  • Babbles tunefully with strings of sounds, e.g. ‘bababa’,‘gadaba’.
  • Words emerging, but unclear; only understood by familiar adults.

Monitor at this stage if… /
  • No interest in physical contact – passive or resists.
  • No eye contact.
  • No interest in watching people/objects.
  • Not turning to sounds/voices.
  • No cooing sounds made.
/
  • Poor use of eye contact.
  • Does not show affection or interact with adults.
  • No interest in interactive games e.g. peek-a-boo.
  • Does not respond to their name
  • Not showing what they want, e.g. by pointing
  • No consonant sounds (b, g, d) used in babble.

Concerns.
Refer to SLT if… /
  • Difficulties with feeding.
/
  • Difficulties with feeding.
  • Communication difficulties due to identified complex needs, e.g. a syndrome, cerebral palsy

By 18 months / By 2 years
Play and Social Interaction /
  • Plays alone, but likes to be near a familiar adult.
  • Explores toys, e.g. putting them into a box and tipping them out.
  • Uses simple pretend play, e.g. pretends to have a drink
  • Enjoys games like ‘peek-a-boo’, songs / rhymes like ‘round and round the garden’, and toys that make noises
  • Will point, make a noise / say a word and look at an adult to get what they want
/
  • Plays alone and with adults for a short time.
  • Doesn’t like adults giving suggestions during play.
  • Enjoys pretend play e.g. pretends to feed teddy, brums a car along.
  • Enjoys looking at pictures in books with adults.
  • May take turns in simple games, e.g. building a brick tower
  • Becomes frustrated when unable to make themselves understood; may lead to tantrums

Listening and Understanding /
  • Points to objects or pictures when asked ‘where’s the…’
  • Understands a variety of single words and simple everyday instructions, e.g. ‘get your shoes’
  • Identifies some body parts, e.g. ‘nose’, ‘feet’
  • Concentrates on a toy for more than a few seconds.
/
  • Will concentrate on an activity of own choosing for a few minutes.
  • Understands 200 - 500 single words.
  • Can understand simple instructions without the support of visual cues such as pointing, e.g. ‘go and get your cup’.
  • Follows adult body language like nodding, pointing, gestures and facial expressions
  • May make a choice, e.g. ‘do you want orange or milk?’

Talking /
  • Babbles to self during play.
  • Copies gestures and words from adults; especially last word heard.
  • Uses up to 20 simple words, e.g. ‘more’, ‘bye’, ‘dog’.
  • Uses intonation, pitch and changing volume when ‘talking’
/
  • Uses 50 or more words.
  • Tries to copy words they hear.
  • Starts to say 2 word phrases e.g. ‘more juice’, ‘bye bye nanny’
  • Asks simple questions like ’what’s that?’
  • May refer to themselves by name

Speech Sounds /
  • Spoken words are unclear; may only be understood by familiar adults.
  • Sounds often missed out and replaced by others.
/
  • Uses a limited number of sounds in their words, often these are ‘p, b, t, d, m, n, w’
  • Misses out sounds and substitutes sounds e.g. ‘ba’ for ball, ‘doo’ for shoe.
  • Can be understood about half of the time

Monitor at this stage if… /
  • No single words.
  • No pretend play evident.
  • Not understanding simple instructions
/
  • Not using 2 word phrases

Concerns.
Refer to SLT if… /
  • No sounds/babble.
  • No pointing.
  • No interest in other children/adults. Little eye contact.
  • Not showing/telling others what he/she wants.
  • Feeding difficulties.
  • Hoarse voice.
  • Communication difficulties due to identified complex needs, e.g. a syndrome, cerebral palsy
/
  • Says less than 20 words.
  • Relies on gestures rather than words to communicate.
  • No interest in other children/adults. Little eye contact.
  • No interest in pretend play. Still bangs/chews/throws/plays repetitively with toys.
  • Not understanding simple instructions.
  • Not showing/telling others what he/she wants.
  • Feeding difficulties. Hoarse voice.
  • Stammer/stutter
  • Child appears to be regressing.

By 2½ years / By 3 years
Play and Social Interaction /
  • Likes to play near other children and watches them play, but may not play with them.
  • Enjoys sequences of pretend play – kisses doll, puts doll in cot, puts cover on, rocks cot.
  • Relies increasingly on words to express themselves, but still uses gestures and actions too.
/
  • Joins in pretend play with other children
  • Responds to adults’ requests to share and take turns.
  • Holds a conversation but may jump from topic to topic
  • Expresses emotions using words, not just actions
  • Enjoys stories and rhymes, and may demand favourites over and over again

Listening and Understanding /
  • Enjoys listening to short stories with pictures.
  • Needs adult’s help to listen e.g. ‘Thomas, look at me’.
  • Can follow instructions relating 2 objects e.g.:
‘put teddy in the box’, ‘get daddy’s shoes’, ‘Give mummy the cup’(without cues from the situation or pointing etc.)
  • Understands action words e.g. sleeping, eating, drinking
  • Understands the negative ‘no’ e.g. ‘there are no biscuits’
/
  • Can listen for longer, but they need to stop what they are doing in order to listen.
  • Can understand simple ‘who?’ ‘what?’ ‘where?’ questions
  • Can understand longer instructions e.g. ‘Make teddy jump’, ‘Where’s Mummy’s coat?’, ‘give the big ball to nanna’
  • Understands and uses simple place words, e.g. ‘in’, ‘on’, ‘under’
  • Understands and uses adjectives, e.g.‘big’, ‘little’, ‘soft’, ‘hot’

Talking /
  • Able to use50-200 words and learning new words all the time.
  • Uses 2-3 word phrases e.g. ‘man run’, ‘my car’, ‘mummy more juice’, ‘eat daddy cake’
  • Continues to copy language they hear
  • Uses action words ending in ‘ing’ e.g.‘mummy singing’.
/
  • Uses 300 or more words
  • Puts 4–5 words together to make sentences e.g. ‘I want more juice’, ‘He took my ball’
  • Grammar may still be immature e.g. ‘me goed to the park’
  • Asks questions ‘why’, ‘what’s that?’
  • Uses simple plurals by adding ‘s’ e.g. ‘cars’, ‘shoes’

Speech Sounds /
  • Understood by people who know them most of the time.
  • Still misses out sounds and substitutes others e.g. ‘tup’ for cup, ‘dee’ for see, ‘poor’ for four, ‘poon’ for spoon
/
  • Can be understood by people outside the family most of the time
  • May still shorten long words e.g. say ‘nana’ for banana
  • Difficulty saying s, sh, ch, j, r, l, th, and consonant blendse.g. ‘pl’, ‘st’

Monitor at this stage if… /
  • Not using many early consonant sounds, e.g. b, d, m, n
  • Speech sounds distorted, e.g. unusual vowels: ‘pet’ → ‘pat’, too much air coming through their nose whilst talking
/
  • Difficulty saying ‘k’ / ‘c’ and ‘f’

Concerns.
Refer to SLT if… /
  • Poor eye contact. Doesn’t initiate interaction
  • Not able to concentrate on activity of their choice. Only engages in repetitive play – no pretend play
  • Doesn’t respond to simple questions/instructions
  • Not using a range of 2 word phrases containing different types of words
  • Echoes what others say without understanding / out of context
  • Difficult for family to understand most of the time
  • Persistently hoarse voice.
  • Stammering
  • Appears to be regressing
/
  • Poor eye contact. Doesn’t initiate interaction
  • Distressed by/doesn’t understand change in routine
  • Not able to concentrate on activity of their choice. Only engages in repetitive play – no pretend play
  • Doesn’t respond to simple questions/instructions
  • Echoes what others say without understanding / out of context
  • Mainly using less than 3 words together
  • Difficulty saying p, b, t, d
  • Misses sounds at the beginning & / or end of words e.g. leaf = ‘lea’.
  • Persistently hoarse voice. Stammering.
  • Appears to be regressing

By 4 years / By 5 years
Play and Social Interaction /
  • Enjoys playing with peers; more willing to share
  • Waits their turn in simple games.
  • Starts off a conversation
  • Joins in longer conversations.
  • Enjoys make-believe. Joins in dressing-up and imaginary play with other children.
  • Starts to plan games with others
/
  • Will choose their own friends
  • Shows awareness of needs, views and feelings of others.
  • Starts conversations with other people and joins in with group conversations
  • Uses words to negotiate with peers and adults.
  • Uses language in role-play with other children.
  • Understands and follows rules of simple games.

Listening and Understanding /
  • Attends to atask of an adult’s choice
  • Able to control their own focus of attention, but they need to stop andlook at the person talking to them.
  • Listens to a simple story without pictures e.g. ‘On Saturday I…’
  • Answers simple questions about a story, e.g. ‘who’, ‘where’
  • Can answer ‘why’ questions
  • Understands more language concepts, e.g. colours, numbers
  • Follows longer instructions with two parts, e.g. ‘….and….’.
  • Starts to like simple jokes, but their jokes make little sense
/
  • Concentrates for up to 10 minutes
  • Maintains attention and waits for their turn in a group.
  • Listens to spoken instructions even when they are doing something else.
  • Can answer questions, e.g. ‘how’, ‘when’ and ‘why’about stories.
  • Follows group instructions e.g. ‘first….then….’
  • Understands explanations e.g. ‘because….’, ‘otherwise…..’.
  • Understands language concepts such as before, after, hot, cold
  • Enjoys jokes and riddles.

Talking /
  • Uses longer sentences (5+ words) e.g. ‘I want to play with cars’, but makes some grammar errors e.g. ‘mouses’, ‘catched’.
  • Talks about things they have done/things they are going to do.
  • Can retell a simple story; may confuse fact and fiction
  • Begins to link sentences together with ‘and’
  • Learns, remembers and uses new vocabulary
  • Asks lots of questions. Talks about feelings.
  • Counts by rote up to 20 or more
/
  • Useswell-formed sentences, with only occasional errors, e.g. ‘goed’, ‘sheeps’
  • Able to explain themselves when not understood.
  • Retells a story in detail, usually in the correct order.
  • Makes up their own stories.
  • Asks questions about how things work and why things happen.
  • Can describe what asimple word means, e.g. a ‘car’ is for driving, and will ask what a new word means.

Speech Sounds /
  • Most sounds clear apart from e.g. r, th, z, v,ch, sh, j and consonant blends, e.g. cr, pl, sn, sm
  • Difficulties saying longer words e.g. ‘spaghetti’.
/
  • All sounds clear apart from r, th and some blends like scr in‘scribble’.
  • Speech is usually fluent
  • Words with a number of syllables may still be difficult, e.g. ‘animals’

Concerns.
Refer to SLT if… /
  • Difficulty saying p, t, k, s, f, l
  • Persistently hoarse voice. Stammering.
  • Poor eye contact. Difficulty listening in a group.
  • Limited interaction with other children/adults.
  • Doesn’t respond appropriately to questions/instructions.
  • Distressed by/doesn’t understand changes in routine. Follows others because not understanding.
  • Uses repetitive phrases out of context /echoes what others say.
  • Obsessed with certain topics of conversation.
  • Frequently calls things the wrong name/says ‘thingy’.
  • Limited sentences. Order of words in sentences is jumbled.
/
  • Difficulty saying p, t, k, s, f, l, sh, ch, j, cr, pl, s blends, e.g. sp.
  • Persistently hoarse voice
  • Stammering
  • Suspected social communication difficulties
  • Difficulty following simple instructions
  • Difficulty putting words together to make a full sentence with correct word order. Small words e.g. ‘is, ‘the’, ‘a’ missed out.
  • Limited vocabulary development and difficulty sequencing ideas to tell a simple story
  • Using stereotypical language, e.g. large chunks of a favoured topic

Based on clinical experiences, departmental resources and a number of published sources, including:

Buckley, B. (2003) Children’s communication skills: from birth to five years

Cooper, J., Moody, M. and Reynell, J (1978) Helping language development

ICAN (2013) (accessed 18.04.16)

ICAN (2007) Stages of speech and language development: A guide for early years practitioners

Locke, J.L. (1993) The child’s path to spoken language.

Meggitt, C. (2007) Child development: An illustrated guide (DVD Edition)

Owens, R. E. (2008) Language development: An introduction. (7th Ed.)

RCSLT (2003) Help your child to talk

Sheridan, M. D. (2008) From birth to five years: children’s developmental progress (3rd Ed., revised and updated by A, Sharma and H. Cockerill)

Stoke Speaks Out (no date) Staged Pathway Toolkit

The Communication Trust (2011) Small Talk: How children learn to talk from birth to age five

WellComm Toolkit (2010)