Stages of Normal Communication Development and When to Refer to 0 5 Years Speech and Language

East Cheshire Speech and Language Therapy Team

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

• 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

• 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’.

• 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.

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

• 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.

• Difficulties with feeding.

• Difficulties with feeding.
• Communication difficulties due to identified complex needs, e.g. a syndrome, cerebral palsy

• 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

• 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?’

• 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

• 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

• No single words.
• No pretend play evident.
• Not understanding simple instructions

• Not using 2 word phrases

• 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.

• 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

• 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.:

• 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’

• 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’

• 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’

• 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’

• 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

• 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.

• 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.

• 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.

• 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’

• 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)