Roughly one in 12 U.S. children has had a speech, language, or swallowing disorder.

Voice, speech, language, or swallowing issues can interfere with a child’s cognitive, social, and academic development.

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Communication Issues in Kids: How You Can Spot the Signs

Children who routinely struggle to communicate with those around them may have a communication disorder.

Communication takes many forms. Kids struggling to communicate may express themselves differently. For example:

  • Some kids struggle with comprehension or understanding language and conversations around them.
  • Some children may learn words late or have difficulty saying some sounds.
  • Others may need help finding the right words.

Developmental or learning delays, genetic conditions, and physical differences can all result in speech and language issues. Autism and other factors can as well.

Early access to intervention is vital for kids with communication disorders. Recognizing the signs of a speech-language disorder and scheduling an exam with a speech-language pathologist are often the first steps.

Here’s what to know.

What Are the Signs of Communication Disorders in Kids?

A child’s speech develops over time. Talk to your pediatric provider for a speech therapist referral if your child seems to fall behind or struggles to communicate.

Generally, children should know 10 or more simple words and understand basic commands by 18 months old.

“Between 12 to 18 months, if they’re not starting to use their first words, learning new vocabulary words, or they tend to rely on using gestures to communicate, those are some signs you may want to schedule an evaluation,” says Carly DeLuca, a speech-language pathologist at UPMC Children’s Hospital of Pittsburgh.

“From 18 months to two years, there’s another huge language burst,” she adds. “Kids start to develop a large vocabulary; anywhere from 50 to 200 words is the average. By two years, they’re starting to combine words.”

By age 3, many children can:

  • Ask some “why” questions.
  • Participate in a simple, back-and-forth conversation.
  • Pronounce final consonants in words.

By age 4, many children can:

  • Ask many questions.
  • Speak in whole sentences.
  • Tell complex stories.

“Unfamiliar listeners should be able to understand 100% of what a child says by the age of 4, even if they may have some residual errors,” says Carly.

What are the symptoms of speech issues in children?

Some common signs of a speech-language disorder in younger children include:

  • Difficulty expressing emotional or physical needs or thoughts and ideas.
  • Difficulty understanding simple directions.
  • Limited, delayed, or no speech consistent with a child’s age milestones.
  • Limited vocabulary for a child’s age or trouble with word retrieval.
  • People have trouble understanding what your child is saying.
  • Stuttering.
  • Trouble interacting with others in social settings.
  • Trouble with reading and writing at a level consistent with their child’s age.

Fortunately, many treatment options are available for kids who have difficulty communicating. As a caregiver, the earlier you identify a speech issue and seek help, the better.

“We don’t like to follow the ‘wait and see’ mentality when it comes to speech and language disorders. If you have any concerns, it never hurts to schedule an evaluation,” Carly says.

“From an articulation perspective, if a parent has to frequently translate for their child when others are having a hard time understanding them … that’s a clear indication to have an assessment.”

Types of communication disorders in children

Speech-language pathologists at UPMC Children’s are experts in evaluating and treating children with various communication disorders. This includes some of the most common types, such as:

  • Childhood-onset fluency disorder: Also known as stuttering. This involves repetition or prolongation of speech sounds, hesitations, long pauses when speaking, or broken words.
  • Expressive language disorder: A child who faces speaking challenges may have an expressive language disorder. They may struggle to share their thoughts or confirm they understand others’ speech. Some signs are using excessive “filler” words like “um” when searching for words, using nondescript words like “thing,” misusing words, delayed speech, speaking very quietly, or avoiding speech altogether.
  • Mixed receptive-expressive language disorder: A child who struggles to speak or understand spoken language may have a receptive-expressive language disorder.
  • Social communication disorder: This involves routine challenges with the use of verbal and nonverbal language for social interaction. It’s not a problem with speech itself or with the mechanics of language but with the “rules” of language within society.
  • Speech-sound disorders: A child that has trouble producing sounds clearly beyond the age at which they might typically learn those sounds may have a speech-sound disorder. This can present as an articulation disorder or a phonological process disorder wherein a child has a pattern of speech sound errors.

What Should I Expect During My Child’s Speech-Language Evaluation?

Your pediatrician may refer your child to a speech-language pathologist (SLP) for diagnosis and treatment of their communication issue.

The SLP will conduct a full evaluation that often involves a parent interview and/or play-based interaction and activities.

“The first question I ask parents during an assessment is, ‘What are your main concerns?’ So, we address that from the beginning. I’ll do a little play-based assessment with the child, and then a standardized measure,” says Kate Apgar, a speech-language pathologist for UPMC Children’s.

The assessment usually takes about 90 minutes.

“Typically, parents are nervous when they come in for their first appointment, and they’re pleasantly surprised that it’s mainly play-based, especially for those younger kids,” says Carly. “We do a combination of formal and informal testing. We do standardized testing to compare their scores to same age/gender peers as well as informal observations to look at other areas of communication that are not of concern to ensure we’re looking at the child as a whole. This typically looks like play.”

“We’ll use bubbles, cars, playhouses, coloring, or pretend food. We do a variety of fun things, and kids have no idea they’re being tested,” she adds.

After the SLP’s diagnosis, they’ll work with you and your child to improve your child’s communication skills. This may include a referral to another specialist to address the whole child.

“We’ll discuss the results and our recommendations,” says Kate. That could include speech therapy, a referral for other testing we think should happen, or work with occupational or behavioral therapists because all these other things can impact speech, too.”

About Pediatrics

From nutrition to illnesses, from athletics to school, children will face many challenges growing up. Parents often will make important health care decisions for them. We hope to help guide both of you in that journey. UPMC Children’s Hospital of Pittsburgh is a national leader in pediatric care, ranking consistently on U.S. News & World Report’s Best Children’s Hospitals Honor Roll. We provide expert treatment for pediatric diseases, along well-child visits, urgent care, and more. With locations across Pennsylvania, Maryland, and West Virginia, you can find world-class care close to home. We also work closely with UPMC Magee-Womens Hospital, a national leader in care for newborns and their mothers. Our goal is to provide the best care for your children, from birth to adulthood and beyond. Visit our website to find a doctor near you.