speech therapy milestones and considerations
12 Months
Receptive Language Milestones
- Responds to voices and sounds by looking at the individual/source
- Responds differently based on speaker’s inflection or tone (understands anger, excitement, and happiness)
- Recognizes labels of basic objects
- Recognizes own name
- Understands simple instruction (come here)
- Uses gestures (waves bye-bye)
Expressive Language Milestones
- Beginning speech sounds continue to emerge (b, p, m)
- Produces 1-2 meaningful words (mama, dada, no)
- Uses many different sound combinations
- Uses varying inflections or pitches when babbling
- Indicates pleasure and displeasure through vocalizations
- Imitates sound combinations
Social Interaction and Play Milestones
- Coos, squeals, or shouts to attract attention
- Laughs when playing with objects
- Plays games with another (peek-a-boo)
- Establishes eye contact
- Exhibits different emotions
- Pokes with index (pointer) finger
- Plays simple back and forth games (ball games)
- Begins pretend play (drink from a cup)
Consider an Evaluation if:
- Does not respond to his or her name
- Does not imitate sounds or noises (animal, environmental)
- Has minimal eye contact
- Doesn’t say single words like “mama” or “dada”
- Does not respond to adult interactions and facial expressions
- Does not actively participate in games
- Does not use basic gestures such as pointing, waving or shaking head
- Doesn’t search for things that they see you hide
- Loses skills they once had
18 Months
Receptive Language Milestones
- Understands more than 50 words (labels of objects, action words)
- Identifies familiar objects when named
- Points to at least one body part
- Is interested in turn-taking games ( peek-a-boo)
- Basic pretend play (talking on the phone)
- Responds to simple commands (“sit down”) and understands the prepositions in/out and off/on
- Says and shakes head “no”
Expressive Language Milestones
- Says 20 meaningful words and adds words monthly
- Uses consonant sounds including p, b, m, t, d, n, and h
- Combines syllables together (baba, puppy)
Social Interaction and Play Milestones
- Exhibits resistance to changes in expected routines
- Repeats actions
- Searches for caregiver when left alone
- Begins to play dress up
- Plays out daily routines
- Have fun playing with toys that make a noise
Consider an Evaluation if:
- Doesn’t gain new words
- Doesn’t have at least 6 words
- Does not use multiple sound combinations
- Does not babble while playing
- Does not respond to voices or other sounds by looking for the source
- Does not recognize names or labels of familiar objects or own name
- Doesn’t notice when a caregiver leaves or returns
- Avoids or has minimal eye contact during interactions
- Loses skills he once had
2 years
Receptive Language Milestones
- Points to things in a book
- Follows direction
- Knows names of familiar people and body parts
- Looks for missing toys and helps put things away
Expressive Language Milestones
- Says 200-300 meaningful word approximations – continues to add words monthly
- Begins to combine two words together into short phrases
- Refers to self by name
- Repeats words overheard in conversation
- Speech is understood 50% of the time
- Uses negation phrases “no go”
Social Interaction and Play Milestones
- Plays mainly beside other children, but is beginning to include other children, such as in chase games
- Uses social words such as greetings
- Talks to self during play
- Shows defiant behavior (doing what he has been told not to)
- Shows pretend play with two toys (puts person in car)
- Enjoys sensory play (e.g. playdough, moon sand, water)
Consider an Evaluation if:
- Does not use at least 20 meaningful words
- Does not use consonants such as p, b, m, t, d, n, and h
- Does not combine syllables together
- Does not understand at least 50 words
- Does not show an interest in turn taking games
- Does not play out daily routines
3 years
Receptive Language Milestones
- Comprehends vocabulary of approximately 900 words
- Consistently follows two step directions
- Understands the concepts “one” and “two”
- Understands prepositions “in, off, under, out of, together, and away from”
- Understands simple wh-questions and starting to understand hypothetical questions
- Matches 3-4 colors
- Learns new words quickly; know most common object names.
- Know their own full name.
Expressive Language Milestones
- Uses over 450 words
- Says words like “I,” “me,” “we,” and “you” and some plurals (cars, dogs, cats
- Carries on a conversation using 2 to 3 sentences
- Is starting to use plurals (books), present progressive (ing), some overgeneralization of past tense –ed
- Can name most familiar thing
- Answers and asks what/where questions
- Frequently ask "why" and "what."
Social Interaction and Play Milestones
- Cooperates with adults in simple tasks
- Communicates desires; orders others around
- Shows a wide range of emotions
- Shows affection for friends without prompting
- Uses realistic props to play out events
- Expands play routines
- Begins to show sequences in play, rather than individual events
Consider an Evaluation if:
- Consider an evaluation if:
- Does not use 200 meaningful words
- Does not combine words together
- Is not understood 50% of the time by others
- Doesn’t understand simple instructions
- Drools or has very unclear speech
- Does not show an interest in cooperative play with other children
- Does not show interest in simple pretend play
- Doesn’t make eye contact
- Loses skills he once had
4 years
Receptive Language Milestones
- Understand the difference between things that are the same and things that are different, such as the difference between children and grown-ups.
- Understands number and space concepts — more, less, in, under, behind
- Understands words for some shapes, like circle and square.
- Recognizes primary colors
- Follows simple commands when the objects are not in sight
- Sorts items according to form/color/use
- Understands first/last
- Can follow three-step instructions, such as "Go to the sink, wash your hands, and dry them on the towel.
Expressive Language Milestones
- Asks what do/does/did questions and asks who/why questions
- Uses descriptive concepts such as, long/short and heavy/light
- Says rhyming words, like hat–cat.
- Use sentences of 5 to 6 words.
- Can describe something that has happened to them or tell a short story
- Uses irregular plurals
- Talks about what happened during the day. Uses about 4 sentences at a time.
- Uses pronouns our/they/their/he/she/I/you/me/me/his/her
- Tells stories
- Uses past tense (ran, ate) and future tense (will go) verbs correctly
- Uses the sounds m/n/ng/p/f/h/w/y/k/b/d/g
- Unfamiliar adults understand 90-100%
Social Interaction and Play Milestones
- Talks about emotions and feelings
- Would rather play with other children than by himself
- Often can’t tell what’s real and what’s make-believe
- Takes turns, shares, and cooperates
- Expresses anger verbally rather than physically
- Enjoys pretending and uses imagination
Consider an Evaluation if:
- Ignores other children or doesn’t respond to people outside the family
- Child does not use 200 meaningful words
- Child does not ask questions
- The child leaves the endings off of words
- Adults cannot understand the majority of what the child says
- Child does not follow simple directions
- Child does not take turns or play with others
- Speaks unclearly
- Loses skills he once had
5 years
Receptive Language Milestones
- Understand relationships between objects, such as "the girl who is playing ball" and "the boy who is jumping rope.
- Understands opposites
- Understand yesterday/today, more/less, and half/whole
- Follows three step directions without interruptions
- Understands simple time concepts: morning, afternoon, night, day, later, after, while
Expressive Language Milestones
- Often call people (or objects) by their relationship to others, such as "Bobby's mom" instead of "Mrs. Smith."
- Use similarities/differences to describe objects
- Uses comparatives/superlatives (bigger, biggest, etc.)
- Tells a simple story using full sentences
- Asks questions to get information
- Knows address and birthday
- (Articulation) Uses all vowels and the consonants
Social Interaction and Play Milestones
- More likely to agree with rules
- Distinguishes right from wrong, honest from dishonest
- Plays make-believe and dresses up
- Seeks to play rather than be alone; friends are important
- Wants to conform; may criticize those who do not
Consider an Evaluation if:
- Doesn’t respond to people, or responds only superficially
- Loses skills he once had
- Doesn’t talk about daily activities or experiences
- Child does not ask questions
- Child is frequently misunderstood by adults and other children
- Child does not follow multiple step directions
- Child does not seek out others to play