Common Signs Your Child May Need Speech Therapy
Most families do not start with a clinical term. They start with a concern. A child who is not talking yet when peers are. A child who is hard to understand. A child who seems to understand everything but cannot get words out. These observations are clinically meaningful, and they are often the first signal that speech therapy is worth exploring. Here is a look at the signs families most commonly notice before a speech therapy referral, organized by age and area of development.
Signs Your Child May Need Speech Therapy
Every child develops at their own pace, but certain communication challenges are worth discussing with a speech-language pathologist. You may want to consider an evaluation if your child:
- Is not using words or combining words as expected for their age
- Has speech that is difficult for you or others to understand
- Struggles to understand or follow simple directions
- Has difficulty expressing their wants, needs, or ideas
- Becomes frustrated when trying to communicate
- Repeats sounds, words, or phrases or frequently gets stuck while speaking
- Has difficulty starting or maintaining back-and-forth conversations
- Uses few gestures, such as pointing, waving, or showing you objects
- Has lost speech or language skills they previously used
Not every sign means your child has a speech or language disorder. An evaluation can help you understand whether your child’s communication is developing as expected or whether additional support may be helpful.
Speech and Language Milestones by Age
By 12 months: Most children are babbling, using gestures like pointing and waving, and responding to their name. They typically have at least one or two words.
By 18 months: Most children have 10 to 20 words and are starting to follow simple directions.
By 24 months: Most children have at least 50 words and are combining two words together, such as more juice or daddy go.
By 36 months: Most children are using three-word phrases, and familiar adults can understand them most of the time.
If your child is significantly behind any of these markers, a speech therapy evaluation is worth pursuing rather than waiting to see if it resolves on its own.
| Age | Speech and Language Milestones | Signs to Discuss With an SLP |
| 12 months | Babbling, using gestures like pointing or waving, responding to their name, and beginning to use words | Little or no babbling, few gestures, not responding consistently to sounds or their name, or no emerging words |
| 18 months | Using a growing number of words and beginning to follow simple directions | Using very few words, rarely trying to communicate, or having difficulty understanding simple directions |
| 24 months | Using around 50 words and beginning to combine two words into short phrases | Using fewer words than expected, not combining words, or having difficulty communicating basic wants and needs |
| 36 months | Using short sentences and being understood by familiar adults most of the time | Using few word combinations, having difficulty forming sentences, or speech that is frequently difficult for familiar adults to understand |
Signs Your Child May Have a Speech Sound or Articulation Difficulty
Beyond milestones, families often notice that their child is hard to understand. By age 2, familiar adults should understand about 50 percent of what a child says. By age 3, that should be closer to 75 percent. By age 4, most people, not just parents, should be able to understand a child most of the time.
If your child’s speech is significantly less clear than these benchmarks suggest, or if you find yourself constantly interpreting for your child in social situations, those are meaningful signals.
Signs of a Language Delay
Language delays can be harder to identify than speech delays because they do not always show up in the number of words a child uses. Signs of language delays include difficulty following directions, limited understanding of questions, trouble telling a simple story or describing an event, and difficulty with the back-and-forth flow of conversation.
Children with autism often show language differences that are distinct from a typical delay, including echolalia, unusual prosody, and difficulty with the social and pragmatic aspects of communication. These patterns often warrant both speech therapy and ABA therapy.
Speech and Language Signs Associated With Autism
Children with autism may communicate differently verbally and nonverbally. Parents may notice limited use of gestures, difficulty with back-and-forth interaction, repeating words or phrases, or language that is not always used to communicate wants and needs. Some children may have a large vocabulary but struggle with conversation, social cues, or adjusting their language to different situations. These signs do not confirm autism on their own, but they can indicate that a speech-language evaluation may be helpful.
Signs Related to Stuttering and Voice
Stuttering in young children is common and often resolves without intervention. However, if your child’s stuttering is increasing in frequency or severity, causing visible physical tension, or leading to avoidance of speaking situations, a fluency evaluation is appropriate. Voice concerns, including a consistently hoarse, breathy, or strained voice, are also worth evaluating by a speech-language pathologist.
When Should Your Child See a Speech-Language Pathologist?
Consider an evaluation if your child’s communication skills are noticeably behind age expectations, speech is difficult to understand, or communication challenges cause frustration or affect everyday interactions. You don’t need to wait until a concern becomes severe. If you consistently notice that your child communicates differently from other children their age, an SLP can help determine whether support is needed or whether their development can simply be monitored.
How a Speech Therapy Evaluation Can Help
A speech therapy evaluation looks more closely at the areas of concern. The SLP assesses skills such as speech sounds, language understanding and use, fluency, and social communication based on your child’s needs. The evaluation can help identify whether there is a delay or disorder, which skills need support, and whether speech therapy is recommended. It also gives families a clearer understanding of what they are seeing at home and what to do next.
What Families Say About Westside
For families, choosing a speech therapist is about more than finding the right clinical services. It is also about finding a team that listens to their concerns, understands their child, and keeps them involved throughout treatment. Families at Westside work directly with their child’s clinicians and receive regular guidance on progress, goals, and ways to support communication outside of therapy.
Frequently Asked Questions
Is my child a late talker or does he have a speech delay?
Late talkers are children who are developing language more slowly than typical but are otherwise on track developmentally. A speech delay involves a more significant gap between a child’s communication skills and what is expected at their age, often alongside other developmental differences. A speech therapy evaluation can distinguish between the two and determine whether intervention is needed.
My child understands everything but does not talk much. Should I be concerned?
Yes. Strong receptive language, meaning understanding what others say, is a positive sign, but it does not rule out an expressive language delay. If your child understands well but is significantly behind on producing words or sentences, a speech therapy evaluation is the right next step.
What if my pediatrician says to wait and see?
Families can pursue a private speech therapy evaluation without a pediatrician’s referral. If something about your child’s communication has been sitting with you, that observation is worth acting on. Early intervention during the window when the brain is most responsive to language learning produces the strongest outcomes, and waiting has a real cost when a child genuinely needs support.
Can speech therapy help a child who is nonverbal or minimally verbal?
Yes. Speech therapy can help nonverbal and minimally verbal children develop more effective ways to communicate. Depending on the child, therapy may focus on spoken language, gestures, signs, or augmentative and alternative communication (AAC), such as picture-based systems or speech-generating devices. The goal is to give your child a reliable way to express their wants, needs, thoughts, and feelings.
Does my child need a referral for speech therapy?
It depends on your insurance plan. Some plans require a referral from your child’s pediatrician before speech therapy is covered, while others allow families to begin the process directly. You can contact Westside first, and our team can help determine what your insurance plan requires before scheduling.
To learn more about speech therapy at Westside and what the evaluation process looks like, visit our speech therapy page.