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HELPFUL INFO

Helpful
Info

Take a moment to familiarize yourself with some of the terms, definitions, disorders, delays, and developmental milestone guidelines frequently referenced in speech and occupational therapy.

Take a moment to familiarize yourself with some of the terms, definitions, disorders, delays, and developmental milestone guidelines frequently referenced in speech and occupational therapy.

SPEECH THERAPY DEFINITIONS

SPEECH THERAPY DEFINITIONS

The way speech sounds are made by the mouth

Paying attention to, analyzing, and organising information we hear

Sounds, syllables, or words may be repeated or “stuck”

Difficulty planning and coordinating mouth movements for clear speech

Use of vocabulary, grammar, explanations and story-telling

Understanding of questions, concepts, instructions and conversation

The way speech sounds are organized in our brain so the right sound is used in the right place

Abilities such as breaking words into syllables and sounds, and combining sounds to make words (necessary for literacy development)

Social skills and the ability to use appropriate language 

Skills such as eye-contact, paying attention, and turn-taking

OCCUPATIONAL THERAPY DEFINITIONS

OCCUPATIONAL THERAPY DEFINITIONS

Developmental delay means that a child is behind in developing skills that are common during a particular age or time period. A developmental delay is more than just being a little behind other children in a skill, it is being behind in a combination of skills or not meeting development milestones. These are examples of developmental delays:

  • Not reaching developmental milestones of sitting, crawling, and walking
  • Not learning at an age-appropriate level
  • Not developing age-appropriate play and social skills

Play skills are skills that can help a child make sense of the world around them. A child can gain self-confidence, learn problem solving, and develop social skills through play. Your child may be developmentally delayed if they show one of the following symptoms:

  • Needs adult guidance to initiate play
  • Difficulty with imitative play
  • Wanders aimlessly without purposeful play
  • Moves quickly from one activity to the next
  • Does not explore toys appropriately
  • Participates in repetitive play for hours (e.g., lining up toys)
  • Does not join in with peers/siblings when playing
  • Does not understand concepts of sharing and turn taking

Remember that all children are different and develop these skill sets at their own pace. However, if you think your child may be struggling with adopting some of the skill areas above, you can contact an occupational therapist.

For more help in determining what skills are appropriate for what age, view these developmental milestones for ages two months to eight years.

Fine motor skills are small movements made with fingers, toes, wrists, lips, and tongue, like holding a small object or picking up a spoon. If your child is struggling with fine motor skills, they may have difficulty with one of these actions:

  • Manipulating toys and puzzles
  • Holding a pencil
  • Using silverware or straws at an age-appropriate time
  • Using scissors
  • Using zippers, buttons, shoelaces
  • Coloring, drawing, tracing, prewriting shapes
  • Poor handwriting and/or letter/number formation
  • Not developing a hand dominance at an age-appropriate time
  • Avoiding tasks and games that require fine motor skills

Gross motor skills help us move and coordinate our arms, legs, and other body parts. They involve larger muscles that help us control our body. A child who is behind in movement, strength, and/or balance may appear clumsy or uncoordinated. They may also have difficulty with these things:

  • Going up and down stairs at an age appropriate time
  • Coordinating both sides of the body
  • Understanding the concept of right and left
  • Poor ball skills
  • Poor balance

Their muscle tone, or muscle tension and resistance, could be higher or lower than the appropriate developmental milestone. They might also:

  • Be fearful of feet leaving the ground
  • Not cross midline of their body during play and school tasks
  • Avoid tasks and games that require gross motor skills

Visual processing is the process we use to make sense of what we see. It is a process in our brain that interprets visual information. If your child has difficulty with one of these things, they may have difficult with visual processing:

  • Difficulty with the spacing and sizes of letters
  • Difficulty with recognizing letters
  • Difficulty with copying shapes or letters
  • Difficulty with visual tracking and crossing midline
  • Difficulty finding objects among other objects
  • Difficulty with copying from the board or another paper
  • Difficulty with the concept of right and left

 

Your child may also lose their place when reading or copying from the board or may have poor eye contact.

Oral motor or oral sensory skills are control of muscle movements in the face and oral area, such as the lips, jaw, tongue, and soft palate. Delayed oral motor and sensory skills can show in one or more of these ways:

  • Excessive drool
  • Çhews food in the front of the mouth, rather than on the molars
  • Difficulty using a cup at an age-appropriate time
  • Difficulty with drinking from a straw at an age-appropriate time
  • Lengthy bottle or breast feedings
  • Tiredness after eating
  • Baby loses excessive liquid from their lips when bottle or breast feeding
  • Child loses excessive liquid or food from their mouth when drinking or chewing
  • Child appears to be excessively picky when eating, only eating certain types or textures of food
  • Child excessively mouths toys or objects beyond an age-appropriate time

Sensory processing is making sense of information that we receive through our senses, like sound and smell. Your child may be over sensitive to things around them and show the following symptoms:

  • Overly sensitive or heightened reactivity to sound, touch, or movement
  • Under-responsive to certain sensations (e.g., high pain tolerance, doesn’t notice cuts/bruises)
  • Constantly moving, jumping, crashing, bumping
  • Easily distracted by visual or auditory stimuli
  • Emotionally reactive
  • Difficulty coping with change
  • Inability to calm self when upset

Social interaction skills are skills that help us have relationships and understand those around us. They help us bond with other people in our life. Your child may have delayed social skills if they show some of the following signs:

  • Difficulty interacting socially and engaging with family and peers
  • Difficulty adapting to new environments
  • Delayed language skills
  • Overly focused on one subject (e.g., space, universe, dinosaurs, trains)
  • Can’t cope in the school environment

Learning challenges, sometimes called learning disabilities, are a type of developmental delay. If your child is challenged by one of the following, you may want to consult an occupational therapist:

  • Unable to concentrate and focus at school
  • Easily distracted
  • Difficulty following instructions and completing work
  • Tires easily with schoolwork
  • Poor impulse control
  • Hyperactivity or low energy
  • Not keeping up with workload at school
  • Difficulty learning new material
  • Makes letter or number reversals after age seven

DEVELOPMENTAL MILESTONES BY AGE

DEVELOPMENTAL MILESTONES BY AGE

0-3 Months
0-3 Months

Auditory detection/attention:

  • Reacts to loud sounds with startle
  • Reacts initially to sounds that are close by; between 2–4 months begins to develop distance hearing
  • Responds to low frequency sounds (vowels) better than to high frequency sounds (consonants)
  • Is awakened by loud voices and sounds
  • By the end of the 3rd month, an infant recognizes his mother’s voice; stops crying to listen; listens to his/her own sounds
  • Enjoys a few noisemakers
  • Infants are unable to control motor movements; therefore, most actions are reflexes. The most important reflex for speech development is the rhythmic suck-swallow pattern, established 3 months prior to birth.
  • Produces sounds such as fussing, crying, burping, and cooing.
  • Produces most sounds on exhalation with lengthy vowel-like sounds (back vowels)
  • Makes single vowel sounds “ah” “eh” “uh” — one syllable
  • Sustains cooing for 15–20 seconds
  • Different kinds of crying for pain and hunger
  • Attends to speaker’s mouth or eyes
  • Moves in response to voice expresses feelings by cooing (one syllable — “ah”), gurgling (at back of throat), and crying (E)
  • Exhibits differentiated crying (E)
  • Vocalizes to caregiver’s smile and voice and to express pleasure (E)
 
Chart Legend:
(E) Expressive Language

(R) Receptive Language 
  • Responds to and imitates facial expressions of others
  • Recognizes bottle or breast briefly looks at objects
4-6 Months
4-6 Months
  • Turns their eyes/head to search for sounds
  • Enjoys hearing their own sounds (gurgling, laughing, and babbling) – auditory feedback loop develops
  • Enjoys sound of musical toys (rattles, bells)
  • Responds to voices by babbling
  • Begins differentiating between environmental and speech sounds
  • After hearing their mother’s voice, cries if the face they see is not their mother’s face
  • Recognizes familiar sounds for feeding (e.g., spoon in a dish)
  • Vocalizes in self-initiated sound play
  • Coos to music
  • Vocalizes -ma- or -mu- tries to repeat heard sound sequences
  • Babbling begins
  • Experiments/plays with sounds (yells, gurgles, blows raspberries and bubbles)
  • Varies volume, pitch, and rate
  • Smiles at speaker (R)
  • Vocalizes to objects (E) 
  • Says -mama- or -dada- without meaning (E)
  • Babbles to gain attention (E)
  • Shows pleasure/displeasure by vocalizing (E)
 
Chart Legend:
(E) Expressive Language

(R) Receptive Language
  • Explores with hands and mouth
  • Smiles/vocalizes to mirror image, reaches out to mirror image
  • Experiments with cause-effect (e.g., shakes rattle)
  • Reaches for objects
7-9 Months
7-9 Months
  • In sitting position, turns eyes/head/body to source of sound (sound localization); has difficulty locating sounds above or behind
  • Responds to simple requests
  • Modifies speech to match what was heard
  • Imitates speech and non-speech sounds (e.g., blowing raspberries)
  • Responds to name
  • Attends to music/singing
  • Understands many onomatopoeias
  • Produces sounds in one breath
  • Enjoys imitating sound sequences
  • Babbles with some CV syllables (“bababa”)
  • Uses /m/, /n/, /b/, /p/, /t/, /d/ in babbling, imitates sounds such as coughing, tongue clicking (increased tongue tip activity), etc.
  • Imitates some onomatopoeias
  • Babbling shows pitch and inflectional changes
  • Copies (sometimes inaccurately) intonational contours
  • Beginning of adult speech (e.g., starting to develop certain vowels, syllables, and diphthongs)

 

Chart Legend:
(CV) Consonant Vowel

  • Recognizes names of family members (R)
  • Responds to “no” most of the time (R)
  • Attends to pictures (R)
  • Uses gesture and vocalization to protest (E)
  • Vocalizes during games (E)
  • Sings along with a familiar song (E)
 
Chart Legend:
(E) Expressive Language

(R) Receptive Language
  • Searches for partially hidden object
  • Struggles to get objects that are out of reach
  • Plays games like “peek-a-boo”
  • Imitates simple acts (e.g., clapping, nodding)
  • Gives, points, shows
  • Pulls rings off peg
10 - 12 Months (I Year Old)
10 - 12 Months (I Year Old)
  • Responds physically to music
  • Responds to questions by searching
  • Can look for named objects that are out of sight
  • Understands some common phrases
  • Uses variegated (non-reduplicative) babbling (“dageedagee”)
  • Begins changing babbling to real words
  • Continues imitating sounds
  • Begins using more back vowels, central vowels, and consonants
  • Recognizes familiar persons or objects when named (R)
  • Looks at named pictures with an adult (R)
  • Attends to new words (R)
  • Identifies two body parts on self (R)
  • Gives objects upon verbal request (R)
  • Uses social gestures (e.g., waving “bye-bye”) (E)
  • Vocalizes with intent frequently (E)
  • Uses onomatopoeias to refer to objects (E)
  • Says one to two words spontaneously

Chart Legend:
(E) Expressive Language

(R) Receptive Language

  • Tries to accomplish simple goals (seeing and then crawling to a toy)
  • Looks for/finds objects that are out of sight (such as a spoon that falls under the table)
  • Stacks rings on peg
  • Begins awareness of in/out (objects/containers)
12 - 18 Months
12 - 18 Months
  • Shows interest in sounds of radio and television
  • Listens to simple stories, songs, and rhymes
  • Demonstrates two item memory
  • Uses echolalia and unintelligible speech/jargon
  • Omits some initial consonants and almost all final consonants
  • Continues to develop vowels and diphthongs
  • Varies pitch when vocalizing
  • Uses 21 different phonemes
  • Imitates words inexactly
  • Follows one-step commands without a gesture/verbal cue alone (R)
  • Uses true words within jargon-like utterances (E)
  • Combines vocalization and gesture to obtain a desired object (E)
  • Identifies/points to 3+ body parts (on self or doll), clothing item, or a toy on verbal request (R)
  • Names objects on request (E)
  • Gives objects if asked (R)
  • By 18 months, uses 20 – 100 meaningful words; 50% of words are nouns (E)
 
Chart Legend:
(E) Expressive Language

(R) Receptive Language
  • Explores objects in many different ways (e.g., shaking, banging, throwing, dropping)
  • Points to named pictures
  • Begins to use objects correctly (drinking from cup, brushing hair, dialing phone, listening to receiver)
  • Laughs at silly actions (as in wearing a bowl as a hat)
  • Solves problems by trial and error (e.g. inverts bottle to obtain object, obtains toy with stick)
  • Scribbles spontaneously
18 - 24 Months (2 Years Old)
18 - 24 Months (2 Years Old)
  • Understands when called from another room
  • Remembers what was heard in the correct order (e.g., “Put the fish in the water and the turtle on the grass.”) –auditory sequencing-
  • Follows a conversation when the topic is known
  • Answers questions about a picture or book
  • Jargon peaks at 18 months
  • Correctly pronounces most vowels
  • Uses /m/, /p/, /b/, /w/, /n/, /t/, /d/ correctly in the beginning of syllables and short words
  • 2 years: 25% – 50% intelligibility
  • Commonly uses 25 different phonemes
  • Uses beginning consonants
  • Word-final consonants emerge
  • Pitch is lower and more stable
  • Follows two-step related commands without visual cues (R)
  • Points to 4+ body parts (on self or doll) (R)
  • Uses question intonation to ask yes/no questions (E)
  • Uses two-word phrases/sentences frequently by 24 months (“more milk,” “a doggie,” “read book”) (E)
  • Names most common objects (E)
  • Understands questions (e.g., where? and what’s that?) (R)
  • Begins using pronouns like “my,” “me,” “mine”; refers to self by name (E)
  • Uses 200+ words (E)
 
Chart Legend:
(E) Expressive Language

(R) Receptive Language
  • Finds objects even when hidden under two or three covers
  • Likes to take things apart
  • Stacks rings on peg in order of size and builds higher towers
  • Turns one page at a time
  • Activates mechanical toy
  • Pretend plays about familiar situations
2 - 2 1/2 Years
2 - 2 1/2 Years
  • Answers questions about a story
  • 60% of speech is intelligible by 30 months of age
  • Continues to develop front consonants
  • Responds appropriately to location phrases (“in”,”on”) (R)
  • Recognizes family member names (R)
  • Uses “and” (e.g., “mommy and daddy”) (E)
  • Uses three-word sentences frequently (E)
  • Begins using verb endings (-ing) (e.g., “Mommy pushing”) (E)
  • Refers to self as “me” rather than by name (E)
  • Asks simple questions (e.g., “Where ball?” “What Daddy doing?” “What color?”) (E)
  • Uses numbers and nouns (e.g., “two doggie”) (E)
 
Chart Legend:
(E) Expressive Language

(R) Receptive Language
  • Begins to sort by shapes and colors
  • Can name one color
  • Begins make-believe play
  • Dramatizes mother and baby
  • Begins to understand functional concepts of familiar objects and part/whole concepts
  • Shares toys
2 1/2 - 3 Years
2 1/2 - 3 Years
  • Begins making cognitive judgments about what was heard, e.g. “Tell me about your trip to Disney World.” (auditory processing)
  • Answers questions about an undisclosed but familiar topic
  • Continues use of echolalia when difficulties in speech are encountered exhibits repetitions
  • Begins making cognitive judgments about what was heard, e.g. “Tell me about your trip to Disney World.” (auditory processing)
  • Answers questions about an undisclosed but familiar topic especially starters (“I” and first syllables)
  • Speaks with a loud voice
  • Increases range of pitch
  • Consistently uses initial consonants (some are misarticulated); frequently omits medial consonants; frequently omits or substitutes final consonants
  • By age 3, 90 % of children produce the following consonants in conversation: /p/, /m/, /n/, /h/, /w/
  • Accurately pronounces all vowels and diphthongs (except those with an r, such as in the word “bird”)
  • Uses approx. 27 phonemes
  • 3 years: 75 – 80% intelligibility
  • Masters 2/3 of the adult speech sounds
  • Answers questions with “yes” or “no” (E)
  • Understands the concepts of “one” and “all” (R)
  • Uses subject pronoun: he (E)
  • Asks “What happened?” (E)
  • Uses “gonna” and “wanna” (E)
  • Uses 3-4 word sentences; converses with self; MLU 2.5-3.0 (E)
  • Shows interest in “why” and “how” explanations (R)
  • Expands use of verb endings (-ing), plurals/possessives (“eat cookies”), contractions (E)
  • Begins the “why” question stage; asks “wh”- questions (“What’s that?” and “Where ball?”) (E)
  • Uses 2-/3-word negative phrases (/”no want that”)(E)
  • Asks for “another” (E)
  • Understands “now,” “soon,” and “later” (R)
  • Negins using singular/ plural noun-verb agreement (E)
  • “Converses:” relates simple imaginative tales; describes actions in book (E)
  • Vocabulary: 900+ words (E)
 
Chart Legend:
(E) Expressive Language

(R) Receptive Language
  • Matches an object in hand or in the room to a picture in a book
  • Completes 5+ piece puzzleCounts 2 to 3 objects; knows more numbers (but not always in the right order)
  • Remembers what happened yesterday
  • Knows where things usually belong
  • Substitutes one object for another in pretend play (as in pretending a block is a “car”)
  • Laughs at silly ideas (like milking a dog)
  • Avoids some dangers, e.g. a hot stove or a moving car
  • Selects objects not the same (“Which doesn’t belong?” from set of objects
  • Names own drawings
  • Pretends to be caregiver
  • Holds up fingers to tell age
  • States first & last name
3 - 4 Years
3 - 4 Years
  • Improves listening skills
  • Comprehends auditory information in a variety of settings (auditory understanding)
  • Listens attentively and retells stories accurately
  • Repeats sentences with high predictability
  • Identifies objects based on description (open set)
  • Substitutes some stops for fricatives (i.e. “tat” for “sat”)
  • Increases speech rate may delete a syllable in multi-syllabic words
  • Simplifies words with blends 4 years: 80 % – 90% intelligibility
  • The following consonants emerge: /r/, /l/, /s/, /t/(ch), /sh, /z/
  • By 4, 90% of children have mastered the following sounds in conversation: /b/, /k/, /d/, /j/, /f/, /g/
  • Uses possessives (E)
  • Uses “we,” “she,” and “they” (E)
  • Uses “some,” “many,” and “all” (E)
  • Uses present progressive: is/are/am + verb ing (E)
  • Uses some irregular verbs (E)
  • Uses “can’t,” “not,” and “didn’t” (E)
  • Uses “hafta,” “have to,” and “want to” (E)
  • Uses 3rd person singular–s (E)
  • Expresses ideas and feelings rather than just talking about the world around him/her (E)
  • Begins using analogies, comparisons; can complete opposite analogies (“sister is a girl; brother is a ___.”) (E)
  • Describes the use of objects such as “fork,” “car” (E)
  • Enjoys poems and recognizes language absurdities such as, “Is that an elephant on your head?” (R)
  • Uses do to ask yes/no questions (E)
  • Vocabulary: 1500+ words (E)
 
Chart Legend:
(E) Expressive Language

(R) Receptive Language
  • Identifies and names primary colors
  • Counts to ten
  • Approaches problems from a single point of view
  • Begins to have a clearer sense of time; wants to know what will happen next
  • Engages in fantasy play; distinguishes between the real and pretend worlds
  • Takes turns and can do so without always being reminded
  • Identifies situations that would lead to happiness, sadness, or anger
  • Draws somewhat recognizable picture that is meaningful to child if not to adult; names and briefly explains picture
  • Distinguishes day activity (playing) from night activity (sleeping)
  • Sequences familiar routines, simple finger plays, patterns of blocks
  • Traces/copies figures (squares), drawn objects
  • Knows division of day – morning, afternoon, night
  • Matches object to occupation – fishing rod to fisherman
4 - 5 Years
4 - 5 Years
  • Recalls 5+ facts from a familiar story
  • Identifies word that rhymes or doesn’t rhyme in set of 3-4
  • 5 years: 98 – 100% intelligibility
  • By age 5, the phonological processes of syllable deletion and fronting are suppressed.
  • The following consonants emerge: (/d /) -“j” as in jump, /v/, voiced(/ð/) and voiceless(/ /) “th
  • Asks what/who/where or why do questions (E)
  • Asks what/who/where or why did questions (E)
  • Asks whose (E)
  • Uses does to ask yes/no questions (E)
  • Converses with longer, more complex sentences, but still makes grammar errors; MLU 4.5+ (E)
  • Uses has, does, had (E)
  • Uses because, when, if, and so in clauses (E)
  • Uses these and those (E)
  • Uses before and after (E)
  • Uses comparative adjectives (“small-smaller”) (E)
  • Answers “why” and “how” questions ; replies to questions like “What is a house made of?” (E)
  • By age 5, uses 2500 words (E)
  • Ends conversations appropriately
 
Chart Legend:
(E) Expressive Language

(R) Receptive Language
  • Draws recognizable pictures; copies more complex figures (triangle)
  • Likes cutting/pasting
  • Knows own street and town
  • Begins to relate clock time to daily schedule
  • Identifies a problem, lists possible solutions verbally and chooses which one(s) are appropriate
  • Tells color of unseen object – “What color is an apple?
  • Categorizes, naming items without visual clues, e.g.animals, food, toys; decides own criteria for categories
  • Predicts story from book cover
  • Names penny, nickel and dime
  • Knows days of the week
5 - 6 Years
5 - 6 Years
  • Expansion of auditory
  • Understanding can provide a word that rhymes with a given word
  • Learns letter-sound associations
  • By 6, 90% of children have mastered the following sounds in conversation: /t/,/r/, / /(ng), /l/
  • Uses a variety of blends
  • Self-monitors speech
  • Stabilizes correct usage of irregular plurals and past tense/irregular verbs (E)
  • Uses pronouns, prepositions, and articles correctly, consistently (E)
  • Uses superlative –est (E)
  • Uses –er to form nouns (teach/teacher) (E)
  • Uses future progressive: will be + verb + __ing (E)
  • Asks wh questions with does (E)
  • Uses sentences with 8+ words; uses compound and complex sentences (E)
  • Understands time sequences (what happened first, second, etc.) (R)
  • Vocabulary: 2800+ words (R); 2500+ (E)
 
Chart Legend:
(E) Expressive Language

(R) Receptive Language
  • Says letters of alphabet
    Understands that letters written on a page represent spoken words
  • Understands number concepts to “ten”
  • Rote counts to 30+
  • Recognizes and can reproduce many shapes, letters, and numbers
  • Plays games by the rules
  • Understands seasons of the year
    Begins to think about their own behavior/actions and to see consequences/ explain situations
  • Begins to read and write, distinguishing capitals and lowercase
    Uses invented spelling (e.g. color could be spelled “kulr”) (E)
  • Arranges objects in order, according to size
  • Completes simple maze
  • Adds, subtracts
  • Comprehends directional commands – left/right
6 - 8 Years
6 - 8 Years
  • Provides a synopsis/ summary after listening to information one time
  • Most children have typical articulation
  • By age 7. By 7, 90% of children have mastered the following sounds in conversation: / /(sh), /t /(ch), /j/ , voiceless (/ /) “th”
  • By 8 90% of children have mastered the following sounds in conversation: /s/, /v/, /z/
  • Most children have typical articulation
  • By age 7. By 7, 90% of children have mastered the following sounds in conversation: / /(sh), /t /(ch), /j/ , voiceless (/ /) “th”
  • By 8 90% of children have mastered the following sounds in conversation: /s/, /v/, /z/
  • Can develop a plan to meet a goal
  • Rote counts to 100+
  • Understand/use riddles and idioms (“Hold your horses.”)
  • Tells jokes
  • Tells own address, phone number
  • Names months of the year
  • Names month for a given holiday
  • Can tell time