Speech and Language Development and Disorders
Speech and Language Development and Disorders covers typical milestones, differential diagnosis, assessment, and intervention for children. The exam tests whether you can separate delay, disorder, and difference and choose culturally valid procedures.
Core rules
- By 12 months, infants use gestures, joint attention, and first words; by 18 months, many use 10-50 words; by 24 months, two-word combinations and roughly 50-300 words are expected. By 3 years, speech is intelligible to unfamiliar listeners much of the time; by 4-5 years, grammar approaches adult forms.
- Speech sound mastery follows a developmental order: /p b m n d h w/ often by 3; /k g f/ by 4; /s z l/ by 5-6; /r, ʃ, tʃ, dʒ, θ, ð, ʒ/ later, about 7-8. A sound not yet expected is not automatically a disorder.
- Language disorder is a persistent deficit in form, content, or use that affects function; delay is slower but typical sequence; difference reflects dialect or bilingual influence.
- Assess hearing first, gather a language sample in the child's dominant language, use interpreters and dynamic assessment, and avoid English-only standardized scores for bilingual children.
- Intervention should be functional, evidence-based, and family-centered; AAC can support communication without blocking speech development.
Worked example
A 4-year-old bilingual child is referred because she uses /w/ for /r/ and has a short English vocabulary. /r/ is not expected until about 7-8, so the substitution is developmental. Her vocabulary should be compared with bilingual norms and assessed in both languages. Reasoning: without a true deficit in functional communication, this pattern is a difference or developmental error, not a language disorder.
Traps
- Overidentifying bilingual children as language disordered from English-only testing.
- Treating dialect features in African American English as errors.
- Waiting to refer a 2-year-old with no words and no gestures.
- Using age norms from one dialect for all children.