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Tel: 604-209 2016; Email:

Address: 1500 Marine Drive, 2nd Floor, North Vancouver, BC, V7P 1T7

Speech Therapy

What to do before you make an appointment for a Speech or Language Assessment.

If you are concerned that your child under three years is not talking the way you expect him/her to

A: Make an appointment with your Family Doctor, and request a referral to a Paediatrician. There may be underlying developmental or medical reasons behind your child's delayed speech and language. General developmental and medical concerns must be ruled out in order for correct diagnosis and management.
B: Make an appointment  with your local health unit for a hearing test for your child. Hearing loss or hearing health factors can affect your child's speech and language development.
C: Make an appointment with your local health unit for a Speech-Language Assessment. You may be eligible for provincial funding for Speech Therapy services. Often there are long wait lists, but it is advisable to get onto these wait lists as soon as possible so as to benefit from services while your child is still eligible.  Services are usually available until the age of five years in BC.
D: Consider a period of private diagnostic Speech Therapy while you wait for provincial services to become available to you. Many extended health plans offer coverage for Speech Therapy. Early intervention in this age-group is crucial.

If you are concerned that your child over three years is talking but other people can't

understand him/her

A: Mention your concerns to your Family Doctor. Your Family Doctor will know if there are more general health or developmental conditions that warrant a referral to a Paediatrician.
B: Make an appointment with your local health unit for a hearing test. Hearing loss and hearing health conditions could affect speech clarity.
C: Make an appointment with your local health unit for a Speech-Language assessment. You may be eligible for funding if your child is under five years of age. If your child is school-aged, you should make your concerns known to the school's resource teacher to arrange for the school Speech-Language Pathologist to become involved.
D: Consider private Speech Therapy if you are not eligible for provincial funding or if the school Speech Therapy services at your child's school are not readily available. Many extended health plans have some coverage for Speech Therapy.

Guidelines for Normal Speech and Language Development

Infants communicate with their parents from the time they are born. Early cries and vocal noises shortly develop into speech sounds and eventually into meaningful words.
Babies are born with the innate ability to develop communication skills. Childhood is a time of rapid growth and development. Children are curious, excited and ready to explore what life has to offer with all of their senses. They develop relationships with the adults who care for them and with other children around them.  Communication is at the core of these relationships.
From the time an infant utters its first cry, communication is initiated!

Speech Sound and Language Acquisition

 “De bwat one, mommy!” – Speech is made up of sounds that are strung together to form
meaningful words which are in turn used in sequences based on the grammatical rules of the language. It is not uncommon for young children to mispronounce words as the speech sound system develops. Children may omit, substitute or distort speech sounds. Parents typically come to know their children’s error patterns and are able to understand most of their speech. Strangers, however, may turn to the parents for help when they cannot understand the child.
Sometimes the words don't come at all, or they emerge more slowly than expected.
Sometimes children remain stuck at one-word utterances when other children of the same age are stringing words together. Children may express frustration through their behaviour when their important messages are not understood.

Here are some broad guidelines as to what to expect at what age:
(From Lanza & Flahive, Linguisystems 2008)

By 12 months a child should be babbling, using combinations of consonant-vowel syllable
combinations, with adult-like intonation;
By age 6 years, most speech sounds should be mastered, although there is some variability in the precision of certain later-developing sounds such as ch, sh, z, j, v, th  and zh.
By 19 - 24 months, a child should be 25% to 50% intelligible (clear);
By 2 – 3 years ,he/she should be 50% to 75% intelligible;
By 4 -5 years, 75% to 90% intelligibility is expected, and
By 5+ years, intelligibility should be at 90% to 100%.

Mean  length of Utterance is a reliable predictor of language complexity and helps
gauge a child’s language development. The mean length of utterance is the number
of meaningful speech units in one utterance.
By 12 - 24 months, the child should be using 2 morphemes (meaningful units) per utterance, e.g. Mummy car;
By 31 – 34 months, he/she should be approaching 3 morphemes per utterance, e.g.
Mummy's car;
By 47 months (almost 4 years) a child's average length of utterance should be more than 4
morphemes per utterance, e.g. Mummy's car here; or Mummy's car's blue.

Sometimes it's helpful to measure the vocabulary that a child uses to determine if their
language is on track. It may be helpful to know that:
By 12 months, a child should have an approximate expressive vocabulary of 2 to 6
By 24 months, that expressive vocabulary should have increased to 200 to 300 words,
By 36 months (three years) the child should be using around 1000 words.

Speech and Language development are far more complex than the above milestones would imply, but these milestones will help parents to know if their child is developing in an
expected way, and if in doubt, they should consider a Speech-Language assessment.
A Speech-Language Pathologist (SLP) is trained to assess the child's speech sounds
development and all aspects of language development, and compare them to expectations for same-age peers.

Is it possible to work on speech and language with a 2-year-old or

Absolutely! By making the therapy fun and interactive, children play games as
they work on speech and language without realizing it. Parents are absolutely
integral to children’s progress in therapy. We ask parents to work with their
children at home. Everyone celebrates the child's success!

A few words about Stuttering

If your preschooler has been stuttering for more than 6 months, it may be time to
consult a speech-language pathologist. Fluency disruptions in the speech of young children who are developing speech and language skills are to be expected; however, as many as 4% will exhibit early stuttering behaviours in their speech. [fluency – the smooth, easy flow of

What is stuttering? Stuttering is easily recognized by repetition of sounds (c-c-c-can) and syllables (mo-mo-mommy), speech sound prolongation (mmmmmommy) and the inability to start or continue speaking (getting stuck). These speech behaviours may be accompanied by struggle, such as changes in voice loudness or pitch, facial grimacing or body movements. Some children may verbalize, "I can't say it!" in frustration. Parents are mystified when stuttering suddenly appears in their previously fluent young child’s speech. Stuttering typically shows up
when children begin using longer, more meaningful sentences, somewhere around the age of 3.

The Good News about Stuttering: About 75% of preschool children will stop stuttering naturally without intervention within one year of beginning to stutter. In about 25% of children, stuttering may come and go but doesn't ever disappear completely. In some cases, stuttering develops to pervade speech, or progressively becomes worse. While it is not possible to predict which
children will recover from stuttering on their own and which will continue to stutter, a speech-language pathologist can assess each child's unique situation to determine an appropriate management plan. Treatment is recommended in the early stages of stuttering because it is more amenable to change than more established stuttering. Waiting until the child is 5 or 6 is
not the wisest decision, even if the stuttering is fairly new.