Children deviating from the age-related development path should be referred to a speech therapist for assessment.
Observation of early interaction is important: how does the adult make contact with the child; what is the developmental stage of the child's emotional life; what is the psychosocial situation?
Adequate hearing ability in essential for normal speech and language development. Therefore, the hearing ability of the child has to be tested.
Family history of language or attention difficulties warrant a closer than normal monitoring of the development of the child's language skills and communication.
Referral to a speech therapist at different ages
First year of life
Little vocalizing and babbling
Poor contact with adults
Suspicion of impaired hearing
Orientation, sucking, and swallowing reflexes are poorly developed; difficulties in eating
No words or attempted words or other attempts at expressing oneself (gestures)
Suspicion of poor speech comprehension or does not obey commands (remember recurrent otitis media as a cause of impaired hearing)
Poor alertness
Difficult to make contact with the child
Speech is scant or not clear after the second birthday.
If a child who has grown in a bilingual family has a sparse vocabulary but otherwise develops normally and understands speech and requests normally, follow-up of speech development is still a sufficient measure.
Children aged 3-4 years
Speech is defective or not clear (phonemes or syllables change place, long words are shortened)
Major grammatical errors
Poor vocabulary, difficulty in finding words
Little speech, no or only a few sentences
Inadequate answers, "own language"
Stammering continues or starts after the physiological stammering age (at about 3 years)
Poor contact, the child does not stop to listen
Difficulties in following short instructions.
Children aged 5-6 years
Pronunciation errors (r, s, l, k etc.) should be corrected before school age
Non-fluent speech (stammering, slurred speech)
Language or speech is scant or poorly developed in relation to age
The overall speech is not clear, which may be due to problems with motor and/or phonological fluency or difficulties in the ability to comprehend spoken language.
Children aged 7-15 years
All the abovementioned problems if they have not been investigated before
Particularly problems that significantly affect speech