The American Speech & Hearing Association
(ASHA) Milestones (7 Months - 5 Years)

When should I refer for Speech/Language Evaluation?


  • Lack of eye contact or gaze
  • Difficulty feeding or swallowing
  • Difficulty with head control or other motor movements
  • Extremely fussy or very quiet baby
  • Difficulty regulating sleep patterns
  • Medical issues such as reflux, prematurity, asthma, ear infections

Toddlers and Preschoolers:


  • Excessive drooling
  • Highly unintelligible
  • Starts to talk and then stops
  • Child omits the end sounds of words
  • Is not producing /m, p, b, t, d/ - 2 year olds
  • Is not producing /k, g, f, n/ - 3 year olds
  • Is not producing /sh, ch, j, v/ - 4-5 year olds

Receptive Language:

  • Child seems to not hear you
  • Child will only respond to things phrased in a certain way (ex., “juice” but not “drink”)
  • Little affect or understanding of feelings
  • Responds very well to visual cues or gestures, rather than speech
  • Echoes what they hear but are not spontaneous in productions
  • Trouble with following directions
  • Trouble in new situations (daycare, preschool)
  • May have behavior problems (frustrations, trouble with transitions)

Expressive Language:

  • Lack of true words to communicate
  • Lots of pointing, grunting, or crying when attempting to communicate what they want
  • Child echoes but is not spontaneous with words
  • Cannot maintain topic at hand for any period of time
  • Child will start to play with a toy, but is not able to expand the play or move to anything new (e.g., performs the same action over and over)
  • Difficulty coming up with names of items or people (word retrieval)

Sensory Integration Issues:

  • Child may avoid touch or being touched
  • Picky about food, texture, and touch
  • Stuffing food in pockets of cheeks
  • Difficulty drinking from a straw
  • Child may bump into things often or seems not notice where he is walking
  • Under reactive to environment
  • Often looks like attentional or behavior issues