“Signs To Watch For”

Communication Milestones and When to Seek an Evaluation -

A Neurodiversity-Affirming Perspective

As a speech and language therapist, I believe in celebrating the diversity of communication styles while recognising when extra support can help a child thrive. Every child develops at their own pace, and differences in speech and language aren’t necessarily deficits; they are simply variations in how children process and express information. Instead of focusing on what a child isn’t doing yet, I encourage parents to look at their child’s unique strengths alongside areas where they might benefit from guidance. Early intervention isn’t about “fixing” speech or language, it’s about empowering children to communicate in ways that work for them.

I once worked with a child, who was mostly non-speaking at age three. She loved patterns, numbers, and music but didn’t use words to express her needs. Her parents worried because she wasn’t following the typical milestones. However, instead of focusing solely on spoken words, we explored alternative forms of communication; gestures, picture-based communication, and even song lyrics as a bridge to language. Over time, the child found her voice not always through speech, but in ways that fit her unique communication style. Her journey reminded me that speech and language development aren’t rigid checklists; they are fluid and deeply personal.

Recognising Communication Differences

Speech and language milestones are helpful guides, but they shouldn’t be seen as strict rules. Children communicate in many ways, and some might develop skills earlier or later than expected. What’s most important is ensuring that a child has effective ways to express themselves, whether through speech, gestures, pictures, or technology. Below is a cheat sheet outlining key milestones for ages 0-3 years and 4-7 years, along with signs to watch for that may indicate a need for additional support.

0-3 Years: Early Communication Foundations

✔ By 12 months: Babbling, gestures (pointing, waving), responding to their name or showing interest in interactions through alternative means (eye contact, sounds, movement). 

✔ By 18 months: Saying 10-20 words, understanding simple commands ("come here"), using gestures or preferred communication styles. 

✔ By 2 years: Combining words or other forms of communication ("want cookie"), understanding simple questions, following basic directions. 

✔ By 3 years: Using short sentences, asking questions, or effectively communicating through a variety of means, such as visuals, AAC devices, or sign language.

Signs to Watch For

• Constantly needing support and having difficulty communicating their needs.

• Showing frustration due to limited interaction.

• Displaying distress around communication attempts.

4-7 Years: Speech and Language for Learning

✔ By 4 years: Using full sentences, telling simple stories, or expressing ideas in their own way, such as pictures, gestures, or structured play.

 ✔ By 5 years: Clear speech (or preferred communication method), following multi-step directions, using sentence structure that suits their processing style. 

✔ By 6-7 years: Understanding jokes, expressing ideas logically, using a wide vocabulary that reflects their interests, reading simple words at their own pace.

Signs to Watch For

• Persistent frustration when trying to communicate.

• Difficulty forming thoughts into sentences in any format.

• Challenges processing language even with visual or structured support.

Speech and Language Support That Honours Neurodiversity

Recognising communication differences is about supporting, not correcting. Here are some approaches that can help children thrive:

Speech Support Strategies

• Embrace Different Speech Styles – Some children naturally develop speech clarity later. Encouraging gentle, pressure-free practice builds confidence.

• Use Multi-Sensory Speech Activities – Games like Scrabble, Dobble, and rhyme-based play allow for speech sound exploration in a stress-free way.

• Recognize Non-Traditional Speech Approaches – Some children thrive with music, patterns, or movement-based speech exercises that engage their natural strengths.

Language Support Strategies

• Encourage Communication in All Forms – Verbal, visual, AAC devices, sign language, and gestural communication are all valid and valuable.

• Word Association and Language Play – Games like Articulate, storytelling dice, and conversation cards allow children to engage in language at their own pace.

• Break Down Instructions for Processing Ease – Instead of rigid expectations, support processing speed by allowing pauses and visual prompts.

Final Thoughts: Let’s Celebrate Communication in All Forms!

No child is “behind” in communication they are simply developing in their own way. Recognising signs to watch for isn’t about labelling deficits but finding the best way to support each child’s unique abilities. Whether your child expresses themselves through speech, gestures, movement, or alternative communication, the goal is always connection.

Have you noticed differences in how your child communicates? I’d love to hear your experiences, thoughts, or questions. Drop them in the comments!

-Nooreen