Speech, language and communication are different
Speech is how sounds and words are produced. Language includes understanding and expressing meaning. A child may know what they want to say but be hard to understand, or speak clearly while struggling to follow instructions. Stuttering concerns the flow of speech and has its own assessment pathway. These differences help guide a speech-language evaluation.
Concerns around ages two and three
At around two years, many children combine words. By three, children usually have brief back-and-forth conversations and are understood much of the time. Milestones are guides, not a diagnosis or a test to give at home. If your two-year-old is not combining words, or your three-year-old struggles with everyday communication, discuss an assessment rather than waiting for school.
- Mention difficulty understanding familiar requests.
- Describe how your child points, shows objects and asks for things.
- Tell the clinician if progress has stopped or skills have been lost.
Why a child may struggle to communicate
Hearing difficulties, speech-sound problems, developmental language disorder and broader developmental differences are among the possibilities. Autism is one consideration when there are wider differences in interaction and behaviour; speech delay alone does not establish it. Learning two languages does not cause developmental language disorder. Assessment should consider every language the child uses and understands.
Hearing and language assessment
A clinician reviews development and health, and a speech-language professional assesses understanding, expression and speech as appropriate for age. Hearing assessment is often included, even when a child seems to hear some sounds. Nursery observations and examples from familiar routines help show abilities that may not appear in an unfamiliar appointment.
Bring hearing results, previous assessments and a short list of words or gestures used spontaneously. Note which languages are spoken at home and by whom.
When to seek help promptly
Arrange a prompt medical review for loss of words or other acquired abilities, reduced response to sound, or concerns affecting several areas of development. A child who has stopped communicating as before needs assessment, not simply more practice. Tests beyond hearing and developmental assessment depend on clinical findings; an EEG is not a substitute for assessing language.
Build communication into everyday life
Treatment follows the identified need and may include speech-language therapy with activities for home and nursery. Discuss achievable communication goals and a review plan. Support can involve understanding instructions, expressing choices or being understood more easily; it is not just a race to increase the word count.
- Follow your child’s interest during play and name what you are doing.
- Pause so your child has time to respond, using words, sounds or gestures.
- Share picture books and add a little language to your child’s message.
- Reduce background noise and avoid repeatedly correcting pronunciation.
Common questions
My child understands but does not speak much. Should I wait?
Good understanding is useful information, but persistent difficulty expressing needs still warrants discussion. A professional can assess the pattern and advise whether support or monitoring is appropriate.
Does speaking Arabic and English cause delay?
Using more than one language does not cause developmental language disorder. Tell the assessor about both languages so the child’s overall communication is considered.
Can hearing need checking if my child reacts to loud sounds?
Yes. Reacting to some sounds does not show how well a child hears speech. An age-appropriate hearing assessment can clarify this.
Should we wait for less screen time to resolve speech delay?
No. Protect daily conversation and play while arranging assessment for persistent concerns. Do not delay seeking advice when a child loses words or other acquired skills.
