12-18 months: During this period, the child develops a vocabulary of around 50 simple words, but is often able to understand more. The child uses words in an isolated, utilitarian way, sometimes to show, often to get something. Pronunciation is not always clear, and parents understand the child better than strangers.  

‍18-24months: In addition to using words to ask, the child begins to enjoy pointing to objects or actions and showing them by name. Thus action words appear and the child can combine two words to express himself. By the age of two, the child's vocabulary should now include 200 to 300 words to express himself, but he can understand up to 1,500 words. 

‍2to 3 years: Language development accelerates exponentially during this period! His sentences now combine 3-4 words. Above all, he's beginning to understand and be able to use more abstract notions like up-down, over-under, front-back, more-minus.

When small books are read to them, children can understand simple stories by making connections between ideas from one page to the next. They can also use adjectives to describe objects and actions.

Around the age of 3-4, children develop their imagination enormously, and sometimes tell invented stories and anecdotes from their own imaginations.

Sometimes converses alone, aloud, using figurines, dolls or doggies. He understands cause-and-effect explanations, if the explanations are simple and concrete (e.g. "we can't go outside because it's raining").

It includes requests containing up to three characteristics (e.g.: give me the big red block) or up to two steps (e.g.: go to your room and bring back a pair of pyjamas).

‍4-5years: the child now has a vocabulary of over 2,000 words. He produces complete sentences and now likes to tell stories. He tells what he has seen, what he has done, what has happened, etc. He uses verbs in the past and future tenses.

At this age, children often talk a lot, even constantly, because they haven't yet internalized language (the ability to talk in their heads). So he says out loud whatever comes into his head! The 4-5 year-old also asks a lot of questions. They want to learn and understand.

The child can understand explanations that justify our decisions, but will be able to use a new tool: argumentation. Articulation should be clear, although some sounds may remain more difficult to articulate. The child is also well understood by strangers when he expresses himself. 

Developmental Language Disorder (DLD) - formerly known as dysphasia

A child may present a delay in language acquisition, which can affect his or her ability to express him or herself (expressive language), or to understand what is said to him or her (receptive language).

These delays can be part of a normal developmental pathway, and in some cases they can simply disappear with maturation, or with the help of training and stimulation, such as speech therapy.

Developmental language disorder refers to a disorder that persists despite intervention and appropriate stimulation. We generally wait until the age of 5 or 6 before confirming the diagnosis. 

The 4 DSM-5 diagnostic criteria for developmental language disorder are as follows: 

1. Persistent difficulties in language acquisition and use. 

The child's oral expression and/or language comprehension skills deviate significantly from the expected learning curve for his age. More specifically, we can observe :

• Pronunciation difficulties. The articulation of words is deficient, and the child is significantly harder to understand than the average of his peers.
• Delays in vocabulary acquisition. The child has few words, both to express himself and to understand what is said to him. 
• Difficulties with syntax and sentence organization. Sentences are disorganized, with verbs and qualifiers out of sync. For example, we don't understand who is the subject of the action the child is trying to explain. 
• Narrative difficulties. They may have difficulty telling stories coherently or following a logical sequence in their speech.
• Limited language comprehension. Children with a language disorder may have difficulty understanding simple instructions, questions or conversations.

2. The difficulties are significant and impose functional limitations on communication. For example, children with dysphasia may feel frustrated or angry when they fail to make themselves or others understood. They may also have difficulty establishing relationships with their peers because of their communication difficulties.

3. Difficulties appear in the early stages of development. This is a developmental disorder, so signs are often present from an early age. 

4. The difficulties are not attributable to a hearing impairment, other neurological/sensory disorder or other medical condition. We could then speak of a language acquisition disorder secondary to ...

Beware of comprehension difficulties that reappear around Grade⁴

Developmental language impairment is often most evident in the preschool period, when difficulties are seen in expressive language. Speech and language therapy can help to improve expressive language skills. 

Receptive difficulties (comprehension) are much harder to identify and work on, because we don't always know what the child has understood from our message.

For example, they may not understand the instructions given to a group, but remain silent, observe what the other young people in the group are doing and reproduce what they see to avoid saying they didn't understand. 

Around the^4th year of primary school (ages 9-10), the instructions given to children often become more complex. The teacher may begin to use metaphors, to give more abstract explanations on more abstract themes.

The language used with children becomes more complex because children of this age have the ability to make connections and understand second degrees.

However, it is not uncommon for children with early developmental language disorders to retain silent, discreet receptive difficulties, which resurface around the^4th year, as the complexities of communication increase.

This can lead to the mistaken belief that children are inattentive or demotivated because they don't listen in class, when in fact they don't understand.

Assessment and diagnosis

Legally, in Quebec, the diagnostic evaluation of developmental language disorders can be carried out by physicians, psychologists, neuropsychologists, speech therapists and certain nurses and guidance counselors certified to do so.

‍In fact,at CERC we consider the speech-language pathologist to be the professional best equipped to carry out the assessment and make the diagnosis.

Our neuropsychologists can detect signs of an oral language disorder, but will often request an additional speech therapy evaluation (if none exists in the child's file) to confirm their diagnostic position.

If the child has previously been seen in speech therapy and an assessment report exists and is forwarded to us, our neuropsychologists will then be able to make a diagnostic decision, completing their analysis with an assessment of all other cognitive functions. 

Theneuropsychological evaluation also helps to establish what is known as the differential diagnosis. Language difficulties may be the result of other underlying disorders, such as intellectual disability (formerly called intellectual handicap), autism spectrum disorder (ASD ) or psycho-affective issues leading to selective mutism.

An audiological evaluation should also be part of the diagnostic process to ensure that the child is hearing well.

Stimulating language

Here are a few tips for parents on how to stimulate language development during the critical 0 to 5 age group. 

• Respond to your baby's babbling: When your baby starts babbling, respond as if you were having a conversation with him. This helps him understand the communication process.

• Sing songs and recite nursery rhymes: Songs and nursery rhymes are fun, and offer an opportunity to play with sounds and words. They also help strengthen memory and language comprehension.

• Read books together: Reading is one of the most effective ways of stimulating language development in young children. Choose a variety of age-appropriate books and read to them regularly. Encourage your child to ask questions about the story, make predictions and discuss the illustrations.

• Use small visual encyclopedias for children: For example, the visual encyclopedia of animals, or means of transport. The child sees the images and learns to name them. This enriches their vocabulary. 

• Guessing games: Guessing games are a great way to encourage expressive language and critical thinking in children. Try guessing objects hidden in a bag or an animal you can think of, based on descriptions.

• Role-playing: Playing role-playing games, such as pretending to store or play doctor, offers many opportunities to practice language and develop storytelling skills.

• Talk to your child a lot: Engage in simple conversations from birth. Even if your baby doesn't understand words, exposure to language is essential for his or her development. 

• Ask open-ended questions: Encourage your child to talk by asking open-ended questions that require more than a simple yes or no answer. For example, "What do you think of this?" or "How did it go?"

• Use gestures and facial expressions: Gestures and facial expressions help reinforce verbal language and can make communication more engaging for young children.

• Use nonsense: For example, recount your day by saying, "I had a great day at daycare today, playing blocks with my friends. Your children will use language to correct you, laughing: "No, you didn't! You went to work today!  

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