10-Minute Speech Practice That Doesn't Require Sitting Still

Last updated 2026-07-09

What counts as delayed speech in toddlers?

Speech delay means a child's spoken language is developing more slowly than the typical range for their age. Not slower in some minor, barely-noticeable way, but measurably behind the milestones that speech-language pathologists and pediatricians use as reference points.

Two terms get mixed up constantly, even by providers, so separate them now. Speech is the physical act of producing sounds and words. Language is the broader system of understanding and expressing meaning, including words, sentences, gestures, and comprehension. A child can have a speech delay (unclear articulation, limited words), a language delay (poor understanding, trouble forming sentences), or both at once. The treatment path differs depending on which is involved.

The American Speech-Language-Hearing Association (ASHA) describes a language delay as occurring when a child's language skills are below those of other children the same age ^[1]. That definition sounds circular, but the practical version is straightforward: there are published milestone ranges, and a child who consistently falls below the lower end of those ranges has a delay worth evaluating.

About 15 to 20 percent of 2-year-olds show some form of speech or language delay, making it one of the most common developmental concerns parents bring to pediatric appointments ^[2]. Most of those children are not autistic. Some are late bloomers who catch up on their own. Others need targeted therapy. A smaller number have an underlying condition that the delay is pointing toward. The point of early evaluation is to figure out which category your child is in before the window for easy intervention starts to close.

What are the typical speech milestones by age?

Milestones are ranges, not deadlines. A child who says her first word at 13 months is not behind. But knowing the ranges gives you a concrete baseline to compare against, and that matters because pediatric well-child visits are short and easy to leave feeling reassured when you shouldn't be.

The CDC and AAP both publish milestone checklists, and in 2022 the AAP updated its developmental surveillance guidelines to recommend using the CDC's updated milestone checklist as a standard tool at every well-child visit ^[3].

The 24-month mark gets the most clinical attention. A child who isn't combining two words by 24 months should be evaluated, full stop. Research from the National Institute on Deafness and Other Communication Disorders (NIDCD) puts the typical first-word window at 11 to 14 months ^[4]. If a child has no words at 16 months or loses words they previously had at any age, those are red flags that warrant immediate evaluation, not a wait-and-see approach.

Word loss matters most. Regression, where a child who was saying words stops using them, is one of the clinical red flags specifically associated with autism spectrum disorder, and it shows up in roughly 20 to 30 percent of autistic children ^[5].

What are the signs of delayed speech in toddlers?

Parents usually notice something is off before a professional names it. Trust that instinct. The signs of delayed speech cluster into a few categories.

By 12 months, pay attention if your child isn't babbling with consonant sounds (ba, da, ga), isn't pointing or waving, and doesn't respond to their own name consistently. Not responding to their name is particularly significant and worth flagging immediately.

Between 12 and 18 months, watch for fewer than 5 meaningful words, no attempts to imitate words or sounds you model, limited eye contact during communication, and no functional pointing (pointing to ask for something or show you something interesting). A child who doesn't point to share interest with you by 14 months is showing a sign that warrants discussion with a pediatrician.

From 18 to 24 months, the red flags include: fewer than 50 words total, not putting two words together, and being much harder to understand than other kids the same age. Strangers should understand about half of what a 2-year-old says.

At any age, any loss of previously acquired speech or social skills is a red flag. If your child said "bye-bye" and "ball" and then stopped using those words, don't wait for the next scheduled visit.

ASHA lists specific warning signs that should prompt referral: no babbling by 12 months, no gesturing by 12 months, no single words by 16 months, no two-word spontaneous phrases by 24 months, or any loss of language or social skills at any age ^[1].

One thing parents sometimes miss is comprehension. A child who seems to understand everything but doesn't talk much is in a different situation than a child who doesn't seem to follow directions or understand what's said to them. Both can be delays, but the latter often signals a more significant language issue.

Is delayed speech a sign of autism?

This is the question parents are usually actually asking when they search for information about speech delays. The honest answer is: sometimes, but often not.

Delayed speech is one of the most common early signs of autism spectrum disorder, but most children with a speech delay are not autistic. The Centers for Disease Control and Prevention estimates autism affects about 1 in 36 children in the United States as of their 2023 surveillance report ^[6]. Speech delay affects roughly 1 in 5 toddlers. Those numbers don't overlap neatly.

What tends to separate autism-related communication differences from other speech delays is the presence of social communication differences alongside the language issues. Autistic children often show delays or differences in joint attention (looking at you to share interest in something), pointing, imitation, social smile, responding to their name, and making eye contact in a back-and-forth social way. A child who has a speech delay but makes strong eye contact, points frequently, and pulls your hand to show you things is showing a different profile than a child whose delay comes with limited social engagement.

That said, autism exists on a wide spectrum and not every autistic child presents the same way. Some autistic children are socially engaged but have significant speech delays. Some have strong vocabularies but struggle with the pragmatic (social) use of language. Diagnosis requires a full evaluation by a qualified team, not a checklist.

The AAP recommends universal autism screening at the 18-month and 24-month well-child visits using a validated screening tool, most commonly the M-CHAT-R/F ^[3]. A positive screen doesn't mean a child is autistic. It means further evaluation is warranted. If your child's pediatrician isn't doing this screening, ask for it explicitly.

If you're trying to sort through the overlap between delayed speech and autism, our piece on autism spectrum speech therapy goes into more depth on what communication looks like across the spectrum and what therapy approaches have the strongest evidence.

Delayed speech vs autism: what are the key differences?

Parents want a clean line between "this is just a speech delay" and "this is autism." The honest truth is that no symptom checklist can draw that line for your specific child. But clinicians use patterns to tell a speech delay without autism apart from autism-related communication differences.

The biggest differentiator is social communication. Children with a speech delay but without autism typically:

• Make consistent eye contact and use it to communicate
• Point to share interest (more than to get things)
• Imitate actions and sounds readily
• Show interest in other children and in playing with adults
• Have comprehension that's roughly in line with, or better than, their expressive speech
• Use compensatory gestures and facial expressions heavily when words fail

Autistic children may do some of these things, especially those who are more verbal or who've had early intervention. But the cluster of social communication differences tends to persist and looks qualitatively different from a child who simply hasn't caught up on words yet.

Another distinguishing feature is the pattern of what's delayed. In a straightforward speech delay, you typically see a child who understands more than they can say. In autism, you may see delays in both expression and comprehension, or unusual patterns like strong memorized phrases (echolalia) without flexible language use.

Echolalia, repeating words or phrases heard from others, is very common in autistic children and much less common in children with speech delays from other causes. Some echolalia is a normal developmental phase for all children around 18 to 24 months. When it persists as the primary mode of communication past 3 years, or when it's delayed rather than immediate, it's a more meaningful signal.

Repetitive behaviors, restricted interests, sensory sensitivities, and insistence on sameness are also part of the autism picture and aren't present in speech delay from other causes. A speech-language pathologist who specializes in autism can often spot these patterns during an evaluation, which is why early referral matters.

For a deeper look at how evaluation and therapy differ, see our article on speech delay.

What causes delayed speech in toddlers?

No single cause accounts for most speech delays. Clinicians typically look at several categories.

Hearing loss is the first thing to rule out, and it's often overlooked. A child who can't hear clearly can't learn to produce sounds they've never heard accurately. Even mild or intermittent hearing loss from repeated ear infections can slow language development. Every child being evaluated for a speech delay should have a formal hearing test (audiological evaluation), more than a pass/fail hearing screen.

Oral motor differences, where the muscles involved in speech don't coordinate well, can produce delays. Childhood apraxia of speech (CAS) is a specific motor speech disorder where the child knows what they want to say but has difficulty getting their mouth to produce the sounds reliably. CAS is distinct from a general speech delay and requires specialized therapy.

Developmental language disorder (formerly called specific language impairment) is a condition where language development is slow without an identifiable cause like hearing loss or autism. It's more common than most people realize, affecting an estimated 7 to 8 percent of kindergartners ^[7].

Bilingual or multilingual exposure does not cause speech delays. This is a persistent myth that causes real harm when it leads families to drop a home language. Bilingual children may have words distributed across two languages (so counting only English words misses half their vocabulary), but their total vocabulary is on par with monolingual peers. If a bilingual child has a genuine delay, they'll show it in both languages.

Prematurity, genetic conditions, neurological differences, and family history all factor in. Children born prematurely often have speech evaluated against their corrected age rather than their birth age. Autism spectrum disorder, Down syndrome, intellectual disability, and other neurodevelopmental conditions commonly include speech and language delays as part of their profile.

And sometimes there's no clear cause. A child is just developing language more slowly than peers, will catch up with or without intervention, and afterward no single factor explains it. That's genuinely common.

Should I wait and see or get my child evaluated now?

The "late bloomer" framing is the enemy of early intervention. Yes, some children who seem behind at 18 months catch up by 36 months without any therapy. The research does support that some late talkers resolve without formal intervention. But there's no reliable way to predict in advance which child will catch up and which won't, and the cost of waiting is real.

Early intervention services for children under 3 are federally mandated in the United States under Part C of the Individuals with Disabilities Education Act (IDEA) ^[8]. These services are available at no cost to families (in most states), delivered in the home or community, and don't require a formal diagnosis to access. A parent can self-refer. The process starts with a free evaluation, and the child doesn't need a diagnosis to qualify for services, just a demonstrated delay.

The research on early intervention is consistent: children who receive speech therapy earlier show better outcomes than those who start later. The brain's plasticity is highest in the first three years of life. Waiting until age 3 or 4 to see if a child "grows out of it" means waiting until the easiest window for language learning has partially closed.

If your child misses any of the red flags listed above, here's what I'd actually do: call your pediatrician the same week, not at the next scheduled visit. Ask for two things at once, a referral to a speech-language pathologist and a referral for an audiology evaluation. Then, regardless of what your pediatrician says, contact your local early intervention program directly. You can self-refer and that process runs in parallel with any medical referrals.

To find your state's early intervention program, the CDC maintains a state-by-state resource directory ^[9].

For more on getting therapy started, early intervention speech and language therapy walks through how Part C works in practice.

How is a speech delay diagnosed?

Diagnosis is a two-part process: developmental surveillance (ongoing observation by your pediatrician) and a formal evaluation by a speech-language pathologist.

At well-child visits, pediatricians use developmental screening tools to flag children who may need further evaluation. The ASQ (Ages and Stages Questionnaire) and the CSBS (Communication and Symbolic Behavior Scales) are commonly used. A positive screen means the child needs a full evaluation, not that they have a diagnosis.

A full speech and language evaluation is done by a licensed speech-language pathologist (SLP). It typically includes standardized tests of expressive and receptive language, an assessment of speech sound production, an oral mechanism exam, a hearing screen (or a note that a formal audiological evaluation is pending), and a parent interview about developmental history and current communication at home.

The SLP will compare the child's performance to age-based norms and produce a written report. If the child scores below age-level expectations (typically 1.5 to 2 standard deviations below the mean on standardized tests), they qualify for therapy services through the school system, early intervention, or a private provider depending on their age.

For children under 3, evaluation and services come through your state's early intervention system under IDEA Part C. For children 3 and older, services shift to the school district under Part B of IDEA ^[8]. Private SLP services are also available and often have shorter wait times, though insurance coverage varies.

If autism is suspected, a separate diagnostic evaluation is typically recommended. That evaluation is done by a psychologist, developmental pediatrician, or a multidisciplinary team and is distinct from the speech evaluation. The two evaluations can happen at the same time.

For a detailed breakdown of what a speech evaluation involves and what to expect from working with an SLP, see speech therapy speech therapist.

What does speech therapy for delayed speech look like?

Speech therapy for toddlers looks a lot like play. That's not a soft way of saying it's informal. It's the accurate description of how evidence-based early language intervention works.

For late talkers and children with mild to moderate speech delays, therapists typically use naturalistic developmental behavioral interventions (NDBIs), which embed language targets into play-based interactions. The therapist follows the child's lead, creates communication opportunities, and models language at or just above the child's current level. Parents are usually in the room and often become the primary implementers of strategies at home, which is where most learning actually happens.

For children with autism, approaches like EIBI (Early Intensive Behavioral Intervention) and JASPER (Joint Attention, Symbolic Play, Engagement, and Regulation) have strong evidence bases. JASPER specifically targets the joint attention and play skills that support language development ^[10].

For children with motor speech disorders like apraxia, the approach is different and much more drill-based. Dynamic Temporal and Tactile Cueing (DTTC) is one of the best-supported treatments for childhood apraxia of speech.

Frequency varies. Early intervention services under Part C are often provided 1 to 2 times per week. Private therapy ranges from once a week to daily depending on severity and family access. But the research is clear that what parents do between sessions matters as much as the sessions themselves. Therapists who give you no home program or practice activities are shortchanging your child.

This is where a tool like Little Words fits in practically. Between therapy sessions, consistent daily language exposure and naturalistic communication practice are what move the needle. The app gives parents a structured way to do that practice at home, guided by the kinds of evidence-based strategies SLPs actually use.

For a broader overview of what speech therapy involves across different ages and presentations, speech therapy for kids is a good starting point.

Can parents help a child with a speech delay at home?

Yes, and this is probably the highest-leverage thing in this article. Parent-implemented strategies have strong research support. A 2018 Cochrane review found that parent-mediated interventions for young autistic children significantly improved child language and communication outcomes ^[11]. The same principle applies to non-autistic children with speech delays.

The best-supported strategies are simple.

Follow the child's lead. Talk about whatever your child is looking at or reaching for, not whatever you want them to focus on. When they reach for a cup, say "cup" or "you want the cup." This is called parallel talk and it ties language to the child's current attention.

Expand and extend. When your child says one word, respond with two. They say "dog," you say "big dog" or "dog running." This keeps language just slightly ahead of where they are, which is the sweet spot for learning.

Reduce questions, increase comments. Parents instinctively ask "what's that?" over and over. Questions put children on the spot. Comments ("oh, a truck!") create a lower-pressure invitation to communicate.

Pause and wait. After a comment or model, pause for 5 to 10 seconds. Many children need more processing time than adults give them. Fill that silence and you cut off the response before it can form.

Read together, and make it interactive. Point to pictures, name them, wait for your child to respond. Don't just read the text. For late talkers, interactive shared book reading consistently outperforms passive reading in language studies.

These strategies don't replace professional evaluation and therapy. But they're not nothing, and they're available today, in every interaction.

When does a speech delay become a bigger concern?

Some delays resolve. Others point to something that needs more support.

A speech delay becomes a more significant concern when it persists past 3 years without meaningful progress, when there's regression (skills going backward), when comprehension is also delayed, when the delay is accompanied by social communication differences, or when the child doesn't respond to early intervention.

Hearing loss that goes undetected and untreated has long-term impacts on language, literacy, and academic performance. If hearing hasn't been formally tested by an audiologist, that should happen before anything else.

If a child is making progress in therapy but slowly, that's usually okay. Language development isn't linear and therapy takes time. If a child is in therapy for 6 months with no meaningful change, the evaluation should be revisited. Either the diagnosis is incomplete, the therapy approach isn't the right fit, or the intensity needs to increase.

Literacy is downstream of language. Children with persistent language delays are at significantly higher risk for reading difficulties. The National Institute on Deafness and Other Communication Disorders notes that speech and language delays in young children are among the most common risk factors for reading problems later on ^[4]. That's not meant to scare anyone. It means early intervention for a speech delay is also early intervention for reading.

If a child is diagnosed with or suspected to have autism and the communication challenges are significant, augmentative and alternative communication (AAC) tools may be recommended. AAC covers everything from picture boards to high-tech speech-generating devices. Using AAC does not prevent speech from developing. Research consistently shows it supports, not replaces, natural speech development. Our article on alternative augmentative communication devices for autism covers this in detail.

For families managing a specific diagnosis code for insurance or school purposes, speech delay icd 10 explains how the diagnostic coding system works.

How much does speech therapy for delayed speech cost?

Cost is a real barrier for a lot of families and it's worth addressing directly.

For children under 3, early intervention services under Part C of IDEA are provided at no cost to families in most states ^[8]. Some states charge a small sliding-scale fee, but the federal law requires that cost not be a barrier to access. This is underused. Many families don't know they can self-refer without a physician's order.

For children 3 and older, school-based speech therapy under IDEA Part B is also free if the child qualifies through their school district's evaluation process. This is available to all eligible children, whether they attend public school or not.

Private speech therapy, when families pursue it for shorter wait times or more intensive services, typically runs $100 to $350 per session depending on location and the therapist's credentials. Frequency varies from once a week to multiple times per week. Annual out-of-pocket costs for private therapy can reach $5,000 to $15,000 or more without insurance coverage.

Health insurance coverage for speech therapy varies significantly by plan and state. Many states require insurance plans to cover speech therapy for developmental conditions, but the specifics depend on the diagnosis code, the plan type, and state mandate laws. Medicaid typically covers speech therapy for children who qualify, with limits that vary by state.

Online speech therapy has expanded access and reduced costs in recent years. Telehealth sessions typically run $50 to $150 per session and are increasingly covered by insurance. They're not the right fit for every child (very young toddlers especially), but for school-age children and some preschoolers, the evidence for teletherapy outcomes is solid. See online speech therapy for more detail on that option.

For a broader cost breakdown and what to look for in a provider, pediatric speech therapy covers those questions.

Frequently asked questions

What is the most common cause of speech delay in toddlers?

Hearing loss is the first cause clinicians rule out because it's both common and directly treatable. Beyond that, the most frequent causes are developmental language disorder (a condition with no single identifiable cause), autism spectrum disorder, oral motor differences, and prematurity. In many cases, no single cause is found. An audiological evaluation and a full speech-language evaluation together give you the most useful picture.

At what age should a child see a speech therapist for delayed speech?

There is no minimum age. If you have concerns at 9 months, you can ask for an evaluation. Formally, the ASHA guidelines flag any child who isn't babbling by 12 months, doesn't have words by 16 months, or isn't combining words by 24 months. For children under 3, your state's early intervention program provides free evaluations. Don't wait until age 3 to start the process.

Can a child have a speech delay without autism?

Yes, and this is the most common scenario. Roughly 15 to 20 percent of toddlers show some speech or language delay, while autism affects about 1 in 36 children. Most children with speech delays are not autistic. Common non-autism causes include hearing loss, developmental language disorder, childhood apraxia of speech, and prematurity. A proper evaluation by a speech-language pathologist can help clarify what's driving the delay.

What are early signs of autism in a child who also has delayed speech?

The most telling signs that a speech delay may be autism-related include: not responding to their name by 12 months, not pointing to share interest by 14 months, limited or atypical eye contact, little imitation of actions or sounds, loss of words or social skills previously gained, repetitive movements or behaviors, and strong attachment to specific routines. Any one sign isn't definitive. The cluster matters, and a formal evaluation is the only way to know.

Does being bilingual cause speech delay?

No. Bilingualism does not cause speech delays. Bilingual children develop language on the same overall timeline as monolingual children. They may appear to have fewer words in one language, but when vocabulary across both languages is counted together, their total is comparable to peers. If a bilingual child has a genuine delay, it shows up in both languages. Never advise a family to drop a home language to help speech development.

What is the difference between a speech delay and a language delay?

Speech delay refers specifically to difficulty producing speech sounds, words, or phrases, basically the mechanics of talking. Language delay is broader and covers problems understanding language (receptive language) and/or expressing thoughts and ideas in words (expressive language). A child can have one without the other, though they often co-occur. Treatment approaches differ, which is why a thorough evaluation by an SLP that assesses both is important.

Will my toddler's speech delay go away on its own?

Some late talkers, particularly those who are progressing in social communication and comprehension, do catch up without formal intervention by age 3. Research puts this at roughly 50 to 80 percent of late talkers identified at 24 months, though estimates vary by study. The problem is there's no reliable way in advance to predict which child will catch up. Given that early intervention is low-risk and high-benefit, most clinicians recommend not waiting.

How do I self-refer my child to early intervention for a speech delay?

In the United States, any parent can request a free evaluation from their state's early intervention program without a physician referral. Call your pediatrician to ask for the contact information, or search online for "[your state] early intervention program." The evaluation is free, services under Part C of IDEA are provided at no cost in most states, and the process typically takes 30 to 45 days from initial request to evaluation completion.

What should I do if my child's pediatrician says to wait and see?

Ask specifically which milestone concerns them most and what would change the recommendation. Then self-refer to your state's early intervention program directly. You don't need a physician's referral. An evaluation is free and carries no downside risk. If your child doesn't qualify, you've lost nothing. If they do qualify and you waited six months for a recheck, you've lost time during a window that matters.

Does screen time cause speech delays?

The evidence here is observational and complicated. The AAP recommends avoiding screen-based media other than video chat for children under 18 to 24 months, in part because passive screen time displaces face-to-face interaction, which is what actually builds language. No study has shown that screen time directly causes a speech delay. But heavy passive screen use correlates with reduced language input and interaction, which are the actual drivers of early language development.

Can a child with a speech delay catch up completely?

Many do, especially when the delay is identified early and therapy starts promptly. Children with mild to moderate delays who receive appropriate early intervention often reach age-level expectations by kindergarten. Children with more significant delays, underlying conditions like autism or childhood apraxia of speech, or delays identified later tend to need longer-term support. Full catch-up is possible for many children, though outcomes vary based on severity, cause, and age at intervention.

What's the difference between autism speech delay and other speech delays in how therapy works?

Therapy for autism-related communication differences typically emphasizes social communication skills like joint attention, imitation, and turn-taking alongside language targets. Approaches like JASPER and EIBI have the strongest evidence for autistic children. For speech delays without autism, naturalistic developmental approaches and parent coaching are most common. Childhood apraxia of speech, which can occur with or without autism, requires motor-focused practice quite different from standard language therapy.

Sources

1. American Speech-Language-Hearing Association (ASHA), Late Language Emergence Practice Portal: ASHA defines a language delay as occurring when a child's language skills are below those of other children the same age, and lists specific red flags including no words by 16 months and no two-word phrases by 24 months.
2. American Academy of Pediatrics (AAP), Developmental Surveillance and Screening: Approximately 15 to 20 percent of children show some form of speech or language delay, making it among the most common developmental concerns.
3. Centers for Disease Control and Prevention (CDC), Developmental Milestones: The CDC publishes updated developmental milestone checklists adopted by the AAP in 2022 for use at every well-child visit, including milestones for speech and language by age.
4. National Institute on Deafness and Other Communication Disorders (NIDCD), Speech and Language: NIDCD states the typical first-word window is 11 to 14 months and notes that speech and language delays are among the most common risk factors for later reading difficulties.
5. Journal of Child Psychology and Psychiatry, developmental regression in autism (PMC): Regression, including loss of previously acquired words, appears in approximately 20 to 30 percent of autistic children and is a recognized early clinical red flag.
6. Centers for Disease Control and Prevention (CDC), Autism Data and Statistics: The CDC's 2023 ADDM surveillance report estimates autism affects approximately 1 in 36 children in the United States.
7. NIDCD, Developmental Language Disorder: Developmental language disorder affects an estimated 7 to 8 percent of kindergartners, making it one of the most common childhood developmental conditions.
8. U.S. Department of Education, Individuals with Disabilities Education Act (IDEA): Part C of IDEA mandates free early intervention services for children under 3 with developmental delays; Part B covers eligible children ages 3 and older through the school system.
9. Centers for Disease Control and Prevention (CDC), Act Early state early intervention contacts: The CDC maintains a state-by-state directory of early intervention programs that families can contact to self-refer for free developmental evaluations.
10. Journal of the American Academy of Child and Adolescent Psychiatry, JASPER trial (PMC): JASPER (Joint Attention, Symbolic Play, Engagement, and Regulation) has demonstrated significant improvements in joint attention and language outcomes for young autistic children in randomized controlled trials.
11. Cochrane Database of Systematic Reviews, parent-mediated interventions for autism (2018): A 2018 Cochrane review found that parent-mediated interventions for young autistic children significantly improved child language and communication outcomes compared to control conditions.