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

Last updated 2026-07-09

Why does a child have delayed speech if it's not autism?

Parents hear "speech delay" and their mind jumps to autism. That's understandable, because autism gets talked about constantly. Most children with speech delays are not autistic. The American Speech-Language-Hearing Association (ASHA) lists well over a dozen distinct conditions that can slow speech and language development, and most of them have nothing to do with social communication differences ^[1].

Speech development is more complicated than it looks. A child needs working hearing, a well-formed mouth and airway, intact motor pathways from the brain to the lips and tongue, a rich language environment, and enough processing speed to sort through all of it in real time. A problem at any single link in that chain can delay speech without touching anything else. That's why two children with nearly identical delays can have completely different causes.

If your child is a late talker, stop trying to diagnose the cause yourself and get two referrals. One to a licensed speech-language pathologist (SLP). One to an audiologist for a full hearing evaluation. Those two assessments rule the most common causes in or out far faster than any online checklist ^[1][2].

What are the most common reasons for speech delay other than autism?

Here are the main causes of speech and language delays in children who do not have autism. This list is roughly ordered by how often each one shows up in clinical practice, though population-level frequency data varies by country and study.

1. Hearing loss This is the single most important cause to rule out first, every time. Children learn to talk by listening. If a child can't hear speech clearly, they can't reliably imitate it. Hearing loss affects roughly 2 to 3 per 1,000 newborns in the U.S., according to the CDC, and many more develop it in early childhood from recurrent ear infections ^[3]. Here's the trap: a child can seem to hear fine in daily life (they respond to loud sounds, they know when a dog barks) and still have enough high-frequency hearing loss to make speech acquisition hard.

2. Childhood apraxia of speech (CAS) Apraxia is a motor planning disorder. The child's brain knows what it wants to say but struggles to send the right movement instructions to the lips, tongue, and jaw ^[4]. CAS is not muscle weakness. It's a coordination problem. Children with CAS often have inconsistent sound errors, do better on shorter words than longer ones, and may reach for a word and produce something completely different than they intended. It's relatively rare (estimates range from 1 to 2 per 1,000 children) but causes significant speech delay and needs very specific, high-frequency therapy ^[4].

3. Expressive language disorder Some children understand language fine but struggle to produce it. That's an expressive language disorder, and it can be developmental (a matter of rate, not permanent deficit) or more persistent. The AAP notes that around 15 percent of 2-year-olds are late talkers, and most of them catch up by age 3 without intervention. A meaningful subset (estimates range from about a third to half of late talkers) go on to have a diagnosable language disorder ^[2].

4. Receptive-expressive language disorder When a child has trouble both understanding language and producing it, that's a broader language disorder. These children may not follow two-step directions, may look lost when spoken to, and lag on vocabulary comprehension as well as output. This differs from autism because the social interest and connection are usually intact.

5. Developmental language disorder (DLD) DLD is the preferred term now, replacing "specific language impairment," for persistent language difficulties that can't be explained by hearing loss, low IQ, or a neurological condition. About 7 percent of children have DLD, making it one of the most common developmental conditions, yet it stays dramatically under-recognized ^[5]. Children with DLD often reach word and sentence milestones late, struggle to learn new vocabulary, and can't easily follow complex classroom instructions.

6. Oral motor differences (dysarthria) Dysarthria is muscle weakness or poor coordination in the structures used for speech: lips, tongue, palate, and jaw. Unlike apraxia, the problem here really is in the muscles. Children with cerebral palsy often have dysarthria, but it can also appear on its own or alongside other conditions. Speech tends to sound slurred, quiet, or effortful.

7. Tongue tie and other oral structural differences A tight lingual frenulum (the band under the tongue) can restrict tongue movement enough to affect certain speech sounds, particularly /r/, /l/, /s/, and /z/. The evidence on whether tongue tie alone causes speech delay is genuinely mixed, and some pediatric professionals worry about overdiagnosis ^[6]. But when there's both restricted tongue mobility and specific sound errors that match the restriction, an assessment by a speech-language pathologist who specializes in feeding and oral motor function is reasonable.

8. Prematurity Babies born before 36 weeks gestation carry a meaningfully higher risk for speech and language delays. Their brains had less time to mature, and early medical challenges (NICU stays, breathing support, feeding difficulties) can affect oral motor development. Milestone tracking for premature babies should use the child's corrected age, not their birth age, up until around age 2 ^[2].

9. Selective mutism Selective mutism is an anxiety condition in which a child who speaks normally at home becomes consistently unable to speak in certain social settings, most often school. It's not stubbornness. It's an involuntary anxiety response. Children with selective mutism don't have a primary speech or language disorder, but they often get referred to SLPs because they aren't talking at school. Treatment is behavioral and anxiety-focused, sometimes with medication support.

10. Intellectual disability Speech and language can lag as part of a broader cognitive difference. When a child's overall developmental milestones (motor, social, cognitive) are all delayed alongside speech, an evaluation for intellectual disability or global developmental delay makes sense.

11. Neurological conditions Seizure disorders (including Landau-Kleffner syndrome, a rare condition where a child loses previously acquired language), brain injuries, and certain genetic conditions can all cause speech regression or delay. Landau-Kleffner is worth knowing by name because speech regression with intact social behavior is one of its signatures, and it can go missed for a long time ^[7].

12. Bilingualism and multilingual exposure This one isn't a disorder at all. Children learning two or more languages at once may mix languages, use fewer words in each language separately, and reach some milestones a bit later than monolingual norms predict. That's a normal variation, not a delay. When a bilingual child is behind in both languages, though, that warrants evaluation just as it would for any child ^[1].

How is a speech delay different from a language delay?

People use "speech delay" and "language delay" interchangeably, but they mean different things and point to different causes.

Speech is the physical act of producing sounds. A speech delay means a child struggles to make the sounds, syllables, or words of their language clearly or on time. Causes are often mechanical or motor: hearing loss, apraxia, dysarthria, structural differences.

Language is the system of meaning. A language delay means a child is behind in understanding or using words, sentences, and grammar, even when the sounds they produce are clear. Causes are often cognitive or neurological.

A child can have one without the other. A child with a severe articulation disorder might have perfectly normal comprehension and a rich vocabulary that nobody can understand. A child with DLD might speak in clear sounds but only string together two-word phrases at age 4. Most children referred for evaluation have some degree of both, which is why a full SLP assessment covers articulation, phonology, expressive language, and receptive language as separate domains ^[1].

What speech milestones should my child have reached, and when?

Milestone ranges reflect real population variation. Hitting the later end of a range is not a problem. Consistently missing ranges is a signal worth acting on.

Source: CDC developmental milestones, updated 2022 ^[8].

The CDC updated its milestone guidelines in 2022 to make them more actionable. Under the old guidelines, "says 50 words" was listed as a 24-month milestone that 50% of children hit. The new guidelines set it as something 75% of children hit by 24 months, so more children who are behind get referred instead of reassured ^[8].

One number matters a lot here: if a child has fewer than 50 words or is not combining two words by age 24 months, the AAP recommends referral for speech-language evaluation, regardless of the suspected cause ^[2]. Don't wait to see if they catch up.

Does hearing loss cause speech delay? How would I know?

Yes, hearing loss is one of the most common and most frequently missed causes of speech delay. The hard part is that parents often don't notice it. A child can respond to their name (especially if they're lip-reading or catching vibration), laugh at the dog, and startle at slamming doors, while still having significant hearing loss in the frequencies where speech lives.

The CDC recommends that all newborns receive a hearing screen before hospital discharge, and most states now mandate it ^[3]. A passing newborn screen does not rule out hearing loss that develops later, which can come from ear infections, illness, noise exposure, or genetic causes that appear gradually.

Any child with a speech delay should have a formal audiological evaluation, meaning a test done by an audiologist, not a pediatrician using an otoscope or a basic screening. An audiologist can test both hearing sensitivity and how well the middle ear conducts sound. Recurrent ear infections (otitis media) are extremely common in toddlers and can cause temporary conductive hearing loss that genuinely slows speech acquisition during a sensitive window ^[3].

When hearing loss is confirmed, intervention moves fast: hearing aids or cochlear implants, depending on severity, combined with early speech therapy. The earlier the better. Research consistently shows that children who receive hearing amplification and language support before age 6 months have meaningfully better long-term language outcomes than those who start later ^[3].

What is childhood apraxia of speech and how is it diagnosed?

Childhood apraxia of speech is a neurological speech disorder in which a child's brain has trouble programming the movements needed for speech ^[4]. The muscles are not weak. The child knows what they want to say. The disconnect sits between the intention to speak and the coordinated movement that makes it happen.

Diagnostic signs SLPs look for include inconsistent errors (the child mispronounces the same word differently each time), more errors as words get longer or more complex, better accuracy with automatic speech ("hi", "yeah") than with intentional speech, and difficulty imitating words on request. The Diagnostic Evaluation of Articulation and Phonology (DEAP) and the Dynamic Evaluation of Motor Speech Skills (DEMSS) are among the tools SLPs use, though CAS diagnosis is fundamentally clinical judgment, not a single test ^[4].

CAS usually needs intensive, frequent therapy, often three to five times per week. Standard once-a-week therapy rarely moves the needle on apraxia. Some children also benefit from augmentative and alternative communication (AAC) while they build their speech skills, because AAC does not slow verbal speech development and gives the child a working communication system right now. You can read more about how apraxia of speech affects kids and how SLPs treat it.

If you suspect CAS, push for an SLP who lists motor speech or CAS as a specialty area. General articulation therapy approaches often aren't the right fit for apraxia.

Can bilingualism or multilingual exposure delay speech?

This is one of the most common questions in pediatric speech-language pathology, and the answer has some nuance.

Bilingualism does not cause language disorder. Decades of research find that bilingual children reach language milestones on the same schedule as monolingual children when you count words across both languages combined ^[1]. A child who says 20 words in English and 30 words in Spanish has 50 words. That's on track.

Where parents and even pediatricians go wrong is comparing a bilingual child's single-language vocabulary against a monolingual norm. A bilingual 24-month-old might say only 25 words in English, which sounds like a delay, but if they have another 30 words in Spanish, they're solidly in range.

If a bilingual child appears behind in both languages, or the total word count across all languages sits below expectations, that warrants evaluation. A bilingual child can absolutely have a real language disorder, and bilingualism is never the explanation for a significant delay. ASHA has explicit guidance that bilingualism does not cause language disorders and that children should be assessed in all their languages, more than English ^[1].

Parents are sometimes told to "just speak one language at home" to help a late-talking bilingual child. Current evidence does not support that advice, and it can do real harm by cutting the child off from a language their family speaks. Most SLPs today would push back on that recommendation.

How does prematurity affect speech and language development?

Preterm birth, defined as birth before 37 weeks gestation, is one of the stronger risk factors for speech and language delay. The risk climbs with degree of prematurity: babies born extremely preterm (before 28 weeks) have substantially higher rates of delay than those born at 34 to 36 weeks.

Several mechanisms are at work. The brain keeps developing rapidly through the third trimester, so early delivery interrupts that. NICU experiences including intubation and oral suctioning can create oral aversion. And medical complications common in preterm babies (brain bleeds, respiratory distress, feeding difficulties) can have downstream effects on development.

The clinical rule that matters: milestone tracking for preterm babies should use corrected age (age from the due date, not from birth) until about 24 months ^[2]. A baby born 2 months early who is using 10 words at 14 months (chronological) is developmentally 12 months old. That's on track. But if the same child is still using only 10 words at 24 months chronological (22 months corrected), take it seriously.

Many NICU follow-up programs include speech-language screening at set intervals specifically because of this risk. If your preterm child graduated from a NICU follow-up program, ask whether speech-language evaluation was part of it.

When should I be worried? Red flags that need evaluation now

Not every late word is a red flag. Some children talk late and catch up entirely on their own. But certain patterns warrant evaluation right away, without a wait-and-see approach.

Seek evaluation immediately if your child:

• Has lost words or skills they previously had, at any age. Regression is a red flag regardless of cause and needs prompt assessment.
• Has no babbling by 12 months.
• Has no words at all by 16 months.
• Has no two-word phrases by 24 months.
• Does not respond consistently to their name.
• Has not passed a newborn hearing screen or has had recurrent ear infections.

The AAP's current guidance is explicit that clinicians should not routinely advise parents to take a wait-and-see approach with speech delays ^[2]. If your pediatrician says "let's check back in 6 months," it is completely appropriate to ask for a referral to a speech-language pathologist now. You can also self-refer to an SLP without a physician referral in most states, and you can request a free evaluation through your state's Early Intervention program if your child is under age 3 ^[9].

Early intervention matters because the brain is most plastic in the first three years of life. That's not a scare tactic. It's consistent with what the research on language acquisition shows about sensitive periods for language learning. Starting even a few months sooner can make a real difference in outcomes ^[9].

What will a speech-language pathologist actually do for a child with speech delay?

An SLP's first job is to figure out which kind of delay your child has. That means a standardized assessment covering receptive language (what the child understands), expressive language (what they say), articulation (how clearly they say it), phonology (how they organize speech sounds), and sometimes fluency and voice. The SLP also watches how your child communicates: eye contact, gesture use, turn-taking in conversation, and how they handle frustration when they can't get a thought out.

From that assessment, the SLP writes a profile. Not a diagnosis, because SLPs are not physicians, but a functional description of what the child can do, what they can't, and what the likely path forward looks like. That profile drives the therapy approach.

Therapy for a child with apraxia looks completely different from therapy for a child with a pure expressive language delay, which looks different again from therapy for a child who is behind mainly because of hearing loss. A good SLP is not running the same program for every late talker. If the intervention feels generic, ask specifically what approach they're using and why.

Frequency matters. For mild delays, once-weekly sessions plus parent coaching at home are often enough. For CAS or significant language disorder, two to four sessions per week is more typical ^[4]. Parent involvement between sessions, practicing specific targets, is probably the highest-leverage thing a family can do to speed progress.

You can learn more about what to expect by reading about speech therapy and speech therapists generally, or about early intervention programs specifically for children under 3.

What at-home strategies actually help a late talker?

There's real evidence behind some of these. Others get recommended constantly but rest on weaker data. I'll be honest about which is which.

Self-talk and parallel talk. Narrate what you're doing ("I'm washing the dishes, it's warm and soapy") and what your child is doing ("You're stacking the blocks"). This floods the environment with language tied to real experience. The approach is well-supported in the SLP literature as a way to raise the quality of language input ^[1].

Following the child's lead. Comment on what your child is interested in instead of directing them to do or say things. If your child is obsessed with trucks, talk about trucks. Interest-driven attention is the state in which children learn language fastest.

Fewer questions, more comments. Parents of late talkers often overcompensate with questions ("What's that? What color is it? What do you want?"). Questions put a child on the spot and often produce silence or frustration. Comments ("Oh, a red ball!") model language without demanding it.

Reading aloud, every day. Shared book reading is one of the most consistently supported activities for language development. Let the child engage with the pictures however they want. You don't have to read every word. Pointing at pictures and naming them counts.

Cutting screen time. The AAP recommends no screen time for children under 18 months (except video chatting) and limited, co-viewed screen time for children 18 to 24 months ^[2]. Background TV in particular seems to cut parent-child verbal interaction significantly. This isn't about screens being inherently harmful. It's about opportunity cost.

For some families, especially those already stretched for time and access, a tool like Little Words can help structure everyday language interactions between therapy sessions, with guided activities based on where a child actually is in their development.

What probably doesn't help. Baby sign language gets recommended a lot and is generally harmless, but the evidence that it speeds verbal speech for neurotypical children is mixed. Waiting silently for the child to speak is sometimes pitched as a pressure technique. It can work in context, but it can also ramp up frustration. Flashcard drills are generally not how young children learn language.

Does speech delay resolve on its own, or does it need treatment?

This is the genuinely hard question, and the honest answer is: it depends on the cause and the severity, and nobody has a reliable crystal ball.

About 70 to 80 percent of children who are late talkers at age 2 (late talkers without other concerns, sometimes called "late bloomers") do catch up to age-level language by age 5 without intervention ^[10]. That sounds reassuring. The catch is we can't reliably predict at age 2 which children will catch up and which won't. The 20 to 30 percent who don't catch up are at real risk for reading difficulties, social challenges, and academic struggles later.

For causes like CAS, DLD, hearing loss, and dysarthria, spontaneous full resolution without intervention is unlikely. These children need treatment.

The practical upshot: an early evaluation costs little and the potential upside is high. Even if a child would have caught up anyway, early SLP involvement and parent coaching can speed that process. And if the child has a condition that needs treatment, catching it at 18 months instead of 3 years makes a real difference in how far behind they fall academically and socially before they get help ^[9].

The research on developmental language disorder, cited by RADLD (a DLD advocacy organization drawing on Bishop et al., 2017), states that DLD affects approximately 7.58% of children, making it "more common than autism, ADHD, and dyslexia individually," yet it receives a fraction of the research funding and public awareness ^[5]. That awareness gap is part of why so many children with DLD go unidentified for years.

How does a doctor figure out why a child has a speech delay?

The diagnostic workup for speech delay usually pulls in several professionals, more than one.

Your pediatrician is the first stop, but their job is mainly to order the right referrals and rule out medical causes, not to diagnose the specific type of delay. A pediatrician should routinely screen developmental milestones at every well-child visit using a standardized tool, refer to audiology for a hearing evaluation, and refer to a speech-language pathologist for a full assessment ^[2].

An audiologist tests pure-tone hearing, speech recognition, and tympanometry (middle ear function). This can be done reliably even in very young children using behavioral audiometry techniques.

An SLP runs the language and communication assessment described in the section above.

Depending on what turns up, other specialists might come in. A developmental pediatrician or child neurologist can evaluate for neurological causes, global developmental delay, or intellectual disability. A geneticist can assess for chromosomal or genetic syndromes that include speech delay. A craniofacial specialist might assess structural differences in the mouth or airway.

For children under age 3, the IDEA (Individuals with Disabilities Education Act) requires states to provide free early intervention evaluations and services ^[9]. You do not need a physician's referral to request this evaluation. You contact your state's Early Intervention program directly, and the evaluation must be completed within 45 days. If your child qualifies, services are provided in the natural environment (usually your home) at no cost or reduced cost based on family income.

For children 3 and older, the school district becomes the responsible entity for evaluation and services under IDEA Part B. The process is similar: you request an evaluation in writing, the district has timelines to complete it, and if the child qualifies, they receive an Individualized Education Program (IEP) ^[9].

Frequently asked questions

Can a child have a speech delay and not be autistic?

Yes, absolutely. Autism is one of many possible reasons for delayed speech, but most children with speech delays do not have autism. Hearing loss, childhood apraxia of speech, developmental language disorder, prematurity, and tongue tie are among the many non-autism causes. A speech-language pathologist and audiologist can help identify the actual reason for any individual child's delay.

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

There isn't one single most common cause, but hearing loss is consistently cited as the most important to rule out first, because it's common, often missed, and highly treatable. Developmental language disorder affects roughly 7 percent of children, making it one of the most prevalent causes overall. In clinical practice, many late talkers fall into a "late bloomer" category with no identified single cause.

Can ear infections cause speech delay?

Yes. Recurrent ear infections (otitis media) can cause temporary conductive hearing loss, and if this happens repeatedly during the 0 to 3 year window when the brain is rapidly building language maps, it can slow speech and language acquisition. The effect is usually temporary once infections resolve, but children who have had frequent ear infections warrant monitoring and sometimes a formal speech evaluation.

Does tongue tie cause speech delay?

The evidence is mixed and the topic is genuinely contested among professionals. A tight lingual frenulum can restrict tongue tip movement and may contribute to errors on specific sounds like /r/, /l/, /s/, and /z/. But tongue tie alone rarely explains significant global speech delay. Assessment by an SLP who specializes in oral motor function is the right first step before any surgical intervention is considered.

Can a child be bilingual and have a speech delay?

Yes, bilingual children can have real speech or language disorders, and bilingualism is never the explanation for a significant delay. Bilingual children should be assessed in both their languages combined. A child on track in one language but behind in both is a candidate for evaluation. Parents should not be advised to drop a home language to help a late-talking bilingual child; current evidence does not support that approach.

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

Speech delay means difficulty producing the sounds, syllables, or words clearly (the physical act of talking). Language delay means difficulty understanding or using words, grammar, and meaning, even if the sounds produced are clear. A child can have one without the other, or both together. They often point to different underlying causes and need different treatment approaches.

At what age should I worry about a speech delay?

The AAP recommends evaluation rather than wait-and-see if a child has no words by 16 months, no two-word phrases by 24 months, or has lost any previously acquired words at any age. Under age 3, you can request a free evaluation through your state's Early Intervention program without a doctor's referral. Sooner is better; don't wait until school age.

Is speech delay in boys more common than in girls?

Boys are diagnosed with speech and language delays more often than girls, with some estimates suggesting boys are 2 to 3 times more likely to be referred for speech evaluation. It's not entirely clear how much of this reflects a real biological difference versus different thresholds for referral. Regardless of sex, the same milestones apply and the same evaluation process fits if milestones are missed.

Can anxiety cause a child not to talk?

Yes. Selective mutism is an anxiety disorder in which a child who speaks normally at home is consistently unable to speak in specific social situations, most often school. It is not the same as a speech or language disorder, though children with selective mutism are often referred to SLPs. Treatment focuses on reducing anxiety, usually through cognitive-behavioral approaches, with the SLP often collaborating with a mental health provider.

Does watching too much TV cause speech delay?

There's no strong evidence that screen exposure directly causes speech delay in neurotypical children, but heavy screen time cuts the back-and-forth verbal interaction a child gets, and that interaction is what drives language learning. The AAP recommends no screens under 18 months and limited co-viewed content for children 18 to 24 months, mainly because of opportunity cost to language-rich interaction, not direct harm from the screens themselves.

What is developmental language disorder (DLD)?

DLD is a persistent difficulty with language that isn't explained by hearing loss, low IQ, or another identified condition. It affects roughly 7 percent of children and is one of the most common developmental conditions, yet it's frequently unrecognized. Children with DLD often struggle with vocabulary, grammar, following instructions, and later with reading. Early identification and speech-language therapy improve long-term outcomes.

How do I get a free speech evaluation for my child?

In the U.S., children under age 3 are entitled to a free developmental evaluation through their state's Early Intervention program under the federal IDEA law. You can request this directly without a doctor's referral by contacting your state's program. For children 3 and older, contact your local school district. Private evaluations are also available through hospitals, university clinics, and private SLP practices.

Can genetic conditions cause speech delay without autism?

Yes. Many genetic conditions are associated with speech and language delay independent of autism. Down syndrome, fragile X syndrome, velocardiofacial syndrome (22q11.2 deletion), and others commonly include speech delay as part of their profile. If a child has dysmorphic features, a family history of a known genetic condition, or global developmental delay, a genetics referral alongside speech evaluation makes sense.

What is Landau-Kleffner syndrome?

Landau-Kleffner syndrome is a rare neurological condition in which a child who was developing typically loses previously acquired language skills, usually between ages 3 and 7, due to abnormal electrical activity in the brain's language areas. Social connection and interest typically remain intact, which sets it apart from autism. It requires neurological evaluation including an EEG, more than speech assessment. It is one reason any language regression warrants prompt medical evaluation.

Sources

1. ASHA: American Speech-Language-Hearing Association, Language in Brief: ASHA lists multiple distinct causes of speech and language delay and guidance on bilingualism assessment; bilingualism does not cause language disorders
2. American Academy of Pediatrics, Identifying Infants and Young Children with Developmental Disorders in the Medical Home (AAP policy): AAP recommends referral for speech-language evaluation if a child has fewer than 50 words or is not combining two words by age 24 months; advises against routine wait-and-see; corrected age guidance for preterm infants
3. CDC, Hearing Loss in Children: Data and Statistics: Hearing loss affects approximately 2 to 3 per 1,000 newborns in the U.S.; early amplification before 6 months associated with better language outcomes
4. ASHA, Childhood Apraxia of Speech practice portal: CAS is a neurological motor planning disorder; prevalence estimated at 1 to 2 per 1,000 children; requires intensive high-frequency therapy; inconsistent errors are a hallmark
5. Bishop DVM et al., Phase 2 of CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development, PLOS ONE, 2017: Developmental language disorder affects approximately 7 to 7.58 percent of children; consensus on DLD terminology and prevalence
6. ASHA, Ankyloglossia and Oral Ties practice portal: Evidence on tongue tie and speech is mixed; SLP assessment recommended before surgical intervention
7. National Institute of Neurological Disorders and Stroke, Landau-Kleffner Syndrome: Landau-Kleffner syndrome causes acquired aphasia in children via abnormal brain electrical activity; language regression with intact social behavior; requires EEG evaluation
8. CDC, Learn the Signs: Act Early, Developmental Milestones (2022 update): CDC updated developmental milestone guidelines in 2022 to set 75th-percentile thresholds for earlier identification; specific speech and language milestones by age
9. U.S. Department of Education, IDEA Individuals with Disabilities Education Act, Early Intervention (Part C): IDEA mandates free early intervention evaluations for children under 3; evaluation must be completed within 45 days of referral; services provided in natural environment
10. ASHA, Late Language Emergence practice portal: Approximately 70 to 80 percent of late talkers at age 2 catch up by age 5; 20 to 30 percent go on to have persistent language disorder; late talker definition and evidence
11. ASHA, Bilingual Service Delivery practice portal: Bilingual children should be assessed in all their languages; bilingualism does not cause language disorders; total vocabulary across languages should meet milestone norms