Common Speech and Language Challenges in Children Under 6

Helping your young child find their voice is one of the most rewarding parts of parenting. Sometimes, children need extra support to develop clear, confident communication. Here are five relatively common speech and language difficulties affecting children under six, how they typically present, and how speech therapy can help.

1. Speech Sound Disorders (Articulation & Phonological Disorders)

• What it means: Some children have difficulty producing certain sounds (articulation errors) or may simplify words using predictable patterns called phonological processes. For example: “ca” for “cat” or “tun” for “sun”.

• How it presents: Speech may be hard to understand, with consistent errors or sound patterns that are not age-appropriate.

• Typical age: Some sound patterns are normal in toddlers but should fade by specific ages (e.g., “wabbit” for “rabbit” is typical at 3 but not at 6).

• Therapy approach: Play-based sessions where the speech-language therapist (SLT) models correct sounds, uses listening games to improve sound discrimination, and gradually builds accurate production in words and sentences.

2. Childhood Apraxia of Speech (CAS)

• What it means: CAS is a motor speech sound disorder where the brain struggles to plan and coordinate the movements needed for speech, even though the muscles are not weak.

• How it presents: Inconsistent errors, difficulty moving smoothly from one sound to another, unusual rhythm or stress in words, and sometimes delayed first word acquisition.

• Typical age: Often noticed between ages 2- 4, when speech progress is slow and unclear despite good comprehension.

• Therapy approach: Frequent, short sessions (30 minutes twice a week) focusing on repeated practice of targeted words and phrases (core vocabulary), using visual, tactile, and auditory cues. Therapy is highly individualised and intensive.

3. Developmental Language Disorder (DLD)

• What it means: A more long-term difficulty with understanding or using language, not linked to hearing loss or another medical cause.

• How it presents: Limited vocabulary, short sentences, difficulty following instructions, trouble retelling stories, or grammatical errors beyond the expected age.

• Typical age: Often identified between ages 4- 6, though early signs can appear in toddlerhood.

• Therapy approach: Builds vocabulary, grammar, and sentence structure through interactive activities, storytelling, and games. Parents are given strategies to use at home to strengthen everyday communication.

4. Stuttering (Fluency Disorder / Disfluency)

• What it means: Stuttering involves disruptions in the flow of speech, such as repeating sounds or words (“b-b-ball”), stretching sounds (“ssssun”), or blocking (pausing with no sound).

• How it presents: May start suddenly or gradually between ages 2- 5. Many children go through short periods of mild "normal" disfluency, but persistent or severe stuttering benefits from early intervention.

• Therapy approach: Focuses on fluency strategies, slowing speech rate, and building the child’s confidence. Parents learn how to respond in supportive ways to encourage smooth speech without pressure.

5. Voice Disorders

• What it means: Less common than speech and language delays and does not include transient voice changes due to common illness. Presents as persistent changes in voice quality, pitch, or loudness that make the voice sound different from other children’s voices. Common causes in young children include vocal nodules (small growths from voice overuse), chronic shouting, or frequent throat clearing.

• How it presents: A consistently hoarse, breathy, or strained voice; a pitch that is unusually high or low for age; or voice loss that doesn’t improve after a few days.

• Typical age: Can occur at any age but is often seen from preschool years onward, especially in children who use their voices loudly or frequently.

• Therapy approach: Voice therapy focuses on healthy voice habits (hydration, avoiding vocal misuse), gentle vocal exercises, and sometimes working with parents and teachers to create a voice-friendly environment.

Why Early Intervention Matters

A 2018 study focusing on preschool-aged children in South Africa reported that approximately 9% of children had speech difficulties. Of these, 75% were determined to have a speech delay rather than a disorder. 

Early speech therapy, combined with parent involvement, can make a significant difference in long-term outcomes. Addressing difficulties early helps children enter school with the best possible foundation for learning and social interaction.

In summary:

• Speech Sound Disorders are common and treatable with focused practice.

• CAS requires structured, high-frequency therapy.

• DLD impacts language comprehension and/or expression but improves with targeted intervention.

• Stuttering benefits from early, family-supported strategies.

• Voice Disorders often improve with therapy and changes to voice use habits.

If you notice signs of these challenges, seek an assessment from a registered speech-language therapist. Early support can help your child communicate clearly and confidently.

We often use play-based therapy

References

Breet, A., Krüger, E., & Hugo, R. (2016). Speech-language therapy in South Africa: A survey of patient profiles and service delivery models in the public health sector. South African Journal of Communication Disorders, 63(1), a132. https://doi.org/10.4102/sajcd.v63i1.132

Geyer, S. M., et al. (2018). Prevalence of speech delay in a group of South African preschool children. South African Journal of Child Health, 12(3), 116–120. https://doi.org/10.7196/SAJCH.2018.v12i3.1483

Meyer, M., & Naudé, E. (2015). Prevalence and nature of communication disorders in a rural district in South Africa. International Journal of Humanities and Social Science, 5(5), 145–153.

Yairi, E., & Ambrose, N. G. (2013). Epidemiology of stuttering: 21st century advances. Journal of Fluency Disorders, 38(2), 66–87. https://doi.org/10.1016/j.jfludis.2012.11.002

American Speech-Language-Hearing Association. (n.d.-c). Spoken language disorders. Retrieved August 11, 2025, from https://www.asha.org/practice-portal/clinical-topics/spoken-language-disorders/