Parents always want the best for their children, and this desire can manifest in many different forms; providing your children the best schools, clothes, and resources. But what do you do when this desire for the “best” is out of your control.

If you’ve ever found yourself counting your child’s words, comparing their sounds to peers and friends on the playground, or scrolling google during the late hours trying to find out what constitutes “normal” in regards to your child’s speech, you’re not alone.

This article gives you a simplified look at what speech and language development typically looks like during this age range, what patterns are worth paying attention to, and what a next step actually looks like if you decide to explore further.

What Speech and Language Development Typically Looks Like at This Age

The 18-to-36-month growth period is an explosive time where your child is learning, and developing at an exponential rate. A child at 18 months and a child at 36 months are in very different places. Alongside this, all children develop differently and at different paces and that variation is part of what makes this period feel confusing for parents.

Here is a general picture of what tends to emerge during these months:

Around 15-18 months,

Most toddlers during this age range are using words more often with a vocabulary range of 8-10 words. They are typically able to echo the last word spoken by an adult, and name familiar objects upon requests.

Around 24-27 months, the vocabulary tends to grow noticeably, and most children begin combining two words together: “more milk,” “daddy go,” “big dog.” This shift from single words to word combinations is one of the more meaningful developments in early language, because it reflects not just vocabulary but the beginning of grammar and intentional communication. During this age range, the child’s vocabulary expands to around 50 words, and they are be able to follow different and new verbal directions.

By 33-36 months, most children are using three-word phrases and short sentences, and verb forms such as -ing. They are also asking and answering to who, what, and where questions. The vocabulary at this age range increases to 300 or more words, and the child is understood by unfamiliar listeners somewhere around 75% of the time.

It is worth noting that there is natural variation within typical development. Some children are quieter by temperament. Some build vocabulary slowly and then expand quickly. Bilingual children may distribute language across two systems in ways that look different from single-language peers. Variation is real – and so are delays. The goal is not to panic over every milestone, but to know what patterns are worth a closer look.

Signs That Are Worth Paying Attention To

Many developmental guidance uses words like “red flags”; this language can indicate something negative and alarming, rather than being helpful. A better frame is this: some patterns suggest a child may benefit from a professional perspective and assistance. None of the following are a diagnosis, and none of them mean something is definitively wrong. They are simply indications that an evaluation could give you useful information.

At 18 months:

• Fewer than 10 consistent words
• Not pointing to show things to others
• Not responding to their name reliably
• Not following simple one-step instructions in context

At 24 months:

• Fewer than 50 words
• Not yet combining two words together
• Vocabulary that seems to have stopped growing or regressed
• Difficult to understand even for close family members

At 36 months:

• Speech that is largely unclear to people outside the family
• Sentences that are mostly one or two words
• Difficulty following two-step instructions
• Frustration, meltdowns, or withdrawal that seems tied to not being understood

A pattern that shows up consistently not just on a tired afternoon, not just during a transition at home is generally more meaningful than an isolated moment.

Why This Window Matters

The 18-to-36-month period is not just when speech differences become visible. It is also when early professional support has the strongest impact.

The brain is developing rapidly during these years, and language learning is highly responsive to input and interaction during this time. When a toddler is struggling to communicate and that difficulty goes unaddressed, it can affect more than just speech. Frustration around communication is a common driver of behavioral challenges at this age. Social development such as learning to play with others, to take turns, to express needs is built on language. And early literacy skills, which begin emerging well before kindergarten, are closely connected to oral language development.

None of this is meant to create urgency for its own sake. It is simply worth knowing that the toddler years are not a window to wait through, instead they are a window that can be used to your child’s advantage.

How Speech Therapy Can Help Toddlers

Speech therapy for toddlers looks very different from what most adults picture when they hear the phrase. There are no worksheets, no drills, no sitting still and repeating sounds. At this age, therapy is almost entirely play-based – built around what a child is naturally interested in, what motivates them, and how they already communicate.

A speech-language pathologist working with a toddler might use books, toys, songs, and everyday routines to build vocabulary, model language, encourage word combinations, and support the back-and-forth of communication. Parents are typically involved in sessions, because one of the most effective things therapy can do at this age is give parents practical strategies to use at home throughout the day.

For toddlers with limited vocabulary, therapy often focuses on building a functional core of words first – words that help a child get what they need, express how they feel, and connect with the people around them.

What You Can Do at Home

There are everyday strategies that genuinely support language development during this age range, and they do not require special materials or a structured schedule.

Talk through what you are doing. Narrating daily routines – getting dressed, making a snack, going for a walk – exposes children to vocabulary in context, which is how language is most naturally absorbed.

Follow your child’s lead. When a toddler shows interest in something, join them there. Name it, comment on it, add a word or two. This kind of responsive interaction builds communication more effectively than drilling words.

Pause and wait. Giving a toddler a few extra seconds to respond – rather than filling the silence – creates space for them to attempt communication. That space matters.

Read together regularly. Even pointing at pictures and naming them counts. Board books with simple, repetitive language are particularly useful at this age.

Reduce background noise during interaction. It is harder to tune in and respond when competing with a television or busy environment.

These strategies support development, and they are worth using regardless of whether a child is showing signs of delay. If concerns are significant or persistent, home strategies are not a substitute for a professional evaluation – they are a complement to it.

How Little Tesla Can Help

At Little Tesla Pediatrics, our speech therapy team works with toddlers across the full range of early language development. Whether a child has a handful of words and is not yet combining them, struggles to be understood outside the home, or is showing patterns that a parent cannot quite name but keeps noticing – our evaluations are designed to give families clarity, not just a checklist. An evaluation is not a commitment, but rather an opportunity to learn more about your child.

We use play-based, family-centered approaches because that is what works at this age. Parents are part of every step, from the initial evaluation through ongoing therapy, because the most meaningful language learning happens in everyday life – not just in a therapy room.

“Have you ever considered looking into Occupational Therapy?”

The question may have caught you off guard. It may have arisen during a parent-teacher conference, or something less formal like a casual conversation as you’re picking your child up from school.

You might nod and say you’ll look into it, but you actually spend the rest of the drive home trying to figure out what Occupational Therapy actually is and what that suggestion might mean with regard to your child.

The most important thing to remember is that if your child’s teacher suggests an Occupational Therapy evaluation, this absolutely does not mean that there is anything “wrong” with your child. Teachers spend the most consecutive hours observing your child in structured, social, and task-based settings. They see how children hold a pencil, manage scissors, navigate transitions, regulate frustration, organize their belongings, participate in group activities, and handle the physical demands of a classroom day. Skills such as cutting with scissors, coloring within the lines, and tying their shoes appear rudimentary; however, if your child needs support in occupational areas such as fine motor skills, these functions can become incredibly difficult.

When a teacher suggests OT, it is typically because they have noticed a pattern over time, not just a single bad day. Teachers tend to be incredibly careful about raising concerns or suggestions for therapy with parents. When they do, it is generally because they have been observing something consistently and feel that it warrants a closer look.

That does not mean something is necessarily wrong. It means a teacher noticed something that an occupational therapist is trained to assess, and they thought you should know. However, your options to proceed are completely your choice.

A teacher suggesting OT is one of the more common ways families first hear about occupational therapy. Oftentimes, this suggestion can seem alarming, because most parents have only a vague sense of what occupational therapists actually do. Parents might begin to wonder what caused this suggestion, and these thoughts can begin to spiral into questions about their child’s developmental progress and overall health. It’s important to note that occupational therapy can have a place for all children, across the spectrum of developmental milestones.

This article is a guide to what a teacher recommendation actually means, what OT involves for children, and how to think about your next step – whatever that turns out to be.

What Teachers Typically Observe Before Suggesting OT

There is no single pattern that leads a teacher to suggest OT. The concerns can look quite different from child to child. Some of the more common observations include:

Fine motor difficulties. A child who struggles with pencil grip, handwriting, cutting with scissors, or managing buttons and zippers may be showing signs of fine motor difficulties that OT directly addresses.

Sensory responses. A child who is frequently overwhelmed by noise, touch, or movement – or conversely, who seeks out intense sensory input in ways that disrupt the classroom – may be processing sensory information differently than peers. Sensory processing is a core area of pediatric OT.

Attention and focus. A child who has significant difficulty sustaining attention on tasks, filtering out distractions, or returning to a task after an interruption may be showing signs of executive function or regulation challenges that OT supports.

Self-regulation and emotional responses. A child who struggles to manage frustration, recover from upsets, or move through transitions without significant difficulty may benefit from the regulation strategies that OT teaches.

Participation and independence. A child who struggles to manage their own belongings, follow multi-step routines, or engage independently with classroom tasks in ways that seem out of step with peers may be showing gaps in the daily living and organizational skills that OT builds.

Your child’s teacher may have mentioned one of these areas specifically, or they may have described what they observed without naming a category. Either way, what they saw maps onto something an occupational therapist is trained to look at more closely.

What Occupational Therapy Actually Is

For children, occupational therapy focuses on the skills needed to participate in everyday life – at home, at school, and in the community. An occupation, in therapy terms, is any meaningful activity: getting dressed, eating, playing, writing, managing a school day, making friends. When a child is having consistent difficulty with the skills that underpin those activities, OT looks at why and works to build those foundational skills.

Pediatric occupational therapists are trained across several areas that often overlap in a single child: fine and gross motor development, sensory processing, executive function, self-regulation, social participation, and daily living skills. This is why a teacher’s concern that sounds like a focus problem might actually involve sensory processing, and why a handwriting concern might connect to core strength or motor planning.

OT is not tutoring, and it is not behavioral therapy in the traditional sense. It is skill-building work – practical, functional, and grounded in how a child moves through their actual day.

For most children at the preschool and early school-age stage, OT sessions look like play. Activities are designed around what motivates the child, built to develop specific underlying skills in ways that feel engaging rather than clinical. Parents are typically involved throughout, because the strategies developed in sessions are most effective when they are carried into daily routines at home.

What an OT Evaluation Involves

If you decide to follow up on the teacher’s suggestion, the first step is an evaluation. This is a professional assessment – not a test your child can pass or fail – designed to give you a clear picture of how your child is functioning across the relevant skill areas.

An OT evaluation typically involves a parent interview covering your child’s developmental history, daily routines, and areas where you’re noticing difficulties at home. The occupational therapist will observe your child directly through structured activities and play-based tasks, and will use standardized assessments to compare your child’s skills against developmental expectations for their age.

Occupational therapists are trained to determine which assessments are most appropriate and effective in identifying the specific difficulties your child is facing. An occupational therapy evaluation helps us understand why your child may be struggling with everyday activities such as dressing, feeding, handwriting, cutting, sitting for learning, coordination, sensory sensitivities, or daily routines.

During the evaluation, we use standardized testing, clinical observation, sensory screening, fine motor and visual-motor testing, and reflex integration screening to establish your child’s baseline skill levels. This allows us to connect testing results to real-life difficulties – for example, poor visual-motor skills may affect handwriting, retained reflexes may affect posture and attention, sensory sensitivities may affect eating or grooming, and weak hand coordination may make buttons, zippers, or scissors difficult.

After the evaluation, we create individualized goals, provide therapy recommendations, work directly with your child, and guide you through parent training and home strategies so that progress can carry over into everyday life.

At the end of the evaluation, you will receive a clear picture of your child’s strengths, the areas where support may be helpful, and a recommendation for whether OT services are warranted – and if so, what they would focus on. You will leave with more information than you had before, regardless of the outcome.

An evaluation does not commit you to ongoing therapy. It gives you information.

Should You Follow Up?

The honest answer is that a teacher raising an OT concern is worth taking seriously – not with alarm or panic, but with genuine curiosity.

Teachers are not required to mention OT. When they do, it reflects a pattern they have observed over time and a belief that your child may genuinely benefit from the services that occupational therapy has to offer.

An evaluation is a low-pressure, one-time appointment that gives you professional information. The outcome might be a clear plan for support. It might be reassurance that your child is within the typical range. Either way, you will know more than you do now – and knowing is almost always more useful than wondering.

If you have recently heard the term ABA therapy – from your child’s pediatrician, a diagnosis report, another parent, or your own research – you have probably also discovered that it comes with a lot of opinions attached. Some families describe it as the most effective support their child has ever received. Others have concerns about older approaches. And most parents in the middle of it all are simply trying to figure out what it actually is before they decide anything.

That is exactly the right place to start.

ABA therapy is one of the most widely recommended and most frequently misunderstood therapies in pediatric care. ABA stands for Applied Behavior Analysis, and it is the “only autism intervention that is approved by insurers and Medicaid in all fifty states.” ABA first planted its roots in the early 20th century through the emergence of a newfound systematic approach to understanding human behavior known as Behaviorism. Behaviorism focuses on external stimuli, as opposed to internal mental states, as a means of determining behavior and was first introduced by American psychologist John B. Watson. Later, another American psychologist, B.F. Skinner, built on this idea of Behaviorism and introduced the theory of operant conditioning. Operant conditioning poses the idea that behaviors are influenced by the events and consequences that follow them: reinforcements increase the likelihood of a behavior, while punishments decrease the likelihood of a behavior. Applied Behavior Analysis emerged from these schools of thought surrounding the relationship between behavior, reinforcers, and punishment. It was not until the 1960s that ABA was applied to children, particularly children with autism, by Dr. Ole Ivar Lovaas. Dr. Lovaas developed many of the crucial foundational aspects of ABA still used today, including the early intervention approach, which found that children who receive intensive, individualized plans earlier in life demonstrate dramatic developmental gains.

Controversies

ABA is a discipline that has made a tremendous impact on the lives of many autistic children and adults. However, that is not to say that people do not have differing experiences and opinions.

Many autism activists criticize ABA as a form of suppression of neurodivergent children and their forms of expression. Anti-ABA advocates argue that redirecting a child away from a behavior that is not harmful, such as stimming, amounts to the erasure of self-expression and an attempt to make autistic children conform to a societal standard.

While these criticisms of ABA reflect legitimate concerns, they are tied to an era of ABA that is no longer practiced. In other words, ABA has undergone extensive development over the years, and the kind of therapy children receive today is significantly different from what was established in the 1960s.

Andjela Avram, BCBA and clinical director at Little Tesla, explains:

Clinical Perspective from Little Tesla

“This is such an important conversation, and we genuinely appreciate when families and communities push us to reflect on our practices, because that is how the field grows.

“We want to be transparent about how we approach this at Little Tesla: we do not work on reducing or eliminating stimming unless it is directly dangerous to the child or significantly interfering with their ability to learn and access their environment. Full stop.

“Stimming serves a real and valid neurological purpose. It helps children regulate their nervous system, manage sensory input, express emotion, and stay grounded. We recognize that, and we respect it. Our goal is never to make a child appear “more normal” or to strip away behaviors that are simply different from neurotypical norms.

“The criticism you are referencing reflects a very real history in ABA. Older, more punitive models of the therapy did prioritize social conformity over the child’s wellbeing, and that was harmful. We take that history seriously. Modern, ethical ABA has moved away from that approach, and practices like ours are committed to a neurodiversity-affirming model.

“What we focus on is helping children build skills that increase their independence, communication, and quality of life: goals that the child and family actually want.

“We ask: is this behavior getting in the way of something this child wants to do? Is it causing them harm? If the answer is no, it is not a target.

“The goal is never to change a child. The goal is a child who has more tools, more access, and more ability to show up in the world in a way that works for them.”

What ABA Looks Like for Children Today

So with this history in mind, what does ABA look like for children today?

One of the most common misconceptions about ABA is that it looks like a child sitting at a table for hours, repeating tasks on command. For most children receiving ABA in a contemporary pediatric clinic, that is not what it looks like at all.

For young children, sessions are typically play-based. A therapist works alongside the child using toys, games, books, and activities the child is naturally drawn to. Learning opportunities are embedded into those activities rather than presented as separate drills. If a goal is to build requesting language, the therapist creates natural moments during play where the child is motivated to communicate.

For older children, sessions may involve more structured activities alongside naturalistic approaches, particularly when working on skills that require explicit practice: social scenarios, problem-solving, or navigating specific situations that come up in school or community settings.

Sessions are typically conducted by a registered behavior technician working under the supervision of a board-certified behavior analyst, known as a BCBA. The BCBA designs the treatment plan, sets the goals, and provides ongoing oversight and adjustment based on how the child is progressing. Parents are involved throughout, because what happens between sessions, in daily life at home, is a critical part of how skills develop and generalize.

How ABA Goals Are Set

This is one of the most important things to understand about quality ABA practice: goals are not standardized. A good ABA program does not apply the same goal list to every child. It starts with a thorough assessment of the individual child, their current skills, the areas where they need support, and what matters most to their family, and builds a treatment plan from there.

Parent input is clinically essential. A BCBA needs to understand what a family’s daily life looks like, what they find most challenging, and what outcomes would make the most meaningful difference, because those things shape what gets prioritized and how success is measured.

Goals are typically reviewed and updated regularly as a child makes progress. Effective ABA is not a fixed program. It is a responsive one, adjusted based on what is working and what the child needs next.

ABA therapy is not a single thing. It is a framework with a complex history and a contemporary practice that looks genuinely different from what many parents expect when they first hear the term. Understanding what it actually involves, how goals are set, what sessions look like, who it is for, and what it is not, is the most useful thing you can do before making any decisions about whether it is right for your child.

If ABA has come up in your child’s care and you want to understand what it would actually look like for them, an evaluation is the clearest way to find out. Little Tesla’s team is here to walk you through that process and answer your questions at whatever pace feels right.