Receptive Language Red Flags

• No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months
• No consistent response to their own name by 12 months​
• Unable to follow simple and familiar directions by 18 months​​

Expressive Language Red Flags

• No back-and-forth sharing of sounds, smiles, or other facial expressions by 9 months
• No babbling by 12 months
• No words by 16 months
• Preference of gestures over vocalizations to communicate by 18 months
• Trouble imitating sounds​ by 18 months
• Unable to make two-word meaningful phrases without imitating or repeating by 24 months
• Can only imitate speech or actions and doesn't produce words or phrases spontaneously​ by 2 years
• Only says some sounds or words repeatedly and can't use oral language to communicate more than their immediate needs by 2 years old
• Has an unusual tone of voice (such as raspy or nasal sounding) by 2 years
• Parents and familiar caregivers should understand 50% of a child's speech by 2 years and 75% by 3 years.
• A child should be mostly understood, even by people who don't know the child by 4 years old.
• Any loss of speech or babbling or social skills (like eye contact) at any age

Pragmatic/Social Language Red Flags

​

• Not smiling by 4 months
• Difficulty making and maintaining eye contact with an adult by 6 months
• No big smiles or other warm, joyful expressions during interaction with another person by 6 months​
• Isn't using gestures, such as pointing or waving bye-bye​ by 12 months
• Not imitating actions and movements by the age of 24 months​
• No back-and-forth conversational turn-taking by 2.5 Years​​
• Getting overly upset with change or transitions from activity to activity
• Unaware of changes in his/her environment and routine
• ​Showing poor or no eye contact

Play Skills Red Flags

• Not imitating body actions on a doll by 15 months of age (kiss the baby, feed the baby)
• Frequently jumping and/or purposely falling to the floor/crashing into things​
• Afraid of/aversive to/avoids being messy, or touching different textures such as grass, sand, carpet, paint, playdoh, etc.​
• Not engaging in pretend play by the age of 24 months
• Not demonstrating appropriate play with an object (i.e. instead of trying to put objects into a container, the child leaves the objects in the container and keeps flicking them with his fingers, lining up toys, spinning wheels excessively)
• Fixating on objects that spin or turn (i.e. See 'n Say, toy cars, etc.)
• Trying to spin things that are not normally spun just to watch them spin

Oral Motor Red Flags

• Difficulty biting or chewing food during mealtime
• Prolonged period of time to chew and/or swallow
• Coughing/choking during or after eating on a regular basis
• Demonstrating a change in vocal quality during/after eating (i.e. they sound gurgled or hoarse when speaking/making sounds)
• Significant difficulty transitioning between different food stages
• Not feeding him/herself finger foods by 14 months of age
• Not attempting to use a spoon by 15 months of age
• Not picking up and drinking from a regular open cup by 15 months of age

Literacy Red Flags

Pre-K

• Cannot pronounce words that rhyme
• Cannot verbally divide words into syllables and sentences into words
• Cannot auditorily discriminate rhyming words
• Does not recognize phonemes within words.

Kindergarten

• Cannot write words or sentences 
• Cannot blend sounds together
• Cannot decode nonsense words
• Cannot divide words into syllables,
• Cannot identify sounds and letters.
• Not able to identify sight words common to their environment 
• Only able to sound out the first letter or syllable and makes up different endings 

Early Elementary 

• Can sound out words but not comprehend the meaning of a sentence 
• Inattention during reading
• Reads out loud laboriously, with lots of guessing and word substitution 
• Poor spelling
• Poor recall of words
• Poor comprehension of reading material
• Not interested and resists reading​

Middle School

• Cannot decode new words quickly
• Reads very slowly
• Sound out all words phonetically
• Cannot recognize words with non-phonetic spellings.

Cognitive Red Flags

• Showing difficulty learning new activities
• ​Having a hard time calming themselves down appropriately​
• Having significant difficulty attending to tasks
• Having a difficult time with transitions between activity or location
• Overly upset with change in routine

Other Considerations...

Possible visual problems may exist if...

• Limited eye contact with others or holds objects closer than 3-4 inches from one or both eyes
• Does not reach for an object that is nearby

Ask your physician for a vision assessment with a pediatric ophthalmologist

Possible hearing problems may exist if...

• There is no or infrequent response to sounds or to the voices of familiar people
• Limited attention to bells or other sound-producing objects
• Does not respond appropriately to loud sounds
• No babbling

Have the child evaluated by an audiologist for a hearing assessment immediately. Language delays are inevitable in children who with unidentified hearing loss.

---

What Causes Speech & Language Delays?