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.
- 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
- 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
- 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...
Possible hearing 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
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