Warning Signs:
When to Refer to a Speech-Language Pathologist
Get in touch with Dr. Wankoff if you have any questions about these behaviors in your child.
Birth to 8 months of age
- Notable feeding difficulties.
- Notable medical, motor, or sensory impairments (e.g., visual and hearing).
- Little exploratory play.
- Limited range of affect display or affective engagement.
- Limited vocalizations.
8–12 months
- Little to no joint attention or gestural communication.
- Little to no affect display.
- Little or no responsivity to others.
- Rarely produces communicative acts (e.g., requests and protests).
- Babbling is restricted to not more than one consonant-vowel combination.
12–18 months
- Lack of vocal, verbal, or gestural reciprocity.
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Lack of comprehension of simple words, concepts, or one-step directions.
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Limited object search and object play and lack of demonstrating an awareness
of object function.
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Restricted range of meanings expressed (e.g., more, up, and bird) and/or
restricted range of communicative functionsexpressed (e.g., requests, comments, greetings, etc.).
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Very low frequency of communicative acts produced per minute (e.g., fewer than two per minute).
18–24 months
- Does not combine objects in play or produce symbolic play
(e.g., pretend play) schemas.
- Meager and slow growing vocabulary.
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Virtually no multiword utterances.
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Lack of reciprocal communication or “circles of communication.”
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Rarely initiates but typically imitates or echoes the language heard.
2–3 year olds
- Lack of elaborate play schemas; prefers to play alone; does not enjoy
symbolic play; and does not take pleasure in peer interactions.
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Lack of grammatical complexity (e.g., relatively few sentences with more
than one verb).
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Does not express a range of meanings (e.g., “more juice,” “no cookie,”
and “pretty baby”) or a range of pragmatic intentions (e.g., requesting objects, requesting action, protesting, and greeting).
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Rarely initiates but typically imitates or echoes the language heard.
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Is not typically producing a substantial number of contingent or topic-related utterances and at least five communicative acts per minute.
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Poor intelligibility for family members, as well as strangers.
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Persistent dysfluencies (e.g., hesitations, repetitions, prolongations,
and interjections).
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Typically noncompliant (i.e., does not follow instructions but rather
“follows their own agenda”).
3–4 year olds
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Typically not intelligible to strangers.
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Little or no conversational competence, i.e., lack of topic initiation, maintenance,
or change; little turn-taking.
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Little or no vocabulary growth.
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Minimal use of grammatical markers for tense, person, and number.
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Does not discuss non-present events; has not begun to tell narratives.
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Apparent noncompliance, inattentiveness, anxiety, or oppositionality, which can
be comorbid with language comprehension deficits.
Wankoff, Lorain, (2011) Warning Signs in the Development of Speech, Language, and Communication: When to Refer to a Speech-Language Pathologist, Journal of Child and Adolescent Psychiatric Nursing, 24, 175-184. (Available on the internet.)