Lorain Wankoff, Ph.D.

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

  1. Notable feeding difficulties.
  2. Notable medical, motor, or sensory impairments (e.g., visual and hearing).
  3. Little exploratory play.
  4. Limited range of affect display or affective engagement.
  5. Limited vocalizations.

8–12 months
  1. Little to no joint attention or gestural communication.
  2. Little to no affect display.
  3. Little or no responsivity to others.
  4. Rarely produces communicative acts (e.g., requests and protests).
  5. Babbling is restricted to not more than one consonant-vowel combination.

12–18 months
  1. Lack of vocal, verbal, or gestural reciprocity.
  2. Lack of comprehension of simple words, concepts, or one-step directions.
  3. Limited object search and object play and lack of demonstrating an awareness
    of object function.
  4. Restricted range of meanings expressed (e.g., more, up, and bird) and/or
    restricted range of communicative functionsexpressed (e.g., requests, comments, greetings, etc.).
  5. Very low frequency of communicative acts produced per minute (e.g., fewer than two per minute).

18–24 months
  1. Does not combine objects in play or produce symbolic play
    (e.g., pretend play) schemas.
  2. Meager and slow growing vocabulary.
  3. Virtually no multiword utterances.
  4. Lack of reciprocal communication or “circles of communication.”
  5. Rarely initiates but typically imitates or echoes the language heard.

2–3 year olds
  1. Lack of elaborate play schemas; prefers to play alone; does not enjoy
    symbolic play; and does not take pleasure in peer interactions.
  2. Lack of grammatical complexity (e.g., relatively few sentences with more
    than one verb).
  3. 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).
  4. Rarely initiates but typically imitates or echoes the language heard.
  5. Is not typically producing a substantial number of contingent or topic-related utterances and at least five communicative acts per minute.
  6. Poor intelligibility for family members, as well as strangers.
  7. Persistent dysfluencies (e.g., hesitations, repetitions, prolongations,
    and interjections).
  8. Typically noncompliant (i.e., does not follow instructions but rather
    “follows their own agenda”).

3–4 year olds
  1. Typically not intelligible to strangers.
  2. Little or no conversational competence, i.e., lack of topic initiation, maintenance,
    or change; little turn-taking.
  3. Little or no vocabulary growth.
  4. Minimal use of grammatical markers for tense, person, and number.
  5. Does not discuss non-present events; has not begun to tell narratives.
  6. 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.)

Get in touch:

(917) 686-8472
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