Warning signs: ASSESS YOUR CHILD
Get in touch with Dr. Wankoff if this describes your child.
Birth to 8 months
- Notable feeding difficulties.
- Notable medical, motor, or sensory impairments (e.g., visual and hearing).
- Little or no exploratory play.
- Limited range of affect (emotional) display
- Limited or no engagement with others.
- Limited vocalizations or sound production.
8–12 months
- Little or no joint attention or gestural communication.
- Little or no affect (emotional)display.
- Little or no responsivity to others.
- Rarely produces communicative acts (e.g., requests and protests).
- Babbling is not more than one consonant-vowel combination.
12–18 months
- Lack of vocal, verbal, or gestural reciprocity.
- Lack of comprehension of simple words, concepts, or one-step directions.
- Limited object search and object play and lack of demonstrating an awareness of object function.
- Restricted range of meanings expressed (e.g., more, up, and bird).
- Restricted range of communicative functions expressed (e.g., requests, comments, greetings, etc.).
- 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.
- Slow growing vocabulary.
- Small vocabulary or lexicon (fewer than 50 words)
- Very few or no multiword utterances.
- Lack of reciprocal communication or “circles of communication.”
- Rarely initiates but typically imitates or echoes the language heard.
2–3 years
- Atypical play: Lack of elaborate play schemas; prefers to play alone; does not enjoy symbolic play; and does not take pleasure in peer interactions.
- Lack of grammatical complexity (e.g., few sentences with more than one verb).
- 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).
- Rarely initiates but typically imitates or echoes language heard.
- Is not typically producing a substantial number of contingent (topic-related) utterances and at least five communicative acts per minute.
- Poor intelligibility for family members, as well as strangers.
- Persistent dysfluencies (e.g., hesitations, repetitions, prolongations, and interjections).
- Typically noncompliant (i.e., does not follow instructions but rather “follows their own agenda”).
3–4 years
- Typically not intelligible to strangers.
- Little or no conversational competence: lack of topic initiation, maintenance, or change; and little turn-taking.
- Little or no vocabulary growth.
- Minimal use of grammatical markers for tense, person, and number.
- Does not discuss non-present (in time or space) events; has not begun to tell narratives.
- 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.)
