Red flags in speech development: when to worry

Stephanie Marz from Bend Speech Express shares an important article with the True North Readers.

by Robin Hansen

Urban legend claims speech delay is not serious. The legend also says,"boys talk later" and "most all" kids will "catch up" naturally. The fact is MOST kids don't just catch up naturally. Never let these urban legends stop you from seeking help. What if you allowed denial to keep your child from the gift of early intervention? What is it turned out to be nothing? What is the worst that can happen? You have a child that speaks well and you can stop speech therapy! There is no loser in seeking help early. Denial, and delay can lead to a tremendous amount of personal guilt as windows of opportunity may never be regained.


Many people still believe children who are speech delayed because of poor parenting skills. This is not the case, unless the parents has been very negligent or abusive. Thanks to the latest research as demonstrated in the documentary, , MRI's now show that at 6 months, they can predict which babies will have speech issues. If your baby shows any delays, do not hesitate to contact your pediatrician. Ask your pediatrician for a referral to a speech and language therapist or a developmental pediatrician for an evaluation as soon as possible. If you child is under age 3, you can call your local regional center for a free appointment to have them evaluate your baby. Regional centers will evaluate and offer intervention services at no cost. If your child is age 3 or over, call your local school district to ask for an evaluation. If the school district finds your pre-schooler eligible, they will offer speech therapy and possibly other services, if needed.

Keep in mind that the wait time for evaluations and eligibility process can take 2-4 months. A "wait and see" approach can waste valuableintervention time. The criteria for eligibility for children age 3 and up, may be far more stringent because they are covered by a different set of state standards than the 0-3 group does. One year of speech therapy at age 2 can negate the need for years of speech therapy at a later age.

If your child does have a speech delay, keep in mind that there is a very high possibility your child may be diagnosed with a learning/attention or reading disability later on. At age 5 or 6, ask the local school district for an educational evaluation to measure phonemic awareness, auditory and perceptual skills plus processing disorders. If there is an inability to acquire oral language naturally, it follows that aquiring written language acquisition will be difficult too.

Newborn to 3 months:

• Startles to loud sounds

• Quiets or smiles when spoken to

• Seems to recognize your voice

• Increases or decreases sucking behavior in response to sound

• Makes pleasure sounds (cooing)

• Cries differently for different needs

• Smiles when he sees you

Red flags: No sounds (cooing)/quiet baby; doesn’t react to you 4 to 6 months

4 to 6 months

• Moves eyes in direction of sound

• Responds to changes in your voice • Notices toys that make sounds

• Pays attention to music

• Babbling sounds (more speech-like); many different sounds including "p, b, m"

• Vocalizes excitement and displeasure

• Makes gurgling sounds when left alone and when playing with

Red flags: Quiet baby—no sounds; no eye contact with you; no attention to voice or music

7 months to 12 months

• Enjoys games and peek-a-boo

• Turns and looks in direction of sounds

• Listens when spoken to

• Recognizes words for common items like "cup", "shoe", "juice"

• Begins to respond to requests ("Come here," "Want more?") • Babbling has both long and short groups of sounds such as "tata upup bibibi"

• Uses speech or non-crying sounds to get and keep attention

• Imitates different speech sounds

• Has 1 or 2 words (bye bye, dada, mama) although they may not be clear

• Uses communicative gestures such as pointing and pulling

Red flags: Quiet baby—few vocalizations; no sound play or babbling, pointing or gesturing by 12 months; only vowels in vocalizations; does not respond to voice or sounds.

12 months to 15 months

• Maintains attention to pictures

• Understands simple directions especially with vocal or physical cues

• Uses one or more words with meaning

Red flags: No communicative gestures such as pointing or pulling; vocalizations with only vowels; no imitative skills; no response to parent’s vocalizations; no response to name.

15 months to 18 months

• Says more words each month; vocabulary of 5-20 words

• Vocabulary composed mainly of nouns

• Much jargon-like speech

•Able to follow simple commands without cues ("Get your bear.")

Red flags: No single words by 16 months; no imitative skills; limited consonants in speech; no response to directions with cues.

18-21 months

• Points to a few body parts when named

• Follows simple commands and understands simple questions ("Roll the ball," "Where’s your shoe?")

• Listens to simple stories, songs, and rhymes

• Points to pictures in a book when named

• Uses many different consonant sounds at beginning of words

• Expressive vocabulary of 25-50 words

Red flags: Limited variety of consonants; vowel distortions; few words, limited imitative skills.

21 months to 24 months

• Uses some 1-2 word questions ("What’s that?" "Daddy?" "Bye bye?")

• Puts 2 words together ("more cookie", "no juice", "Mommy book")

• Language explosion around 18-24 months; vocabulary of 150-300 words by 24 months

Red flags: Limited spoken vocabulary; limited variety of consonants; distortions of vowels or sounds; little response to name, directions, questions.

24 months to 36 months

• Understands differences in meanings of words (in/out, go/stop, up/down)

• Follows two requests ("Get the book and put it on the table")

• Has a word for almost everything

• Uses 2-3 words to talk about and ask for things

• Speech is understood by familiar listeners most of the time

• Often asks for or directs attention to objects by naming them

Red flags: No language explosion by 30 months; unintelligible speech; small vocabulary; no simple 2-word combinations by 27 months.

36 months

• Hears you when you call from another room

• Answers simple "who?," "what?," "where?," "why?" questions

• Talks about activities at school or friend’s home

• People outside family usually understand child’s speech

• Uses a lot of sentences that have 4 or more words

Red flags: Unintelligible speech; limited vocabulary; short utterances (only 1-2 words); limited consonants; little response to questions or directions.

Review of Red Flags for Developing Speech and Language:

• Little sound play or babbling as infant

• No babbling, pointing, or gesturing by 12 months

• No single words by 16 months

• No spontaneous 2 word phrases by 27 months

• Missed "language explosion" by 30 months

• Any regression in speech, language, or social skills at any age

• No eye contact or response to sounds

• No response to name by 15 months

• No response to directions or questions by 24 months

• Limited number of consonant sounds or vowel distortions by 24 months; low intelligibility for toddler (24-36 months)

• Poor verbal imitation skills by 12 months

• Small vocabulary for age; not much variety

Risk Factors:

• Family history of speech and language disorder

• Medical history of chronic otitis media with effusion

• Motor disorders/muscle weakness

• Limited or poor parental interactions

For more info: http://www.childrensmemorial.org/documents/SpeechLangDevellMilest.pdf



How Does Your Child Hear and Talk? American Speech-Language-Hearing Association, http://www.asha.org/ .

Agin, Marilyn C, M.D., " The Late Talker-When Silence Isn’t Golden", November 1, 2004, http://www.contemporypediatrics.com/ .

Language Development in Children, http://www.childdevelopmentinstitute.org/ .

Resources: Beyond Baby Talk, by Apel and Masterson, 2001.