“Red Flags” That Warrant a Referral for Early Intervention or Preschool Therapy Services

I get so many questions from parents who want to know if their child should be evaluated by a speech-language pathologist or other professional. On my October 23 show “Teach Me To Talk with Laura and Kate” we discussed “red flags” that we note in toddlers and preschoolers that warrant a referral to an early intervention program (if your child is not yet 3) or therapy services through your local school system (if your child has turned 3 but is not yet in kindergarten).

If you want to hear the complete discussion, please listen to the show #13 by clicking the blogtalkradio link from this page or the home page.

For those of you who would like to review the entire list we found at  www.sensory-processing-disorders.com here goes:

Gross Motor

If a child is…

  • Not rolling by 7 months of age
  • Not pushing up on straight arms, lifting his head and shoulders, by 8 months of age
  • Not sitting independently by 10 months of age
  • Not crawling (“commando” crawling–moving across the floor on his belly) by 10 months of age
  • Not creeping (on all fours, what is typically called “crawling”) by 12 months of age
  • Not sitting upright in a child-sized chair by 12 months of age
  • Not pulling to stand by 12 months of age
  • Not standing alone by 14 months of age
  • Not walking by 18 months of age
  • Not jumping by 30 months of age
  • Not independent on stairs (up and down) by 30 months of age…an early intervention/developmental therapy referral may be appropriate.Here are some other gross motor “red flags”:
  • “walking” their hands up their bodies to achieve a standing position
  • only walking on their toes, not the soles of their feet
  • frequently falling/tripping, for no apparent reason
  • still “toeing in” at two years of age
  • unusual creeping patterns
  • any known medical diagnosis can be considered a “red flag”: Down’s syndrome, cerebral palsy, congenital heart condition etc.

    Fine Motor

    If a child is…

  • Frequently in a fisted position with both hands after 6 months of age
  • Not bringing both hands to midline (center of body) by 10 months of age
  • Not banging objects together by 10 months of age
  • Not clapping their hands by 12 months of age
  • Not deliberately and immediately releasing objects by 12 months of age
  • Not able to tip and hold their bottle by themselves and keep it up, without lying down, by 12 months of age
  • Still using a fisted grasp to hold a crayon at 18 months of age
  • Not using a mature pincer grasp (thumb and index finger, pad to pad) by 18 months of age
  • Not imitating a drawing of a vertical line by 24 months of age
  • Not able to snip with scissors by 30 months…an early childhood intervention/development therapy referral may be appropriateHere are some other fine motor “red flags”:
  • Using only one hand to complete tasks
  • Not being able to move/open one hand/arm
  • Drooling during small tasks that require intense concentration
  • Displaying uncoordinated or jerky movements when doing activities
  • Crayon strokes are either too heavy or too light to see
  • Any know medical diagnosis can be considered a “red flag”: Down’s Syndrome, cerebral palsy etc.

    Cognition/Problem Solving

    If a child is…

  • Not imitating body action on a doll by 15 months of age (ie, kiss the baby, feed the baby)
  • Not able to match two sets of objects by item by 27 months of age (ie, blocks in one container and people in another)
  • Not able to imitate a model from memory by 27 months (ie, show me how you brush your teeth)
  • Not able to match two sets of objects by color by 31 months of age
  • Having difficulty problem solving during activities in comparison to his/her peers
  • Unaware of changes in his/her environment and routine…an early intervention/developmental therapy referral may be appropriate

    Sensory

    If a child is…

  • Very busy, always on the go, and has a very short attention to task
  • Often lethargic or low arousal (appears to be tired/slow to respond, all the time, even after a nap)
  • A picky eater
  • Not aware of when they get hurt (no crying, startle, or reaction to injury)
  • Afraid of swinging/movement activities; does not like to be picked up or be upside down
  • Showing difficulty learning new activities (motor planning)
  • Having a hard time calming themselves down appropriately
  • Appearing to be constantly moving around, even while sitting
  • Showing poor or no eye contact
  • Frequently jumping and/or purposely falling to the floor/crashing into things
  • Seeking opportunities to fall without regard to his/her safety or that of others
  • Constantly touching everything they see, including other children
  • Hypotonic (floppy body, like a wet noodle)
  • Having a difficult time with transitions between activity or location
  • Overly upset with change in routine
  • Hates bath time or grooming activities such as; tooth brushing, hair brushing, hair cuts, having nails cut, etc.
  • Afraid of/aversive to/avoids being messy, or touching different textures such as grass, sand, carpet, paint, playdoh, etc.…an early childhood intervention/developmental therapy referral may be appropriate.NOTE: sensory integration/sensory processing issues should only be diagnosed by a qualified professional (primarily, occupational therapists and physical therapists). Some behaviors that appear to be related to sensory issues are actually behavioral issues independent of sensory needs.

Possible visual problems may exist if the child…

Does not make eye contact with others or holds objects closer than 3-4 inches from one or both eyes

  • Does not reach for an object close by Possible hearing problems may exist if the child…
  • Does not respond to sounds or to the voices of familiar people
  • Does not attend to bells or other sound-producing objects
  • Does not respond appropriately to different levels of sound
  • Does not babble

    Self-Care

    If a child is…

  • Having difficulty biting or chewing food during mealtime
  • Needing a 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)
  • Having 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
  • Not able to pull off hat, socks or mittens on request by 15 months of age
  • Not attempting to wash own hands or face by 19 months
  • Not assisting with dressing tasks (excluding clothes fasteners) by 22 months
  • Not able to deliberately undo large buttons, snaps and shoelaces by 34 months…an early intervention/developmental therapy and referral may be appropriate.?

    Social/Emotional/Play Skills

    If a child is…

  • Not smiling by 4 months
  • Not making eye contact during activities and interacting with peers and/or adults
  • Not performing for social attention by 12 months
  • Not imitating actions and movements by the age of 24 months
  • 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)
  • Fixating on objects that spin or turn (i.e. See ‘n Say, toy cars, etc.); also children who are trying to spin things that are not normally spun
  • Having significant difficulty attending to tasks
  • Getting overly upset with change or transitions from activity to activity…an early intervention program referral may be appropriate

THESE ARE THE FOLLOWING LANGUAGE MILESTONES THAT A CHILD SHOULD HAVE MASTERED BY THESE AGES FROM THE ARTICLE ON THIS SITE TITLED “WHEN TO WORRY”

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
No back-and-forth sharing of sounds, smiles, or other facial expressions by 9 months
No babbling by 12 months
No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months
No consistent responding to their names by 12 month
No words by 16 months
No following simple and familiar directions by 18 months
No two-word meaningful phrases without imitating or repeating?& says at least?50 words by 24 month
No back-and-forth conversational turn-taking by 30 months
Any loss of speech or babbling or social skills (like eye contact) at any age
The presence of any of these concerns warrants an immediate discussion with your pediatrician and insistence for a referral to an early intervention program and/or speech-language pathologist for a complete evaluation of your child?s communication skills.
Let me also add that babies who are doing well with development exceed these milestones by leaps and bounds.These are very, very low thresholds for all the skills listed.If your child is not meeting these basic guidelines, please don’t dismiss your feelings.There is in all likelihood a true developmental delay or disorder present.Seek professional help from your pediatrician, your local school system, an early intervention agency, a children’s clinic, a university evaluation team, or a therapist in private practice.
If you are not sure how to do this, e-mail me at laura@teachmetotalk.com, and I will help you!

 

Comments

  1. Tara Ling says

    I have a 4 years old daughter who doesnot talk like the other 4 years old do. i have braught her for speech pathologist evaluation and they diagnosed her with language disorder. but during the evalutaion i discovered that i didnot teach her about this or about that the questions which the pathologist were asking her.she is very good in learning, if i tell her anything once she won’t forget it and also she started writing down her Alphabets all by herself.i also want to mention that she stayed home for 4 years.and we donot have any family around,i myself didnot make any friends so that i can spend more time with her whenever i had off from work but my problem was i was so quiet which now gives me a guilt that probably due to which she cannot speak like she should be.now all the time i am trying to get different ideas so that i can help her. she just started going to daycare. she is doing well over there but still not talking due to kids not being friendly with her probably due to that language barrier which hurts me a lot. i want to help but donot want anybody to misjudge her because she doesnot have any development issues its only the speech part.please help me with the advice

  2. Laura says

    Tara – This website is full of ways you can help your daughter with expressive language. Click the category “expressive language” and read the articles, beginning with ones from last January, and then read forward to the more recent ones. Expressive language issues can be overcome with speech therapy and lots of hard work on your part at home. Read – read – read! Then play- play – play. Ask your SLP for specific ideas to work on at home. Let me know if you have any other questions! Laura

  3. Karen says

    Hi, can you further explain what is unusual “creeping” patterns and walking their hands up to their body to achieve a standing position? Also, my son tends to cruise along the furniture on his tip toes, but I also find him standing flat on his feet too. How do I stop him from standing on his toes when cruising? Thanks.

  4. Laura says

    Karen – Unusual creeping(traditionally referred to as crawling) patterns would mean anything other than a baby using his hands and knees to crawl. Commando crawling, or pulling your body with your arms while your tummy and legs stay flat on the floor, is common, but not necessarily typical. Other unusual patterns could be a child sitting on his bottom and propelling himself with his legs and feet, using both hands but with one knee down on the floor and the other foot on the floor, etc… This could indicate coordination problems.

    Walking hands up to the body to achieve standing means a kid who gets up by placing his hands flat on the floor way in front of him who then “walks” his hands on the floor back toward his body to push himself up from the floor.

    My PT friends tell me that kids are less likely to walk on their toes when they are wearing shoes.

    Hope this answered your questions! Laura

  5. Rebekah says

    Hi Laura. I conratulate you on your site. It is fantastic. I have a question. I am a native English speaker and my husband is a native Spanish speaker. Caroline is 30 months and has a very limited vocabulary. She uses about 30 words spontaneously, however none are more than 2 syllables. However, when she hears me speak English (not that frequently) she is quick to repeat 2 and 3 words together. She is receiving speech therapy in Spanish 3 times a week since the last week of December and I have seen moderate improvement but not not like I would have hoped. She sings 3 different songs rather effortlessly in English. Is it possible that she has a tendency toward English and we are stunting her ability to speak buy insisting she learn Spanish first? Should we switch gears? If so, then after she masters English, when do we begin teaching her Spanish?

  6. Laura says

    Rebekah – This is an interesting question. I’d recommend that you stick to Spanish if that’s the predominant language she’ll need for school and to interact with the little friends she’ll make. I don’t think she’s “hard-wired” for one language over another, or that English is any easier to learn than Spanish. You didn’t mention how she’s understanding Spanish. I’m also curious to know what her SLP thinks the issue/s is/are. Studies tell us that children who are raised in bilingual homes do speak a little later than children learning just one language. Since she’s exhibiting delays, and especially if there are delays in comprehension too, I’d stick to one predominant language for the time being, and it sounds like you’re already doing this.

    Glad you’re liking the site! Hope you pick up some new ideas! I love hearing from readers around the world!!!! Laura

  7. Elena says

    Hi Laura –
    We have a 33 month old daughter. Our native language is Russian, but she has been in an English-speaking day care/preschool full-time since she was 26 month old. We have followed “one place – one language” model, so we only speak Russian to her at home, and only English is spoken at the preschool. The school has, however, some French, Spanish and Portugese speaking kids.
    Her teachers report that they “are working on communication” with her. Basically, after almost a year there, she is still not understanding or speaking English well enough. At home we have problems communicating with her as well. We would like of course to help her overcome any language/communication issues before they might turn into learning disabilities. However, we feel that our situation (because of the bilingual environment) is somewhat different from other similar cases, and have a hard time finding resources that we can use to make any progress. Can you recommend what might be helpful here?
    I apologize for such a long post, was only trying to describe the situation.

  8. Laura says

    Elena – I’d go ahead and try to find a pediatric SLP who can evaluate her and help you know whether she’s learning language later since she’s being raised in a bilingual environment, or whether it’s a more serious language delay or disorder. Since you’re having problems at home too, I’d think it’s likely the latter.

    When I assess children who are having great difficulty with more than one language, I always recommmend that parents pick one primary language and use this one until she’s “caught up” and understanding and using at least one language at an age-appropriate level. Are you planning on doing an English school forever? Do most of her friends speak English? If that’s the case, I’d stick to English. If not, then you should decide which language is going to be her primary language for her education and predominantly use this one of her, even at home. I hope that you can find a good SLP to help you sort all of this out and give you a better idea for recommendations that will be helpful to you! Thanks for your question! Laura

  9. Marsha says

    I have a 28 month old son who is only using vowel sounds, occansionly he will use a consonant. Only for such words as bubba, papa, dada, mama, wolf wolf. He uses the words ool, for cool or full. At for cat, hat. Ahh, and Eee, are commonly used for his “language”. He is trying to tell us stories, but gets frustrated with us, because we lack understanding on what he is trying to tell us. I have him in Speech Therapy once a week, but I would love some tips on how to move him forward. Thank you

  10. Laura says

    Marsha – Read ideas in the apraxia section since it will give you strategies for targeting new language while working on more specific speech development (new consonants). I also have a DVD that targets this difficulty called Teach Me To Talk with Apraxia and Phonological Disorders. It includes very basic language techniques as well as more specific recommendations for working on speech sounds. Laura

  11. Anne says

    Hi Laura,

    My 11 month old son is not babbling, he is very social (lots of eye contact, laughing etc). We have the full array of vowel sounds, and he’ll make “mmm” sounds back and forth with his dad and me. We’ll hear consonants within his vocal play, but none of the ma-ma-ma, ga-ga that we keep expecting. He is on the slow side of development in general (just like his dad was), sitting at 8 months, still just creeping, and so on. Is there something we could be doing to encourage him?

    Thanks!
    Anne

  12. Laura says

    Anne – The website is FULL of ideas for you to use with him in play, but the important thing is to keep modeling those sounds and words so he can learn to imitate. You didn’t mention his developing receptive language skills and that’s probably even more important than developing expressive language at this point. Read the articles in that section for ideas too. You’ll also want to make sure he’s using gestures – pointing to what he notices and then later wants to ask you to get for and even waving bye-bye. Gestures are a very important pre-cursor to words and sounds because then you know he’s developing communicative intent. I love that his social skills are a strength for him!! Keep playing those fun games with him! It sounds like you’re doing a great job with him and that he may be following Dad’s later pattern of development. It really doesn’t matter when he walks or talks – just that he does!! Keep trying – he’ll get there! Laura

  13. Jen says

    Hi Laura,

    I have a question/concern regarding my daughter’s language development and would love your opinion.

    She is exactly 14.5 months. Repetitive babbling began at approximately 5.5 months with lots of dada, mama, baba, nana, and yaya. This type of babble was frequent during her infancy, along with other types of vocal play (raspberries, yells, etc.) However, I am still waiting for the “jargon” babble to emerge. While she does have a couple of “stock” nonsense phrases which can be transcribed as “yabeedabeedabee” and “abeeabeeabee“, there is not much variety. Actually, if I ask her to “talk” to me, she breaks out with one of these phrases. There is other vocal play, just not really any of that “foreign” language type that I keep reading about.

    That said, she has about 25 words/approximations and an additional 5 animal sounds, all of which are used spontaneously and consistently. She probably uses her entire set of words and sounds 2-3 times in a day, by pointing out and labeling things she knows. There is some inflection in words as well. She has a handful of two syllable words in her vocabulary that are said rather well if not perfectly such as Mommy, apple, Elmo, doodle (as in cheese), bottle (although she says baboo), so I know that she CAN sequence at least SOME different sounds. She has several “basic” words like, “up,” “more,” “no,” “down” and she has found a way to use those thorough the day to tell me what she needs/wants. Basically, instead of a lot of nonsense, most of what she “says” during the day makes sense (at least to a familiar listener like myself.)
    By the way, receptive language is excellent.

    So, here are my questions:
    1. Is there still time for “jargon” to emerge for her?
    2. Is it a “red flag” if jargon does not emerge for her?

  14. Laura says

    Jen – There’s still time for jargon to emerge, and in my opinion, not a red flag if it doesn’t. She has an excellent spontaneous vocabulary for her age, so I wouldn’t worry about her at all!

    Things you can do to make sure sequencing emerges are singing and doing little rhymes with her. Ring Around the Rosies is a favorite for this age. You can usually get “Ashes, Ashes” or “fall down” pretty quickly with this game. Now these aren’t the most functional phrases, but it does let you know she can sequence some new sounds.

    Again, I wouldn’t worry about her at all. It sounds like she (and you!) are doing a great job!! Relax Mom!! Laura

  15. Jennifer says

    Thank you so much for your opinion/advice. I think this site is amazing and I have learned so much from you.

    One last question. You mention sequencing. When I say to her “all done” she says “ah duh” back. If I say “no no” she will repeat me and say “no no.” If I line up two objects like an “apple” and a “banana” and point to each, she’ll name them one after the other. If she falls, she says “boo boo.” I realize that these are not phrases, but is this what you mean by “sequencing some new sounds?”

    She is not yet imitating phrases like “more apple,” even though she has both words in her vocabulary. If say to her “more apple?” she says “apple.” Does this concern you at all? (She’s 15 months now.)

    Thank you again!

  16. Laura says

    Jennifer – Most children begin combining words into phrases when their spontaneous vocabulary (or words they say completely on their own unprompted by you) reaches 35-50 words. She should be able to repeat multisyllabic words and even phrases before then, but I would not be concerned AT ALL that she’s not doing this yet. Most of the time, this begins at 18 months.

    To answer your question, your examples of sequencing sounds above were right on target.

    Based on what you’ve said about her, I think she’s right on track and you’re doing a great job!! Laura

  17. Caroline says

    This is auch a wonderful site, thank you so much.

    I am concerned about my son: he is 27 months old and has a significant speech delay. He was evaulated at 18 months and was diagnosed being at a 9 month old level. He has never called me Mama/Mommy but he can say Mama. He has been seeing a speech therapist for about 6 months now but can only say about 30 words but uses babbling words the majority of the time. When he does use words, half the time he uses them incorrectly. For example, he can say ball but if a ball is out of reach he will look at me, point to the ball and say “aaaaaaa.” His eating has slowly deteriorated and there are days when he’ll eat oatmeal for breakfast and milk for the rest of the day. And he won’t ask me for milk, he will go to the fridge and pull the jug out and hand it to me with his cup. He has wonderful eye contact, laughs/smiles/cries appropriatley and follows directions nicely. His favorite is peek-a-boo and cracks up everytime we play it. He will line up objects, but only a few times and moves on. Plus he will not get upset if I mess up this line. A couple of times he has waved bye bye or said hi to me but hasn’t for a while. I read your article “Could My Toddler Be Autistic” and there were a few items that jumped out at me. Should I be worried?

  18. Laura says

    Caroline – Since I can’t see him, you’re going to have to rely on his SLP and your other team members. What do they think? Have they given you a specific diagnosis other than delay? One of the responsibilities of an SLP is to discuss a parent’s concerns, and discussing this with you is a very valid way to spend treatment time. I’d also recommend that you not wait until she’s on her way out the door to ask her what she thinks. You can call her or shoot her an email to let her know that you’re going to want to talk about this so she has a “heads up” and you don’t catch her off guard. I hope it goes well for you. Good luck! Laura

  19. Tiffany says

    Hi-

    My son is 24 months and he says no words yet. He makes this weird noise and pushed his tongue down to the bottom of his mouth. Once and a while he will babble dada, but that is it. He has been in speech for 4 months and I have seen no improvement. He has been to a developmental pediatricaina and he is not Autistic. His face tenses up so much when he tries to talk. How do I help him to talk an is there a possibility that he will NEVER talk!!! Please help!!!

  20. Laura says

    Tiffany – I’m so glad your son is in speech therapy. Since I can’t SEE him myself, I really don’t know what’s going on with him, so I can’t help you with a diagnosis. What does his SLP say? Does she have a specific reason he’s not talking yet? Children with apraxia often display facial grimmaces or other oral groping behaviors when learning how to talk. Ask your SLP about that possibility. I also have a DVD for ideas for parents for how to work with these kids at home. It’s called Teach Me To Talk with Apraxia and Phonological Disorders, and you can find information about it by clicking the blue oval in the right hand column at the top of the page.

    Although there are some children who don’t learn how to talk, the percentage is very low compared to those who still aren’t talking at 2. You’re doing everything you can, by having him in therapy AND more importantly, by working with him yourself at home (that is the case, right?), so try not to worry so much yet.

    Read the articles here on the site for ideas and check out the DVDs so you can see strategies to help him at home. Thanks for your question and try not to worry!!! Laura

  21. Jennifer says

    Hi Laura, I (
    First off, I’d like to say that I appreciate all of the valuable information that you have put into this article.
    My question is regarding my 18 month old daughter. She has excellent receptive language skills, but falls behind in the receptive language catergory. She does very little verbally labeling and refers to almost everything as “this”. She says “nana”(for banana), “dada” and “this” constantly, although she has other words: “that”, “there”, “uh-oh”,”dow” for down, “all-duh”for all done, and “no”, she does not use them on a steady basis. You may here them one day and then not again for another for a few days. She can make 3-4 animal sounds and sings all the time. Whwn she sings she does have a few whole words within the song that she says correctly. When she does speak it always appropriatelt but does not like to imitate a word if asked. Certain words that sound similar to “this” she will attempt if asked such as “yes” and “juice” but gets mad if asked too many time. She understand what we say to her and can follow 2 steps direction and does use gestures for what she wants. With all of that said (and I apologize for the length of this), my major confusion is whether or is if she needs to be evaluated at this time or am I better off waiting until 2. Her ped. wants to wait until 2 and feels she is just stubborn. My parents have also told me that I myself spoke very little until 2 years of age. I do not want to jump the gun but at the same time I would like to get her help as soon as possible if she needs it. I am a teacher and have also been a nanny for a little boy who had special needs and received services. My gut tells me her language level is not age appropriate, but I am unsure if I am right.
    I appreciate any advice you could give me on this matter. Thank you so much and keep up your wonderful work!!!

  22. Jennifer says

    Please excuse my terrible typos and grammar in the above comment. I was trying to type with my daughter on my lap.

  23. Laura says

    Jennifer – If your gut is telling you to get her evaluated, then go ahead and do it. You’ll feel so guilty later on if she does turn out to have a problem and you waited wasting valuable time. If she doesn’t qualify, then you’ll know you did the best you could. Parents who proceed with services never say they should have waited, but unfortunately I know many, many parents who beat themselves up for ignoring those gut feelings and trusting a pediatrician who is much better at diagnosing and treating medical issues rather than looking at developmental problems. I also would question his judgment since he characterized your daughter as “stubborn.” Children aren’t late talkers because they “won’t” talk – it’s because they CAN’T talk. There’s an article here on the site called “Can’t vs. Won’t,” and it’s at the core of my practice. Take a look at that and see if it doesn’t make more sense than calling your daughter stubborn, lazy, or a host of other negative things that don’t do anything to HELP her.

    That being said, by 18 months the minimum number of words a child should use on their own is 10-15. However, many state programs require a child to be much more behind that it seems like she might be. She may very well not qualify yet. But that doesn’t mean you shouldn’t do anything. There are LOTS of articles here on the website to help give you ideas for working with her at home. You may want to check out my DVD Teach Me To Talk so you can SEE how to work with her too.

    Thanks for your questions – and I NEVER fault a mom for typos when she’s holding her baby and trying to type:)

    Laura

  24. Colleen says

    My son is almost 29 months and he has some quirks about him. We’re not sure what should concern us and what we can dismiss as typical toddler behavior – especially when you add them all up.
    He is a very fun, loving, and communicative little boy. He is a little shy but is eager to interact with family and pets and kids his age. He’s very eager to “help” with every thing I do.

    Lately we have noticed that he drools a lot. We don’t notice this in other kids his age. He doesn’t seem to notice that he is doing it and it doesn’t seem to bother him. Lately, he has also been putting his fingers in his mouth and chewing on them like he is teething. He has all of his teeth so I know that its not his 2 year molars coming in. He has had them for a while now.

    He picks and scratches at his face in the same spot. It seems to be a nervous habit. I’m not sure how to stop or redirect it. I started putting a band aid and some medicated cream on the spot to try healing it. He’s generally ok with this but he takes the band aid off and later gets really upset that he’s no longer wearing it. If we get to a point where his face actually heals up, its not long before he starts picking at it again.

    He talks a lot and has a good vocabulary but has trouble with some sounds for example, “truck” comes out sounding like the “F” word. Grandma = “gamma”. Grand-dad = “gwandad”. Billy = Bee.

    He frequently babbles “vay vay vay” in place of words or in between words or sentences. We’re not at all sure what it means or why he does it. He always seems very factual when saying it.

    He’s loud. He talks loud, he makes loud sounds. He’s just all around loud. We talk about using an inside voice and we will talk quietly or whisper to emphasize, but he just seems set on being loud.

    He jumps a lot. Not sure if its a new skill and its fun or if its excessive. I’ve also very recently noticed that he flaps/flicks his hand at his ears when he’s excited (for example, today he asked to watch a tv show. I said yes and he ran to the couch yelling and flapping at his ear while I turned on the tv).

    He is able to eat with a spoon and fork but needs constant reminders. He digs into everything with his hands. A lot of the time he will then get upset because there is a “mess” on his hands and he will cry and refuse to eat until I clean them. He’s becoming increasingly concerned about messes. The other day he was crying so I hugged him. He got tears on my shirt and it turned a darker color. He noticed this and got really upset about the “mess” on my shirt.

    How do I know what is typical 2 year old behavior and what, if anything should be a red flag for us?

  25. Sarah says

    Hi,
    My almost-18-month daughter failed her hearing test. The dr. switched her antibiotic so we’re waiting to see if this works. She has NO words at this point, yet is VERY engaged in playing with others, responds to requests, uses gestures, babbles often. The question is, how long do we wait and see before we go with tubes? I don’t want her too far behind her peers as she is not speaking “real” words yet. I have contacted early intervention, but I’m wondering if the new medicine works, will we be able to tell because she’ll just start talking?? How does this work?

  26. Laura says

    I’d wait about 6 weeks and then meet with the ENT. If the meds work, then she’ll still need a few weeks to pull it all together, but this is just my opinion based on personal experience. If her ears are the only issue, you should see some results fairly quickly. If she’s not imitating more real words after waiting a few weeks, then you’ll know there may be another issue. It sounds like she has some great strengths, so hopefully, a round of antibiotics will do the trick. I’m glad you’re seeing EI too to be on the safe side. Keep modeling words during play (read articles here on the site & watch the DVD clips for ideas to get you started). Keep us updated with her progress. Good luck! Laura

  27. Sarah says

    Thank you, Laura! I was so pleased to get a response. I will continue to read your articles and work with my little woman to get her words going. Keeping my fingers crossed the antibiotics will do the trick.
    Thanks again,
    Sarah

  28. Juliana says

    HI. Hope I’m not asking something that has been answered! My son just turned two. He has at least 100 words and tons of animal sounds, many of which he has said in context and has never said again. He is not combining words or answering questions, though he talks constantly. He spends a LOT of time ‘reading’ his books, and then bringing them to us to ‘remind’ him what things are called, but won’t repeat the words when we tell him. Instead, he smiles to himself as if to say “yeah, that’s what I thought…” Without going in to too much detail, I have a question about consonants/pronunciation. He has a friend named “Marcus” who he decided to call “Ungus”. He has done this with many words, seemingly substituting, at random, other sounds, even though he can clearly say “Ma” and “kiss”, and does, all the time. Can you explain this? I am in the process of seeking Early Intervention, but while I wait, can you shed any light? Thanks!

  29. Laura says

    Juliana – Thanks for your question.I have so much to say about your question that I’m going to answer it tomorrow on the weekly podcast for May 13. Listen in as Kate and discuss your question. Better yet, you can call and ask us yourself. Email me at Laura@teachmetotalk.com if you want details for calling in to the show.

    I do want to quickly answer one thing. I would not say that your son has 100 words if he’s only said some of them once and never again. We do not count a word as a part of a child’s vocabulary until he’s saying it consistently and on his own, meaning he’s not repeating you after you’ve said it. This will be VERY important info as you have him evaluated thru Early Intervention. Only count the words he says on his own and consistently as words.

    When you’re saying he “talks” constantly, are you meaning that he says real single words that you understand and consistently recognize, or that he’s using jargon? Jargon is unintelligible sentence-length utterances. Is this what he’s doing when he’s “reading,” or do you mean he’s just quietly looking at the books by himself?

    If you can’t call in to the show, shoot me an email with these responses so I can more thoroughly answer your questions! Thanks again! Laura

    Thanks! Laura

  30. Amy says

    My 20 month old son probably has about 25 words, many of which are only recognizable to immediate family. Examples include: “cluck” for clock, “hat” for cat, “ter” for helicopter. He also refers to my sister as “mmmm” (we call her Em). He probably has 10 animal sounds. Do we count these as words? I’m just feeling really scared that there is no way he’ll have 50 words by 2. He also seems to have no interest in linking 2 words together in phrases, which causes me more concern. My ped says to wait until 2 to see where he is but I’m wondering if I should get a second opinion.

  31. Laura says

    Amy – Believe it or not, four months is a long, long time in language development at this age. I talked about this on last week’s podcast – Guidelines for counting words in a new talker’s vocabulary are: Count words that are consistent(meaning you hear the word every day or two), words are spontaneous (meaning that he says words on his own – he’s not just repeating someone else), and you can actually spell the word (meaning something like “moo” counts, but not an “odd” sound that you can figure out how to spell). When he gets a large enough vocabulary – usually close to 50 words – he will begin to combine words into phrases. Just keep building that single word vocabulary and it will happen! I would definitely wait for his 2nd birthday since he would not qualify for therapy right now. He’s still on track. Keep doing what you’re doing – hopefully with a little less worry! Let me know if you need more ideas. If you’re thinking you need more ideas for home, you may want to check out my DVD Teach Me To Talk. When you put those ideas in place, then you’ll know you’re doing all you can to help him. Either way – good luck and let us know how he does! Laura

  32. Dilesha says

    Hi Laura, My son is 13.4 months old, very happy child. He is not yet babbling baba.. or mama.. We did his hearing test on last week. Dr. said that he has normal hearing with some delay in respond to sound. He never responds to his name, never imitates any sound. He start crawling at 10 month, pulling himself up, climbing on every thing, but not walking yet(he is good in his gross motor or fine motor skills). I am really worried about his language development.
    My major confusion is whether or is if he needs to be evaluated at this time or am I better off waiting few months?

  33. Laura says

    Dilesha – More importantly, how is his receptive language developing? I know you said he doesn’t respond to his name, but is he following simple directions yet such as, “Give it to me,” identifying a few body parts, looking toward you or dad when asked, “Where’s Mommy/Daddy,” etc… How are his social skills? Is he interested in playing games like Peek-a-boo with you? If he waving bye bye? Is he pointing to indicate his wants and needs, or still just crying? If he isn’t doing those things, then he may qualify for services even at this young age. You could always check with your state program. In the meantime, I hope you’re using the ideas here on the website to jump start his language. There’s LOTS of good info for parents to use at home in both the receptive and expressive language categories. You may also want to check out my DVDs so you can SEE how to work with him at home. Good luck with him! Laura

  34. Shannon says

    Hi Laura-
    I am new to your site and have literally spent the last 2 hours reading and listening to all of your valuable information! Thank you for your diligence in helping parents like myself who have genuine concerns for their children!

    I have a 13 month old boy. I just *know* something is a miss with him and I don’t know which direction to turn. In the beginning I feared that he was displaying many signs of autism but as I have been reading and researching my focus has shifted some to speech/lang and sensory issues- but honestly am still at a loss for the “odd” behaviors that I see with him. He is so wonderful and my husband and I just over the moon for this kid (our first and only right now). The feeling that something is “wrong” cuts so deep I can’t even put into words. All we want is to figure out what is going on (big or small) and help him. I apologize in advance for being so long winded :)

    I’ll just jump right in! First off he is not speaking. Not even mama or dada. He does babble. His receptive language seems to be great as he follows simple directions and will look in the direction of people/objects as we name them- such as “where’s dada” or “where’s the cat”. He will clap and wave on command, however, he does not point. He loves to play peek a boo and will eagerly hand me objects if I ask for them. He loves also to be chased and tickled. His interaction with other children, however, leave a lot to be desired. This is largely due (in my opinion) to his frequent inappropriate use of toys. He LOVES to spin wheels to the point of obsession – I literally hide his stroller in my bedroom because if he sees it he will play with the wheels ignoring everything else around him. He will spin toys that are not meant to be spun (sippy cups, DVD cases, etc). He will also “throw and chase” toys all the time. It began with balls which was fine because that’s what your are supposed to do with balls! but now it’s any toy or object in his hand. He will toss it, or ROLL it and then chase it down and do it again. I work REALLY hard at structured play- showing him how to use his toys for what they were meant for and when we are playing one on one or with my husband and I, he will happily oblige and play very well (stack rings, shake the tambourine, separate toys in bins, etc). When left to his own devices however, he almost always will (try to) revert back to spinning and throwing and chasing. Funny though he does not do this with books. He loves to “read” books and will flip through each page and feel textures and loves to be read to. He has gotten somewhat better I will say since I have not been allowing him to play inappropriately. He understands “don’t throw that” and will usually go out of my sight to sneak it!

    A few other things that aren’t as odd as I just mentioned are the fact that he will get very upset when changing diapers or changing clothes (about 75% of the time). He HATES when I wipe his hands and face after eating. I don’t know if that’s related or? For now I am most concerned with his social play or lack thereof when he is not actively engaged in structured play. Combined with not showing expressive language have just got my stomach in knots. Any insight you could provide will not fall on deaf ears. Thank so much!

    Shannon

  35. Shannon says

    Hi Laura- I would also like to ask in regard to my above comment/concern- is it possible for a child to have a sensory processing disorder and NOT be diagnosed Autistic? Or so they always go hand in hand? Thanks so much.

    Shannon

  36. Laura says

    Shannon – Yes, a child can have sensory processing disorder and NOT be on the autism spectrum. However, most children who are on the spectrum exhibit sensory processing differences. Make better sense? Laura

  37. Sandra says

    HI Laura,

    the site is very helpful! I found it last week and planing to visit it many times in the future.
    Here is my question: My daughter is 25 months and is raised 3-lingual. My native is serbian, father is French and in pre-school she started month ago – it is English.
    I believe she is a bit slower on the laguage development that I would expected. She did meet 2 year milestone with 50 words and combining 2 words togther (like 4 days before her second birthtday!) and I took her for evaluation in Early Prevention which concluded she is developing exactly for her age.
    Where I am a little concern is that I am not seeing any meaningful 2-3 words phrases: Usually is it “buye, buye something (mama, house, dogs, car)..” depending on the situation but not like “give me….” (milk, cheese…)
    I also notice lately repeating of the last word in the question especially if it is a new word she never heard before or super familar sentence: Do you want milk? She should say “milk” instead “yes” . However is 60% of the question I would get a clear “no” or “a!” (which is a version of “yes”) When I would correct it and say ” We don’t say “a” but …” she will alwasy fill the blanks, smile and say “yes!” (she does this in all 3 laguagues. I did not hear “why” or “who” questions yet. The teacher in school belives that she is where she suppose to be for her age but she also pointed out that she hears repeating of the word like “Come inside” she would repeat “inside” then but not after again. However, she believes it is normal and that it is progress withing next several months that is critical. Apart from that I don’t see any other indications that anything else is out of order – her motor skills are very good, great eye contact, smiling, trying to sing and trying to count in all 3 laguages (usually just some numbers not all). What is your advice? I am expecting a bit too much from 25 months old? I am just comparing with 25 months old that already ask why questions and combine 3 words in the phrase.

  38. Laura says

    Sandra – I like this question so much that I’m going to discuss it on podcast #87 (Sunday, 9/26), so tune in for that answer. Or better yet, call in yourself to talk to Kate and me! Thanks – Laura

  39. Holly says

    Hi Laura,

    I ordered your DVD and have been reading your site and it is very helpful. My 24 month old son was just evaluated for the early intervention program. He is delayed in several areas but I think the key is the receptive language. For example, cognition was a bit low but I think he didn’t understands what we are asking him to do. He was in the 1st percentile for his age for receptive language. I have tried some of your tips for a week and have already seen some progress. A developmental interventionist will come to our home once a week. Do you think it is also a good idea to take him to speech therapy as well or do you think that is too much for him?

    Thanks, Holly

  40. Alisha says

    Laura,

    My son is 2 and 8 months. He is receiving therapy for speech and developmental therapy and has been for a little of 6 months. He has a huge vocabulary and speaks in 2-4 word phrases. He is not using “I” or “me”, “my”, or “you” very often. He says “mine” on occasion. We had a case worker come in to consult on whether or not to evaluate for autism. She didn’t think there was a concern because he spontaneously speaks and shows interest in others etc. My concerns are these: he still “echos” probably 20% of the time, he has always been a very independent player (although has recently been asking “mommy play” more and want to engage his toys in conversation, pretend play etc.), he has been obsessed with certain subjects, such as “football/sports” and “trains/train tracks”, he sees details in everything (lines, crosses, shapes etc.), he plays laying down with his head to the ground or like he is watching his cars with his head turned at times, he LOVES to run (although now will say next to me and walk when I ask him to, he turns his head to the side when he walks/throws a ball sometimes, he LOVES to tackle, he used to line up his cars (although not obsessed with keeping them that way …. haven’t seen him do as much of that lately, he repeats things over and over a lot (or a least until I tell him “I heard you”). His speech is improving, but he is still only asking the question “Where _____ go?”, and not any other question. His head is in the 90%, but his height is as well. Any thoughts or ideas? He is full of life and smiles and loves on me all the time. He loves me or his sister to play with him now. Should we get a second opinion or officially have him diagnosed? Thank you SOOOO much for your input!!

  41. Shannon G. says

    My son had a fairly normal vocabulary until he was 19 mths when he had several seizures in his left temporal lobe. From then on, he hasn’t spoken hardly anything and we are in speech therapy once a week. He has been able to start babbling and “jargening” but no true words that are meaningful. Sometimes there are words that come out then we won’t hear them again. Everyone says once his brain figures out how to “speak” again – on the other side of the brain – he will start talking again. Do you think that your DVD would be able to help in any way and have you ever heard of something like this? Thanks for you thoughts!

  42. Laura says

    Shannon – My first DVD Teach Me To Talk will be helpful to demonstrate how you can work with him at home to address his language delays. You mention that he’s not talking other than jargon, but how is understanding and following directions? Is he able to identify objects at home and follow simple requests such as, “Get your shoes,” or “Put your cup in the sink.” Until he understands language consistently and can demonstrate that by following directions, he’s not likely to say much of anything. Focus on language comprehension as much as you are emphasizing talking. Teach Me To Listen and Obey 1 and 2 will give you ideas for that at home.

    I have seen many children with seizure disorders. Some recover to the point where they are catching up to their peers, and sadly, some do not. Neuroplasticity, or the brain’s ability to change and take over function for damaged areas, is the term for what you’re talking about, and it’s a very real probability for a young child. However, you’ll still want to do everything you can to be sure you’re doing your part to maximize his chances of getting better. Speech therapy is definitely recommended so that you can learn how to address his communication delays.

    Thanks so much for your questions. Laura

  43. eileen says

    Hi! I have a 17 month old who is fascinated by spinning and tries to spin just about everything under the sun. Someone commented on it, so I did some research and found your blog/website. Can you explain to me why it’s a concern? He’s advanced in most other areas of development and on target for the rest. Thank you!

  44. Laura says

    Eileen – If the spinning preoccupies most of his play so that it interferes with other areas of development, then it may be a problem. For example, if he won’t play with a toy in a way other than spinning, then his hyperfocus will prevent further development of his cognitive play skills since he won’t advance to more mature pretend play, or perhaps his fine motor skills will plateau since he’s not practicing stacking, connecting, or any other higher level coordinated movement patterns. His language and social skills could be impacted if he “tunes out” others during this time. Is he talking? Is he using toys in other ways too? If so, then you have nothing to worry about. If he’s not, then you may have to help him learn to move on after he’s spun a toy a time or two. It’s probably not the spinning per se that’s so interesting – it’s the visual movement patterns he likes. Introduce other toys that are visually appealing and more social – like popping bubbles, playing with a brightly colored beach ball by throwing, catching, and kicking, etc… If you notice other sensory processing differences that do seem to be interfering with his daily routines and development, then you should schedule an evaluation with a pediatric Occupational Therapist who specializes in sensory processing disorder. Sensory processing issues can be a child’s only concern, or they can be a part of an overall pattern of delayed/disordered development. Many of us who are completely functional exhibit sensory quirks that do NOT interfere with learning, but some children are so significantly impacted that they begin to exhibit true developmental lags. If his milestones are on track, this is likely not the case for him. I hope this information helped you! Thanks for your question! Laura

  45. DV says

    Hi Laura,
    Same concern as the above. I have a 23 month old (22 months corrected age – not sure it matters anymore). He spins everything that can be spun and sometimes things that I wouldn’t even think could be spun. He also runs around at times with his eyes looking upwards. Also spins himself at times with his eyes looking sidewards. He also flaps his right arm every now and then. He LOVES ceiling fans and lights. He also spins the wheels o his car more than he plays with it the right way (which he does at times and on prompting)

    However, this has not stopped his progress in other areas. He has very good eye contact, loves to play with us (particularly peek-a-boo and chasing), loves to play with his twin sister, Loves to be tickled (asks to be tickled), started putting together 2 words at 20 months, puts about 4-5 words together now (like Big Black Bow-Bow going or sister crying or Mommy, sit down here or Blue ball under here, R(his name) get it), brings over things that interest him, understands instructions (like throw your diaper in the garbage or go to the living room and put this piece on your puzzle). His pretend play so far – pretending to comb his hair with a puzzle piece, sweeps floor with a leaf, drinks coffee out of a cup, tries to feed me coffee with the cup, tries to tie a ponytail, pretends to talk on the phone, wants me to put the towel around him saying it’s a jacket).

    I am going to have him looked at here in India (where I will be for the next 3 months after which I will be back in the US). I was hoping to get your insights on this situation. Does this sound like autism or SPD? If it is SPD, what is usually the prognosis? Can a person live a fulfilling life and do things “normal” people do? Could you please shed some light on what may be happening?

    I have been worrying myself sick (in the real sense of the word – have been such an anxious mess that I may consider seeking help myself).

  46. says

    Hi Laura
    I have a 15 month old son who I am becoming increasingly worried about in regards to his non-existent speech and sounds. He only has one word which he uses consistently which is ‘wow’, he will randomly say ‘hello’. My son has never made any consistent sounds, no babbling or baby chatting at all and has never done mumma or dadda. When he wonders around the house he does a ‘br-br-br-br-br’ sound and other random sounds in his cot but nothing else. He will always copy actions but will not copy the sounds i.e he has a special car kept only for the change table and I make zooming noises around the room until I give it to him, when he gets it he copies the zooming action but just smiles at me mutely.
    When he wants something he grunts or does ‘eh’ and points at what he wants, he gets VERY angry and frustrated when he cant convey what he means and went through a faze of chucking things quite violently or hitting when he got frustrated by this. I would take him aside and say ‘no hit’ or ‘no chuck’ so he would understand, and this behavior has stopped. When he wants something I say what the item is several times like ‘cup’ when I hand it to him and wait for a response but get nothing in return. I go to a Mothers group where there are two 7 month old babies, they are saying more than him.
    Liam does has a very good understanding of what you are saying to him and can carry out complex commands like ‘go and sit on the step with your sister and have your snack’, or ‘go and grab the toy car and put it in the toy box’. Which he does.
    I have a 3 year old daughter who was very advanced for her age in every aspect, she was crawling at 3 months, sitting at 4.5 months and walking freely by 9 months, using several words by 12 months and using full sentences by 15 months. He does have a pacifier but he is only allowed it at bed times or when he is hurt or distressed, he is not allowed to walk around with it in his mouth.
    Is Liam behind or am I just comparing him to his advanced older sister? He is otherwise a very healthy and happy little boy and is an absolute joy.
    Thank you for your time.
    Sharon

  47. Nike says

    My son is 24 months old and has a very limited vocabulary, maybe about 10 words in total. He understands everything we say to him, responds to commands perfectly, even lets you know when he’s had a poo (not potty-trained yet) by pulling you and patting his nappy. He is very sociable, plays football, laughs, is very affectionate – every thing seems perfect – except, there seems to be a delay in his speech. When you do pronounce some words and ask him to repeat, sometimes he does (his attempts are ok sometimes, sometimes off). At other times, you can see him start to try, then he says a categorical “no” (no being one of his words).

    What do you think the problem is and how best can I help him? He has an older brother who is extremely talkative, they play very well together and he also attends play group twice a week (8am to 6pm). They confirm he’s very sociable, loves to play and run about, absolutely loves dancing but just won’t say much! I live in the UK and we don’t have early intervention programmes like I’ve read about on your site here. What can I do?

    Nike
    London, UK.

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