When to be Concerned:

• Does not use a variety of vowel & consonant sounds during vocalization
• Does not babble strings of consonant-vowel sounds
• No turn-taking/sound imitation
• Does not request items by using a gesture + sound
• Does not follow simple, familiar directions with gesture cues (pointing)
• No word attempts
• Does not finish recommended feeding amounts within 20 minutes or has excessive fluid leakage
• Does not transition to pureed or textured foods
• Does not show recommended weight gain

By 18 Months

• Less than 10 word vocabulary
• Does not follow most familiar directions
• Does not maintain eye contact during interactions
• Does not consistently initiate verbal interactions
• Does not include most of the following sounds in word attempts (b, p, m, n, t, d, k, g)
• Does not show an interest looking at books

By 2 years

• Less than 50 word vocabulary
• No 2-word combinations
• Does not follow 2-step or unfamiliar directions
• Does not include the above sounds plus (n, w) in words
• Does not show an interest in book reading
• Does not tolerate chewy foods
• Continues to drool after teething ceases

By 3 years

• Does not use simple, complete 3-4 word sentences
• Does not relay simple personal events using sentences
• Does not follow most unfamiliar and multi-step directions
• Does not appropriately answer most simple questions
• Does not include (f, v, y, ng) in words
• Continues to repeat the first sounds of words (b-b-b-ball)
• Does not pretend to read books

By 4 years

• Does not relay events or maintain conversation using complex sentences
• Does not include (s, z, sh, ch, j, l, r, th) in words
• Does not sound play with rhyming

By 5-6 years

• Does not recognize letters or letter sounds
• Does not break down words into sounds (bat starts with a /b/ sound)
• Does not sound out simple words (cat, big)
• Does not meet grade expectations for reading or spelling

Certified by ASHA