Module 35

Speech Delay Red Flags Checklist

Clear age-based markers for when to seek a speech-language evaluation

Early identification of speech and language delays leads to significantly better outcomes. The brain's plasticity for language is highest in the first 3 years, and intervention during this window is dramatically more effective than after age 5. This checklist is not a diagnostic tool — it's a screening guide. If you check ANY red flag items at your child's age, request an evaluation from a speech-language pathologist. You do not need a doctor's referral to get an evaluation in most states, and early intervention services (birth to 3) are often free or low-cost.

By 6 Months — Seek Evaluation If:

Does not react to loud sounds

Does not turn toward sound sources

Does not make vowel sounds ('ah', 'oh')

Does not smile or laugh in response to you

Does not make eye contact during face-to-face interaction

By 9 Months — Seek Evaluation If:

No babbling at all (no 'baba', 'dada', 'mama' sounds)

Does not respond to own name

Does not follow your gaze when you look at something

Does not show objects to you (sharing attention)

Limited facial expressions or emotional range

By 12 Months — Seek Evaluation If:

No babbling with consonants (only vowel sounds)

Does not use gestures: pointing, waving, reaching

Does not respond to 'no' or simple routine commands

Does not say any words (even approximations like 'ba' for bottle)

Has lost skills they previously had (any regression)

By 18 Months — Seek Evaluation If:

Uses fewer than 10 words

Does not point to show you things (not just to request)

Does not understand simple instructions ('get your shoes')

Does not imitate words or actions

Prefers gestures over attempting words (after 15 months)

Any loss of previously acquired words or skills

By 24 Months — Seek Evaluation If:

Uses fewer than 50 words

Does not combine 2 words together ('more milk', 'daddy go')

Does not follow 2-step directions ('get the cup and put it on the table')

Cannot point to body parts or pictures when named

Speech is less than 50% intelligible to familiar people

Does not use words for a variety of purposes (requesting, commenting, greeting)

Echoes phrases exactly without understanding (echolalia)

By 3 Years — Seek Evaluation If:

Does not use 3-word sentences

Speech is less than 50% intelligible to unfamiliar listeners

Does not ask simple questions

Cannot tell you what happened in a familiar activity

Does not engage in pretend play with language

Stuttering that lasts longer than 6 months or includes visible struggle

Cannot have a simple back-and-forth conversation (at least 2-3 turns)

By 4 Years — Seek Evaluation If:

Speech is less than 75% intelligible to unfamiliar listeners

Does not use 4+ word sentences

Cannot retell a simple story

Does not understand 'who', 'what', 'where' questions

Cannot identify basic colors or count to 4

Frequently frustrated when trying to communicate

Avoids speaking in social situations (selective mutism)

By 5 Years — Seek Evaluation If:

Speech is not fully intelligible to strangers (aside from r, l, s, th sounds)

Cannot tell a story with a beginning, middle, and end

Does not use complex sentences (because, so, if-then)

Difficulty following multi-step classroom instructions

Cannot answer 'why' and 'how' questions

Has trouble with rhyming or recognizing beginning sounds in words

Noticeably behind peers in conversation skills

Red Flags at ANY Age

Important

Seek immediate evaluation if your child shows ANY of the following at any age: Loss of previously acquired words or social skills (regression); No response to their name by 12 months; No pointing or gesturing by 12 months; No single words by 16 months; No spontaneous 2-word phrases by 24 months; Consistent echolalia (repeating exactly what's said without understanding).

Where to Get Help

1Early Intervention (birth-3 years): Contact your state's Part C program. Services are typically free. Search 'early intervention [your state]' or call the Pediatrician for a referral.
2Preschool Special Education (3-5 years): Contact your local school district. Under IDEA, schools must evaluate and provide services for eligible children at no cost.
3Private Speech-Language Pathologist: For faster or more intensive evaluation. Check ASHA ProFind (asha.org) to find a certified SLP near you.
4Pediatric Audiologist: If there is ANY concern about hearing, get a hearing test first. Even mild or intermittent hearing loss (from ear infections) can delay speech.

Trust your instincts. If something feels off, get an evaluation. You will never regret evaluating too early. The data is clear: children who receive speech-language intervention before age 3 have significantly better outcomes than those who start after age 5. 'Wait and see' is the most expensive advice in speech pathology.