Red Flags

Early intervention, accurate diagnosis, and specialized treatment plans are crucial for all communication disorders. However, children exhibiting the disorders listed below require highly skilled therapists to diagnose the disorder and develop very specialized treatment plans.

Red flags of autism spectrum disorder

If your child demonstrates several of the following characteristics, speak to your pediatrician about an evaluation. Your local birth to three agency or a developmental pediatrician can provide necessary information and evaluations. Early speech and language therapy is crucial for children with autism spectrum disorders.

  • Does not respond to name
  • Inability to follow directions
  • No pointing
  • Does not often share or show (e.g., points to show you an airplane)
  • Inappropriate eye gaze (e.g., using peripheral vision more than usual to look at objects)
  • Little to no imitative skills (e.g., does not play peek a boo or imitate funny faces)
  • Decreased variety in play (e.g., only enjoys playing with trains, cars, or toys with buttons)
  • Lack of pretend play (e.g., does not pretend to talk on the phone or put a baby to sleep)
  • Repetitive movements with objects (e.g., continually opens and closes doors, watches the wheels move on a car more than the usual amount, lines up toys, sorts toys by color)
  • Unusual sensory explanation (e.g., holds/shakes objects at the side of face, holds ear close to toys producing sound, puts unusual items in mouth)
  • Excessive interest in particular toys, letters, numbers
  • Memorizing and scripting of familiar movies, books, etc
  • Excessive behavioral outbursts
  • Delayed expressive language skills (see developmental milestones)

Signs of a possible learning disability

If your child demonstrates a cluster of the following symptoms, which do not disappear, as he/she grows older you may want to discuss an educational evaluation with your child’s school. A child psychologist can also provide important information related to your child’s learning profile.

  • Short attention span
  • Poor memory
  • Problems remembering routines
  • Difficulty following directions
  • Inability to distinguish between and among letters, numbers, or sounds
  • Poor hand-eye coordination
  • Generally clumsy, uncoordinated and disorganized
  • Distractible, restless, impulsive
  • Difficulty telling time and knowing left from right
  • Delayed speech development
  • Difficulty understanding words and concepts
  • Difficulty sounding out words
  • Difficulty learning sight words
  • Reverses letters
  • Cannot sequence or organize a story verbally

Red flags for Sensory Processing Disorder:

If your child demonstrates several of the following characteristics, an occupational therapy evaluation may be necessary.

  • Refusal or avoidance of various sensory stimuli
    • Avoids bathing, water or messy play
    • Only wears a particular type of clothing
    • Selective eater, only eats certain colors/textures/tastes
    • Avoids messy art materials (glue, paint, sand, slime)
  • Avoids movement
  • Clumsy or slow movement
  • Always on the go
  • Not playing with toys or limited toy interaction
  • Difficulty making or keeping friends
  • Frequent emotional outbursts
  • Withdraws from touch, hugs

Signs of possible auditory processing difficulty

If your child demonstrates several of the following characteristics, a speech and language evaluation may be necessary.

  • Difficulty paying attention to information presented orally
  • Difficulty remembering information he/she heard orally
  • Difficulty following multi-step directions
  • Seems to take more time than normal to process, follow or understand a direction given orally
  • Poor performance in school
  • Behavior problems
  • Shows difficulty developing language skills (i.e., poor grammar rules, difficulty with syllable sequences, immature vocabulary, disorganized sentence formation, low language comprehension)
  • Difficulty learning to read
  • Easily distracted or bothered by loud or sudden noises
  • Is generally upset in noisy environments
  • Disproportionate reaction to painful event

Characteristics of childhood apraxia of speech

Professionals and researchers are not in complete agreement regarding the characteristics that define verbal apraxia (or apraxia of speech). Some of the characteristics mentioned below appear in other severe communication disorders. However, if your child demonstrates several of the following symptoms a speech and language evaluation is highly recommended.

  • Understands language significantly better than he/she can express language
  • Limited vocalizations and sound play during the first 2 years
  • Produces a limited number of consonant sounds
  • Produces vowel sounds incorrectly
  • Deletes initial and final consonant sounds in words
  • Omits syllables
  • Cannot produce consonant clusters in words (e.g., stop, brown, black, skate)
  • Inconsistent production of words (i.e., often produces the same word differently)
  • Connected speech is unintelligible
  • May use an inventive gestural or non-verbal communication system
  • May not be able to produce words on command but can produce them in spontaneous speech

Other learning difficulties, speech and language deficits, and neurological problems are likely co-existing. Therefore, professionals may not readily consider apraxia of speech as a diagnosis. Accurate diagnosis is crucial for a successful treatment plan. A very specific and intensive treatment plan is required for children with signs of apraxia.

Signs of a phonological disorder

Children with a phonological disorder show patterns of sound errors. Usually these children are highly unintelligible. They do not only substitute a few sounds (e.g., uses /w/ for /r/, /f/ for /th/, /s/ for /sh/) but have a completely disorganized phonological system. This causes children to display many of the following errors:

  • Omission of syllables (e.g., “ku” for “cookie”, “fin” for “elephant”)
  • Reduction of clusters (e.g., “top” for “stop”)
  • Consistent fronting of sounds (e.g., “tup” for “kup”)
  • Consistent backing of sounds (e.g., “dough” for “go”)
  • Deletion of initial consonants (e.g., “it” for “sit”)
  • Deletion of final consonants (e.g., “ma” for “map”)

A phonological disorder is more severe than an articulation disorder. A child with an articulation disorder may display speech with errors in the production of specific sounds. The error sounds are usually easier to identify and the child’s speech is usually not unintelligible. Children develop the ability to produce more difficult sounds (e.g., s, th, r, l, ch, sh) as they grow older. Please see sound acquisition chart [coming soon!]

If your child is unintelligible or has not developed speech sounds appropriate for his/her age, a speech and language evaluation is recommended. A very specific and often intensive treatment plan is required for children with phonological disorders. Early intervention is key!

Sources: American Speech-Language-Hearing Association (ASHA), Apraxia-Kids, Autism Speaks, Evaluating and Enhancing Children’s Phonological Systems, Barbara Williams Hodson, PhD, 2007, First Words Project (Wetherbyet al., 2004; McCoy, Wetherby, & Woods, 2009), Learning Disabilities Association of America, Occupational Therapy for Children (Case-Smith),,

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