Red Flags Bermuda
EARLY INTERVENTION
BIRTH TO AGE SIX
Growth & Development
Speech & Language
Approximately 1 in 10 preschool children has difficulties acquiring speech, language and/or social communication. Because communication skills are critical to the child’s future success in socialization, learning to read and write (literacy) and do math (numeracy), it is important to identify those children who might need support in this domain.
This domain considers development of attention, comprehension, expression via gestures and words, the development of clear intelligible speech, social skills and play skills
Healthy Child Development
There are several stages of healthy speech & language development that are marked by key abilities.
By 6 months
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Turns to source of sounds
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Startles in response to sudden loud noises
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Makes different cries for different needs i.e., hungry, tired
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Watches the face of parent/caregiver as they talk
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Smiles/laughs in response to parent/caregiver smiles and laughter
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Imitates coughs or other sounds such as “ah,” “eh,” buh”
By 9 months
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Responds to his or her name
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Turns to look for a source of sound, or responds to the telephone or a knock at the door
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Understands being told “no”, and other short instructions
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Imitates facial expressions
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Gets attention or help, or what they want, through gestures e.g. reaching to be picked up and sounds
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Plays social games with parent/caregiver e.g. peek-a-boo
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Enjoys being around people
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Fusses or cries if familiar caregiver looks or behaves differently
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Babbles and repeats sounds such as “babababa” or “duhduhduh”
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Mouths and chews on objects
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Looks for dropped object or hidden toy
By 12 months
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Follows simple one-step directions such as “Sit down”, “Find your shoes”
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Follows simple requests and questions such as “Where is the ball?”
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Looks across the room to something when an adult points to it
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Consistently uses three or more ‘words’ such as “dada” or “mama,” using the same sounds to indicate same object or person, even if these ‘words’ are not pronounced accurately
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Uses specific gestures to communicate needs or to protest e.g. waves hi/bye, shakes head “no”
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Gets attention using sounds, gestures and pointing while looking at the eyes of parent/caregiver
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Brings/extends toys to show parent/caregiver
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“Performs” for social attention and praise
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Combines lots of sounds together as though talking e.g. “abada baduh abee”
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Shows an interest in simple picture books
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Starts and plays social games with parent/
caregiver; takes turns e.g. “peek-a-boo,”
“patty cake” -
Finger-feeds him/herself some foods
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Holds, bites and chews crackers
By 18 months
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Understands the concepts of “in and out,” “off and on”
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Points to three or more body parts when asked
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Responds with words or gestures to simple questions e.g. “Where’s teddy?”, “What’s that?”
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Uses at least 20 words consistently, even if not clear
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Makes at least four different consonant sounds e.g. p, b, m, n, d, g, w, h
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Enjoys being read to and sharing simple books
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Points to familiar pictures using one finger
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Demonstrates some pretend play with toys e.g. gives teddy a drink, pretends a bowl is a hat
By 2 years
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Follows two-step directions e.g. “Go find your teddy bear and show it to grandma”
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Uses 100 or more words
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Uses at least two pronouns such as “you,”
“me,” “mine” -
Consistently combines two to four words in short phrases e.g. “daddy hat,” “truck go down”
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Forms words/sounds easily and effortlessly
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Uses words that are understood by others 50 to 60 per cent of the time
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Enjoys being around other children
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Begins to offer toys to peers and imitate other children’s actions and words
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Holds books the right way up and turns pages one at a time
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“Reads” to stuffed animals or toys
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Scribbles with a writing utensil
By 2½ years
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Understands the concepts of size such as big/little and quantity such as a little/a lot, more
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Uses some adult grammar e.g. “two cookies,” “bird flying,” “I jumped”
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Uses more than 350 words
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Uses action words e.g., run, spill, fall
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Produces words with two or more syllables or beats e.g. “ba-na-na,” “com-pu-ter,” “a-pple”
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Uses consonant sounds at the beginning of words e.g. “big” instead of “ig”
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Begins taking short turns with peers, using both words and toys
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Demonstrates concern when another child is hurt/sad
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Demonstrates pretend play involving several actions e.g. feeds dolls and then puts them to sleep; puts blocks in train then drives train and drops blocks off
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Recognizes familiar logos and signs involving print e.g. golden arches of McDonalds,
“Stop” sign -
Remembers and understands familiar stories
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Speaks in sentences of at least three words
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Tries to join in with singing songs or making rhymes
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Recognizes self in a mirror or a photo
By 3 years
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Understands “who,” “what,” “where” and
“why” questions -
Creates long sentences using five or more words
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Talks about past events e.g. trip to grandparents’ house, day at childcare
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Tells simple stories
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Understood by most people outside of the family, most of the time
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Shows affection for favourite playmates
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Engages in multi-step pretend play with actions and words e.g. pretending to cook a meal or repair a car
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Understands and uses some describing words e.g. “big,” “dirty,” “wet”
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Joins in play with a group of two or more peers
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Listens to stories or music for five minutes with an adult
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Aware of the function of print e.g. in menus, lists, signs
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Beginning interest in, and awareness of, rhyming
By 4 years
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Follows directions involving three or more steps e.g. “Get some paper, draw a picture, and give it to mom”
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Shows four colours when asked
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Asks and answers a lot of questions e.g. “Why?”, “What are you doing?”
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Uses adult-type grammar
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Tells stories with a clear beginning, middle and end
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Talks with adults and other children to try to solve problems
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Speaks clearly enough to be understood by strangers almost all the time
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Demonstrates increasingly complex imaginative play using words, characters, action and interactions with peers
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Able to generate simple rhymes e.g. “cat-bat”
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Matches some letters with their sounds e.g. “letter T says ‘tuh’
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Enjoys singing children’s songs
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Participates with peers in small group activities, sharing and taking turn e.g. catch, snakes and ladders
By 5 years
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Follows group directions e.g. “All the boys get a toy”
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Understands directions involving “if…then” e.g., “If you’re wearing runners, then line up for gym”
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Describes past, present and future events in detail
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Uses almost all of the sounds of their language with few to no errors
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Seeks to please his/her friends
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Shows increasing independence in friendships
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Knows all the letters of the alphabet
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Identifies the sounds at the beginning of some words e.g., “Pop starts with the ‘puh’ sound”
... If a child is missing one or more of these expected age outcomes, consider this a red flag
Problem
Signs
... if a child is experiencing any of the following, consider this a red flag:
► Stuttering i.e. using repetitions of words, syllables, sound prolongations, or blocks e.g. “I-I-I”, “da-da-daddy”, “mmmommy” “b—all”
► Ongoing hoarse voice or unusual voice quality
► Difficulty with feeding or swallowing
► Excessive drooling
Speech and language challenges are sometimes associated with other developmental concerns. Also refer to the following domains in this guide for other potential referrals:
► Autism Spectrum Disorders (ASD)
► Hearing
► Feeding skills