Table 2.

Red flags indicting high risk of language or speech disorder and prompting evaluation

By age	Red flag or indication for referral for evaluation
Any age	Failure to participate freely and frequently in social interactions
6 months	Lack of ability to laugh, vocalize, respond to sound, participate in reciprocal vocal interactions
9 months	Failure to respond differentially to name or produce babble (such as baba, dada)
12 months	Inability to point to objects or actions Lack of use of gestures, such as shaking head “no” Inability to participate in verbal routines, such ability to wave to “wave bye-bye” No use of mama or dada specifically for a parent
18 months	Less than 5 words beyond mama and dada Failure to follow simple commands with gestures
24 months	Vocabulary less than 50 words No two-word combinations < 50% of utterances intelligible to unfamiliar adults
36 months	Inability to follow simple directions without gestures No 3 or more word combinations < 75% of utterances intelligible to unfamiliar adults
≤ 36 months	Loss of language and speech skills, particularly in the presence of regression in social abilities and in the absence of regression in motor skills