Red Flags for Language Development

What are they and what can you do if your child has them?

What are red flags?

Red flags are things that children do in their development which are not typical. We often talk about ‘late talkers’ and ‘language delay’. Some children follow a typical pattern of language development but at a slower rate than the majority of their peers: Everything happens in the right order but they just aren’t keeping up. However, for some children language development doesn’t follow the typical pathway. Red flags point us to things that are atypical in these children’s development. They are ‘early warning signs’ or things to watch out for.

Autism and Developmental Language Disorder (DLD)

People talk about red flags for autism and red flags for Developmental Language Disorder (DLD). These conditions start with delayed language but they are pervasive and persistent, continuing as children age. These are difficulties with language that continue beyond the early years.

Autistic children have difficulties with social communication and interaction. Often a language delay is involved but not necessarily. These children find interacting and using language purposively very difficult.

DLD refers to children who continue to find aspects of language very difficult. They may struggle with comprehension, or find it difficult to put sentences together, or to find words at the right time, or they may have grammatical difficulties, or problems with semantics (working out which words go with other words), or even have phonological difficulties (working out sounds). Children with DLD find all or parts of language very difficult.

Red flags for Autism

Under 12 months:

Less facial expressions than others
Limited eye contact
Lack of serve and return of actions (early turn taking may be absent)
Little or no babbling
Not using gestures from around 9 months (e.g. putting hands up to be picked up) or pointing
Not responding to their name

Over 12 months

Very few or no words
Lack of back and forth reciprocal communication.
They don’t point or use gestures to compensate for their lack of speech
Speech may regress (they may lose speech)
They may avoid eye contact

Red flags for DLD

Under 12 months:

Not reacting to sound as a baby
Not babbling
Difficulties with feeding
No imitation
Limited use of gesture

By 2 years

Minimal attempt to communicate
No first words
Difficulty following simple directions
Not consistently responding to no

Other problems which can also underlie these red flags (Hearing and Tongue Tie)

While it is important to be aware of these red flags, it is also important to keep in mind that they are not diagnostic in themselves. A child with other conditions may have similar red warning signs. For example, a child with tongue tie might not babble or a child with hearing loss might not babble reciprocally. Even an intermittent hearing loss for example glue ear can have an impact not just on words and sounds but also on the desire to take part in backwards and forwards communication. It is always worth getting these potential issues checked out.

Tongue ties are sometimes identified and snipped early on if they are preventing an infant from breastfeeding. However they are often missed and their impact on speech underestimated and dismissed by health professionals. Health professionals are often under skilled in this area. To find someone skilled in identifying and treating tongue tie in your area (often an ENT consultant or dentist) go to Tongue Tie UK (www.tongue-tie.org.uk) and enter your location. It is important to access the right team as it can be a very different journey depending on who you see.

Some children can carry on with little effects from a tongue tie while for others it really stops language development and impacts on their speech sounds when they do start talking. It is useful to look at pictures of children with tongue tie so you can compare your own child’s mouth. It is not sufficient that your child can stick their tongue out. Ask them to open their mouth wide and see if they can touch the top of their mouth with their tongue.

What can you do if you are seeing these ‘red flags’?

It is important is to recognise ‘red flags’ so you can begin to put strategies in place to help your child. Even if they are genetically or neurologically predisposed for speech to be difficult long term, putting strategies in place early on will maximise their potential and give them the best chance of making progress with their language.

Often signs are picked up around 2 years old but if you can be vigilant and recognise these symptoms as early as 16 to 18 months and put support for language development in place, encouraging that very early interaction, that to-ing and fro-ing, then you will help your child to begin to develop sounds. Those really early foundations around interaction are so important. It is amazing how children can learn when direct action is taken to build their communication skills.

However, the big take away message is, although you should be vigilant for red flags and seek out local services and get your child’s name on appropriate waiting lists (UK waiting lists, certainly are long), don’t over worry about the future. The now is where we are and the now is where we can help. It is very easy to get carried away with worrying about what the future holds but the only place we can effect change is in the present. Sitting worrying, looking for help and taking no action is not going to benefit your child but putting strategies in place to support them now can have a longer term beneficial impact. Focus on what you can do to support your child’s language development now. Make every interaction count!

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