0-6 months

• Does not startle to or awaken to loud sounds or has been identified as hearing-impaired
  
• Does not respond to changes in tone of voice
  
• Has been identified with a neuro-developmental disorder or motor delay
  
  

9 months

• Is still making only vowel sounds, with no speech-like consonants (e.g., “aaa” instead of an occasional “mmm” or “bah”.)
  

12 months

• Is not babbling (saying “ba-ba-ba” or “dee-dee”)*
  
• Is not using eye gaze or gestures like pointing and showing, to communicate interests or needs*
  
• Has infrequent eye contact or little interest in interaction*
  
• Does not respond to own name, or common words like “no”, “bye-bye”, etc.
  
  

18 months

• Is not saying 10 single words
  (don’t have to be pronounced perfectly)

24 months

• Does not say at least 50 single words
  
• Is not combining words into two-word phrases* (e.g., “mommy go”,  “daddy ball”)
  
• Does not follow simple directions (e.g., “Roll the ball”)
  
• Does not point to named body parts or pictures

36 months

• Says only one or two words at a time (e.g., “kick ball” instead of “I kick ball to daddy”)
  
• Cannot answer “what” or “who” questions.
  
• Does not initiate conversations; speaks only when spoken to, or only repeats what others say*
  
• Strangers understand less than half of what child says
  

4 years

• Talks only about the “here and now” rather than events in the past and future, objects/people that are not present, etc
  
• Puts words in the wrong order in sentences, and /or leaves out little words (in, the, of) and word endings (-ing, -ed,–s)
  
• Does not follow two-step directions
  
• Cannot listen to 2-3 lines of a story and answer simple questions about it
  
• Speech is still hard to understand (i.e., many sound errors)

5 years

• Uses only 3-4-word sentences to talk about “here and now”
  
• Talks a lot, but does not engage in reciprocal conversation and/or make comments relevant to the situation*
  
• Cannot answer “how” and “why” questions, or questions about past or future events
  
• Except for r, l and th, cannot say most sounds correctly

*Signs of possible autism spectrum disorder