• Parent concern about child's developmental progress
    • Diagnosed physical or mental condition or disorder that has a high probability of resulting in developmental delay - regardless of whether the child has a demonstrated need or dealy
    • Delays in meeting developmental milestones
    • Lack of eye contact
    • Unusual or repetitive play schemes
    • Loud or unusual vocal patterns
    • Extreme sensory (touch, movement) aversions or repetititve seeking of sensory input
    • No back & forth gestures - pointing, showing, reaching or waving by 12 months
    • Poor attention span
    • Behavioral concerns
    • No speech, or few words, compared to other children of same age
    • Unintelligible speech
    • Any loss of speech or babbling or social skills at any age
    • Inability to follow simple instructions
    • Poor balance, clumsiness, weakness
    • Atypical muscle tone (too tight or too floppy in arms, legs, or trunk
    • Prematurity (birthweight at 1500 grams or less, 3lbsd 5oz.)
    • Hearing and/or vision problems
    • High lead level
    • Failure to thrive
    • Suspected Autism Spectrum Disorders (see following for checklist and red flags)

    The above concerns should be taken seriously, prompting further investigation and referral to immediate evaluation.

    Concerns about social reciprocity such as ...

    By 4 months

    • Not turning toward sounds
    • Not showing interest in people's faces

    By 6 months

    • No big smiles or no expressions of joy
    • No cooing when happy or crying when unhappy

    By 9 months

    • No exchanging back & forth smiles and sounds with family members
    • No back & forth gestures such as giving, taking, and reaching

    By 12 months

    • Not responding when name is called
    • No babbling such as "ma" "ba" "da" "ga"

    By 15 months

    • No pointing gestures to draw attention to something of interest
    • Not using or understanding at least three words such as "mama" "dada" "bye-bye"

    By 18 months

    • No purposeful pretend play such as feeding a doll or stuffed animal
    • Not indicating familiarity with family names or body parts

    By 24 months

    • No two-word meaningful phrases (without imitating)
    • Not showing enjoyment in playing with children of the same age

    By 36 months

    • Not answering simple questions such as "what" "when" "who"
    • Not showing enjoyment in playing with the children of the same age

    Refer for immediate evaluation:

    • No big smiles or other warm, joyful expressions by 6 months or thereafter
    • No back & forth sharing of sounds, smiles or other facial expressions by 9 months or thereafter
    • No babbling by 12 months
    • No words by 16 months
    • No two-word meaningful phrases (without imitating or repeating) by 24 months
    • ANY loss of speech or babbling or social skills at ANY age