18 month communication red flags – Don’t worry, but don’t wait!

The people have spoken, and you want to know more about milestones. I wrote a blog post earlier this year about communication milestones and red flags at 24 months, so this week, we’re taking it back to 18 months. Our Facebook page featured some of the milestones on Monday (see below), but what are some of the signs that it’s time to seek some help from a speech-language pathologist?


Early On Michigan has a wonderful phrase, “Don’t worry, but don’t wait.” If you see some of these signs, it’s not time to worry! It’s just time to call for a little back up (and that’s OK). Remember, we look at the entire child, not just the number of words they say.

Some signs it’s time to seek assistance for your 18 month old:

  • Your child doesn’t point to things in a meaningful way (like a want or a need or to get attention).
  • They don’t seem to know familiar objects (very familiar ones – bottle, favorite toy, common foods, etc.).
  • Your child isn’t gaining new words.
  • They use less than 10 words.
  • Your child doesn’t imitate/copy things they see others doing.
  • They don’t follow simple 1-step directions.
  • Your child doesn’t respond to their name.
  • ANY REGRESSION – or the losing of a skill that the child once had. This is not to be confused with a “pause” in a skill. Sometimes, when kiddos are learning something new, they might get a little quiet for a few days. Immediately, their language skills come back (along with a newly acquired skill of some variety!). Regression means that a child had a skill set and then it went away and never came back.

The Next Steps

If you believe your child has one or more of these red flags, you have a few options. First, you can contact your pediatrician for a referral for an evaluation. They may be able to give you the names of speech therapists in the area that can evaluate your child. However, if your pediatrician is of the “wait and see” mindset, I strongly encourage you to remind them of the outdatedness of the “wait and see” approachIf that fails, branch out on your own to find a provider for an evaluationIf you’re not sure how to proceed, contact your friendly neighborhood speech-language pathologist and they will likely be very willing to help you!

One option is an independent private speech practice like Duncan Lake Speech Therapy. You may not need a doctor’s referral for a speech evaluation if you go to a private practice. If you are going to pay privately, you will certainly not need a doctor’s referral. If you want to use your insurance, you will probably need to find someone in network. That might require some prior authorization fancy-dancing, none of which I’m qualified to speak about as I do not currently take insurance. You’ll need to verify through them. Call the practice and schedule an evaluation.

Another option is to go through your state’s early intervention system. You also absolutely do not need a doctor’s referral to contact your state’s early intervention providers for an evaluation. In the state of Michigan, we have an extremely robust early intervention program called Early On. You can make a request online and someone from Early On will contact you about setting up a time for an evaluation and then services if your child qualifies. This is a free service through the state!

At the end of the day, what I want you to do is trust your gut. If you feel that your child may have a speech delay and they need an evaluation, there are plenty of ways to go about it. There is no harm in doing an evaluation, but there is lots of evidence to suggest that waiting is not beneficial if there is a problem.



  1. Shammy PetersonApril 2, 2023

    You got my attention when you said that when your child uses less than 10 words and isn’t gaining new words, you must consider consulting a speech pathologist. This is something that I will consider because my three-year-old daughter does not speak a lot and keeps using her fingers and hands to let us know what she wants. I want to make sure that she can undergo the necessary treatments as early as now, so I will keep your tips in mind.

  2. Sofia DavisSeptember 24, 2023

    “Reading this post took me back to when my little Jamie was 18 months old. We noticed a few of these signs and immediately consulted a speech therapist. It made a world of difference, reinforcing that it’s better to act than just wait!”


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