San Diego Center For Speech Therapy & Occupational Therapy
“Helping children communicate, build friendships, and succeed!”
Office (858) 488-4810 / Fax (858) 746-4113
EMAIL: [email protected] WEBSITE:SanDiegoCenterForSpeechTherapy.com
Grade
RED FLAGS
***THE FOLLOWING ARE “RED FLAGS” THAT WARRANT A REFERRAL TO A SPEECH-LANGUAGE PATHOLOGIST OR OCCUPATIONAL THERAPIST***
An SLP works on speech, language, and social skills while an OT works on motor and sensory skills. View our website for more details.
If your observe any of these behaviors in your child or student at the ages listed, a referral to an SLP or OT is important:
Preschool
(ages 3-5)
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Misuse of personal pronouns “I” (e.g., “Me like it”)
Speaks in sentences of 4 words or less
Cannot answer Yes/No or WH questions appropriately
Does not use the prepositions “in”, “on”, “under”
Does not use present progressive verb form (e.g., child says “He run” instead of “He is running”)
Does not use plural nouns (e.g., “cat” instead of “cats”)
Speech errors on any of the following sounds: P, B, M, N, H, W, F, Y, T, D, K, G
Shows a lateral lisp on S, Z, J, SH, or CH, in which the speech sounds “slushy”
Leaves out sounds in words
Difficult for parents and strangers to understand
Sits with mouth open and/or sits with tongue forward between the teeth
When speaking, repeats entire words or parts of words (“D-d-d I need my p-p-pencil?”), prolongs sounds in words (“Mmmmmy mommy’s at home”)
Physical signs of struggle when talking such as hand flapping, clenching, mouth exaggerations or tension
Any signs of frustration or aggression when talking
By age 3-4: Does not follow 2 step directions without cues; Is not identifying colors; not matching 1:1; not able to point to an object that is different from others
By age 4-5: Does not follow 3 step directions without cues; Does not understand the concepts: yesterday, today, tomorrow, first, then, next, days of the week, last week, next week,
different, nearest, through, thin, whole, first, middle, last; Does not attend to a short story and answer simple questions about it; does not understand most of what is said at home and
in school
 SOCIAL/PRAGMATICS: Does not take turns and play cooperatively; does not separate easily from caregiver; unable to express ideas and feelings; unable to relate personal
experience through verbalization; By the age of 4-5: does not use words to invite others to play; does not use language to resolve disputes with peers; does not have relatively good
control of the elements of conversation; unable to speak of imaginary conditions such as “What if ...” or “I hope ...”
 LITERACY: By the age of 3-4, does NOT identify some letters and makes some letter/sound matches; By the age of 4-5, does NOT know many letter names
 OCCUPATIONAL THERAPY RELATED SKILLS:
 Before age 3:
 Does not scribble
 Does not make a 6 block tower with big blocks
 Does not enjoy exploring different textures (play dough, paint, sand)
 Does not take a bite off a sandwich/ eat only certain textures
 Does not scoop with spoon independently with minor spilling
 Does not listen to a song or a short story (2-3 minutes)
 Does not help in dressing self (pull off socks, pull pant on and off, help with shirt)
 Does not jump up and down
 By age 3-4:
 Cannot copy a circle, vertical and horizontal lines
 Does not imitate hand movements to familiar songs (the wheels on the bus, Itsy-Bitsy spider etc)
 Does not show a preferred hand for fine motor, feeding activities
 Does not attempt to use a tripod grasp on writing utensils
San Diego Center For Speech Therapy And Occupational Therapy: Office (858) 488-4810; EMAIL: [email protected]; WEBSITE:www.SanDiegoCenterForSpeechTherapy.com
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Kindergarten
(ages 5-6.7)
First Grade
(ages 6-7.7)
Does not cut on line with scissors
Does not stand on one foot and balance for 3-5 seconds
By age 4-5:
Cannot draw a square and start to imitate triangle
Does not write own name independently
Does not attend in circle time for 7-10 minutes
Does not skip with alternating legs
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Any red flags from previous grade level
Unable to talk about a recent event
Does not use complex sentence structure, such as compound sentences (the word “and” to join two sentences), adjectives, and prepositional clauses (i.e., location sentences such as,
“the cat is behind the chair”)
 Difficulty categorizing or sorting
 Difficulty with quantity and time/sequence concepts
 Does not show interest in and start conversations
 Unable to follow 3-step directions
 Speech errors on any of the following sounds: P, B, M, N, H, W, F, V, Y, T, D, K, G, L
 Shows a lateral lisp on S, Z, J, SH, or CH, in which the speech sounds “slushy”
 At the age of 6: has a frontal lisp (tongue sticks out) for any of the following sounds: S, Z, SH, CH, J
 Omits sounds in words or consonant blends
 Is difficult to understand (most people should be able to understand the child; speech should be 90%-100% intelligibile by the age of 5)
 Sits with mouth open and/or sits with tongue forward between the teeth
 When speaking, repeats entire words or parts of words (“(“I need to…to…to...to go the bathroom”), prolongs sounds in words (“Mmmmmy mommy’s at home”)
 Physical signs of struggle when talking such as hand flapping, clenching, mouth exaggerations or tension, face squishing
 Any signs of frustration or aggression when talking
 By the end of Kindergarten does NOT: answer simple "yes/no" question or open-ended questions (e.g., "What did you have for lunch today?"); Does not retell a story or talk about an
event; participate appropriately in conversations; print own first and last name; draw a picture that tells a story and label and write about the picture; write upper- and lowercase letters
(may not be clearly written); understand opposite concepts such as big/little, over/under; understand left/right; understand number concepts up to 20; answer “How are things the
same/different?”; use adjectives for describing; use yesterday and tomorrow; does not use concepts backward and forward; does not use prepositions through, nearest, corner, middle;
name ordinal numbers, such as first, second, third
 SOCIAL/PRAGMATICS: By the age of 5-6 does NOT: Begin to use word play; Ask meanings of words; Like to complete projects; Ask questions for information; Choose own
friends; Take more care in communicating with unfamiliar people; Engage in cooperative play such as making group decisions, assigning roles, and playing fairly; Announce topic
shifts
 LITERACY: At the beginning of Kindergarten does NOT: recognize letters and letter-sound matches; understand that print is read left to right and top to bottom; retell simple stories;
begin to write letters and some words heard often; begin to write stories with some readable parts with assistance; try to spell words when writing. By the end of Kindergarten does
NOT: understand that spoken words are made up of sounds; recognize some words by sight; identify words that rhyme; Understand that letters represent speech sounds and match
sounds to letters; Imitate reading by talking about pictures in a book; identify and write uppercase and lowercase letters; “read” a few picture books from memory; print own first and
last name; Draw a picture that tells a story and label and write about the picture; Write upper- and lowercase letters (may not be clearly written)
 OCCUPATIONAL THERAPY RELATED SKILLS:
 By the age of 5-6:
 Does not throw and catch small balls (tennis balls)
 Does not cut, past and color inside lines
 Does not understand and remember 3 step patters (blue, yellow, green, blue yellow, green…)
 Does not follow verbal direction given by adult to a group of kids
 Shows difficulties with working independently on a task for 10-15 minutes
 Needs multiple verbal and visual directions to complete activity
 Any red flags from prior grade levels
 Cannot follow multiple step (3+) directions in a sequence
 Cannot retell stories using specific details
 Unable to answer questions about a short story
San Diego Center For Speech Therapy And Occupational Therapy: Office (858) 488-4810; EMAIL: [email protected]; WEBSITE:www.SanDiegoCenterForSpeechTherapy.com
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Second
Grade
(ages 7-8.7)
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Third Grade
(ages 8-9.7)
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Fourth
Grade
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Speech is not easy to understand for family members and strangers
Speech errors on any of the following sounds: P, B, M, N, H, W, F, Y, T, D, K, G, L, S, Z, SH, CH; by the age of about 6.5 years old, the child should be producing the R sound
correctly
Drops the L sound or replaces it for another sound in consonant blends (e.g., play = “pay” or “pway”)
Shows a lateral lisp on S, Z, J, SH, or CH, in which the speech sounds “slushy”
Shows a frontal lisp (tongue sticks out) for the S, Z, SH, CH, J sounds
Sits with mouth open and/or sits with tongue forward between the teeth
Whole word repetitions (“I need to…to…to...to go the bathroom”), Part word repetitions (“D…d…d…do I need my p…p…p…pencil”), Prolongations of sounds (“Mmmmmmmy
mommy’s at home”) , Physical signs of struggle (hands flapping/clenching, face squishing)
By the end of First Grade does NOT: tell and retell stories and events in a logical order; express ideas with a variety of complete sentences; use most parts of speech (grammar)
correctly; ask and respond to "wh" questions (who, what, where, when, why); stay on topic and take turns in conversation; start conversations
LITERACY: Beginning of First Grade does NOT: Identify an increasing number of words by sight; begin to decode new words independently; use a variety of reading strategies
such as rereading, predicting what will happen, asking questions, or using visual cues or pictures; Read and retell familiar stories; Read aloud with ease; Decide independently to use
reading and writing for different purposes; Sound out and represents major sounds in words when trying to spell; Try to use some punctuation and capitalization. By the end of First
Grade does NOT: identify letters, words, and sentences; Have a sight vocabulary of 100 words; understands what is read; create rhyming words; reads grade-level material fluently;
express ideas through writing; print clearly; spell frequently-used words correctly; begin sentences with capital letters and attempt to use punctuation; write a variety of stories, journal
entries, or notes
Any red flags from prior grade levels
Difficulty following 4 oral directions in a sequence
Speech is difficult for strangers to understand
Errors of any sounds other than /th/ - by the age of 8 years, the child should be correctly producing the TH sound
Drops or replaces a sound in consonant blends
Sits with mouth open
Sits with tongue forward between the teeth
Whole word repetitions (“I need to…to…to...to go the bathroom”), Part word repetitions (“D…d…d…do I need my p…p…p…pencil”), Prolongations of sounds (“Mmmmmmmy
mommy’s at home”) , Physical signs of struggle (hands flapping/clenching, face squishing)
By the end of second grade does NOT: Follow 3-4 oral directions in a sequence; Understand direction words (e.g., location, space, and time words); Correctly answer questions about a
grade-level story; Answer more complex "yes/no" questions; Ask and answer "wh" questions (e.g., who, what, where, when, why); Use increasingly complex sentence structures;
Clarify and explain words and ideas; Give directions with 3-4 steps; Use oral language to inform, to persuade, and to entertain; Stay on topic, take turns, and use appropriate eye
contact during conversation; Open and close conversation appropriately
LITERACY: By the end of second grade does NOT: Have fully mastered phonics/sound awareness; Associate speech sounds, syllables, words, and phrases with their written forms;
Recognize many words by sight; Use meaning clues when reading (e.g., pictures, titles/headings, information in the story); Reread and self-correct when necessary; Locate
information to answer questions; Explain key elements of a story (e.g., main idea, main characters, plot); Use own experience to predict and justify what will happen in grade-level
stories; Read, paraphrase/retell a story in a sequence; Read grade-level stories, poetry, or dramatic text silently and aloud with fluency; Read spontaneously; Identify and use spelling
patterns in words when reading; Write legibly; Use a variety of sentence types in writing essays, poetry, or short stories (fiction and nonfiction); Use basic punctuation and
capitalization appropriately; Organize writing to include beginning, middle, and end; Spell frequently used words correctly; Progress from inventive spelling (e.g., spelling by sound)
to more accurate spelling
There should be no articulation errors; all speech sounds should be produced correctly; Misarticulation of any sound warrants a referral at this level
Sits with mouth open and/or sits with tongue forward between the teeth
Speech is difficult to understand, unclear, voice is inappropriate
Whole word repetitions (“I need to…to…to...to go the bathroom”), Part word repetitions (“D…d…d…do I need my p…p…p…pencil”), Prolongations of sounds (“Mmmmmmmy
mommy’s at home”) , Physical signs of struggle (hands flapping/clenching, face squishing)
By the end of third grade does NOT: Listen attentively in group situations; Understand grade-level material; Ask and respond to questions; Participate in conversations and group
discussions; Use subject-related vocabulary; Stay on topic, use appropriate eye contact, and take turns in conversation; Summarize a story accurately; Explain what has been learned
LITERACY: By the end of third grade does NOT: demonstrate full mastery of basic phonics; Use word analysis skills when reading; Use clues from language content and structure to
help understand what is read; Predict and justify what will happen next in stories and compare and contrast stories; Ask and answer questions regarding reading material; Use acquired
information to learn about new topics; Read grade-level books fluently (fiction and nonfiction); Reread and correct errors when necessary; Plan, organize, revise, and edit; Include
details in writing; Write stories, letters, simple explanations, and brief reports; Spell simple words correctly, correct most spelling independently, and use a dictionary to correct
spelling; Write clearly in cursive
Any red flags from prior grade levels
Speech should be clear, no articulation errors; voice should be appropriate
San Diego Center For Speech Therapy And Occupational Therapy: Office (858) 488-4810; EMAIL: [email protected]; WEBSITE:www.SanDiegoCenterForSpeechTherapy.com
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(ages 9-10.7)
 Challenges expressing oneself; repeats words or parts of words
 Sits with mouth open and/or sits with tongue forward between the teeth
 Words are not used appropriately in conversation
 Does not use language effectively for a variety of purposes
 Does not participate in group discussions
 Has a hard time giving accurate directions to others
 Does not listen and understand information presented by others (including in the classroom); does not listen for specific purposes
 Has difficulty following written directions
 By the end of fourth grade does NOT: Form opinions based on evidence; Understand some figurative language; Summarize and restate ideas; Organize information for clarity; Use
subject area information and vocabulary (e.g., social studies) for learning; Make effective oral presentations
 LITERACY: By the end of fourth grade does NOT: Read for specific purposes; Read grade-level books fluently; Use previously learned information to understand new material;
Follow written directions; Take brief notes; Link information learned to different subjects; Learn meanings of new words through knowledge of word origins, synonyms, and multiple
meanings; Use reference materials (e.g., dictionary); Explain the author's purpose and writing style; Read and understand a variety of types of literature, including fiction, nonfiction,
historical fiction, and poetry; Compare and contrast in content areas; Make inferences from texts; Paraphrase content, including the main idea and details; Write effective stories and
explanations, including several paragraphs about the same topic; Develop a plan for writing, including a beginning, middle, and end; Organize writing to convey a central idea; Edit
final copies for grammar, punctuation, and spelling
Fifth Grade
(ages 1011.7)
 Any red flags from prior grade levels
 Speech should be clear, no articulation errors; voice should be appropriate
 Challenges expressing oneself; repeats words or parts of words
 Sits with mouth open and/or sits with tongue forward between the teeth
 Does not maintain eye contact and use gestures, facial expressions, and appropriate voice during conversations and group presentations at school
 By the end of fifth grade does NOT: participate in class discussions across subject areas; Summarize main points; Report about information gathered in group activities
 LITERACY: By the end of fifth grade does NOT: Read grade-level books fluently; Learn meanings of unfamiliar words through knowledge of root words, prefixes, and suffixes;
Prioritize information according to the purpose of reading; Read a variety of literary forms; Describe development of character and plot; Describe characteristics of poetry; Analyze
author's language and style; Use reference materials to support opinions; Write for a variety of purposes; Use vocabulary effectively; Vary sentence structure; Revise writing for
clarity; Edit final copies
These are general guidelines, derived from a variety of sources.
***Do not hesitate to talk the Speech-Language Pathologist or OT with any questions or concerns about a particular child/student***
Goldman, R., & Fristoe, M. (2000). Goldman-fristoe test of articulation, 2nd edition (GFTA-2), Circle Pines, MN: American Guidance Service. Semel, E., Wiig, E., & Secord, W. (2003). Clinical evaluation of language fundamentals, 4th edition (CELF-4). Toronto, Canada: The Psychological Corporation.
Zimmerman, I., Steiner, V., & Pond, R. (2002). Preschool language scale, 4th edition (PLS-4). San Antonio, TX: Harcourt. Rev. August, 2012; ASHA.org; Linguisystems Communication Milestones Guide
San Diego Center For Speech Therapy And Occupational Therapy: Office (858) 488-4810; EMAIL: [email protected]; WEBSITE:www.SanDiegoCenterForSpeechTherapy.com
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