CRITERIA FOR SPEECH AND LANGUAGE EVALUATION — Children with any of the criteria listed below should be referred for a speech and language assessment:

• Concern by the parent, teacher, professional, or other caregiver about the child's speech or language
• Slowed or stagnant speech and language development
• Excessive drooling
• Difficulty sucking, chewing, or swallowing
• Difficulty coordinating movements of lips, tongue, and jaw
• No babbling by nine months
• No first words by 15 months
• No consistent words by 18 months
• No word combinations by 24 months
• Speech is difficult for parents to understand at 24 months
• Speech is difficult for strangers to understand at 36 months
• Dysfluencies (stutters) consist of more than tension-free whole-word repetitions
• Child is frustrated by communication difficulty
• Child is teased by peers for "talking funny"
• Child avoids talking situations
• Child acquires vocabulary and sentence structure but does not use language appropriately for communicative purposes
• Language is unusual or confused, or ideas are not expressed clearly
• Child cannot follow instructions without supplemental visual cues
• Loss of milestones
• Poor memory skills at five to six years