Developmental Red Flags for Children Ages 3-5 (page 3)
Social–Emotional Development, Which Includes
- Affect (mood)
- Anxiety level
- Impulse control
Be alert to a child who, compared with other children the same age or 6 months older or younger, exhibits these behaviors:
- Does not seem to recognize self as a separate person, or does not refer to self as “I”
- Has great difficulty separating from parent or separates too easily
- Is anxious, tense, restless, compulsive, cannot get dirty or messy, has many fears, engages in excessive self-stimulation
- Seems preoccupied with own inner world; conversations do not make sense
- Shows little or no impulse control; hits or bites as first response; cannot follow a classroom routine
- Expresses emotions inappropriately (laughs when sad, denies feelings); facial expressions do not match emotions
- Cannot focus on activities (short attention span, cannot complete anything, flits from toy to toy)
- Relates only to adults; cannot share adult attention, consistently sets up power struggle, or is physically abusive to adults
- Consistently withdraws from people, prefers to be alone; no depth to relationships; does not seek or accept affection or touching
- Treats people as objects; has no empathy for other children; cannot play on another child’s terms
- Is consistently aggressive, frequently hurts others deliberately; shows no remorse or is deceitful in hurting others
How to Screen
- Observe child.
- Note overall behavior. What does the child do all day? With whom? With what does child play?
- Note when, where, how frequently, and with whom problem behaviors occur.
- Describe behavior through clear observations. Do not diagnose.
- Note family history.
- Make-up of family: Who cares for the child?
- Has there been a recent move, death, new sibling, or long or traumatic separation?
- What support does the family have—extended family, friends?
- Note developmental history and child’s temperament since infancy.
- Activity level
- Regularity of child’s routine—sleeping, eating
- Intensity of child’s responses
- Persistence/attention span
- Positive or negative mood
- Adaptability to changes in routine
- Level of sensitivity to noise, light, touch
Motor Development—Fine Motor, Gross Motor, and Perceptual—Which Includes
- Quality of movement
- Level of development
- Sensory integration
Pay extra attention to children with these behaviors:
- The child who is particularly uncoordinated and who
- Has lots of accidents
- Trips, bumps into things
- Is awkward getting down/up, climbing, jumping, getting around toys and people
- Stands out from the group in structured motor tasks—walking, climbing stairs, jumping, standing on one foot
- Avoids the more physical games
- The child who relies heavily on watching own or other peoples’ movements in order to do them and who
- May frequently misjudge distances
- May become particularly uncoordinated or off balance with eyes closed
- The child who, compared to peers, uses much more of her or his body to do the task than the task requires and who
- Dives into the ball (as though to cover the fact that she or he cannot co- ordinate a response)
- Uses tongue, feet, or other body parts excessively to help in coloring, cutting, tracing, or with other high-concentration tasks
- Produces extremely heavy coloring
- Leans over the table when concentrating on a fine motor project
- When doing wheelbarrows, keeps pulling the knees and feet under the body, or thrusts rump up in the air
- The child with extraneous and involuntary movements, who
- While painting with one hand, holds the other hand in the air or waves
- Does chronic toe walking
- Shows twirling or rocking movements
- Shakes hands or taps fingers
- The child who involuntarily finds touching uncomfortable and who
- Flinches or tenses when touched or hugged
- Avoids activities that require touching or close contact
- May be uncomfortable lying down, particularly on the back
- Reacts as if attacked when unexpectedly bumped
- Blinks, protects self from a ball even when trying to catch it
- The child who compulsively craves being touched or hugged, or the older child who almost involuntarily has to feel things to understand them, who both may
- Cling to, or lightly brush, the teacher a lot
- Always sit close to or touch children in a circle
- Be strongly attracted to sensory experiences such as blankets, soft toys, water, dirt, sand, paste, hands in food
- The child who has a reasonable amount of experience with fine motor tools but whose skill does not improve proportionately, such as
- An older child who can still only snip with scissors or whose cutting is extremely choppy
- An older child who still cannot color within the lines on a simple project
- An older child who frequently switches hands with crayon, scissors, paintbrush
- An experienced child who tries but still gets paste, paint, sand, water everywhere
- A child who is very awkward with, or chronically avoids, small manipulative materials
- The child who has exceptional difficulty with new but simple puzzles, coloring, structured art projects, and drawing a person, and who, for example, may
- Take much longer to do the task, even when trying hard, and produce a final result that is still not as sophisticated compared to those of peers
- Show a lot of trial-and-error behavior when trying to do a puzzle
- Mix up top/bottom, left/right, front/back, on simple projects where a model is to be copied
- Use blocks or small cubes to repeatedly build and crash tower structures and seem fascinated and genuinely delighted with the novelty of the crash (older child)
- Still does a lot of scribbling (older child)
How to Screen
Note level and quality of development as compared with other children in the group.
Speech and Language Development, Which Includes
- Articulation (pronouncing sounds)
- Dysfluency (excessive stuttering—occasional stuttering may occur in the early years and is normal)
- Language (ability to use and understand words)
- Articulation. Watch for the child
- Whose speech is difficult to understand, compared with peers
- Who mispronounces sounds
- Whose mouth seems abnormal (excessive under- or overbite; swallowing difficulty; poorly lined-up teeth)
- Who has difficulty putting words and sounds in proper sequence
- Who cannot be encouraged to produce age-appropriate sound
- Who has a history of ear infections or middle ear disorders
Note: Most children develop the following sounds correctly by the ages shown (i.e., don’t worry about a 3-year-old who mispronounces t).
2 years—all vowel sounds
3 years—p, b, m, w, h
4 years—t, d, n, k, h, ng
5 years—f, j, sh
6 years—ch, v, r, l
7 years—s, z, voiceless or voiced th
- Dysfluency (stuttering). Note the child who, compared with others of the same age,
- Shows excessive amounts of these behaviors:
- repetitions of sounds, words (m-m-m; I-I-I-I-)
- prolongations of sounds (mmmmmmmmmmmmmmm)
- hesitations or long blocks during speech, usually accompanied by tension or struggle behavior
- putting in extra words (um, uh, well)
- Shows two or more of these behaviors while speaking:
- hand clenching
- eye blinking
- swaying of body
- pill rolling with fingers
- no eye contact
- body tension or struggle
- breathing irregularity
- pitch rise
- avoidance of talking
- Is labeled a stutterer by parents
- Is aware of her or his dysfluencies
- Shows excessive amounts of these behaviors:
- Voice. Note the child whose
- Rate of speech is extremely fast or slow
- Voice is breathy or hoarse
- Voice is very loud or soft
- Voice is very high or low
- Voice sounds very nasal
- Language (ability to use and understand words). Note the child who
- Does not appear to understand when others speak, though hearing is normal
- Is unable to follow one- or two-step directions
- Communicates by pointing, gesturing
- Makes no attempt to communicate with words
- Has small vocabulary for age
- Uses parrotlike speech (imitates what others say)
- Has difficulty putting words together in a sentence
- Uses words inaccurately
- Demonstrates difficulty with three or more of these skills:
- making a word plural
- changing tenses of verb
- using pronouns
- using negatives
- using possessives
- naming common objects
- telling function of common objects
- using prepositions
Note: Two-year-olds use mostly nouns, few verbs. Three-year-olds use nouns, verbs, some adverbs, adjectives, prepositions. Four-year-olds use all parts of speech.
How to Screen
- Observe child. Note when, where, how frequently, and with whom problem occurs.
- Check developmental history—both heredity and environment play an important part in speech development.
- Look at motor development, which is closely associated with speech.
- Look at social–emotional status, which can affect speech and language.
- Write down or record speech samples.
- Check hearing status.
- Note number of speech sounds or uses of language.
Even a mild or temporary hearing loss in a child may interfere with speech, language, or social and academic progress. If more than one of these red flag behaviors is observed, it is likely that a problem exists.
- Speech and language. Look for the child
- Whose speech is not easily understood by people outside the family
- Whose grammar is less accurate than other children of the same age
- Who does not use speech as much as other children of the same age
- Who has an unusual voice (hoarseness, stuffy quality, lack of inflection, or voice that is usually too loud or soft)
- Social behavior (at home and in school). Look for the child who
- Is shy or hesitant in answering questions or joining in conversation
- Misunderstands questions or directions; frequently says “huh?” or “what?” in response to questions
- Appears to ignore speech; hears “only what he wants to”
- Is unusually attentive to speaker’s face or unusually inattentive to speaker, or turns one ear to speaker
- Has difficulty with listening activities such as storytime and following directions
- Has short attention span
- Is distractible and restless; tends to shift quickly from one activity to another
- Is generally lethargic or disinterested in most day-to-day activities
- Is considered a behavior problem—too active or aggressive, or too quiet and withdrawn
- Medical indications. Look for the child who
- Has frequent or constant upper respiratory tract infections, congestion that appears related to allergies, or a cold for several weeks or months
- Has frequent earaches, ear infections, throat infections, or middle ear problems
- Has had draining ears on one or more occasions
- Is mouth breather and snorer
- Is generally lethargic; has poor color
How to Screen
- Observe current behavior related to speech and hearing.
- Consult behavioral and medical history.
- Consult audiologist or communication disorders specialist.
Vision, Which Includes
- Acuity (ability to see at a given distance)
- Are watery
- Have discharge
- Lack coordination in directing gaze of both eyes
- Are red
- Are sensitive to light
- Appear to cross or wander, especially when child is tired
- Have crusts on lids or among lashes
- Are red
- Have recurring sties or swelling
- Behavior and complaints
- Rubs eyes excessively
- Experiences dizziness, headaches, nausea on close work
- Attempts to brush away blur
- Has itchy, burning, scratchy eyes
- Contorts face or body when looking at distant objects, or thrusts head forward; squints or widens eyes
- Blinks eyes excessively; holds book too close or too far; inattentive during visual tasks
- Shuts or covers one eye; tilts head
How to Screen
- Has child had an eye exam? If not, recommend one.
- Screen using a screening tool appropriate for young children, such as the Snellen E chart or Broken Wheel cards.
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