Early Warning Signs

All children develop at different rates and in different ways. Some children are born with special needs that can affect their growth and development. Other children may not show developmental problems, delays, or differences until later in childhood. Fortunately, many of these children can get the support they need to reach their potential if parents and child care providers recognize the signs of special needs and seek help early on.

General Behavior

Some behaviors may be causes for concern or just part of the child’s temperament or personality. The following behaviors should be looked at in light of the whole child.

• By six months of age, avoids being held or talked to, or resists being soothed or comforted.
• Does not pay attention or stay focused on an activity for as long a time as other children of the same age.
• Avoids or rarely makes eye contact with others.
• Gets unusually frustrated when trying to do simple tasks that most children of the same age can do.
• Often acts out; appears to be very stubborn or aggressive.
• Acts extremely shy or withdrawn.
• Does not like being touched.
• Does not like having certain types of materials or clothing next to the body.
• Treats other children, animals, or objects cruelly or destructively.
• Tends to break things a lot.
• Displays violent behavior (tantrums, fighting, screaming, or hitting other children) on a daily basis.
• Stares into space, rocks body, or talks to self more than other children of the same age.
• Often bangs head against an object, floor or wall.
• Does not recognize dangerous situations, such as walking in traffic or jumping from high places.
• Tends to be sick often; complains of headaches or stomachaches.
• Has sleeping, feeding, eating or toileting problems.
• Is overly impulsive, active, or destructible.
• Does not respond to discipline as well as children of the same age.
• Has difficulty putting thoughts, actions and movements together.
• Does not seek approval from parent of child care provider.

Hearing

• Has frequent earaches.
• Has had many ear, nose or throat infections or allergies.
• By four months, does not look at the source of sounds or voices or react to loud noises.
• Talks in a very loud or very soft voice.
• Seems to have difficulty responding when called from across the room, even when it is for something interesting.
• Turns body so that the same ear is always turned towards a sound.
• Breathes through mouth.
• Has difficulty understanding what is said.

Moving

• Has stiff arms or legs.
• Has floppy or limp body posture.
• Uses one side of the body more than the other.
• Has poor coordination or moves in a disorganized, clumsy manner compared with other children of the same age.
• At three months, still has difficulty holding head up.
• By age one, has difficulty sitting without help, standing up, reaching for objects, or picking up objects with thumb and index finger.
• By age two, has difficulty walking without help, kicking a large ball, scribbling, or building a tower with two or three blocks.
• By age three, has difficulty walking up or down stairs, running without falling frequently, or turning pages of a book.
• By age four, has difficulty with such activities as standing on one foot, jumping from a bottom step, pedaling a tricycle, catching a large bounced ball, closing a fist, or wiggling a thumb.
• By age five, has difficulty skipping using alternate feet, pumping self on a swing, or cutting with scissors.

Seeing

• Rubs eyes frequently.
• Seems to have difficulty following objects or people with eyes.
• Has reddened, watering, or crusty eyelids.
• Holds head in a strained or unusual position when trying to look at an object.
• Has difficulty focusing or making eye contact.
• Seems to have difficulty finding or picking up small objects dropped on the floor.
• Closes one eye when trying to look at distant objects.

Communicating

• By age six months, rarely cooing or gurgling.
• Is usually quiet.
• Does not shake head no.
• By age one, does not understand first words, such as milk, bottle, or bye-bye.
• By age one, does not say mama or dada.
• By age two, rarely names family members and/or common objects.
• By age two, does not speak in two word phrases.
• By age two, does not point to objects or people to express wants or needs.
• By age three, does not know last name, gender or common rhymes.
• By age three, does not follow simple directions or speak in three or four word sentences.
• By age four, does not tell stories, either real or make-believe, or ask frequent questions.
• By age four, does not speak in four or five word sentences and has speech that is not understandable by adults.
• By age five, does not know age and cannot answer who, what, where, when or why questions or use various types of sentences.

Thinking

• By age one, has a hard time figuring out simple problems, such as finding an object after seeing it hidden.
• By age two, does not identify simple body parts by pointing, match similar objects, or recognize self in mirror.
• By age three, does not understand simple stories and ideas.
• By age three, does not understand simple mathematical concepts such as one, more, less, or count 1-2-3.
• By age four, does not give correct answers to questions, such as What do you do when you are sleepy or hungry?
• By age four, cannot tell the difference between shapes or colors.
• By age five, does not understand the concepts of today, tomorrow, or yesterday.

Playing

• By three months, does not coo or smile.
• By age one, does not play games like peek-a-boo or pat-a-cake or wave bye-bye.
• By age two, does not imitate parent or provider doing routine tasks such as washing dishes, cooking or going to work.
• By age three, tends to play alone more than with other children.
• By age three, does not play purposefully, or intimates play through pushing and hitting.
• By age three, does not interact with adults and children outside the family.
• By age four, does not play make believe games and group games such as hide-and-seek with other children.
• By age five, does not share or take turns.
• By age five, does not express concern or compassion, when appropriate.
• By age five, does not show off occasionally.

Risk Factors

The following situations place children at greater risk for health and developmental difficulties:

• Prematurity and/or low birth weight.
• Prenatal or other exposure to drugs, alcohol or tobacco.
• Violence in the community or home.
• Poor nutrition.
• Family stress (i.e., poverty, poor housing, homelessness, death in the family)

The early warning signs described herein are only a few of the indicators that a child may need further observation and assessment. If, for any reason, you suspect that your child or a child in your care may have special needs, we urge you to seek help immediately. The period from birth to age three is the best time to help the child and you may prevent more serious problems from occurring later. DON’T WAIT until the child enters kindergarten before you ask for assistance. Call the local school district or the special education program of the county office of education. Representatives of those agencies may schedule an assessment to see if the child qualifies for services. Parents must give written permission for the child to be tested and receive special education. All services are confidential and provided at no cost to the family.
For concerns regarding children birth to age three, call the California Department of Developmental Services at 1-800-515-BABY (2229). You will be provided with information on resources in your local community or your Family Resource Center for parent-to-parent support.