Which finding at 18 months is a red flag for language development?

• A. Absence of single words
• B. Speaks in full sentences
• C. Frequent pointing with no words
• D. Uses two-word phrases

Answer: (A)

At 18 months, language development hinges on the emergence of real words in addition to gestures. A child at this age should have begun using single words to name familiar people or objects and to request or label things. When there is an absence of any single words by 18 months, it signals expressive language delay and higher risk for broader communication challenges. This finding typically prompts further evaluation, such as developmental screening and possibly a referral to a speech-language pathologist, to determine if there’s a need for early intervention.

Saying full sentences is not expected at this age and would indicate more advanced development. Two-word phrases are usually emerging in the latter part of the second year, so this isn’t itself a red flag for a child who is starting to speak single words. Frequent pointing with no words reflects reliance on nonverbal communication, which can be concerning, but the lack of any spoken words at this age is a clearer and more definitive red flag that warrants timely assessment.