Why I Stopped Using the Terms "Red Flags" and "Warning Signs"

When I was in graduate school, I was taught about all of the “red flags” for speech and language disorders. If you search the term “red flags for speech and language issues”, you will get results with many resources from well-respected organizations. You’ll find articles telling parents and caregivers the “red flags” for Autism and ADHD, the warning signs for speech and language delay, “red flags” for apraxia, etc., the list is rather long. I used to throw these terms around early in my practice as an SLP. 5 years later, you will not hear me use those terms when describing a child’s speech and language skills, and I encourage others to give it a try.

Why? That’s because the language that we use to describe things matter greatly.

If you search the definition of the term “red flag” you will get “something used as a warning of danger”.

We do not say that when your child is crying and reaching towards their bottle, it is a “red flag” that they are hungry… they are expressing a need for food. We do not say that a child who is closing their eyes and nodding their head is expressing the “warning signs” of tiredness. They are simply showing behaviors that they need a nap. And as caregivers, when we see children doing these things, we respond to these needs quickly and appropriately.

So why is it that professionals use this term to describe a child who is showing the need for speech or language supports? For example…

Why say that a child who is not making eye contact, responding to their name, and who is lining up toys, is showing “red flags” of Autism? Instead, we should be supportively telling caregivers that their child may be Autistic. That the earlier that we get an evaluation, the sooner we can ensure that they thrive with the needs and supports that will benefit them the most. Another example that I see so often, is the 8-year-old child who is already frustrated with school every day, and who is not yet reading. Why do we often say that this child is showing “red flags” for Dyslexia? As if Dyslexia is a “dangerous” identity that needs to be avoided? Instead, I prefer to tell a parent that their child who hates books and cannot read, is struggling because we are not yet providing them what they need to thrive in the classroom. Let’s find out as soon as possible and get the supports they need as quickly as possible (the same way that we would get a hungry child a snack as quickly as we could).

We cannot in one breath use fearful language such as “red flag” to describe a child’s language needs to a parent, and then in the next breath tell them that “there is nothing wrong with their child”, “they shouldn’t worry” and that they can trust us to help support them through the process.

While I never used the terms often, about two years ago, I made a choice to stop using “red flags” and “warning signs” completely. and now use language such as indicators, displays, or signs.

Example:

“I have worked with M for 2 months now. I am seeing some indicators that she has Autism such as (specific examples). I think that to better understand her needs and to continue to support her progress that we are already seeing in the most successful way, we should get an evaluation as soon as possible!"

How “fresh outta grad school” Shayna would have said it:

"I am not the professional who diagnoses it, and I really can’t be sure until you talk to your doctor so my intention is not to scare you but M is showing some things that we consider a red flag for autism such as (example) and I think it would be good if they got an eval” (super comforting, right?)

When I made that switch, many things changed in my professional practice, for the better. Here are just a few:

1. As a “newby” professional, I was terrified to tell parents that their child could be Autistic, that they may never have verbal speech, that their kid could have ADHD, that their kid could be Dyslexic, etc. Even though I knew that these weren’t things to be afraid of, I didn’t want to upset anyone. I do not experience this same sense of fear anymore, because I know that I am simply just telling a parent what their child might need and what they might benefit from and I am not delaying this process.

2. I am 10000x more successful as a professional, the kids I worked with are 10000x more successful, and parents/caregivers were 10000x are frustrated (actual statistics, obviously). OK, So I don’t have the exact figures and charts to show you the data here, but I can ensure you that all around, everyone does better, feels better, and trusts each other more. I now see a noticeable difference in my client’s self-confidence and more positive perceptions of themselves. I became more confident and supportive as a therapist… parents are able to provide more purposeful feedback about what is working and what is not working without feeling it is their “fault”…I could go on for a while here. Why are these things happening? I would say it is because nobody is being “red flagged” away from discovering the exact thing that a child needs to succeed.

3. Some other professionals who I work with, such as Occupational Therapists/Physical Therapists, teachers, and pediatricians started to “copy” my method, which reduced frustration and increased positive perceptions and outcomes through our team-based approach.

I want to emphasize that I am not saying that caregivers will not worry about a speech and language difficulty just because we eliminate the term “red flag”. If you are a parent reading this, please know these concerns and frustrations are expected, justified, and normal. I will equally emphasize that regardless of what speech/language “label” “disability”, “delay”, or “disorder” your child may have... and although it might look “different”... they will have the opportunity to communicate, read, think, play, love others, love themselves, make friends, and succeed just the same as the child without those difficulties when given the supports that they deserve.

I believe that it is up to professionals in this field to purposefully think of the language that we use and the consequences that it has... whether they are positive or negative, and regardless of if they are intentional or non-intentional. Let’s save “red flags” for warnings about big waves in the ocean and dating advice…. and keep it out of the conversations we are using to tell a parent how to best give their child the speech and language supports that they need!