Home Private Practice What Does It Mean if a Child Doesn’t Respond to Their Name?

What Does It Mean if a Child Doesn’t Respond to Their Name?

by Jasna Cowan
Cute little Asian toddler baby boy play with colorful wooden pyramid toy / stacking ring toy. Kid playing with educational toy isolated on white wall,

Speech-language pathologists working in early intervention often consider a young child’s lack of response to their name as a potential sign of autism spectrum disorder (ASD). It can also be an indicator of issues with receptive language skills.

 Sometimes, the parent reports their child does respond to their name, but you notice otherwise. So we need to dig beyond just asking the parent whether they feel like their child responds to their name.

The first step when identifying a child is not responding to their name (or other sounds) involves a referral to audiology. Ruling out a hearing loss is vital and the first step in the process of evaluation. If results from an audiology evaluation indicates normal hearing, here are some tips to figure out what’s happening.

Here’s the thing—kids might respond at some times, but not at others. One of the challenges experienced by young kids, especially those with ASD, is generalization of skills. Performing a skill—like responding to their name—in a session is different from doing the same in various locations and with a variety of people. So what should SLPs consider when looking for response to name in early-intervention clients and how do we explain this to parents?


Eustachian tube dysfunction combined with otitis media with effusion can raise the risk of speech and language delay. 
Delayed talking alone is not considered a risk factor for autism. So what accounts for high rates of language impairment in the disorder?
When a child who is deaf or hard of hearing also presents with autism symptoms, what can audiologists do to promote appropriate care?

SLPs need to determine if the child needs assistance with this skill or not, as well as if it is a sign of ASD. These insights work for me when evaluating a young child’s response to name:

Even during sessions, a child might focus so much on a particular type of activity or favorite toy that they tune out their name. A child who likes organizing, stacking or lining up objects, for example, might not respond to their name while in the process of this type of play.

A child might ignore their name or parent’s verbal cues during active play. Some kids don’t respond to their name while participating in movement. When climbing, running and jumping the child gets so focused on movement that they dismiss an adult calling their name.

I don’t solely rely on parent report to find out if a child responds to their name. I’ve evaluated thousands of children where their parent reported the child could perform this skill consistently.

Let the child play with a preferred toy during an evaluation and ask the parent to call their child’s name—preferably from behind because sometimes parents use visual cues along with calling the name. If the child responds to their parent, ask another adult to call them as a second source of data.

I think it’s important for parents to see for themselves what we want to happen in evaluating response to name. If you can set up a few moments in an evaluation or in a session where the child practices their response, this helps the parents understand what you expect and what you’re looking for in this aspect of an evaluation.

Defining the skill more specifically for parents also helps us explain why it is such an important foundational skill and how it falls into the category of receptive language skills. If you notice the child can’t perform the skill consistently, you can target the skill in treatment to make sure the child can perform it in all settings before moving on to more difficult receptive language skills.

Also, because a child not responding to their name consistently is a red flag for ASD, we need to keep a close eye on the skill in our work with young children.

Jasna Cowan, MS, CCC-SLP, is the founder and director of Speech Goals, a private practice in San Francisco. jasna@speechgoals.com 

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29 comments

Debbie Fulop January 2, 2019 - 6:24 pm

Hi
Just read your article and wondered if you could let me have your thoughts regarding my grandson. He has just passed his first birthday (15 December). He never, ever responds to his name. We consistently try to call him but he totally ignores us. However, if I say to him, clap your hands he immediately stops what he’s doing smiles and claps his hands. We thought perhaps he had a hearing problem and so we stood behind him and asked him to clap and he immediately clapped. He seems to have good eye contact and is very loving and sociable. He isn’t yet walking but crawls and walks around furniture with ease. His speech seems a little slow, he only babbles the sounds baba and dada and doesn’t appear to have any real understanding of language. He is generally a very happy boy, healthy of good weight and eats everything in sight. He was delivered by cesearean section and my daughter was given steroid injections prior to his delivery (he was born just over a week prior to his due date). My daughter had previously suffered a fourth degree tear and so it was advised that she didn’t go into labour and that’s why she had a booked cesearean. Should we be worried that he may be autistic? I worry about this but then when I see him he just seems perfect and I think why am I so concerned. Perhaps I’m just bring paranoid. Your thoughts would be helpful please!!
Thanks
Debbie

April Hubbard, AuD. Audiologist January 3, 2019 - 8:27 pm

Please do have his hearing checked. These can be classic signs of hearing loss.

Dr. Terese Huber, Board Certified in Audiology January 4, 2019 - 7:10 pm

Dr Hubbard gave excellent advice, have his hearing tested. Has he had colds or ear infections. This can hamper hearing and reduce response. Please, whenever you do call a child’s name have a purpose in mind. After they look up, show them something interesting, sit down and play, or give them a different toy showing them some fun things to do with it.

Johnnie Sexton, Au.D. January 3, 2019 - 11:33 am

There is no mention of assessing hearing as a part of determining why a child may not be responding. Hearing status should be determined early on anyway but progressive hearing loss in children can be a factor.

Angie azuendt, AuD January 5, 2019 - 12:06 am

This! Thank you, Dr Sexton.

Jason Wigand January 3, 2019 - 4:21 pm

It could also be hearing loss. How was that not mentioned at all?? That should be the first thing to assess.

Eve Leinonen, Au.D January 3, 2019 - 8:16 pm

After reading the article, as an Audiologist and someone with hearing loss I’m concerned that not once was it recommend that a child have their hearing assessed to rule out a hearing loss or middle ear issues. This should be a consideration when there are language/speech concerns.

April Hubbard, AuD January 3, 2019 - 8:25 pm

Why is there zero mention of hearing loss being a potential factor? Many behaviors for hearing loss are also behaviors seen in children with autism or ADHD. See the IT-MAIS for examples of questions regarding how a child responds to their name and other sounds. How can you not recommend that these children be evaluated for possible hearing loss? Have ASHA and its SLPs completely forgotten that audiology and hearingoss exist? I am very disappointed in this article coming from this source.

Shelley D. Hutchins January 6, 2019 - 7:31 pm

Thank you for your comment, April. Leader editors crafted a response to your (and other’s) concern. As the manager of Leader Live, I am constantly looking for more audiologists to write for us, so would welcome a post from you if you’re interested. -Shelley D. Hutchins, content editor/producer, the ASHA Leader shutchins@asha.org.

Jane Rosner, AuD January 3, 2019 - 8:32 pm

Well gee……did you consider that may a hearing exam might provide a piece of relevant information???? The last time I checked, the “H” is ASHA stood for hearing……or maybe you just forgot.

Karen Schaaf Au.D. January 3, 2019 - 8:38 pm

Thank you Johnnie Sexton. It seems like checking for hearing loss should always be the first step when a child does not respond to his or her name.

Erica W. January 3, 2019 - 8:47 pm

If a child is not responding to his or her name (or other auditory stimuli), then hearing loss must be ruled out before anything else. It is extremely disappointing that a hearing evaluation and involvement of an audiologist as part of the team is not mentioned at all in a blog on ASHA’s own website.

Derek Petti January 3, 2019 - 8:55 pm

I’m glad to see that ASHA is no longer even trying to hide the fact that they never cared about audiologists, despite us wasting $250 on useless dues every year. This is so infuriating. Quick recap on the basics of name-detection – you have to have normal hearing to have normal responses to sound. Not responding to a name being called? Have your child’s hearing tested.

RAJASUMAN M January 4, 2019 - 12:58 am

Did you forget the hearing loss??

V.L. January 4, 2019 - 1:53 am

By what age would this be considered a concern/red flag for ASD?

Erin Bagley, AuD, CCC-A/SLP January 4, 2019 - 9:50 am

I would hope that, before assuming ASD, hearing concerns have been ruled out by an audiologist.

Shelley D. Hutchins January 7, 2019 - 1:21 pm

Thank you for your comment, Erin. Leader editors crafted a response to your (and other’s) concern. ALso, the article does only indicate ASD as one possible issue related to lack of response to name. We do ask contributors to be specific in their articles and focus on a single issue.
As the manager of Leader Live, I am constantly looking for more audiologists to write for us, so would welcome a post from you if you’re interested. Please contact me directly. Thank you.
-Shelley D. Hutchins, content editor/producer, the ASHA Leader shutchins@asha.org.

Lindsay Alexander, Au.D., CCC-A January 4, 2019 - 2:23 pm

I really hope that this article gets amended or a follow up is issued to address the role of hearing assessment in the diagnostic process. Jus as I would hope that you would expect me to send a speech delayed child for further evaluation if I was the first to see them clinically, I would hope that you would require a hearing evaluation to rule out other concerns and comorbidities.

Shelley D. Hutchins January 7, 2019 - 1:19 pm

Thank you for your comment, Lindsay. Leader editors did amend the article and replied to these concerns.
As the manager of Leader Live, I am constantly looking for more audiologists to write for us, so would welcome a post from you if you’re interested. Would you like to write on assessment insights for evaluating hearing in a young child? Or any other topic that you’d like to share with your peers? Please let me know!
-Shelley D. Hutchins, content editor/producer, the ASHA Leader shutchins@asha.org.

Shelley D. Hutchins January 4, 2019 - 2:37 pm

The author in this case is specifically focusing on tips for determining if a child does not consistently respond only to their name, what that specific lack of response to name might mean, and if it might indicate some other issue. Of course, when a child is not responding to any spoken word—whether their name or otherwise—a hearing screening should be conducted to rule out hearing loss. We are sorry that this was not made clear in the original blog post. -Leader editors

Julie Link, AuD January 4, 2019 - 4:50 pm

Hi Shelley, can you please update this article to include that information as well as the recommendation for a hearing assessment (a hearing screening in this situation would not suffice). Thanks so much!

Shelley D. Hutchins January 6, 2019 - 7:28 pm

Hi Julie,

I did update the article and changed screening to assessment. As the manager of Leader Live, I am constantly looking for more audiologists to write for us. Would you be interested in writing a post for us? You can select any topic you’d like to share with your peers or I’m happy to suggest something. Please let me know if you’re interested.
Thank you! -Shelley D. Hutchins, content editor/producer, the ASHA Leader shutchins@asha.org.

Rachel January 4, 2019 - 3:57 pm

As a blog written by the American Speech and Hearing association, I am shocked there is no mention of hearing testing here. If a child does not respond to their name or has any type of speech/language delay the absolute first thing to rule out is hearing loss. ASHA should ensure that message is given loud and clear as long as it wants to keep hearing in its title. As an audiologist, I have seen far too many children identified with significant hearing loss AFTER years of speech therapy had been done. Hearing evaluation is a critical step in evaluating child development and specifically if a child does not respond to his or her name.

Shelley D. Hutchins January 6, 2019 - 7:24 pm

Thank you for your comment, Rachel. We did include an editor’s note about a hearing assessment, but this post was not written by ASHA staff. Like most of our posts, it was written by a member who is focusing on a very specific topic of a child not responding exclusively to their name, and not including other verbal commands or sounds. We ask contributors to write a narrow topic with a single focus in our writing guidelines to keep posts short and concise.

As the manager of Leader Live posts, I am constantly looking for more audiologists to write for us, so would welcome a post from you on signs to look for in detecting possible hearing issues or a related topic. Please let me know if you’re interested. -Shelley D. Hutchins, content editor/producer, the ASHA Leader shutchins@asha.org.

Dr. Terese Huber, Board Certified in Audiology January 4, 2019 - 7:01 pm

Why wasn’t a hearing evaluation mentioned in this article? I’m impressed that the author mentions the child might be focusing on a task and ignore the adult calling their name. Also there was no mention of the acoustic environment or of the child’s name.
Suspecting ASD because of a lack of response to their name Is overreaching. I’ve seen many children not respond because there is no point, the parent and therapist call the child’s name just for the sole purpose of getting a response from the child. Have something to give the child or talk about. Too many children are being labeled as ASD. Time for full valuations that include hearing.

Oluwaseyi Olokodana January 7, 2019 - 11:33 am

But what about in the case where audiologist did an evaluation twice and couldn’t determine whether or not there is hearing loss because of the preschooler’s inconsistent response to sound? What would you advise please?

Allison Harris, AuD January 11, 2019 - 9:04 am

Was the audiologist a pediatric specialist? There is a hearing test called an ABR that can test a child’s hearing without his or her participation. This requires sedation but will give a very good estimate of the hearing.

Arya Smith January 7, 2019 - 11:26 pm

Thanks for helping me understand that we should get our child checked regarding their hearing first when they don’t respond to their name. As you said, it will assess if the issue is regarding their hearing. I will tell this to my best friend because she said that their son is already two years old, and he doesn’t seem to know that his name is being called. Like when they were taking pictures of him, he would not even look at them when called.

Jasna Cowan January 30, 2019 - 2:31 pm

Thank you to all the audiologists who took the time to read and respond to this article, and specifically for rightly pointing out the need to have a hearing screening when a child is not responding to their name to rule out hearing loss as a factor. This article was meant to be step two in the process of looking at reasons why a child doesn’t respond to their name of hearing loss has already been ruled out. Of course, HEARING IS FIRST AND FOREMOST. So sorry that I didnt make that clear here. Audiology is our sister profession and I truly respect and acknowledge that this referral is vital in this process. As an early start evaluator, I am often including in my reports and feedback to parents referrals for further evaluations with other professionals, including audiologist, occupational therapists, behavior analysts, etc to address other possible factors in why a child is or is not demonstrating specific behavior. This all-inclusive assessment is important to getting a full picture of the child so we are able to direct the family to the best possible therapies and support. Again, thank you to all of you for your comments and additions on this topic.

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