# Absent Pointing to Show: A Clinician's Signs Guide Canonical: https://pinnacleblooms.org/ask/what-developmental-conditions-can-not-pointing-to-show-things-in-a-child-point-to Publisher: Pinnacle Blooms Network / Bharath Healthcare Laboratories Private Limited Absent or reduced declarative pointing (pointing to share, not just request) by 12–18 months is a recognised social-communication marker. It most often raises autism spectrum disorder, but also hearing impairment, global developmental delay and language disorder. Exclude hearing loss in parallel; it is a referral prompt, not a diagnosis. *A child who doesn't point to share a discovery — the aeroplane, the dog, the biscuit just out of reach — is telling us something about how they connect, long before they have words for it.* ## In short Absent or markedly reduced declarative pointing (pointing to *show* or *share*, not just to *request*) by around 12–18 months is a recognised early marker of social-communication difference. It most commonly raises the question of autism spectrum disorder, but it is also seen in hearing impairment, global developmental delay, language disorder and, less specifically, in temperamentally cautious children. It is a referral prompt, not a diagnosis. ## What absent protodeclarative pointing can point to **Most clinically salient** - **Autism spectrum disorder** — reduced joint attention, absent showing/pointing-to-share, limited gaze-following and response to name are core early markers. Protodeclarative pointing is typically more affected than protoimperative (requesting) pointing. - **Global developmental delay / intellectual disability** — gesture emerges late alongside broader cognitive and adaptive delays. **Always exclude first** - **Hearing impairment** — reduced shared referencing and gesture can be the presenting sign; arrange audiology in parallel. - **Developmental language disorder** — expressive/receptive delay where gesture may lag but social reciprocity is relatively preserved. **Lower-specificity contributors** - Visual impairment, severe environmental deprivation, or a cautious/slow-to-warm temperament — pointing-to-request and warm reciprocal engagement are usually intact here. The discriminating feature is **joint attention**: is the child trying to *share* an experience (alternating gaze between object and caregiver) versus only *obtaining* an object? Reduced declarative pointing with poor gaze-alternation and weak response to name is the higher-concern cluster. ## When to refer Do not adopt "wait and see" when the gesture deficit persists across settings. Refer for developmental assessment — with audiology in parallel — when there is no pointing or showing by 16–18 months, especially alongside no babble or gesture by 12 months, no single words by 16 months, or any loss of skills at any age. Persistent parental concern alone is a sensitive indicator and justifies onward referral. ## The Pinnacle way A clinical [AbilityScore®](/ask/what-is-the-abilityscore-and-how-is-it-calculated) and any diagnosis are formed only at a Pinnacle Blooms Network centre under qualified clinician care — the score is a clinician-administered structured assessment that complements, never replaces, your clinical judgement. Pinnacle supports referral pathways with structured multi-domain profiling and onward [speech therapy](https://www.pinnacleblooms.org/top-speech-therapy-center-india-proven-improvement-rate) when indicated. Explore the wider [developmental network](/). ## Trusted sources Aligned with WHO ICD-11 (autism spectrum disorder), CDC "Learn the Signs. Act Early." developmental milestones, AAP/Healthychildren guidance on joint attention and gesture, ASHA on early social communication, and NIMHANS clinical resources on early autism markers. **Next step —** to refer a child or establish a clinical referral partnership, reach the Pinnacle clinical team on WhatsApp: +91 91001 81181. ## Sources - CDC Learn the Signs. Act Early. — developmental milestones: https://www.cdc.gov/child-development - ASHA — early social communication and gesture: https://www.asha.org/public/speech/development/ - WHO ICD-11 — autism spectrum disorder: https://icd.who.int/ - AAP HealthyChildren — joint attention and early communication: https://www.healthychildren.org/ ## Connected topics and perspectives - Behaviours: https://pinnacleblooms.org/ask/behaviours - Doctor: https://pinnacleblooms.org/ask/lens/stakeholder/doctor - Communication: https://pinnacleblooms.org/ask/lens/domain/communication - Signs: https://pinnacleblooms.org/ask/lens/intent/signs - Screen: https://pinnacleblooms.org/ask/lens/lifecycle/screen - Book Assessment: https://pinnacleblooms.org/ask/lens/route/book-assessment - Early Clarity: https://pinnacleblooms.org/ask/lens/empowerment/early_clarity ## Related question paths ### Recognise signs & concerns - When should a doctor investigate not pointing to show things in a young child?: https://pinnacleblooms.org/ask/when-should-a-doctor-investigate-not-pointing-to-show-things-in-a-young-child - Should a frontline worker refer a child not pointing to show things?: https://pinnacleblooms.org/ask/should-a-frontline-worker-refer-a-child-showing-not-pointing-to-show-things - Can Not Pointing To Show Things Be an Early Sign of a Developmental Concern?: https://pinnacleblooms.org/ask/can-not-pointing-to-show-things-be-an-early-sign-of-a-developmental-concern - Should I worry about not pointing to show things in a 1-year-old?: https://pinnacleblooms.org/ask/should-i-worry-about-not-pointing-to-show-things-in-a-1-year-old - When should I worry about not pointing to show things?: https://pinnacleblooms.org/ask/when-should-i-worry-about-not-pointing-to-show-things-in-my-child ### Explore causes & influences - What causes not pointing to show things in young children?: https://pinnacleblooms.org/ask/what-causes-not-pointing-to-show-things-in-young-children - Why a 1-Year-Old May Not Point to Show Things: https://pinnacleblooms.org/ask/what-causes-not-pointing-to-show-things-in-a-1-year-old ### Explore therapy & support - Therapy techniques for not pointing to show things: https://pinnacleblooms.org/ask/what-therapy-techniques-help-a-child-with-not-pointing-to-show-things - Can Not Pointing To Show Things Be a Sign of Autism?: https://pinnacleblooms.org/ask/can-not-pointing-to-show-things-be-a-sign-of-autism - How therapy addresses a child not pointing to show things: https://pinnacleblooms.org/ask/how-does-therapy-address-not-pointing-to-show-things-in-a-child - Do children usually outgrow not pointing to show things?: https://pinnacleblooms.org/ask/do-children-usually-outgrow-not-pointing-to-show-things - How can a teacher support a 1-year-old who isn't pointing to show things?: https://pinnacleblooms.org/ask/how-can-a-teacher-support-a-1-year-old-who-shows-not-pointing-to-show-things-in-class - How should a frontline worker respond to a child not pointing to show things?: https://pinnacleblooms.org/ask/how-should-a-frontline-worker-respond-to-not-pointing-to-show-things-in-a-child - How should a teacher respond to not pointing to show things in a young child?: https://pinnacleblooms.org/ask/how-should-a-teacher-respond-to-not-pointing-to-show-things-in-a-young-child - Is Not Pointing To Show Things Normal?: https://pinnacleblooms.org/ask/is-not-pointing-to-show-things-a-normal-part-of-child-development - What makes not pointing to show things worse in a child?: https://pinnacleblooms.org/ask/what-makes-not-pointing-to-show-things-worse-in-a-child - What other behaviours often occur with Not Pointing To Show Things?: https://pinnacleblooms.org/ask/what-other-behaviours-often-occur-with-not-pointing-to-show-things ### At home & in everyday life - How to Help a Young Child Who Isn't Pointing to Show Things: https://pinnacleblooms.org/ask/how-can-i-help-a-young-child-with-not-pointing-to-show-things - How do I handle not pointing to show things in a 1-year-old?: https://pinnacleblooms.org/ask/how-do-i-handle-not-pointing-to-show-things-in-a-1-year-old