By Nathaniel Beers, MD, MPA, FAAP
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Among the many questions that parents of young children ask me in my practice, the question of whether their children are developing normally is right at the top. Determining the answer is no small task. The simple truth, that what is normal development for one child is not normal for another, leaves many parents thinking “that’s great, but is my child’s development normal or not?” Unsatisfied and curious, parents become amateur detectives. We avidly read books and websites (that give us conflicting messages!), surreptitiously compare our child to other children on the playground, and sort through the various unsolicited comments of family, friends and neighbors—all in an attempt to make an educated guess about how our child is really doing.
Perhaps deep down inside, we already know that this approach makes very little sense, but it becomes especially clear when we observe the amazing diversity among young children. Some are very physically active and are going to develop quickly in their physical skills as a result. Some are highly verbal and are entertaining everyone at an early age with fantastic stories and insights. Some children are very introverted and will not engage with people they do not know; others will talk to anyone willing to listen. Some children are cautious and need time to feel confident before they attempt a task, and others will jump right in even if it is beyond their current ability level. Yet, despite all these differences, we also know that an estimated 13% of American children aged birth to three do in fact have developmental delays that require services (Rosenberg, et. al. 2008). Thankfully, we also know that many of these delays, if discovered early, can be substantially remediated. So we need a more systematic approach to learning whether our children are developing normally, because even highly educated guesswork is still guesswork, and the stakes are so high. Here’s what you can do:
First, trust your instincts when they tell you something does not seem right. As parents, we know our children better than anyone and when you find yourself repeatedly wondering about some aspect of your child’s development or behavior, it’s a sign to take action and speak to a professional. All of the behaviors mentioned in the previous paragraph are perfectly normal, but any one of them in the extreme may be a cause for concern. You may be the only person who observes just how frequently your child exhibits a behavior that seems just fine to others who see it only occasionally. Acting on a gut feeling may feel like an overreaction, but it is the first, essential step in answering the question.
Second, ask your doctor to include developmental screening as part of your child’s well child visit. The American Academy of Pediatrics (AAP) made a formal recommendation in 2006 that every child be screened with a standardized developmental screening tool at 9, 18 and 30 months and in 2007 the AAP expanded the recommendation to include screening with a standardized tool for Autistic Spectrum Disorders at 18 and 24 months. There is good reason for this. For years, doctors have relied primarily on developmental surveillance to ensure that children are developing typically, and as of 2005, nearly three quarters (71%) of pediatricians still used this approach to identifying delays (Sand et. al. 2005). As a parent, you have experienced surveillance when you visited the pediatrician with your child and were asked a group of age appropriate questions about your child’s development. Unfortunately, surveillance alone misses lots of children who could benefit from more formal evaluations, because the process is so variable from doctor to doctor. In contrast, the use of a standardized tool encourages uniformity of the questions and assures that each area of development is formally explored. The addition of a formal screening tool to a doctor’s clinical judgment has been shown to more than double the rate of identification of children in need (NC Abecedarian Project, 2002-2004).
Third, contact the Early Intervention or Child Find program in your area. Under the Individuals with Disabilities Education Act (2004), every school district is required to locate, identify and provide services to children who have developmental needs. The programs typically involve a screening process and, if necessary, formal evaluations to determine what services your child may need. If your child meets eligibility criteria, these services are provided free of charge to you, typically in the home or daycare setting for children under age three, and through the school system for children three and older. These programs can usually be found on the web by searching for “child find” and the name of your county or state, or you can call your state’s Superintendent of Education. If your child does have needs but you do not qualify under one of these programs, you will walk away with concrete information to provide to your child’s doctor and be able to help determine the next course of action.
However you decide to pursue the question of your child’s development, doing it early is absolutely essential to creating successful outcomes. As more is understood about brain development, there is increasing evidence to support the need for identifying and taking action to address developmental delays as early as possible. During the first 5 years of life, 90% of the brain is developed, with the bulk of that occurring during the first 3 years of life (Purves, 1994). There have also been numerous studies showing the savings of intervening early, specifically, decreased costs in education, health care and social services for children who receive intensive early intervention services. While the financial savings are important for society at large and for individual families, much more important is the trajectory of a young child’s educational and emotional life. Early intervention may be able to substantially reduce or even eliminate the turmoil that children experience when their needs go undiagnosed and untreated.
It is important to remember that the vast majority of children, even those who develop more slowly in one or more areas, end up just fine. So please don’t be afraid to take the initiative in systematically checking in on your child’s development as a routine part of his or her medical care during the early years. It will help ensure that your family and your child’s caretakers and teachers are able to fully understand, support and celebrate your wonderful and unique child.
Nathaniel Beers is the Executive Director of the Early Stages Center with the District of Columbia Public Schools. To find out about the Early Stages Center visit their website at www.earlystagesdc.org.
To learn more about early childhood development click on these links:
Screen Time: The Impact of Television on Babies and Children