Jackie Spinner
For the first time in decades, the nation’s top pediatricians have changed the checklist of developmental milestones for infants and young children to make it easier to identify delays that could be a sign of autism or other social-communication disabilities.
The updates from the Centers for Disease Control and Prevention, made with the American Academy of Pediatrics, raised the percentage of children who typically meet certain milestones from 50 percent to 75 percent, an important adjustment signifying that instead of just half, now the majority of children are capable of certain behaviors and achievements at specified ages.
The changes are designed to give parents, doctors and caregivers clearer benchmarks for when children typically do things such as acting shy around strangers (6 months), clapping when excited (15 months) and engaging in pretend play (4 years).
“This has been a need that is long overdue,” said Paul Lipkin, a pediatrician and director of medical outpatient services at the Kennedy Krieger Institute in Baltimore.
The developmental markers had not changed since they were first released in 2004. By adjusting the ages to account for societal changes such as when children first need to tie their shoes or pick up cereal with their fingers, among other capabilities, developmental experts hope to encourage parents to seek interventions earlier instead of waiting until the delays become more obvious.
The new milestones, published in Pediatrics this week, were developed by a group of 13 developmental experts and pediatricians, including Lipkin. “We wanted to take a close look at all the data and milestones through multiple sources to come up with what we think is an accurate reflection of a child’s development,” he said.
The milestone markers are based on observations, and in particular the previous ones missed some of the indicators that a child may be autistic, including the first age when most children typically smile to get attention, which is now included in the checklist for a 4-month-old. The CDC also added milestones for 15 months and 30 months and clearly defined social-emotional markers such as when a child typically hugs a doll or other toy, shows affection and uses words to say, “Look at me!”
I had overlooked these possible signs of autism with my oldest son. His pediatrician picked up on some of them at his 18-month checkup. My son, now 10, started receiving early intervention services shortly after that and was later diagnosed with autism just before he turned 3, the age when children age out of the government-subsidized early intervention program that provides therapies and support for children with developmental delays.
By the time my middle son came along, I had been more in tune to these important social-emotional milestone. He started early intervention services at just over a year old and was diagnosed with autism around age 2. By kindergarten, he no longer met the criteria for autism, in part because of the early interventions he had received.
Patty Vazquez, an early-intervention occupational therapist in Chicago, said children do better when they start therapy earlier.
“I think that it is always good to catch things sooner to help a child develop a strong foundation upon which they can stack and build the variety of skills that they need to succeed in all the domains of development,” she said. “Often, self-regulation and attaining and maintaining a calm, alert state is key to attention and language-based development, so [occupational therapy] can be beneficial if that is an area of challenge for the child. And body awareness and motor planning is foundational for fine motor development, so early OT involvement can support the child in that scenario as well.”
Unlike my boys, Amanda Palo’s son was diagnosed with autism when he was older, just before his 7th birthday. He is now 8.
Palo first raised concerns with her son’s pediatrician when he was 2 and using very few words. “She wasn’t overly concerned at the time, but I pushed,” Palo recalled. At her request, the doctor referred Palo’s son for early intervention services, and he started receiving speech and occupational therapy.
“As a new mother, and with nearly no knowledge about autism, I was wholly unprepared to properly navigate this situation,” Palo said. “I believe, had I been provided with more-definitive milestones, I could have been able to obtain a diagnosis earlier on and provide my son the additional resources he needed. I didn’t know the possible autism signs or markers to look for regarding a possible diagnosis. No one does the research unless you have to do it, and you don’t know what you don’t know.”
We looked together at the new CDC milestone markers for 2-year-olds, which is how old her son was when I met them at a sensory story time at the public library in 2016.
The new guidelines would have provided some clues about his delays, she said. When he was 2 and she first started raising concerns, her son didn’t look at her face to see how she’d react to a situation. He was not yet pointing, and he couldn’t focus on any particular activity for more than five minutes. He was over 3 before he invited her to look at something he was doing.
“I feel as if all the pieces were there and no one, including myself, was able to properly put them together for quite some time,” she said. “I do have some guilt about not getting his diagnosis sooner, but I’m doing my best to get him all the support he needs now and for the future.”
from https://www.washingtonpost.com/parenting/2022/02/10/new-developmental-milestones/