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Stepping Past the Milestones

Every parent welcomes, to some degree, evidence that their child is sequentially triumphing over the normal milestones of childhood development. Unfortunately, our education about the “normal” highlights and timelines for these landmarks is often gathered from our own foggy childhood recollections or from a neighbor with a child destined for membership in Mensa. It is simply not easy to learn the normal ranges of development from our limited personal experience. It is reassuring if one’s child walks by 14 months, or stacks three blocks by 18 months of age, but what if he/she does not?

Progress through childhood is usually monitored in our society in the form of unsolicited observations by grandparents and friends, evaluations conducted at the time of routine preventive health care, or from assessments conducted in preparation for childcare, preschool or kindergarten. Another often unrecognized source of developmental screening of high risk youth comes from the social support network that quietly chugs along the tracks of Social Services Departments, Health Departments, Offices of Education and some private agencies across the country, including in the Sierra Foothills. A look at this important part of our health care safety net is worthwhile.

To begin with, one might ask what difference it makes to recognize children early who fall outside the norms of childhood development. First, remember that kids who do not pass the expected landmarks at the usual time or in the usual way may have any number of explanations for the situation, including the possibility that this pattern is perfectly normal for the particular child. On the other hand, there may be inherited patterns of development that make it difficult for children in some families to keep up with their generational companions. Genetic predispositions are well recognized for conditions like Autism Spectrum Disorders, with an approximately three-to-one male-to-female ratio, and reading disorders, with recognized inherited delays in phonological processing. In other cases, there may be modifiable environmental factors that are contributing to the delay, for instance in situations where family turmoil is fostering anxiety and derailing normal development. Another environmental effect to consider is the environment and health of the child’s mother during pregnancy. Identifying a specific pathology when one exists makes it possible to design a treatment plan to target the specific diagnosis.

In many cases, these children will eventually catch up to others in their age group without intervention, but when a delay occurs during a vulnerable period of development it may hobble efforts to master other important skills. Herein lays one of the important messages – early therapeutic interventions through counseling, occupational, speech or physical therapy are remarkably effective treatments. Teachers can be made aware of challenges facing particular students, just as a student with a broken leg can be given special consideration during dance class. In many cases, such treatments will accelerate developmental progress where delays have been recognized, thereby bringing other developmental milestones within reach. Weaknesses in processing information may remain a lifelong challenge for the child, but the impact on other developmental achievements can be minimized by early recognition and evidence-based management.

Regressive patterns of childhood development – that is, the loss of abilities that have previously been mastered – may warrant particular attention, as these findings are sometimes, albeit infrequently, the earliest signs of more serious underlying health conditions such as hormonal maladies or occult tumors. Obviously, early recognition in these circumstances is critical.

The tools used by social workers, nurses and health care providers in child welfare agencies, health departments, social service agencies, child care agencies, family support agencies and clinics to screen children for developmental delays are invaluable. A great deal of testing has been done in order to standardize various screening instruments for this purpose. Nearly all of these tools include a component which the parent fills out, describing the parental perception of the child’s abilities. Contrary to the parental reputation for viewing their children through rose-colored glasses, parents are nearly always the most important source of information for the struggles of their own children.

These screening tools go by acronyms that misrepresent the elegant work that went into their development. Accommodations for cultural effects and sensitivity to the frustrations of the child under evaluation are taught to the professionals performing the testing, and results are compared and recompared as the yard sticks continue to undergo refinement. As screening tests, these are designed to trigger more in-depth evaluations of certain children in the lower tail of the bell curve by experts in the field of child development in order to determine if interventions should be considered.

A class is being made available by the Tuolumne County Human Services Agency to teach people how to administer a child screening tool known as ASQ-3. This training opportunity is open to any community providers who could utilize the ASQ-3 screening tool in their work with children, and will be held on February 24th, 2011, from 9:00 to 2:00 PM in the Central Conference Room at the Health Department at 20111 Cedar Rd. North, Sonora. For more information call 533-7378.

While outcomes of child development screening and treatment will never be perfect, numerous agencies throughout our communities are engaged in the fight, and for that we can be thankful. The community itself is one of the main benefactors of this effort, and the ultimate self-satisfaction of the growing child is the fruit that results.