When do you know if your child needs help–in school, at home, on the playground. . .? Let me begin by suggesting that if you are asking that question, the time might be now! You might be especially concerned, with good reason, if you or someone in your family struggled when they were little, and/or if your child was born prematurely. We hear that a child develops in stages, but what does that really mean? After all, some children are quick to develop in one area, slow in another. That is not unusual in and of itself. But there are some tell tale signs at different ages of “typical” developmental milestones and basic skills. If you question your child’s development in these or other similar areas, do not hesitate to seek support, or at least get answers to your questions.
An infant begins noticing the world around him or her fairly quickly by turning their head to sounds. By about 6 weeks of age, most infants recognize human faces and smile back when someone smiles at them. By 6 months, most infants grasp at objects, try to verbalize when spoken to by moving their mouth and tongue or making noises, giggle when you blow on their bellies, sleep a few hours at a time (or even overnight) without crying for food or a clean diaper, and recognize the faces of primary caregivers. By 18 months, toddlers walk, talk in words and/or phrases, eat (messily) with a fork or a spoon, hold a cup or a bottle by themselves, and try to run away to explore the world when you don’t want them to. Many know the word “No!” quite well and are not afraid to use it, even if they seem to forget what it means when you say it.
Children who are slower to develop these early skills at about these times, but who continue to develop nonetheless should be monitored closely. While they may not yet need significant supports, they should not be neglected, for it is our timely development of basic milestones that seems to have the deepest impact on later development. For example, our language skills develop exponentially in those early months, and we acquire several hundred to thousands of words in our first two years of life! We may not speak all the words we know, but we know them when we hear them. And our sense of grammar and syntax develops with equal speed in that time frame. Children who seem to have a limited number of words, who do not speak even in “babble”, and/or who do not respond at all may have any number of developmental language issues. Similarly, a child who does not walk, crawl, or grasp at objects may have any number of muscular or skeletal problems, many of which are easily addressed. On the other hand, some toddlers have night terrors for no apparent reason, are particularly shy or particularly bold, or flit from one activity to the next. These types of behaviors by themselves are not necessarily worthy of concern unless accompanied by other behaviors or limitations. So a child who cannot grasp small objects, who does not respond when you speak to them, has a very limited ability to communicate, and has poor sleep patterns may have developmental disabilities that need to be explored and addressed.
By the time our children enter preschool and kindergarten (3 years and older), they should be talking, using the bathroom (with fading support by age), feeding themselves, playing with toys, and interacting with others. If a child exhibits unexplained outbursts, experiences poor sleep on a consistent basis, does not respond to his/her name and/or seems “absent” most of the time, has difficulty walking, running, and/or throwing, does not speak or speaks unintelligibly, does not interact with caregivers or others without significant prompting, cannot manipulate small objects in their hands (such as buttons), tears at clothing or exhibits nearly obsessive behaviors with certain articles of clothing, eats things that are not food, and/or exhibits overly aggressive, overly passive, and/or inappropriate behaviors with others, then outside intervention is likely needed. Any of these traits can be signs of something organic, such as a food allergy or headaches, or a neurobehavioral or developmental condition (such as ADHD or Autism Spectrum Disorder), or a musculoskeletal condition (such as low tone or dyspraxia). By kindergarten and 1st grade, children should know basic two dimensional shapes, know primary and secondary colors, and be developing early reading, writing, and math skills. A child who has been exposed to books from an early age should speak their alphabet by age 6 (with minor errors that are not always consistent), even if they make mistakes writing it (such as letters slightly out of sequence). Mirror writing or letter or number reversals are not highly unusual at this age, but should be monitored especially if the errors are consistent (such as a child who mirror writes numbers all the time).
Do not be afraid to ask questions of the professionals who work with your child. And if you are still concerned, keep asking! Some issues are easily remediated, such as b and d reversals when writing. But others require expert and professional support. The best barometer to determine when to question whether or not your child needs help? When you think he or she might need help. Trust your instincts!