Concerns Over the Revised Developmental Checklist
by Lauryn Bates, M.S., CCC-SLP
Kids Place Speech and Language Pathologist
Research has indicated that 80% of brain development occurs in the first 3 years of life. The brain is more flexible during this time because it must learn to accommodate new environments, interactions, and experiences. A child is born with billions of neurons that have not yet been connected in networks or formed synapses. Forming synapses are crucial because it makes everyday skills and activities more automatic. We do not have to think about how to move our mouth to form certain words, or we do not have to think about how to pick up our leg so that we can take a step forward when walking.
Pruning occurs when networks are eliminated if not used frequently. Around 3 years of age, the rapid growth of synapsis decreases significantly. Pruning begins to occur so that other connections that are used more frequently can become more efficient and automatic. The brain starts to become more specialized so that it can take on more complex functions. These functions are the skills that support children’s future learning and skill acquisition. Children can continue to learn language at any age; however, it will take more time and effort.
Wait & See Approach
Pediatricians frequently followed the “wait and see” approach. If young children were not using many words, pediatricians would recommend waiting to refer out for a speech-language evaluation. Support for this approach came from a study that was conducted that analyzed book reading between adults and children. The study showed that vocabulary did increase; however, the study did not measure morphology (word forms) or syntax (sentence structure). Upon further examination, children’s vocabulary increased, but they continued to show deficits in understanding and using various word forms (ex: use of plural –s as in “cats” or prefixes and suffixes to change word forms, such as pre- in “pretest” or –ness in “happiness”). These children also had deficits in understanding and using more complex and varied sentence types.
The origins of the “wait and see” approach included fear of causing anxiety in parents associated with further testing of the child and taking extra time and effort to have the child assessed (Singleton, 2018). When in reality, parents more than likely will feel anxious until an assessment is completed, and it will take more time and effort to have the child play “catch up” as opposed to taking advantage of the time that we have during the first 3 years of life.
Updates to Developmental Milestones
Recent updates to the Centers for Disease Control and Prevention’s (CDC) and the American Academy of the Pediatrics (AAP) developmental milestones were put into effect in 2022 with the hopes of decreasing the “wait and see” approach. However, these updates may just have the opposite effect.
There are some positives to this updated list, such as adding in a 15-month-old and 30-month-old checklist in an effort to detect potential developmental delays earlier. The updates have also included more parent-friendly terms that are less vague, including making items more easily observable in everyday life. For instance, the previous checklist stated at 18 months that a child “says several single words.” The new checklist states that at 18 months a child “tries to say three or more words besides ‘mama’ and ‘dada’.”
These updated adjustments represent what most of the children are doing by a certain age instead of what is average at that age. Furthermore, in a statement from the American Speech-Language-Hearing Association (ASHA), a review is underway because “some of the new milestones do not align with the ASHA specified speech, language, and social-communication milestones used by SLPs and other professionals to assess a child for possible communication or developmental delay or disorder” (McNeilly, 2022).
For example, according to ASHA standards a child may have a language disorder if they say fewer they 50 words at 24 months of age. The updated checklist states that most children should have 50 words at 30 months of age. Although this 6-month difference may seem small, this is actually a significant discrepancy that could have severe repercussions on children and their development. Children with developmental delays could potentially be identified later due to these modifications, potentially missing the critical window for optimal treatment outcomes.
If you are worried about your child’s speech, language, or hearing, or for more information on developmental milestones for speech, language, and social-communication milestones, please visit asha.org or visit their page “Early Identification of Speech, Language, and Hearing Disorders”.
As always, feel free to reach out to us here at Kids Place Pediatric Therapy. We’re here to help!
American Speech-Language-Hearing Association. (n.d.). Early identification of speech, language, and hearing disorders. https://www.asha.org/public/early-identification-of-speech-languageand-hearing-disorders/ McNeilly, L.G. (2022, February 25).
New developmental milestones: Reviewing the changes and evidence. ASHAWire. https://leader.pubs.asha.org/do/10.1044/2022-0225-cdc- developmental-milestone-concerns/full/ Singleton, N.C. (2018).
Late talkers: Why the wait and see approach is outdated. Pediatric Clinics of North America, 65(1), 13-29. https://doi.org/10.1016/j.pcl.2017.08.018