Archive for the ‘ Intervention ’ Category

The 3 Speech Benchmarks 3-Year-Olds Should Have

Monday, June 30th, 2014

Although toddlers reach language milestones at different ages, substantial delays can be associated with long term language problems. Given that, it’s worth giving careful consideration to benchmarks at different key ages. For example, a typical milestone is using 50 words by age two – though recent research suggests that a more telling indicator may be functional use of 25 words by that age. Perhaps less attention is typically given to language milestones at later ages – even though these can signal the need for evaluation and intervention.

To this end, Dr. Leslie Rescorla – a leading expert on language delay – has offered 3 speech benchmarks for 3-year-olds:

1) Using 3-4 word sentences with subject-verb-object (e.g., “I like ice cream”)
2) Can be understood consistently by most people – not just family members
3) Using the following: -ing (e.g., “crying”); in/on (e.g., “on the table”), plural forms (e.g., “two cars”), and possessives (e.g., “daddy’s car”)

This array of speech benchmarks provides a good indicator of a 3-year-old’s emerging language skills. Delays on one or more of these do not necessarily indicate the need for intervention. That said, there is utility to having your pediatrician determine if an evaluation by language experts is warranted – for one principle we have learned is that early intervention can be very beneficial for toddlers. It’s better to evaluate early and intervene if necessary rather than simply “wait and see.”

Development Milestones: Age 24 Months
Development Milestones: Age 24 Months
Development Milestones: Age 24 Months

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Parenting Principle #7: Embrace Intervention

Monday, June 30th, 2014

What are the parenting principles for raising happy, well-adjusted children? Here the focus is on the importance of intervention.

Many parents of babies and toddlers grew up in an era of “wait and see” – the idea being to not focus too much on developmental milestones and wait until there was a strong signal that a baby or toddler may have a developmental issue. That has changed.

It’s still a reality that babies and toddlers develop at different rates. There is much more of a normal range for developmental milestones than there is hard and fast age markers. That said, there are benchmark milestones and ages that are useful checkpoints for potential evaluation and intervention.

What has changed? Two things. First, developmentalists have a much more sophisticated understanding of developmental milestones and early signs of potential problems, including early symptoms of autism, language delay, and motor delay. Second, early interventions are much more powerful and can be administered at younger ages. They can make a huge difference in a young child’s life.

Pediatricians are trained to screen at key ages for fundamental milestones. If your pediatrician suggests a developmental evaluation, it doesn’t mean that intervention will be necessary. It may be that the conclusion is to “wait and see.” But given the sophistication of modern evaluation and the success of early intervention, it’s very much worth letting professionals make that call.

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Development Milestones: What to Expect at 6 Months
Development Milestones: What to Expect at 6 Months
Development Milestones: What to Expect at 6 Months

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Parenting Principle #4: Reduce Electronic Noise

Monday, June 30th, 2014

What are the parenting principles for raising happy, well-adjusted children? Here the focus is on reducing the electronic noise that permeates modern family life.

Electronic devices are a fundamental part of the fabric of modern family life. Most families have some form of electronic device in operation, and most have multiple streams going on, typically simultaneously. There’s no point to suggesting that life will be any different in the near future.

The reality is that it is up to parents to try to make sure that the benefits of screen time outweigh the downsides. The primary downside is when electronics interfere with parent-child interaction.

We can see this everywhere. It’s not hard to discover young kids in restaurants spending most of their time on their smartphone or other device. Their parents may be on theirs as well. The fact that this is happening isn’t so disconcerting, if it is balanced with some quality family talk time. Meals used to be a primary way for families to interact and talk and all be together without interruption. We need some of that back.

And the same goes for family time at home. Even the good old television is a continuing source of interference for parent-child interaction. A recent paper published in the Journal of Children and Media found, using a controlled experimental setting, that parental talk (number of words and utterances per minute, as well as number of new words used) decreased when there was background noise from the TV. Electronic noise becomes intrusive even when we aren’t aware of it and, simply put, interferes with parent-child interaction.

We are aware that we need to monitor what kids are exposed to on television, radio, smartphones, tablets and computers. We know that it’s important to turn those things off sometime so that parents and kids can talk and play and interact without distraction. But it’s really important to keep in mind that we aren’t good at blocking out the background noise even if we think we aren’t paying attention to it. We all get more than enough screen time. It’s worth making sure we get in the habit of reducing the electronic noise that we have floating in the background because it’s an insidious siphon of parent-child time. It’s easy – just turn it off.

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If you have school-age children, make sure they sign our Family Use Internet Contract.

Setting Limits on Technology
Setting Limits on Technology
Setting Limits on Technology

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Genes and Autism: New Challenges Ahead

Wednesday, May 21st, 2014

A new twin study of autism suggests that while genetics clearly play a key role , environmental factors are influential too – and in fact may be as important important.

This work – which involved analysis of twins in a large national database in Sweden – partially replicates a recent twin study of autism with US twins sample published in 2011. The only difference is the US study found evidence of “shared environmental” influences on autism – environmental factors that partially explain the similarity of twins (or siblings) independent of genetics. But in both cases, the heritability estimate (a statistical, not biological, metric) suggests that the sum effect of genes on autism is less than estimated in the past.

Overall, the implication is that we need to ramp up efforts to examine environmental contributions to autism – without diluting genetic research. This is easier said than done in a climate in which research funding continues to retract. The reduction of funding makes it harder to pursue the complex issues that require sorting out. Here’s a sampling of issues requiring further intensive investigation:

  • It is likely that there is no one “cause” of autism, such that there may be subtypes that are more strongly effected by genes than others. Testing out this idea would require very large samples – which requires substantial funding.
  • Isolating multiple genes that have “small effects” rather than finding one “disease gene” is still a tricky proposition (akin to looking for multiple needles in a haystack). Researchers continue to evolve biological and statistical approaches to achieve this – but again this work is costly.
  • The same complexities characterize efforts to isolate environmental contributors to autism. Bear in mind that the twin studies don’t identify the sources of the environmental effect – rather, they provide evidence suggesting that environmental factors are critically important and should not be ignored. Again – funding is needed for this.

As the estimated rate of autism continues to climb, and the science keeps telling us that the causes are varied and complex, we need to embrace the idea that funding is critical. Yet we continue to hear that funding for autism research is limited at the national level. Private organizations like Autism Speaks are making great strides but the effort required necessitates a national commitment to increase funding for research on autism. Disseminating that perspective to law makers is one way to try to provide the level of support necessary to examine the roots of a disease that affects more and more children each year.

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Early Signs of Autism
Early Signs of Autism
Early Signs of Autism

Nature and Nurture via Shutterstock.com

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Medicating Young Toddlers For ADHD: A Disturbing New Trend

Tuesday, May 20th, 2014

The Centers for Disease Control and Prevention (CDC) have provided new data suggesting that it is becoming common to not only diagnosis attention deficit hyperactivity disorder (ADHD) in 2- and 3-year-olds – but also to prescribe medication to these toddlers. As reported in the New York Times, data collected by the CDC suggested an estimate that 10,000 young toddlers are being given stimulant medication. And, of course, it could be more and the number could be growing.

There are many problems with diagnosing and medicating young toddlers for ADHD. Here are three primary issues:

ADHD is difficult to diagnosis – even in older children. While comprehensive, multidisciplinary clinical teams can offer productive diagnostic assessments of school aged children, ADHD is still difficult to diagnosis with certainty. It’s clear from prior analyses and studies that many school aged children are being given diagnoses of ADHD without such careful clinical evaluation and put on medications that they may not need. Given this, the idea that ADHD can be reliably diagnosed in 2- and 3-year-olds is shaky, to say the least – or simply not advisable.

The effects of stimulant medications in young toddlers have not been studied. Stimulant medications require careful clinical monitoring in school-aged children. It is controversial to administer them to 4- and 5-year olds. Prescribing them to 2- and 3-year-olds is not within the clinical boundaries. There is a reason that drugs are studied and approved for specific conditions and age groups. We don’t know the side effects of stimulants on young toddlers or how they influence the developing brain.

Behavioral management of toddlers is important but can be achieved without medication. Young toddlers need to be socialized. They need to have some structure and learn boundaries. They need to know how to modify their behavior in different settings. These are developmental goals, not the stuff of psychiatric diagnosis. If parents are having difficulties with young toddlers – and as we know, they can be rambunctious, as they should be – it’s certainly worth thinking about getting some advice or even learning behavioral management techniques that can be especially effective with some youngsters. The idea that this process may be circumvented by inappropriate clinical diagnosis and drug treatment is very troubling – especially since there is good evidence that behavioral techniques work and no evidence supporting the use of stimulant medication in young toddlers.

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Life with ADHD and Sensory Processing Disorder
Life with ADHD and Sensory Processing Disorder
Life with ADHD and Sensory Processing Disorder

ADHD via Shutterstock.com

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