Posts Tagged ‘ AAP ’

Another Reason To Interact With Your Baby (And Turn Off The Electronics)

Thursday, January 19th, 2012

My fellow blogger Holly Lebowitz Rossi published a really important post on a new study showing how babies read lips as part of the language learning process. I urge you to read Holly’s blog post to learn the details of the study. Here I want to expand a little on the findings and the very important implications for parents.

What does this study teach us?  The study used a clever design and methodology to reveal developmental patterning in the way babies orient to an adult’s face when they hear speech. Throughout the first year of life, differential attention is first given to an adult’s eyes (4 months), then eyes and mouth (6 to 8 months), then mouth (8 to 10 months), and then eyes (12 months). What’s going on here? Well, think of it this way. Young babies orient first to the eyes as the logical point of social contact; then they start to gain the ability to selectively attend to the mouth, which is cool since they’ve figured out that’s where the sounds are coming from; then they study the mouth really hard to make sense of the sounds and observe how they are produced; and finally as the sounds are making sense they refocus more on the eyes to, if you will, take in the whole social experience of language and connect with the speaker. (Keep in mind this is just my take on what’s happening – I haven’t done research with infants in a very long time!). The nice twist to the study was to observe 12-month-old infants as they looked at an adult speaking a foreign language: they focused on the mouth, just a like a 6-month old would. Why? Because they were trying to make sense of the new sounds they were hearing.

What are the implications for parents? These findings demonstrate how important the face is to a baby when they are hearing words – and how many different ways they use the face to learn a language and, more broadly, the pleasure of communication. Think about all the developmental stages that happen in just the first 12 months of life. And all of it centers on the face. So the biggest take-home message here is that babies need uninterrupted face-to-face interaction to achieve all this. Think about how pleasantly focused a baby is when you are talking, smiling, and laughing. Think about how much babies love playing games like peek-a-boo and how the game morphs with age (click here for a nice description). This is why organizations like the American Academy of Pediatrics strongly recommends that babies don’t spend too much time focusing on a TV/DVD/Smart Phone – and spend lots of time focusing on your face. It’s much more interesting (and informative) to them.

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Safe Sleep Guidelines: Beyond Sleep Methods

Wednesday, November 30th, 2011

If you have a baby younger than 1 year of age, I hope you have had a chance to review the new guidelines to promote safe sleeping offered by the American Academy of Pediatrics (AAP) (click here to see the GoodyBlog post on this if you haven’t seen these yet). In addition to providing the latest thinking aimed at keeping your baby healthy and safe, I think these kinds of recommendations serve another important function: they remind us that there are principles to follow that override the often polarizing debates about sleep methods.

In particular, I’d like to emphasize how the AAP is using a platform that combines clinical observations along with research to generate their guidelines. So when they suggest that babies under 1 should NOT sleep in a bed with a parent, but SHOULD sleep in the same room as a parent, they have only 1 thing in mind – the safety of your baby. And notice that their suggestion sort of splits the difference between bed-sharing and cry-it-out: your baby should be close by but not by your side.

Now of course this recommendation applies to the infancy period. As your baby gets older you can start to morph your child’s sleep routine into whatever works for all of you. But I suggest that you remember to consult resources such as those offered by the AAP website to help you make sure that your decisions are executed safely throughout your child’s life.


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Should ADHD Be Diagnosed In Toddlers?

Tuesday, October 18th, 2011

The American Academy of Pediatrics (AAP) has issued new guidelines on ADHD: it is now suggested that kids as young as 4 years old should be evaluated, diagnosed and treated. I don’t agree. Stick with me here as I lead up to telling you why I feel this way.

Diagnosing ADHD is a tricky business at any age – there are no benchmark biological indicators that tell you “yes or no.” Experienced clinicians have to rule out a host of factors (biological, psychological, social) that could contribute to a child showing the key constellation of symptoms that go into making an ADHD diagnosis. In addition, practitioners have to consider age as a relevant factor, since many of the symptoms of ADHD are extreme versions of age-appropriate behavior. As kids enter the normative years for traditional schooling (say by 7 years of age), there is some calibration in a classroom and a reasonable metric of comparison with other kids – so a kid who’s behavior is extreme compared to other kids the same age and gender might have what we label clinically as ADHD. Keep in mind that to make a thoughtful diagnosis of ADHD, it’s important to see that the behavior is not limited to one context (e.g., you need to see it at home and at school). So the school years provide a few key reference points for differential diagnosis: some clear comparisons with relevant peer groups, an opportunity to assess behavior outside the home, and some opportunity to observe barriers to learning. 

My issue with lowering the age bracket for screening and diagnosing ADHD is that we really shouldn’t expect 4- and 5-year old kids to behave like 1st graders – even if they are in preschool or kindergarten. We expect them to observe some rules, and to dip into the academic readiness pond – but let’s face it, if we apply the expectations of formal schooling to toddlers we are going to be labeling lots of normative behavior as pathological. And the consequence of that could be starting medication regimens with toddlers without having a solid platform to know that they will need this – and in many cases take on the risks for a number of side effects without knowing that there will be meaningful benefits. A quick case in point is dyslexia – although you can observe the early signs of this in toddlers, diagnosis is typically not applied until the school years because it’s only then that you can gather sufficient developmental evidence for it (you need to let kids get through the developmental window of opportunity for learning to read before you can really know that they have an underlying problem with it).

Look, it’s quite possible to observe behaviors in 4-year-olds that can be improved. The preschool years are an important time for parents (and teachers) to socialize kids, and set up some expectations for behavior that are age-appropriate. There could be lots of reasons why toddlers are showing acting out and disruptive behaviors. Addressing these behaviors and sharing with parents good behavioral techniques and parenting strategies to promote more regulated behavior is a fine goal that would help kids and parents alike. But applying diagnostic labels that may promote immediate prescription drugs for toddlers seems to pull us away from what we should be doing: focusing on best practices for socialization at an age where youngsters should be youngsters. And the reality is as kids get older, there will be much better opportunities to properly identify the small percentage who may profit from more intensive intervention.

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