Developmental Check For Young Children

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Developmental Check For Young Children

• January 24, 2009
• 9 am to 12 pm
• Sponsored by Salem Association of Early Childhood
  Directors Willamette ESD Early
  Intervention/Early Childhood Special Education
  Program
• Presented by
• Devora Gramson, WESD EI/ECSE Coordinator
• Debbie King, WESD EI/ECSE Speech/Language
  Coordinator
• Tonya Coker, WESD Autism Specialist

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TODAYS AGENDA

• WELCOME INTRODUCTIONS
• TRAINING GOALS
• BRIEF INTRODUCTION TO EI/ECSE
• SETTING THE STAGE
• VISION HEARING CHECKS
• DEVELOPMENTAL CHECKLISTS/RED FLAGS
• AUTISM SPECTRUM DISORDER CHARACTERISTICS
• ADD/ADHD
• PARENT INTERACTIONS
• ASQ

3

• When we plant a rose seed in the earth,
• we notice that it is small,
• but we do not criticize it as rootless and
  stemless.
• We treat it as a seed,
• giving it water and nourishment required for a
  seed.
• When it first shoots up out of the earth,
• we do not condemn it as immature and
  underdeveloped
• nor do we criticize the buds for not being open
• when they appear.
• We stand in wonder at the process taking place
• and give the plant the care it needs at
• each stage of its development.
• The rose is a rose
• from the time it is a seed to the time it dies.
• Within it, at all times, it contains
• its whole potential.
• It seems to be constantly in the process of
  change
• yet at each state, at each moment,

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Goals

• Participants will learn
• About the EI/ECSE program and the services
  provided for children birth to age five
• To recognize the signs and symptoms of a possible
  vision concern
• To be familiar with typical hearing development
  and the 3 types of hearing losses children can
  experience
• To identify developmental red flags for children
  1 months to five years of age
• To be acquainted with the characteristics of
  autism spectrum disorder for young children
• To be aware of the Indicators of ADD/ADHD from
  infancy through preschool age
• To know how to relay concerns to parents on their
  childs developmental progress
• To become familiar with the Ages Stages
  Questionnaire

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EI/ECSE

• About EI / ECSE Services
• The Oregon Department of Education is the lead
  agency for the statewide system of early
  intervention and early childhood special
  education services for families with children
  ages birth to five who have developmental delays.
• What is EI / ECSE?
• Early intervention (EI) and early childhood
  special education (ECSE) are specialized services
  offered throughout the state of Oregon to
  eligible children with special needs, ages birth
  to kindergarten. These programs are administered
  through 10 regional contractors around the state.

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EARLY INTERVENTION

• What is early intervention?
• Children who receive early intervention services
  from birth to three years of age have a need for
  services because of a delay in any one of a
  number of developmental areas, including
  cognitive, physical, communication development,
  self-help and psycho-social development.
• In addition, for very young children, eligibility
  for services can be determined on the basis of a
  medical diagnosis of a condition likely to result
  in a developmental delay.

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EARLY CHILDHOOD SPECIAL EDUCATION

• What is early childhood special education?
• Children who receive early childhood special
  education range in age from 3 years to entry into
  public kindergarten. They need these services
  because they experience a developmental delay or
  have been evaluated as having
• one of the school-age disabilities, such as
  vision impairment, communication disorder, or
  autism.
• Children in early childhood special education
  programs
• have disabilities that range from mild to severe.

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EI/ECSE SERVICES

• What services does Oregon provide to children and
  families?
• The focus of Oregons EI/ECSE service is on
  building on the familys strengths to meet the
  special needs of the child.
• Family members, preschool teachers, and
  caregivers are given strategies for teaching the
  child in situations where and when learning
  occurs every day.
• Services may include
• Providing the family with specific information
  about the childs delay
• Incorporating the childs special needs into
  family routines within the home
• Connecting the family to community resources,
  including classes.
• Coaching parents, family and caregivers on
  specific child skills.

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EI/ECSE SERVICES

• Programs are specially designed to address the
  special education needs of young children with
  disabilities.
• Services may include a combination of the
  following
• Evaluation
• Developmental consultation/education
• Parent consultation/education
• Physical or occupational therapy
• Speech therapy
• Vision services
• Hearing services
• Augmentative communication
• Assistive technology

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Is there a cost to families?

• EI/ECSE services are free to families.

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Marion County EI/ECSE

• EI/ECSE program has 14 classrooms throughout
  Marion County (including one in West Salem)
• There are 33 licensed staff and 34 assistants.
• We see over 1000 children in the home, community,
  and specialized classrooms.

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SETTING THE STAGE

• Experience and opportunity
• Medical information
• Vision and hearing
• Adverse impact on developmental skills
• Need for early intervention or special education
• Suggest parent talks to childs
  pediatrician/physician
• Referral to other community programs
• Referral to EI/ECSE

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VISION CHECK

• SIGNS AND SYMPTOMS
• Observable behavior
• One eye drifts or aims in a different direction
  than the other (look carefully this can be
  subtle). This is significant even if it only
  occurs when the child is tired or stressed.
• Turns or tilts head to see
• Head is frequently tilted to one side or one
  shoulder is noticeable higher
• Squinting or closing of one eye
• Excessive blinking or squinting
• Poor visual/motor skills (often called, hand-eye
  coordination)
• Problems moving in space, frequently bumps into
  things or drops things

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Vision Check continues

• While reading or doing close work your child
• Holds the book or object unusually close
• Closes one eye or covers eye with hand
• Twists or tilts head toward book or object so as
  to favor one eye
• Frequently loses place and fatigues easily
• Rubs eyes during or after short periods of
  reading
• Frequently complains of
• only being able to read for short periods of
  time
• Headaches or eyestrain
• Nausea or dizziness
• Motion sickness
• Double vision
• The above information is from
• http//children-special needs.org/parenting/presch
  ool/children_eye_exams.html

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Vision Conclusion

• Encourage all parents and especially those who
  children demonstrated some of the previously
  listed signs and symptoms, to take their child to
  an optometrist or ophthalmologist for an eye
  exam.
• If the family does not have insurance and is not
  eligible for Oregon Health Plan, the Sight for
  Students Program will provide free eye exams and
  glasses. To access this program contact Sight for
  students at 222.sightforstudents.org. On the
  home page select Finding Partners.
• Eligibility criteria for Sight for Students
• Family income is no more than 200 of the federal
  poverty level
• Child is not enrolled in Medicaid or any other
  vision insurance
• Child or parent is US citizen or documented
  immigrant with SS
• Child has not used the program during the last 12
  months

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Vision Conclusion

• An vision examination is required before a
  referral for a functional vision evaluation
  through the EI/ECSE Program.
• Must meet state Vision Impaired eligibility
  requirements for special education services
  including having an adverse impact on the childs
  developmental progress and the child needs
  special education as the results of the vision
  impairment.

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Hearing Check

• Hearing loss is invisible, and the signs of a
  hearing loss are
• subtle in young children
• Developmental Guidelines
• 0-28 days
• Should have a startle response,
• Attend to music and voice
• Soothed by a parents voice
• Some will synchronize body movements to speech
  patterns
• Enjoys time enface position
• Hears caregiver before being picked up

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Hearing Check

• 1-3 months
• Looks for sound source
• Associates sound with movement
• Enjoys parents voice
• Attends to noise makers
• Imitates vowel sounds

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Hearing Check continues

• 4-8 months
• Babies will turn their heads and eyes toward a
  sound when the sound is coming from outside the
  childs peripheral vision
• Babies begin to enjoy the sound of musical toys
  (rattles, bells, etc.)
• At approximately six months of age, babies begin
  babbling in response to someone talking to them
• 8-12 months
• Babies voices go up and down in intonation when
  vocalizing
• Babies turn directly toward a soft noisemaker, or
  to the calling of their names
• Babies seem to enjoy music and respond by
  listening, bouncing, or singing along

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Hearing Check continues

• 12-16 months
• Children understand many words and speak about 25
  single words, dances to music, listens to simple
  stories, songs rhymes
• 18-24 months
• Children undergo a name explosion they begin
  to understand that everything has a word that
  goes with it, and they begin speaking two word
  sentences
• Children know about 100-200 words
• 24-36 months
• Children begin speaking more fully in sentences,
  and usually know about 200-400 words

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Hearing Check continues

• Three Types of Hearing Losses
• Sensorineural hearing loss permanent loss,
  affects the inner ear or the nerve detectable at
  birth can occur later in life (excessive
  exposure to loud noise)
• Conductive hearing loss affects the outer or
  middle ear, such as ear infections associated
  with fluid in middle ear space. Any time
  children have middle ear infections with fluid in
  their ears, they have an accompanying hearing
  loss
• Mixed hearing loss combination of sensorineural
  and conductive hearing losses
• Information obtained from AGBELL

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Hearing Check Continues

• High Risk Factors
• Excessive middle ear effusion
• Rh incompatibility
• Ear and other craniofacial abnormalities
• Stressful delivery
• Low birth weight
• Hyperbilirubinemia
• In utero infection associated with hearing loss
  such as toxoplasmosis, cytomegalovirus, herpes
• Heredity hearing loss
• Genetic syndromes

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Hearing Check Continues

• High Risk Factors
• Other postnatal conditions such as meningitis,
  head or ear injury, high fevers and some
  medications
• Respiratory distress
• Prolonged mechanical ventilation for more than 10
  days
• Ototoxic medication administered for more than 5
  days or used in combination with loop diuretics
• Physical features or other stigmata associated
  with a syndrome known to include hearing loss
  such as Down Syndrome, Waardenburgs Syndrome,
  etc.

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Hearing Check conclusion

• Newborn Hearing Screening for all newborns
• Does not identify mild or progressive hearing
  loss
• Recent NIH studies shown that children with
  hearing loss who are identified and receive early
  intervention prior to six months of age develop
  significantly better language ability than
  children identified after six months
• Must meet state Hearing Impaired eligibility
  requirements for special education services
  including having an adverse impact on the childs
  developmental progress and the child needs
  special education as the results of the hearing
  impairment.
• The above information was obtained from AGBELL

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Developmental Check

• Developmental Checklists Birth to Five
• Available in Spanish
• The CNY Early Childhood Direction Center
• Syracuse University
• ecdc_at_syr.edu

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Developmental Red Flags

• 1 to 3 months
• Doesnt seem to respond to loud noises
• Doesnt follow moving objects with eyes by 2 to 3
  months
• Doesnt smile at the sound of your voice by 2
  months
• Doesnt grasp and hold objects by 3 months
• Doesnt smile at people by 3 months
• Cannot support head well at 3 months
• Doesnt reach for and grasp toys by 3 to 4 months
• Doesnt bring objects to mouth by 4 months
• Doesnt push down with legs when feet are placed
  on a firm surface by 4 months
• Has trouble moving one or both eyes in all
  directions
• Crosses eyes most of the time (occasional
  crossing of the eyes is normal in these first
  months)

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Developmental Red Flags

• 4 to 7 months
• Seems very stiff, tight muscles
• Seems very floppy, like a rag doll
• Head still flops back when body is pulled to
  sitting position (by 5months still exhibits head
  lag)
• Shows no affection for the person who cares for
  them
• Doesnt seem to enjoy being around people
• One or both eyes consistently turn in or out
• Persistent tearing, eye drainage, or sensitivity
  to light
• Does not respond to sounds around them
• Has difficulty getting objects to mouth
• Does not turn head to locate sounds by 4 months
• Doesnt roll over (stomach to back) by 6 months
• Cannot sit with help by 6 months (not by
  themselves)
• Does not laugh or make squealing sounds by 5
  months
• Does not actively reach for objects by 6 months
• Does not follow objects with both eyes
• Does not bear some weight on legs by 5 months

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Developmental Red Flags

• 8 to 12 months
• Does not crawl
• Drags one side of body while crawling (for over
  one month)
• Cannot stand when supported
• Does not search for objects that are hidden
  (10-12 mos.)
• Says no single words (mama or dada)
• Does not learn to use gestures such as waving or
  shaking head
• Does not sit steadily by 10 months
• Does not show interest in peek-a-boo" or "patty
  cake by 8 mos.
• Does not babble by 8 mos. (dada, baba, mama)

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Developmental Red Flags

• 12 to 24 months
• Cannot walk by 18 months
• Fails to develop a mature heel-toe walking
  pattern after several months of walking, or walks
  exclusively on toes
• Does not speak at least 15 words by 18 months
• Does not use two-word sentences by age 2
• By 15 months does not seem to know the function
  of common household objects (brush, telephone,
  bell, fork, spoon)
• Does not imitate actions or words by 24 mos.
• Does not follow simple one-step instructions by
  24 mos.

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Developmental Red Flags

• 24 to 36 months
• Frequent falling and difficulty with stairs
• Persistent drooling or very unclear speech
• Inability to build a tower of more than 4 blocks
• Difficulty manipulating small objects
• Inability to copy a circle by 3 years old
• Inability to communicate in short phrases
• No involvement in pretend play
• Failure to understand simple instructions
• Little interest in other children
• Extreme difficulty separating from primary
  caregiver

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Developmental Red Flags

• 3 to 4 years
• Cannot jump in place
• Cannot ride a trike
• Cannot grasp a crayon between thumb and fingers
• Has difficulty scribbling
• Cannot copy a circle
• Cannot stack 4 blocks
• Still clings or cries when parents leave him
• Shows no interest in interactive games
• Ignores other children
• Doesn't respond to people outside the family
• Doesn't engage in fantasy play
• Resists dressing, sleeping, using the toilet
• Lashes out without any self-control when angry or
  upset
• Doesn't use sentences of more than three words
• Doesn't use "me" or "you" appropriately

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Developmental Red Flags

• 4 to 5 years
• Exhibits extremely aggressive, fearful or timid
  behavior
• Is unable to separate from parents
• Is easily distracted and unable to concentrate on
  any single activity for more than 5 minutes
• Shows little interest in playing with other
  children
• Refuses to respond to people in general
• Rarely uses fantasy or imitation in play
• Seems unhappy or sad much of the time
• Avoids or seems aloof with other children and
  adults
• Doesn't express a wide range of emotions
• Has trouble eating, sleeping or using the toilet
• Can't differentiate between fantasy and reality
• Seems unusually passive
• Can't understand two-part commands and
  prepositions ("put the cup on the table" "get
  the ball under the couch")

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Developmental Red Flags

• 4 to 5 years continues
• Can't give his first and last name
• Doesn't use plurals or past tense
• Cannot build a tower of 6 to 8 blocks
• Seems uncomfortable holding a crayon
• Has trouble taking off clothing
• Can't brush teeth or wash and dry hands

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Developmental Red Flags conclusion

• Early Intervention eligibility 
• The child is under three years of age and has a
  developmental delay of 2 standard deviations or
  more below the mean in one or more of the
  following developmental areas
• Communication Adaptive Physical
  Social/Emotional Cognitive
• OR
• The child is under three years of age and has a
  developmental delay of 1.5 standard deviations or
  more below the mean in two or more of the
  following developmental areas
• Communication Adaptive Physical
  Social/Emotional Cognitive
• AND
• The child needs early intervention services.

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Developmental Red Flags conclusion

• Early Childhood Special Education eligibility
• The child has a developmental delay of 1.5
  standard deviations or more below the mean in two
  or more of the following developmental areas
  Communication , Adaptive, Physical
  Social/Emotional, Cognitive
• and
• The childs disability has an adverse impact on
  the childs developmental progress and
• and
• The child needs early childhood special
  education services
• and
•  The Eligibility Team has considered the childs
  early childhood special education eligibility,
  and determined that the eligibility ___ is ___is
  not due to a lack of instruction in reading, math
  or limited English proficiency.
•  

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Developmental Red Flags conclusion

• Communication Disorder
• For a phonological or articulation disorder
• The students phonology or articulation is rated
  significantly discrepant as measured by a
  standardized test and
• The disorder is substantiated by a language
  sample or other evaluation(s).
• For a syntax, morphology, pragmatic, or semantic
  disorder
• The students language in the area of syntax,
  morphology, pragmatics, or semantics is
  significantly discrepant as measured by
  standardized test(s) and
• The disorder is substantiated by a language
  sample or other evaluation(s) and
• The disorder is not the result of another
  disability. 

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Developmental Red Flags conclusion

• Communication Disorder continues
• The Team has determined that
• The students disability has an adverse impact on
  the childs developmental progress when the child
  is age three through kindergarten and
• The student needs special education services.
• The team has considered the students special
  education eligibility, and determined that the
  eligibility __is __ is not due to a lack of
  appropriate instruction in reading, including the
  essential components of reading instruction
  (phonemic awareness, phonics, vocabulary
  development reading fluency/oral reading skills
  and reading comprehension strategies) __is
  __is not due to a lack of instruction in math
  and __is __ is not due to limited English
  proficiency.
•  

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Autism Spectrum Disorder (ASD)

• For the preschool child, Autism signifies a
  developmental disability affecting the
  processing, integrating, and organizing of
  information that significantly impacts
  communication, social interaction, and
  developmental progress.
• Autism is a spectrum disorder. The symptoms and
  characteristics of autism present themselves in a
  wide variety of combinations, from mild to
  severe.

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ASD More Indicators

• Early Indicators of ASD and/or Communication
• and Interaction Disorders
• Often suspect the child may be deaf. Doesnt
  have typical startle response. Doesnt turn when
  you come into the room. Seems unaware of sounds
  in the room, etc.
• Extremely good babies seldom cry, are not
  demanding, seem very content to be alone or very
  fussy, colicky babies cry a lot, sleep
  problems, not easily comforted.
• Engage in an excessive amount of rocking
• May hand gaze, look at lights through fingers
  or have other self-stimulatory behavior.
• Often very fussy eaters. Become upset with the
  change from pureed baby foods to junior baby
  foods. Prefer only salty foods or only sweet
  foods, etc.

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ASD More continues

• Lack of molding the baby just doesnt feel
  right when you pick him up. Often feels stiff,
  arches his back, etc.
• Does not have anticipatory response. Doesnt put
  up his arms to be picked up. Doesnt seem to
  want to be held.
• Seems to actively avoid looking at people. Lack
  of eye contact.
• Seems to tune out a lot. Isnt aware of what
  is happening around him
• Prolonged tantrums up to two hours in duration
  or more. Often it is difficult to figure out
  what set the child off.
• Wants things to stay the same. May have
  difficulty adapting to winter coat or boots.
  Wants to wear the same clothes. Doesnt want
  furniture or toys to be out of place.

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ASD More continues

• Doesnt play typically with toys is more likely
  to spin wheels on truck rather than move truck
  across the floor. Will line things up rather
  than play.
• Does not begin to talk or use words in a
  communicative way at the appropriate age. Fails
  to develop language or uses echolalic speech
  without really understanding the meaning of the
  words.
• Often seems perfectionistic. Wants everything to
  be just right. If he tries to make something
  work and it doesnt, he gets upset and will quit
  or get angry and wont try the activity again.

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ASD More continues

• Often has splinter skill in areas like music or
  can do puzzles extremely well or has excellent
  gross motor skills or is very interested in
  numbers and letters.
• Seems to have an excellent memory. Knows exactly
  where cookie jar is in a home he hasnt visited
  for several months, etc.
• Likes to watch things go around such as record
  players, tops, etc.
• May bang his head or engage in other
  self-injurious behaviors
• May have very high tolerance for pain. He may
  get hurt but not come to an adult for comfort.
• Changes in routine are very upsetting.

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ASD More continues

• Does not spontaneously imitate the play of other
  children.
• May have difficulty generalizing information from
  one setting to another
• May not experience separation anxiety at the
  typical age of 8 12 months.
• May experience extreme auditory sensitivity.
• May use an adults hand like a tool for
  accomplishing a task.

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ASD More conclusion

• Aspergers Definition
• Medical vs. Educational Diagnosis
• Special Education eligibility requirements for
  ASD
• Medical statement
• Referral developmental and communication
  evaluation with Autism referral for evaluation to
  follow
• Obligated to review medical report with autism
  diagnosis but we may need to do additional
  assessments to meet the eligibility criteria

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ADD/ADHD IN PRESCHOOL AND TODDLERS

• Early Indicators
• The following symptoms and behaviors are not to
  be used for diagnostic purposes. These behaviors
  do not necessary indicate ADD/ADHD. The
  following list should only be used as a guideline
  and only to determine if further medical
  attention is warranted. Not all children with
  ADD will exhibit the following behaviors and not
  all children with these behaviors will have
  ADD/ADHD. A good developmental screening is
  important when considering any further
  evaluation.
• If a child has had inconsistency in parenting,
  has experienced traumatic events, or has delays
  in language development they may exhibit many
  symptoms listed below.

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ADD/ADHD continues

• Infancy/Late Infancy
• Problems sleeping through the night
• Short, sporadic naps during the day
• Excessive crying/colic
• Ear infections/allergies/asthma
• Not interested in being held
• Content when put down
• Difficulty bonding
• Cries when held
• Rapid or delayed milestones
• Irritable in high stimulus settings
• Irritable when routines change

47
ADD/ADHD continues

• Toddler
• Does not respond to normal behavioral controls
• Difficulty in sharing/taking turns
• Inability to sit still or sustain attention
  (normal attention span for this age is 7 9
  minutes)
• High incident of falling or accidents
• Clumsiness
• Can be destructive with toys
• Trouble with playing with other children, higher
  incident of biting, kicking, or pushing playmates
• Does not like to be read to
• Fidgets when restrained or help for more than a
  few minutes
• Can act as if driven by a motor

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ADD/ADHD continues

• Preschool
• Always in motion
• Inability to sit sill or sustain attention
  (normal attention span for this age would be 9
  15 minutes)
• Clumsiness
• Coordination problems or delays
• Difficulty following directions
• Seem as if they are not paying attention
• Impulsive grabs toys, acts before thinking
• Difficulty sharing and taking turns
• Trouble waiting turn or standing in line
• Inappropriate touching, poking of other children
  or intruding on others personal space

49
ADD/ADHD continues

• Preschool
• Bed-wetting
• Interrupts often
• Can be aggressive hitting, kicking or biting
  playmates
• Forgetful
• This material is from Eileen Bailey.
• http//add.about.com/cs/adhdinpreschool/a/earlyind
  icators.htm

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ADD/ADHD conclusion

• Medical Diagnosis
• Many children with ADD/ADHD do not require
  special education or meet special education
  eligibility

51
Parent Interactions

• Establish a relationship with parents
• Build rapport, honesty and caring
• Reinforce the practice of parent participation in
  helping their child learn and develop
• Have developmental checklists available to
  parents
• Complete developmental checklist with parents or
• Share developmental checklists you have completed
  on their child
• Identify goals for the child with the parents
  each year
• Encourage parents to ask questions
• Ask parents if they have any concerns
• Have list of parent resources available

52
Parent Interactions continue

• Relay the message with compassion
• Respect the parents right to grieve that their
  child may be different. Their dream has been
  altered.
• The grieving process can include shock,
  disbelief, denial, anxiety, fear, despair and
  depression.
• Parents can experience the grief process many
  times throughout the childs life.
• What if you were hearing the message? How would
  you want the message relayed to you?
• Parents have the ultimate decision.

53
ASQ screening tool

• Who completes it Parents/caregivers complete
  questionnaires professionals score them
• Ages Stages Questionnaire (ASQ)
• A Parent completed, child-monitoring system
• Age range covered 2-60 months
• General areas screened communication, gross
  motor, fine motor, problem-solving,
  personal-social
• Ages Stages Questionnaire/Social-Emotional
  (ASQ SE)
• A Parent completed, child-monitoring system for
  social emotional behaviors
• Age range covered 660 months
• General areas screened Personal-social
  (self-regulation, compliance, communication,
  adaptive functioning, autonomy, affect, and
  interaction with people)

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• Together we can make a difference.
• Referral Line 503-385-4714 or 1-888-560-4666
• Program coordinators Devora Gramson _at_
  503-385-4651
• devora.gramson_at_wesd.org
• Debbie King _at_ 503-385-4512
• debbie.king_at_wesd.org