Developmental delay (aka delayed milestone) is where a child doesn't reach 1 of the milestone stages at the expected age, which can be in one of the 4 developmental domains:
However, a wide variety of ages can be considered normal, and not a cause for medical concern. Milestones are often measured using percentiles, and milestones between the 5th and 95th percentile don't require intervention, but values towards the edges of that range can be associated with other medical conditions. It is not possible to treat.
Global developmental delay (GDD) is delay that occurs in 2 or more developmental domains.
Wait. You said language and social, aren't these 2 things basically autism?
It is, but the diagnosis of autism requires that it's not better accounted for by GDD .
Developmental milestones are recognized norms of pattern of development that children are expected to follow. In premature infants (<37 weeks gestation), we use corrected gestational age until 2yo.
The 7 developmental domains include:
A mnemonic that can be used to memorize is at 1yo, single words. At 2yo, and parallel play (2 things). At 4yo, counts 4 objects.
|Gross motor||Fine motor||Speech||Social|
|6wk||Lifts chin occasionally when prone||Social smile|
|2mo||Arms extend forward when prone||Pulls at clothes||Cooing sounds|
|3mo||Moro reflex gone|
|4mo||Rolls from front to back||Reaches, pulls objects to mouth||Responds to human voice|
|6mo||When prone, can put weight on hands||Ulnar grasping||Responds to name. Babbling starts||Stranger anxiety|
|9mo||Pulls to stand||Finger-thumb grasping||"Mamma, Dadda"||Separation anxiety|
|12mo||Walks under support||Pincer grasp. Throws. Babinski begins to disappear||2 words beyond "Mama, Dadda", so a word with meaning||Drinks with cup|
|15mo||Walks without support||Draws line||Jargon||Points to needed items|
|18mo||Climbs steps with support||Scribbling||Says own name. 10 words||Uses spoon|
|2yo||Runs. Kick ball. Climb 2 steps||Undresses||2 word sentences, with pronouns. Favorite word is "No"||Parallel play|
|3yo||Ride tricycle||Copies a circle||Prepositions||All dress/undress except buttons|
|4yo||Hop on 1 foot||Copies a cross||Tells story||Cooperative play. Toilet trained. Buttons clothes|
|5yo||Skip. Catch ball||Copies a square. Prints own name. Ties shoelaces||Alphabet. Future tense||Oedipus complex|
|6yo||Rides bicycle||Copies a triangle||Begins reading||Develops right vs wrong sense|
Source: Clinical exam
Fine motor. What about that?
So that's using the smaller muscles of the hands, fingers, and of course the eyes. So we start with the major land mark at 12mo, which is the pincer grasp and throwing. So working back, at 9mo, there's the whole-hand grasp. At 6mo, there's ulnar grasp, where you grab without using the thumb. At 4mo, reaching, and pulling objects to mouth. At 2mo, pulling at clothes. Going the other way, at 15mo, they can draw a line. At 18mo, they can scribble. At 2yo, they undress. At 3yo, they can copy a circle. At 4yo, they can copy a cross. At 5yo, they can copy a square, write their name, and tie shoelaces. At 6yo, they can copy a triangle. The shapes can be memorized from 3-6, involving a stick figure with a circle face at the top, a cross hanging on the neck, a square body, and a triangle skirt.
Speech. So that's talking, right? Can bubs talk lol?
Well eventually they can, right ? Remember that it also includes listening too . So the big landmark is 1yo, where bub can say 2 words beyond "mama, dada". At 9mo, they can say "mama, dada". At 6mo, they start to babble, and they can also respond to their name. At 4mo, they respond to human voice. At 2mo, they coo. At the other end, at 15mo, they speak jargon, so it's context specific. At 18mo, they can say their own name, and 10 words. At 2yo, 2 word sentences, around 200 words (2 zeros), and understand 2 step commands. At 3yo, they can speak 1,000 words (3 zeros), use 3 word combinations (and therefore use preopositions), and repeat 3 digits. At 4yo, they can count 4 objects, and tell a story. At 5yo, they can say the alphabet. At 6yo, they begin reading.
Social. Is that how bubbly they are ?
So the big landmark is 1yo, where they can drink with a cup. At 9mo, they have separation anxiety. At 6mo, they have stranger anxiety. At 6 weeks, they have a social smile. At the other end, at 15mo, they point to needed items. At 18mo, they can use a spoon. At 2yo, they have parallel play, where children play alone but are interested in what other children are doing. At 3yo, they can dress and undress, except for buttons. At 4yo, they have cooperative play, are toilet trained, and can buton clothes. At 5yo, they have oedipus complex, where they have sense of rivalry with a same gender parent. At 6yo, they develop sense of difference between right and wrong.
Wait. Why are you doing this up to 6 months? You being a bit lazy ?
It's why we do it. We do it because under the age of 6, they bub can't readily express themselves, so we use this to find out what's going on with them. Also, they start going to school, so things become more obvious when they're around others all day.
What happens at 1 year old?
They can walk alone. Use 2 fingers in a pincer grip. Say mama and dada. And imitate a parent. That's where we want them to be .
Let's go down to the short end. 1 month. What do we expect?
Not a lot, obviously . Lift their head. Track things with their eye. Coo. And recognize their parents.
What happens part way between then? At 6 months?
It's the stuff in between. So what's between lifting their head and walking? Sitting up. What's between not using their hands and a pincer grip? A raking grasp. What's in between cooing and saying mama/dada? Babbling. What's in between recognizing parents and imitating parents? Recognizing strangers.
How about between 6 and 12 months?
Again, it's the stuff in between. So in between sitting up and walking, is walking with assistance. In between raking grasp and a 2 finger prince grip, is a 3 finger pincer grip. Language we sort of ignore here. And in between stranger anxiety and imitating their parent, is interacting with parents, such as waving bye-bye or play "pat-a-cake" with parents.
That sub-division type strategy made memorizing a lot more easier . But how about as you go up to 2 years of age?
It's easy because it correlates with the age. Climb 2 steps. Say 2 word phrases. Follow 2 step commands. And the only exception - stack 6 blocks.
So 3 years would be the year of 3's?
Yep! Ride a tricycle. Say 3 word sentences. Copy a circle, which can be memorized with the fact that it is a 360 degree angle! For fine motor, they should be able to draw a person with as many parts as their age - for example, a face, eyes, and mouth. And, they can brush their teeth.
So a 4 year old can add a nose to their picture?
Yep. Also, they can hop. Copy across. And play with other kids.