As parents, we want to do everything possible to ensure that our children reach their fullest potential. An important part of this is being knowledgeable about their development and seeking more information when we have any concerns.
That's why the different types of developmental monitoring and assessment are so important—they make sure that we have accurate information about our kids' progress so that we can get them the help they need as soon as possible.
This article will discuss developmental evaluations in more detail—what they are, the tools used to conduct them, and why they are so essential to a child's developmental success. With this knowledge in hand, you'll know how to make informed decisions about your child’s development to help them succeed.
In this article:
This article is a part of a series where we cover the different types of developmental care, the gaps in care, and how you as a parent can help your child flourish.
Assessing child development
There are numerous ways to check on and measure a child's development that are useful in different contexts, including:
developmental monitoring,
developmental screening, and
developmental evaluations/assessments.
This article will discuss them in the order that they would usually be performed and pay particular attention to developmental evaluations.
1. Developmental monitoring
Developmental monitoring is an ongoing surveillance of milestones and behavior that happens over a long period of time.
This manner of continuously assessing young children can be performed by a child's healthcare provider, teacher, or caregiver based on their knowledge of the child and/or expertise in early childhood development, rather than any formal screening tests.
Yes, as a parent you have a role to play in monitoring your child's development!
However, many children’s development is not sufficiently monitored.
Most children only see their doctor for 15 minutes at a time a couple of times a year.
This is not long enough to gain a personal familiarity with a child’s development, especially if a different provider sees them at each visit.
Additionally, most of a child’s development happens outside of the doctor’s office. Parents are left to monitor their children’s development themselves, but most lack the knowledge and support to do so effectively.
But don't worry--developmental monitoring doesn't have to feel obsessive or anxiety-provoking. By regularly using the Pathfinder Health app, you can feel reassured that you are fully aware of your child's developmental progress.
2. Developmental screening
Developmental screening is a formal assessment of the milestones that a child has achieved at a very specific point in time.
Screening tests can be administered at any time during a child's development, but are typically done at regular well-child check-ups.
Developmental screening does not diagnose a developmental delay or developmental disability--it only flags areas of concern.
The American Academy of Pediatrics (AAP) recommends 3 developmental screening tools for general developmental screening:
A separate screening test, the Modified Checklist for Autism in Toddlers (M-CHAT), is used to assess risks for autism spectrum disorder (ASD).
However, developmental screening rates are abysmally low—only 17-30% of U.S. healthcare providers perform the recommended screenings at the appropriate times.
3. Developmental evaluation
If a screening test flags a developmental issue, the child's healthcare provider may refer them for a formal developmental evaluation.
A parent can also seek an evaluation if they have any concerns based on their own monitoring of their child.
What is a developmental evaluation?
A developmental evaluation is a more detailed examination and assessment of a young child’s development to determine if there are any developmental delays or developmental disabilities.
The evaluation will look at a child's abilities in multiple developmental domains, including:
Movement/motor/physical: Includes gross motor skills (those involving the large muscles in the body, such as those in the arms, legs, and torso) and fine motor skills (those involving the small muscles in the hands and fingers as well as those in the mouth, tongue, and jaw).
Cognitive: The way a child thinks, learns, and solves problems, including skills such as reasoning, understanding cause and effect, thinking abstractly, and engaging in make-believe play
Social-emotional: A child's developing interactions and relationships with others as well as their awareness and understanding of themselves and their own emotions
Speech and language: A child's acquisition of communication skills, namely receptive language skills (listening and understanding others), expressive language skills (communicating ideas to others), and speech (articulating words that can be understood by others)
The terms "developmental evaluation" and "developmental assessment" are generally used interchangeably in this context. Sometimes, "assessment" is used to refer to a more focused consideration of a child's development in a specific domain, compared to a more holistic "evaluation" that looks at multiple domains.
For purposes of this article, we will use the terms interchangeably.
Examples of developmental evaluations:
Autism evaluation
ADHD evaluation
Behavioral evaluation
Educational evaluation
Neuropsychology evaluation
Who performs the evaluation?
A developmental evaluation/assessment of a young child is generally performed by a team of different child development specialists. Depending on the specific types of developmental concerns involved, a child may be evaluated by some or all of the following specialists:
1. Developmental-behavioral pediatrician
A developmental-behavioral pediatrician (DBP) specializes in assessing developmental delays and diagnosing disabilities and other developmental disorders by considering both the child's medical history and psychosocial factors (such as the child's family and home environment).
There are only 700 DBPs in the entire country, for 4.6 million children who need to be assessed, diagnosed, and potentially treated.
2. Child psychologist
Child psychologists specialize in evaluating a child's cognitive, emotional, and social growth. They perform comprehensive psychological assessments, which may include everything from analyzing cognitive function to evaluating behavior and social-emotional abilities.
3. Educational psychologist
Educational psychologists evaluate children's cognitive abilities, identify learning styles, and evaluate academic skills. They can diagnose learning disabilities that may be impacting a child's development and recommend educational interventions and accommodations.
4. Speech-language pathologist
Speech-language pathologists (SLPs) specialize in evaluating and treating communication disorders. They assess a child's language skills (both receptive and expressive), speech production, and overall communication abilities to identify any delays or disorders.
5. Occupational therapist
Occupational therapists (OTs) specialize in delays relating to sensory processing, fine motor skills, and self-help skills. In particular, they assess a child's ability to perform daily tasks and other activities appropriate for their age.
6. Physical therapist
Physical therapists (PTs) evaluate concerns related to a child's physical abilities, primarily gross motor skills, balance, and coordination.
7. Early Intervention Specialist
Early intervention specialists usually have a background in early childhood education or special education. They design and implement individualized programs at home or in school to help young children with developmental delays or disabilities.
When these professionals work together, they can provide a truly holistic view of a child's development.
The gap in developmental evaluation
There are 23 million children in the US under the age of 5 and approximately 20% will have some form of developmental delay condition–that’s 4.6 million children!
Early diagnosis is essential to helping these children begin treatment before age 5, when it can have the greatest impact on their growing brain.
However, there is a critical gap in developmental evaluations that prevents many children from receiving care when it’s most effective–or at all.
In fact, only 20% of children with a developmental delay condition receive treatment before age 5.
A primary reason is the shortage of developmental resources in the US.
There are only 700 DBPs in the entire country, for 4.6 million children who need to be assessed, diagnosed, and potentially treated. As a result, some families have to wait up to 14 months to see a DBP, which can waste precious treatment time.
Child development professionals are particularly rare in rural and low income areas. For example, 84% of US counties have no autism resources whatsoever. The effects of this evaluation gap can be devastating.
Where an evaluation is performed
1. In-person evaluation
A child development assessment can be performed in a number of settings, such as doctors' offices, schools, and early intervention offices, such as Child Find.
An evaluation can also be conducted at a developmental evaluation center. These centers, which are often affiliated with a university or hospital, have multiple developmental specialists under one roof, to facilitate the evaluation process.
Developmental evaluation centers also provide case management services and a variety of intervention and treatment programs for children with developmental delays, mental health conditions, and intellectual disabilities.
2. Virtual evaluation
Pathfinder Health's Virtual Evaluation and Care Plan for Autism, ADHD, Learning, and Language Concerns steps in to bridge the gap in developmental evaluations.
Parents can access appointments on demand with board-certified child development physicians and receive a personalized care plan for their child—all without leaving home or waiting for months!
The developmental evaluation/assessment process
Pediatric developmental evaluations involve systematically gathering and assessing information from a variety of sources. Although the process can differ somewhat based on the child's circumstances, who is conducting the evaluation, and where it is being conducted, evaluations generally involve the following steps.
1. Referral
A developmental evaluation usually begins because someone—a pediatric healthcare provider, teacher, or a parent or caregiver—has a concern about the child's development and requests or provides a referral for an evaluation.
The referral will provide information about the child's growth and development to date and the specific concern(s) being assessed.
2. Data collection
The professional leading the evaluation gathers data from a number of sources to allow them to fully assess the child's development. This data may include:
A parent interview, in which the parent or caregiver provides details about the child's developmental history, including milestones achieved and concerning behaviors
Records such as medical reports, test results, and educational assessments
A physical examination of the child
Observation of the child in different settings, such as school and home, to gain firsthand knowledge of their behavior, developmental skills, and interactions with others
Standardized tests or other assessments in specific developmental domains (such as cognitive skills), which provide objective data that can be used to compare the child's development to age-appropriate norms
Assessments provided by professionals in other areas of child development
3. Analysis
Using all of this data, the evaluator identifies patterns of behavior, developmental strengths and weaknesses, and areas of potential delay and creates a comprehensive picture of the child's development.
4. Feedback and recommendations
When the evaluation is complete, the evaluator will share the results with the parents or caregivers. The evaluator may make recommendations and referrals for any necessary therapies, services, or interventions.
These might include:
Occupational therapy
Physical therapy
Speech therapy
Special education services
Counseling for the child or family
Several specialists involved in the evaluation and/or child's care will likely work together to create a plan for the child's treatment.
5. Monitoring and follow-up
The evaluator may recommend additional assessments and/or monitoring of the child's progress. The child may need further evaluations on a regular basis to track their developmental progress and gauge the effectiveness of the recommended interventions so that changes can be made to their care plan if necessary.
The importance of early identification
Early identification and evaluation of developmental concerns is critical.
Developmental delays are relatively common and can be more effectively treated when intervention begins early.
However, many children do not receive the care they need when it will have the greatest impact.
The prevalence of developmental delays
Of the nearly 4 million babies born every year, 20% will have some form of developmental delay condition.
17% of US kids suffer from a mental, behavioral, or developmental disorder.
2.3% of US kids have autism spectrum disorder (ASD)
These statistics are not intended to be scary, but instead to motivate you to monitor your child's development. Most delays are not severe and there are many ways that you can help your child reach their full potential—the key is to detect delays early.
The impact of early intervention
90% percent of a child's brain develops by age 5.
This is the time when it has the highest neuroplasticity (the brain’s ability to essentially "rewire" itself to function in a different way).
This flexibility means that treatments and interventions have the greatest impact during the early years, especially birth to age 3.
These services can help a young child learn the skills they need to be successful in school and life, reduce the need for more costly special education and related services later on, and even change a child's developmental path.
Frequently Asked Questions
1. What is a pediatric developmental evaluation?
A pediatric developmental evaluation is a comprehensive assessment of a child’s development across multiple areas: cognitive, movement, social-emotional, and speech-language. A team of professionals in these areas evaluates the child and makes recommendations.
2. What can I expect at a developmental evaluation?
In an evaluation, child development professionals will collect and review data, interview parents, examine and observe the child, administer standardized tests, and confer with other specialists to gain a holistic picture of the child and identify developmental delays.
3. Who performs a developmental evaluation?
A developmental evaluation is performed by a team of child development specialists in different areas, including developmental and behavioral pediatrics, child psychology, physical therapy, occupational therapy, and early childhood education.
4. How much does a developmental evaluation cost?
Child Find (publicly-funded programs in each state) provides free evaluations with a goal to identify children with developmental delays and provide early intervention. Parents can also get a private evaluation, which can cost between $1000 and $5000, depending on location.
The Takeaway
Developmental monitoring, screening, and evaluation are not things to fear. They simply provide information about your child and how to best help them reach their full developmental potential.
If your child is diagnosed with a delay, they are still the same child.
A diagnosis is simply the means of accessing the best possible treatment and services for both your child and your family.
Remember that the earlier the intervention, the better the outcome will be for your child. So don't delay if you have any concerns!
Sources:
Centers for Disease Control and Prevention, Developmental Monitoring and Screening, available at https://www.cdc.gov/ncbddd/childdevelopment/screening.html
Ning M, Daniels J, Schwartz J, et al. Identification and Quantification of Gaps in Access to Autism Resources in the United States: An Infodemiological Study. J Med Internet Res. 2019 Jul 10;21(7):e13094. doi: 10.2196/13094.
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