Common Developmental Delays

Introduction

Common Developmental Delays Developmental delays range from very mild to severe. Say your two-year-old isn't making circular scribbles when all the other children in day care are, yet she has developed her other fine motor skills. She may be scribbling circles soon enough with time and opportunity to observe and practice. On the other hand, a child who still cannot stand on one foot for a few seconds by age four is more significantly delayed. So in some cases, delays are minor and may be overcome naturally over time with the process of normal maturation and with a little extra help, while others are severe and require intensive intervention.

How can you tell the difference between a simple delay that will resolve itself and one that won't? You can't know for certain, so the best thing you can do is to get an evaluation. Even then, the evaluator may be unable to predict whether your child will "grow out of it" if your child has subtle delays and is quite young. In such a case, the evaluator will probably recommend therapy to address mild delays or to monitor development.

Another aspect to consider is how many age-appropriate tasks are too hard for your child within a particular skill area. If your five-year-old can string beads, assemble a jigsaw puzzle, build a fort out of Legos, and button her shirt, but can't use scissors, does she truly have a fine motor delay? Also, a child who is delayed in one area is quite likely to have other delays as well. At the same time it's quite common for a child who is delayed in one area to be ahead of the game in another area. It can all be very confusing, and for a parent, upsetting. With so many variables, it's essential to get professional help to identify and sort out your child's strengths and weaknesses, and to provide appropriate interventions.

We'll give you a few developmental benchmarks here (based loosely on a combination of developmental scales), but keep in mind that age expectations vary between scales, evaluation is subjective, and most developmental delays are not an irreversible, major catastrophe.

Self-regulation milestonesSome of the self-regulation milestones are as follows.

By about six months:

  • tolerates and enjoys being touched and moved

  • maintains active interest in objects and people for more than one minute

  • no longer cries for no apparent reason, and can usually self-console
By about nine months:

  • plays attentively with one toy for two to three minutes

  • maintains attention to pictures and to a speaking person
By about twelve months:

  • moves in response to musical rhythms (bounces, moves from side to side)

  • sleeps twelve to fourteen hours at night, naps once or twice daily for one to four hours (may outgrow morning nap)
By about eighteen months:

  • enjoys messy play (such as playing with food, or water and soap)

  • sleeps ten to twelve hours at night, naps once for one to three hours

  • prefers some toys over others
By about twenty-four months:

  • plays purposefully, actively attending, by himself for a few minutes

  • freely plays with paint, Play-Doh, and other substances

  • enjoys roughhousing
By third year:

  • wants to do things independently

  • may give up naps

  • participates in interactive and circle games
By fifth year:

  • attends to an activity without adult supervision for 10 minutes

Fine motor benchmarksSome fine motor benchmarks are listed below.

By about seven months:

  • bangs two objects together

  • pokes objects with index finger

  • has good grasp and voluntary release
By about thirteen months:

  • marks paper with crayon

  • puts three or more objects into small container
By about sixteen months:

  • points with index finger

  • builds tower using two cubes
By about eighteen months:

  • one hand holds object, while the other manipulates

  • scribbles spontaneously
By about twenty-four months:

  • snips with scissors

  • strings one one-inch bead

  • imitates vertical stroke and circular scribble
During fifth year:

  • prints first name

  • writes numbers 1-5

Gross motor benchmarksSome gross motor benchmarks are listed below.

By about six months:

  • supports most of weight on hands while on tummy

  • brings feet to mouth

  • sits for a few seconds
By about one year:

  • stands alone for a few seconds

  • walks with hands held
By about sixteen months:

  • walks independently

  • bends and straightens knees to squat down and stand back up

  • throws a ball underhand while sitting
By about twenty-six months:

  • walks up a few steps

  • catches a large ball while standing

  • generally runs well without arms up in high-guard position
By third year:

  • stands on one foot for several seconds

  • walks down several stairs

  • pedals a tricycle a few feet forward

Visual-perceptual benchmarksSome of the visual-perceptual benchmarks are listed below.

By six months:

  • follows a moving object with eyes in all directions

  • looks at objects several feet away
By around eight or nine months:

  • watches surrounding activities more

  • follows trajectory of quickly moving objects, such as a ball
By about fifteen months:

  • touches pictures while looking at them

  • visually guides activity using two hands
By about eighteen months:

  • looks at pictures in books

  • shows understanding of color and size
By thirty-six months:

  • stacks rings in correct order

  • watches and imitates other children
During fourth year:

  • recognizes own printed name

  • knows left and right

  • draws and names pictures

Self-help benchmarksSome self-help benchmarks are listed below.

By about twelve months:

  • finger feeds and holds a spoon

  • drinks from a cup held for him

  • cooperates with dressing by presenting arms and legs
By about eighteen months:

  • holds and drinks from a cup all by herself

  • shows discomfort with soiled diaper

  • can remove loose socks and hat
By about twenty-four months:

  • scoops food with spoon to self-feed

  • rubs soapy hands and dries with help

  • sits on potty or adapted toilet with help

  • can remove shoes with laces undone
By third year:

  • uses a fork to stab food

  • undresses by himself (except for fasteners) and dresses with supervision

  • buttons larger buttons

  • uses toilet, needing help with clothing and wiping
By fifth year:

  • dresses independently

  • grooms hair independently

  • brushes teeth independently

Speech-language benchmarksHere are some of the speech-language benchmarks.

By around six months:

  • recognizes her own name

  • babbles, laughs, vocalizes, and whines purposefully

  • cries in response to angry voices

  • turns and looks at unfamiliar sounds
By around twelve months:

  • understands simple directions

  • imitates various sounds, and says one or two words

  • identifies two body parts on himself
By around eighteen months:

  • recognizes familiar people and objects in pictures

  • communicates needs and wants by gesture or vocalization

  • may say up to fifteen words
By around second year:

  • says his own name

  • says two-word phrases often, as well as some three-word phrases

  • uses 150-300 words, including nouns, verbs, and adjectives (e.g., puppy, go, dirty)
By around third year:

  • is understood by strangers most of the time

  • follows three-step commands (e.g., get your plate, put it in the sink, and wash your hands)

  • imaginary play emerges – plays with dolls, talks to stuffed animals, and uses objects symbolically, such as pretending that a string bean is an airplane
By around fourth year:

  • has a complex conversation, asks who and why

  • repeats simple words in order

  • shows mastery of simple grammar, but may mispronounce up to half the basic sounds
By about fifth year:

  • speaks in detailed sentences

  • communicates well with peers and adults

  • says most sounds correctly but may have trouble with l, s, r, v, z, ch, sh, and th

Cognitive benchmarksListed below are some cognitive benchmarks to look for.

By six months:

  • uses hands and mouth to explore objects

  • finds a partially hidden object
By nine months:

  • plays two to three minutes with one toy (examining, rotating, touching, poking)

  • imitates a familiar gesture

  • finds a completely hidden object

  • deliberately touches an adult's hand or toy to start an activity
By twelve months:

  • retrieves an object to resume play

  • guides a toy with hands

  • throws objects to see what happens
By two years:

  • rotates an upside-down picture

  • uses tools to solve problems such as climbing on a chair to get a toy on a table

  • matches sounds to appropriate animal picture

  • engages in symbolic play (e.g., uses a stick to brush a doll's hair)
By three years:

  • talks to himself to expand on play theme or to an imaginary friend

  • understands the concept of two (e.g., can pick out two toys when directed)

  • discriminates between sizes (points to the Oreo instead of the M&M when asked which is larger)

Social-emotional benchmarksSome social-emotional benchmarks are listed below.

By about twelve months:

  • enjoys exploring the environment, but makes sure parent is looking

  • shows preferences for certain people, places, and things

  • tests parents' reactions (such as throwing food or refusing to go to sleep)
By about eighteen months:

  • has frequent temper tantrums, typically no more than six a day, for fewer than ten minutes per episode, with reasonably short recovery time

  • may develop fears and show new insecurities that do not significantly interfere with function (for example, she may become afraid of animals or the dishwasher, but not to the point of "freaking out")
By about twenty-four months:

  • shows a variety of emotions – affection, happiness, jealousy, fear, anger

  • recognizes self in photographs and refers to self by name

  • defends possessions
By about third year:

  • separates easily from parent in familiar surroundings

  • insists on doing things independently, and takes pride in achievements

  • parallel plays (alongside, but not interactively) with other children
By about fourth year:

  • follows directions and obeys authority figures, such as teachers

  • plays cooperatively with other children, needing occasional adult help

  • asks lots of questions, frequently starting with why
By about fifth year:

  • plays games with rules

  • accepts disappointment and failure without excessive behavioral outbursts
By about sixth year:

  • has a best friend

  • likes to finish what he has started

  • works in a small group of children for twenty minutes or more

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