BY DEEPA SRINIVASAVARADAN

Developmental Health Promotion takes into consideration the current developmental reality of the child, as well as the developmental expectations for the next months and the developmental potential for growth over time.

Developmental disabilities are a group of conditions due to an impairment in physical, learning, language, or behavior areas. About one in six children in the U.S. have R one or more developmental disabilities or other developmental delays. Also, 1 in 59 of eight-year-old children were identified with autism spectrum disorders (ASD) in 2014, compared to 1 in 68 children in 2012. The autism rate in New Jersey continues to skyrocket, and once again leads the nation with the highest percentage of children with ASD. In New Jersey, it is 1 in 34 in 2014, compared to 1 in 41 children in 2012, according to a new report by the Centers for Disease Control and Prevention's (CDC's) Autism and Developmental Disabilities Monitoring (ADDM) Network. That represents a 19-percent increase from two years ago when the report was last released. Access the snapshot of key findings of the ADDM Network at cdc.gov/ncbddd/autism/addm-community-report/documents/key-find- ings-addm-community-report-2018-h.pdf. 

Of great concern is that many children with developmental delays or disabilities are not identified until after they enter school, by which time they may have already experienced significant delays socially and/or academically and missed key opportunities for early intervention and supports. This is particularly true for children of color, immigrant children, and children in families with limited English proficiency, who are underrepresented in preschool special education but overrepresented in school-age special education. This is in part because, by not being identified early, they miss out on early intervention and preschool services that could reduce or eliminate the need for special education as children and youth. Early childhood is a critical period that can set the stage for one's health trajectory and positive future outcomes. Research and science have also demonstrated that what happens to children, both positive and negative, in their early years can have lasting effects. Therefore, it is important to ensure that young children have good physical, cognitive, social, and emotional development through developmental health promotion activities.

What is Developmental health promotion?

Developmental Health Promotion takes into consideration the current developmental reality of the child, as well as the developmental expectations for the next months and the developmental potential for growth over time. It consists of activities to promote awareness of the importance of and need for tracking and celebrating developmental milestones in young children and following up immediately when concerns are noted. Developmental Health Promotion helps children and families achieve better outcomes by supporting parents to address delays promptly and connecting them to the resources they need. Developmental Surveillance or Monitoring and Developmental Screening of children are integral components of Developmental Health Promotion. 

Developmental Monitoring

Developmental Monitoring means paying attention to how your child plays, learns, speaks, acts, and moves, all of which denote a child's physical, cognitive, communicative, social, and emotional well-being. It is an on-going process that begins at birth and can be done by parents, teachers, and health and early childhood professionals.

Comprehensive child development surveillance or monitoring may include:

• Eliciting and attending to the parents' concerns

• Maintaining a developmental history of the child

• Making accurate and informed observations of the child

• Identifying the presence of risk and protective factors

• Periodically using screening tools

• Documenting the process and findings

• Connecting parents to necessary supports and services

CDC's "Learn the Signs. Act Early." Program

The Centers for Disease Control & Prevention's "Learn the Signs. Act Early." (CDC's LTSAE) program ( cdc.gov/actearly) aims to improve early identification of children with autism and other developmental disabilities, so children and families can get the services and support they need as early as possible. LTSAE materials educate families about developmental milestones, including what to expect and when to be concerned about their child's development. These materials are not a replacement for developmental screening, but they help parents to be better informed partners in monitoring early development. With these resources, parents can base their observations on objective, research-based, age-appropriate developmental milestones. They are easy to use and help parents have more realistic expectations about their child's development. Here are some LTSAE resources that parents can use to track their child's development: At each well-child visit, the parent(s) and the child's doctor should discuss the child's development and any concerns either of them may have. Any concerns noticed during developmental monitoring should immediately be followed-up with a developmental screening.

Developmental Screening 

Developmental Screening can help to tell if a child is developing and reaching his or her milestones when he or she should, or if there are delays. Developmental Screening is a process that is completed by doctors and other professionals with training to use validated screening tools, at doctors' offices, in schools, or in community settings. As part of the screen, the doctor or another professional might ask parents some questions about their child or talk and play with the child to see how he or she responds in comparison to other children the same age. Commonly used developmental screening tools include the Ages and Stages Questionnaires (ASQ) and the Survey of Well-being of Young Children (SWYC). The American Academy of Pediatrics and the Bright Futures Guidelines recommend that all children be screened for developmental delays and disabilities during regular well-child doctor visits at: • 9 months • 18 months • 24 or 30 months The American Academy of Pediatrics also recommends that all children be screened for autism at: • 18 month and 24 months Additional screening may be needed if a child's parent or doctor has concerns or if the child is at high risk for developmental problems due to preterm birth, low birth weight, or other reasons.

Tips For Parents

• ACT EARLY: As a parent, you know your child best. If your child is not meeting the milestones for his or her age, or if you think there could be a problem with the way your child plays, learns, speaks, acts, and moves, talk to your child's doctor and share your concerns. Don't wait! Acting Early can make a real difference for your child and you!!

• Visit cdc.gov/Milestones to find the milestone checklist for your child's age. Use it to track your child's development. When it's time to talk with the doctor, write down the questions you have and show the doctor the milestones your child has reached and the ones that concern you.

• If your child's doctor does not do the recommended screening and/or if you have concerns about your child's development, you can ask for a screening to be done.

• Developmental Screening results are not to be considered as a formal diagnosis. 

• If you or the doctor is still concerned about your child's development: or if your child is under 3 years of age – Call your state's Early Intervention provider for evaluation and services that can help your child. You don't need a doctor's referral. Find your state's early intervention contact information at cdc.gov/ncbddd/actearly/parents/states.html  

o If your child is 3 years or older - Call your local, public elementary school or school district and ask to speak with someone who can help you have your child evaluated, even if your child does not go to that school. Follow up with a written request for evaluation. For a sample parent letter requesting evaluation and letter writing tips, visit parentcenterhub.org/evaluation-2

o Ask the doctor if you need to take your child to a specialist who can take a closer look at your child's development. If you do, ask the doctor for a referral and contact the specialist right away. Doctors your child might be referred to include:

➢ Developmental pediatricians. These doctors have special training in child development and children with special needs.

➢ Child neurologists. These doctors work on the brain, spine, and nerves.

➢ Child psychologists or psychiatrists. These doctors know about the human mind.

o If your appointment with the specialist is many weeks away, remember you can call back every week to see if an earlier appointment has opened

o Contact the Department of Health or the Early Childhood Administrator in your state about additional intervention services that may be available. Early Childhood Development State and Regional contacts can be found at acf.hhs.gov/ecd/state-and- regional-contacts

o Find more information, including what to say when you make these important calls, and what to do while you wait to have your child seen, and how to get support for your family at: cdc.gov/Concerned. You can also access the SPAN Parent Advocacy Network's tip sheet, What to Do While Waiting for the Results of your Child's Evaluation, spanadvocacy.org/search/node/waiting%20for%20evaluation 

• Connect with local community resources such as advocacy/family organizations (for example: SPAN Parent Advocacy Network in New Jersey) in your state who can provide support for you to navigate the early childhood system to access services, in addition to information about parent workshops, support groups, recreational programs, etc. Parent Training and Information Centers are found at parentcenterhub.org/find-your- center/and Family Voices/Family-to-Family Health Information Centers are found at: familyvoices.org/affiliates. For Sample flowcharts highlighting the resources and next steps for parents, visit: rwjms.rutgers.edu/boggscenter/projects/Act_Early.html

• Getting help early for your child often means being persistent. 

• Children with special health care needs should also be monitored and screened for developmental delays and, depending on their condition, they may need more frequent monitoring and screening. •

ABOUT THE AUTHOR: Deepa Srinivasavaradan is the CDC's "Learn the Signs. Act Early." Ambassador for NJ and the State Parent Lead for NJ's Early Childhood Initiatives – Help Me Grow, Early Childhood Comprehensive Systems Impact, & Home Visiting CoIIN 2.0. She is also a NJ LEND Family Fellow and the Southern Regional Coordinator of the Family to Family Health Information Center at SPAN Parent Advocacy Network: spanadvocacy.org

References

cdc.gov/ncbddd/autism/new-data.html cdc.gov/ncbddd/actearly/index.html healthychildren.org/English/family-life/health-management/Pages/Well-Child-Care-A- Check-Up-for-Success.aspx

DEVELOPMENTAL MILESTONES : RESOURCES FOR PARENTS

Milestones Checklists, Milestone Moments Booklets, Milestones Tracker App, and other resources can be found at cdc.gov/actearly

Milestones checklist

Explains the four domains of development and tracks the developmental milestones for children 2 months through 5 years of age. cdc.gov/ncbddd/actearly/milestones/index.html

Milestones Tracker mobile App

The app features parent-friendly, interactive milestone checklists for ages 2 months through 5 years; photos and videos that illustrate milestones; personalized milestone summaries that can be easily shared with the child's healthcare provider and others; tips and activities for supporting early development, including what to do if there's a concern, and reminders for appointments and recommended developmental screening. cdc.gov/MilestoneTracker

NJ's Child Developmental Passport

A tool for parents to track their child's growth and development. This booklet is intended to be used with the Milestone Moments booklet. Parents can bring this Passport with them to every well-child visit and to update it regularly. 

spanadvocacy.org/sites/default/fifiles/fifiles/Child%20Develop ment%20%26%20Health%20Passport-English.pdf

Milestone Moments booklet 

Explains what babies do from 2 months to 5 years of age. It also provides tips that parents can use to help their child's development. cdc.gov/ncbddd/actearly

TIPS FOR DOCTORS AND PROFESSIONALS

Doctors and other professionals can help perform developmental surveillance or monitoring at each health supervision visit and encourage parents to monitor milestones between visits. They can also:

❑Provide Milestone checklists and the Milestone Moments booklet to families; have parents complete the checklist that is appropriate for the age of their child.

❑Print and post a free flyer encouraging families to use CDC's Milestone Tracker app to track and quickly share developmental progress at visits. 

❑FREE materials are available from CDC: print or order (in limited quantities) in English and Spanish. You can also provide customized parent-friendly resources to families by adding your practice's logo and contact information. Email ActEarly@cdc.gov for more information.

Doctors and other professionals can conduct developmental screenings and autism-specific screenings as recommended by the American Academy of Pediatrics using a validated screening tool

❑Visit American Academy of Pediatrics' Screening Technical Assistance and Resource (STAR) Center for information on screening tools, practice resources, and technical assistance: aap.org/en-us/advocacy-and-policy/aap-health- initiatives/Screening/Pages/Screening-Tools.aspx

❑View the Birth to 5: Watch Me Thrive! healthcare provider guide that addresses how to talk with parents and where to go for help

• Refer children with concerning screening results for further evaluation AND to your state's early intervention services. Find your state's early intervention contact information at: cdc.gov/ncbddd/actearly/parents/states.html 

• DON'T WAIT! Pay attention to parental concerns and ACT EARLY to make a difference!!