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“Knowledge is power.” 

                                  
 Sir Francis Bacon

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Knowledge HUB

The path to understanding is in your hands.

 

Below is information that may be relevant to your needs and addresses the most frequently asked questions associated with our services.  

 

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Developmental Milestones

The early years of a child’s life can be critical in his or her overall health and development. Family members, caregivers, and early childhood providers are strongly encouraged to take an active approach to developmental monitoring by observing how a child grows and changes over time.  It is also important to identify if a child is meeting typical developmental milestones with regards to play, learning, language, behavior, and movement.  Developmental milestones are things most children (75%) can do by a certain age.  Missed milestones or concerns with development should be discussed during well-child visits or as early as possible with a specialist with a trained eye and expertise in childhood neurodevelopmental disorders for proper screening and evaluation. 

 

The CDC’s developmental milestones checklists are geared to encourage conversations between families and medical professionals. They may help identify areas of concern but should not be used as standards for development.  The below lists contain some common milestones at different ages of development. â€‹â€‹â€‹â€‹

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Important Milestones: 0 - 2 Months

Social / Emotional

  • Calms down when spoken to or picked up

  • Looks at your face

  • Seems happy to see you when you walk up to him/her

Language / Communication

  • Makes sounds other than crying

  • Reacts to loud sounds

Cognitive (Learning, Thinking, Problem Solving)

  • Watches you as you move

  • Looks at a toy for several seconds

Movement / Physical Development

  • Holds head up when on tummy

  • Moves both arms and both legs

  • Opens hands briefly

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Important Milestones: By 6 Months

Social / Emotional

  • Knows familiar people

  • Likes to look at self

  • Laughs

Language / Communication

  • Takes turns making sounds with you

  • Blows "raspberries" 

  • Makes squealing noises

Cognitive (Learning, Thinking, Problem Solving)

  • Puts things in mouth to explore

  • Reaches to grab a wanted toy

  • Closes lips to show he/she doesn't want more food

Movement / Physical Development

  • Rolls from tummy to back

  • Pushes up with straight arms when on tummy

  • Leans on hands to support him/herself when sitting

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Important Milestones: By 1 Year

Social / Emotional

  • Plays games with you, like pat-a-cake

Language / Communication

  • Waves "bye-bye"

  • Calls a parent "mama" or "dada" or other special name

  • Understands "no" (pauses briefly or stops)

Cognitive (Learning, Thinking, Problem Solving)

  • Puts something in a container, like a block in a cup

  • Looks for things he/she sees you hide, like a toy under a blanket

Movement / Physical Development

  • Pulls up to stand

  • Walks, holding on to furniture

  • Drinks from a cup without a lid, as you hold it

  • Picks things up between thumb and pointer finger, like small bits of food

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Important Milestones: By 18 Months

Social / Emotional

  • Moves away from you, but looks to make sure you are close by

  • Points to show you something interesting

  • Puts hands out for you to wash them

  • Looks at a few pages in a book with you

  • Helps you dress him/her by pushing arm through sleeve or lifting up foot

Language / Communication

  • Tries to say three or more words besides “mama" or “dada”

  • Follows one-step directions without any gestures, like giving you the toy when you say, “Give it to me.”

Cognitive (Learning, Thinking, Problem Solving)

  • Copies you doing chores, like sweeping with a broom

  • Plays with toys in a simple way, like pushing a toy car

Movement / Physical Development

  • Walks without holding on to anyone or anything

  • Scribbles

  • Drinks from a cup without a lid and may spill sometimes

  • Feeds self with fingers

  • Tries to use a spoon

  • Climbs on and off a couch or chair without help

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Important Milestones: By 2 Years

Social / Emotional

  • Notices when others are hurt or upset, like pausing or looking sad when someone is crying

  • Looks at your face to see how to react in a new situation

Language / Communication

  • Points to things in a book when you ask, like “Where is the bear?”

  • Says at least two words together, like “More milk.”

  • Points to at least two body parts when you ask 

  • Uses more gestures than just waving and pointing, like blowing a kiss or nodding yes

Cognitive (Learning, Thinking, Problem Solving)

  • Holds something in one hand while using the other hand; for example, holding a container and taking the lid off

  • Tries to use switches, knobs, or buttons on a toy

  • Plays with more than one toy at the same time, like putting toy food on a toy plate

Movement / Physical Development

  • Kicks a ball

  • Runs

  • Walks (not climbs) up a few stairs with or without help

  • Eats with a spoon

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Important Milestones: By 3 Years

Social / Emotional

  • Calms down within 10 minutes after you leave, like at a childcare drop off

  • Notices other children and joins them to play

Language / Communication

  • Talks with you in conversation using at least two back-and-forth exchanges

  • Asks “who,” “what,” “where,” or “why” questions, like “Where is mommy/daddy?”

  • Says what action is happening in a picture or book when asked, like “running,” “eating,” or “playing”

  • Says first name, when asked

  • Talks well enough for others to understand, most of the time

Cognitive (Learning, Thinking, Problem Solving)

  • Draws a circle, when you show how

  • Avoids touching hot objects, like a stove, when warned

Movement / Physical Development

  • Strings items together, like large beads or macaroni

  • Puts on some clothes by him/herself, like loose pants or a jacket

  • Uses a fork

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Important Milestones: By 4 Years

Social / Emotional

  • Pretends to be something else during play (teacher, superhero, dog)

  • Asks to go play with children if none are around, like “Can I play with Alex?”

  • Comforts others who are hurt or sad, like hugging a crying friend

  • Avoids danger, like not jumping from tall heights at the playground

  • Likes to be a “helper”

  • Changes behavior based on where he/she is (place of worship, library, playground)

Language / Communication

  • Says sentences with four or more words

  • Says some words from a song, story, or nursery rhyme

  • Talks about at least one thing that happened during the day, like “I played soccer.”

  • Answers simple questions like “What is a coat for?” or “What is a crayon for?”

Cognitive (Learning, Thinking, Problem Solving)

  • Names a few colors of items

  • Tells what comes next in a well-known story

  • Draws a person with three or more body parts

Movement / Physical Development

  • Catches a large ball most of the time

  • Serves him/herself food or pours water, with adult supervision

  • Unbuttons some buttons

  • Holds crayon or pencil between fingers and thumb (not a fist)

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Important Milestones: By 5 Years

Social / Emotional

  • Follows rules or takes turns when playing games with other children

  • Sings, dances, or acts for you

  • Does simple chores at home, like matching socks or clearing the table after eating

Language / Communication

  • Tells a story he/she heard or made up with at least two events. For example, a cat was stuck in a tree and a firefighter saved it

  • Answers simple questions about a book or story after you read or tell it

  • Keeps a conversation going with more than three back-and-forth exchanges

  • Uses or recognizes simple rhymes (bat-cat, ball-tall)

Cognitive (Learning, Thinking, Problem Solving)

  • Counts to 10

  • Names some numbers between 1 and 5 when you point to them

  • Uses words about time, like “yesterday,” “tomorrow,” “morning,” or “night”

  • Pays attention for 5 to 10 minutes during activities. For example, during story time or making arts and crafts (screen time does not count)

  • Writes some letters in his/her name

Movement / Physical Development

  • Buttons some buttons

  • Hops on one foot

Autism Spectrum Disorder

Upset autistic little boy covering his ears and feeling distressed and overwhelmed by the
Examples of Social Communication & Interactions
Restrictive or Repetitive Behavior Related to ASD

Autism Spectrum Disorder (ASD) is a neuro-developmental disorder characterized by impaired social interactions and communication, behavioral challenges, rigidities, sensory processing deficits and restricted interests. In the Diagnostic and Statistical Manual, 5th Edition (DSM-5), ASD replaces the previous group of diagnoses that included Autistic Disorder, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and Asperger’s Syndrome. According to estimates from the Center for Disease Control and Prevention’s (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network, currently about 1 in 36 children, age 8 and under are identified with Autism Spectrum Disorder. Boys are four times more likely than girls to be diagnosed with ASD and it is reported to occur across racial, ethnic, and socioeconomic groups.

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Due to the extraordinary rise in prevalance of ASD, The American Academy of Pediatrics (AAP) recommends that all children be screened specifically for ASD at 18 and 24 months of age.  

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Examples of social communication and interaction characteristics related to ASD:

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  • Avoids or does not keep eye contact

  • Does not respond to name by 9 months of age

  • Does not show facial expressions like happy, sad, angry, and surprised by 9 months of age

  • Does not play simple interactive games like pat-a-cake by 12 months of age

  • Uses few or no gestures by 12 months of age (for example, does not wave goodbye)

  • Does not share interests with others by 15 months of age (for example, shows you an object that they like)

  • Does not point to show you something interesting by 18 months of age

  • Does not notice when others are hurt or upset by 24 months of age

  • Does not notice other children or join them in play by 36 months of age

  • Does not pretend to be something else, like a teacher or superhero, during play by 48 months of age

  • Does not sing, dance, or act for you by 60 months of age

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Examples of restricted or repetitive behavior or interests related to ASD:

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  • Lines up toys or other objects and gets upset when order is changed

  • Repeats words or phrases over and over (called echolalia)

  • Plays with toys the same way every time

  • Is focused on parts of objects (for example, wheels)

  • Gets upset by minor changes

  • Has obsessive interests

  • Must follow certain routines

  • Flaps hands, rocks body, or spins self in circles

  • Has unusual reactions to the way things sound, smell, taste, look, or feel

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Other Characteristics

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  • Delayed language skills

  • Delayed movement skills

  • Delayed cognitive or learning skills

  • Hyperactive, impulsive, and/or inattentive behavior

  • Epilepsy or seizure disorder

  • Unusual eating and sleeping habits

  • Gastrointestinal issues (i.e., constipation)

  • Unusual mood or emotional reactions

  • Anxiety, stress, or excessive worry

  • Lack of fear or more fear than expected

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As no two children with ASD are alike, their treatment plan will only be effective if it specifically suited to their individual strengths and challenges.  Replicated, empirical research confirms that early detection / diagnosis and the commencement of evidence-based services and placements are absolutely critical in the achievement of a child’s potential.  Applied Behavior Analysis (ABA) is the scientifically supported, evidence-based model recommended by the surgeon general to treat individuals affected by Autism.  ABA therapy can be provided in school, in the home, and / or a clinical site and can be supported by health insurance, school districts, or other 3rd party funding agencies such as Regional Centers in California.  Other approaches may also be considered to support efforts towards a comprehensive, best practice approach to treatment.  They include but are not limited to speech therapy, occupational therapy, social skills groups, medication, diet, biomedical interventions, assistive technology, 1:1 school support, and other classroom accommodations. 

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References

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  1. ​https://www.cdc.gov/ncbddd/autism/signs.html

  2. Data & Statistics on Autism Spectrum Disorder | CDC

  3. Screening and Diagnosis of Autism Spectrum Disorder | CDC

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High-Functioning Autism & Adults on the Spectrum

High-functioning autism (HFA), previously referred to as Asperger’s Syndrome, is informally used to describe individuals with typically milder or less severe symptoms but still meet the criteria for diagnosis. In general, they tend to have developed language, can engage socially with others, are largely independent, and often present within the typical range for intellectual development.

 

Living with HFA is not without its challenges. Individuals with HFA often exhibit ritualistic, repetitive, or routine behaviors that can be associated with behavioral rigidity or difficulties adapting to change, and frustration due to the potential negative impact on self-care skills, organizational skills, and social interactions. Although they may socially interact with peers and may even have one or more friends, these relationships are typically limited and not long-term. Social cues and other forms of non-verbal communication are not picked up readily and there is difficulty interpreting them consistently. Conversations may be one-sided; topics may not shift fluidly and there is an absence of on-going reciprocity. Understanding nuances in language such jokes, teasing, metaphor and sarcasm are also hard to grasp. Moreover, there is often fixated or intense interest in specific areas or activities, and a lack of interest in the interests of others. Theory of Mind or perspective-taking is a concept that is particularly challenging those affected by Autism. With limited understanding of what others think, feel, intend, like, and want, those with high functioning autism are therefore also limited in their ability to communicate and engage in complex interactions with others.

 

Although the types of support and / or treatment (i.e., ABA, speech therapy, OT, etc.) may be roughly the same regardless of the level of functioning, the intensity of services, their focus, and the length of long-term assistance may be less so with individuals with HFA. Older teens and adults especially benefit from services geared to assist with vocational skills or job training, college success, and independent living skills as they help set the foundation towards adult independence. Likewise, cognitive behavior therapy has been helpful in furthering communication skills within interpersonal relationships such as friendships or platonic relationships, professional relationships, and intimate or romantic relationships as these relationships are integral to future emotional development and reinforce a positive, happy life.

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Undiagnosed adults may be facing challenges in interpersonal relationships, employment, and independent living that are unclear to them. Despite their relative success as independent and successful adults, these challenges persist and have an impact on their overall well-being. Further assessment could lead to a greater understanding of oneself and how they interact with the world. By gaining clarity, family members, friends, and associates can better understand one’s unique characteristics and how they can foster their continued relationships.

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Individual therapy from a clinician seasoned in ASD and its impact on relationships, self-esteem, employment and one's emotional well-being can be effective. More specifically, Cognitive Behavior Therapy (CBT), a form of psychotherapy that usually involves efforts to change thinking and behavioral patterns, or in conjunction with other successful approaches, is considered an effective treatment approach. With the appropriate support, patients are guided through the process of recognizing their areas of need and identifying goals and strategies to improve their quality of life.  

 

Adults on the Spectrum

Adults on the Spectrum

Learning Disabilities / Disorders

Upset tired preteen child sitting at the table, doing his homework among pile of books. Wo
Symptom examples of Learning Disorder

Specific Learning Disorders are characterized by persistent difficulties learning key-stone academic skills, with onset during the developmental period of formal schooling. Affected academic skills are performed well below average for one's age, unless sustained by extraordinarily high levels of effort or support.  Learning disorders are characterized by impairments in reading (Dyslexia), mathematics/ processing numerical information (Dyscalculia) or writing (Dysgraphia).  In children, the low academic skills interfere with school performance significantly, resulting in considerable frustration.  They may act out, withdraw, or develop helplessness.  In older individuals and adults, activities that require the academic skills are avoided and the impaired academic skills interfere with occupational perfomance or everyday activities requiring those skills.  Obtaining a diagnosis as early as possible is critical for eligibility for resources, accommodations and services in the educational setting. 

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In some situations, an individual’s diagnosed learning limitations may benefit from testing accommodations that will ensure that the test-taker can demonstrate their true aptitude or achievement level without affecting test validity. Testing accommodations may involve but are not limited to Braille or large-print exam booklets, extended time, distraction-free rooms, allowing for breaks, screen-reading software, and alternative response formats. Test accommodations may be applied within a classroom setting as well as when taking high school entrance or equivalency exams such as the SSAT, ISEE, or GED, college entrance exams such as the SAT or ACT, admission exams to professional schools such as the LSAT or MCAT, admission exams for graduate school such as the GRE or GMAT, and for licensing exams for trade or professional purposes such as cosmetology, the bar or medical licensing. 

 

References

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1. Learning Disorders in Children | NCBDDD | CDC

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Attention-Deficit / Hyperactivity Disorder (ADHD) 

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Diagnostic Criteria for ADHD

ADHD is a neurodevelopmental disorder that affects millions of children and often extends into adulthood. It is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.  The inattentive component reflects behaviors including wandering off task, lacking perstistence, difficulty with sustained attention and focus, and being disorganized.  These are not due to defiance or lack of comprehension.  The hyperactivity component reflects excessive motor activity when it is not appropriate, restlessness, excessive fidgeting, tapping or talking.  The impulsivity component reflects hasty actions that occur in the moment without forethought and decisions made without consideration of (long-term) consequences.  A desire for immediate rewards or an inability to delay gratification are also often present.  These actions are often socially instrusive and may impact interpersonal relationships.  Individuals with ADHD often also struggle with self-esteem, perform poorly in school, and have difficulty getting along with others.  Although symptoms sometimes lessen with age, some individuals never fully outgrow them, but learn strategies to navigate themselves through adulthood and be successful.  

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Executive functioning (EF) issues often overlap with common symptoms presented in ADHD.  Although many individuals with ADHD have some limitations in EF skills, it’s important to note that it is possible to have EF issues without having ADHD.  Executive functions are cognitive processes and mental skills needed to plan, monitor, and successfully execute goals.  They often include working memory, attention, planning, self-awareness, emotional regulation, motivational regulation, flexibility, and the ability to problem-solve.  Someone with EF issues may have difficulty staying focused, holding information in their mind, getting started on tasks, breaking down tasks into steps or parts, and staying organized to follow through.  They may also struggle with maintaining physical organization and have difficulty redirecting or changing tasks if something does not go as planned.

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​​Although most healthy children can be inattentive, hyperactive, or impulsive, missed milestones or concerns with behavioral development should be discussed during visits with a doctor, nurse, or other specialist to determine if further screening should be completed. Treatment recommendations for ADHD typically include but are not limited to behavior intervention therapy, psychotherapy, parent training, medication, and / or school accommodations. Similar to those diagnosed with learning disabilities / disorders, students diagnosed with ADHD may qualify for certain accommodations at the school setting, such as individualized instruction, positive reinforcement and feedback, assistive technology, additional time for breaks or movement, organizational help, minimizing distractions, test accommodations, and additional time on assignments. In addition, alternative approaches such as yoga/meditation, supplements, special diets, and neurofeedback have been considered with physician discretion.

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References

1. Learn About Attention-Deficit / Hyperactivity Disorder (ADHD) | CDC

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