Developmental Delays Charlotte

Developmental Checklist for the 1^st Year of Life: 5-6 months Expected Skills

***(Refer to “Developmental Reflexes in 1^st Year of Life” blogs for reflex descriptions)

Motor Skills:

• Rolls from lying on back to tummy (purposeful)
• Brings foot to mouth
• Props forward on hands while sitting
• Voluntary release of objects Head control established
• Trunk rotation
• First self-care skills- feeding self with bottle
• Quadruped at end of 6 months (propping on all fours like about to crawl)
• Radial palmar grasp & raking reach grasp (swiping to reach)
• Pivoting while lying on tummy
• Protective Extension forward present
• Symmetrical Tonic Neck Reflex

Visual Skills:

• Dissociation of head and eyes (eyes move independently from head)
• Can fixate eyes on object while another object is moving
• 20/20 vision by 6 months
• Able to release focus and relocate a target
• Increased eye-hand coordination
• Drawn to mirrors
• Tracking and localization in visual fields

Cognitive Skills:

• Object permanence beginning (ability to know that a toy is still there once removed from its visual field)
• Stereognosis (ability to determine objects by shape, size, weight)
• Seek stimulation on their own
• Explore by touching, shaking, and tasting objects
• Understand speech by tone of voice
• Imitate facial expressions
• Knows own name
• Recognizes face and own reflection

My Disclaimer...

This blog is going to be for a step by step guide to my child's developmental milestones  I have a girl, please note that girls typically develop speech milestones faster, whereas boys typically develop physical milestone faster.  It can be used as a guide for other families, but please keep in mind that all children develop at different rates and should you have any concerns about where your child should be, you should speak to your pediatrician or schedule an appointment with a therapist in our office. 

Her first month...

I want to make sure that as a first time mom I do not wear blinders and miss something in my child's development that might not be normal.  I mean I think my daughter is the cutest, most advanced child on the earth, but does that mean she really is?  Probably not...I know, but it doesn't prevent me from thinking it.

As a speech therapist in Charlotte, NC, I of course want to insure that my child is on target for meeting all of her developmental milestones, and I don't just mean her speech milestones.  Therefor, In her first month of life I brought my daughter to lunch with my friends and collegues to show her off, of course, but also to have them check her and to get confirmation of her gifted abilities.  :-)  I know I am going to be that mom, but I just can't help it.

A little of my reasoning on why I did this...My daughter was born breech and at birth the doctor recommended an ultrasound as a precaution to ensure that the ball and socket joint in her hip had grown appropriately.  Evidently it is common for the socket to not grow around the ball joint when a child is breech, don't know why, just know that is what they told me.  After finding this out, as a psychotic  parent to her her first child, I had Erin Harkins, DPT, one of our Physical Therapist at Child and Family Development, check her hips to see what she thought.  Erin very gently checked my daughter's hips and reflexes, (although she did eventually make her cry) and reassured me that she too thought everything looked great.  We had the ultrasound in December and low and behold nothing is wrong with her hips.

I had Marion Wilm, OTR/L, an occupational therpist at Child and Family Developemt check out her neck control.  I think she is crazy advanced in this department, as when I burp her she picks her head up, turns it and then burps.  It was really crazy to watch her at weeks old do this.  Marion also confirms she has great head control.

So in her first month of life she cried when she was hungry, this really was the only time she cried.  She slept in everyone's arms, which of course makes everyone love her even more.  She slept 3-4 hours a night.  She breast fed like it was her job.  She had very active bowels.  She lifted her own head to burp.  And she began to notice things and people in a room, or is she just staring off into space pretending I am not staring at her?  

It is amazing how little a baby at this age can do, but how much a new parent will stare at them and completely loose a whole day doing so.  I know I did and I was okay with doing it because everyone keeps telling me how fast she is going to grow up so I should be savoring every second, right.  At her 1 month appointment she has aready grown several inches, although some of this is due to her having been breech and she has stretched out her legs some.  She has put on over a pound, making her a little over 8 lbs.

Below is a chart summary of righting reflexes that begin to develop at birth or after birth and take a couple of months to fully integrate. It describes what to do to elicit the reflex and what you should see your child do in response.

Developmental Checklist for the 1^st Year of Life: 3-4 months: Activities to Promote Skill Acquisition

Motor Skills:

• “Tummy time”- helps child bear weight and strengthen shoulder muscles
• Help sit with support
• Encourage rolling from lying on back to tummy
• Put toys to side to encourage reaching and sidelying
• Promote frog leg sitting (squatting on feet) to desensitize feet

Visual Skills:

• Mobiles over cribs
• Rattles
• Shiny or light reflective toys
• Colorful socks
• Practice tracking objects 180 degrees across midline
• Hold objects at different distances

Cognitive Skills:

• Sidelying position helps with dissociation
• Playing with toys that provide sensory feedback (i.e. rattles, chimes, music); hanging a mirror to look at
• Cause and effect games
• Exposure to objects of different sizes and textures
• Facial expressions
• Communication (talking, singing, reading books)
• Establish a routine (i.e. feeding, bathing, bedtime)

Developmental Checklist for the 1^st Year of Life: 3-4 months Expected Skills

***(Refer to “Developmental Reflexes in 1^st Year of Life” blogs for reflex descriptions)

Motor Skills:

• Brings hands to midline
• Raises head and chest while lying on tummy
• Starts voluntary movements, voluntary grasp
• Rolls from side to side (mostly accidental)
• Lies in sidelying position (on side)
• Reach and try to hold objects
• Can lay on tummy supporting self with elbows
• Raises head 90 degrees
• Maintains standing when hands are held

Visual Skills:

• Eyelid reflexes are integrated- to protect eyes
• Can track 180 degrees
• Can fixate on stationary target
• Can dissociate head and eye movements during tracking (eyes beginning to move independently from head)
• Downward gaze (allows to explore body with eyes)
• Can sustain midline convergence (bringing eyes to middle)

Cognitive Skills:

• Smile at reflection
• Show interest in sounds
• Learns from looking, holding, putting things in mouth
• Responds to familiar faces
• Purposeful, coordinated movements
• Dissociates right and left sides of body
• Integrates information from multiple sensory systems
• Repeats actions for pleasurable experiences

Birth to 3 years: A critical time for learning

At Child and Family Development, we have a large pediatric therapy team working together to provide early intervention services for young children who appear to be developing at a slower rate than their peers. Early intervention services targets the following areas including but not limited to: oral motor skills, expressive and receptive language development, fine and gross motor skills, cognition and social skills. We believe that evaluation and treatment are most effective when started from the time difficulties are first seen. Below is a summary of typical skills from birth to 36 months of age. If your child is not meeting these developmental standards, an evaluation may be beneficial.

6 months:

• Makes eye contact
• Turns head to a sound
• Plays and imitates sounds
• Rolls over from back to tummy
• Props up on elbows
• Sits with support
• Uses both hands to explore
• Puts objects in mouth

12 months:

• Babbles and uses few words
• Understands some requests
• Pulls up to stand
• Walks with help
• Claps hands
• Picks up small objects
• Waves “bye”

18 months:

• Makes short sentences
• Runs with flat feet
• Removes shoes and socks
• Stacks objects
• Uses a cup and spoon
• Hugs and plays with family

24 months:

• Talks clearly with more words
• Follows directions
• Jumps forward and down
• Throws a ball
• Puts beads on a string
• Pretend plays

36 months:

• Asks and answers questions
• Remembers 2 things
• Walks the stairs
• Hops on 1 foot
• Rides a tricycle
• Copies a line or circle
• Goes potty independently

According to the Neuro-Developmental Treatment (NDT) Association, the NDT Approach is used for management and treatment of individuals with central nervous system (CNS) pathphysiology. The individual's strengths and impairments are identified and addressed in relation to functional abilities and limitations. The NDT Approach continues to evolve with the emergence of new theories, models, research, and information in the movement sciences. NDT is a hands-on, problem solving approach. Intervention involves direct handling and guidance to optimize function. The approach is guided by the client's reactions throughout every treatment session.

An NDT Trained or NDT Certified™ therapist's education in neurology, physiology, and current research is translated into daily practice. They work collaboratively with patients, families, caregivers, and other healthcare professionals to develop individualized comprehensive treatment programs based on NDT theory and philosophy.

4 members of the C&FD team are NDT Certified:

1. Gail Fennimore, Physical Therapist
2. Ann Guild, Speech-Language Pathologist
3. Amy Sturkey, Physical Therapist
4. Marion Wilm, Occupational Therapist

Many others on our team have completed some training with this approach.  

For more information about Neuro-Developmental Treatment, visit their website, www.ndta.org

Developmental Checklist for the 1^st Year of Life: 0-2 months: Activities to Promote Skill Acquisition

Motor Skills:

• Place finger in baby’s palm on pinky finger side (Palmar Grasp Reflex)
• “Tummy Time” and place in non-constricted positions for free movement
• Lay child on side with support to increase body awareness
• Move legs in bicycle motion to strengthen muscles
• Give baby something to reach for and hold onto (finger toys such as rattles); toys that make noise or squeak when pressed will help the baby become more aware of what his/her hand is doing

Visual Skills:

• Hold and carry in different positions to see surroundings
• Use high contrast/black and white mobiles and toys
• Patchwork blankets with different textures/colors
• Rolling a colored ball in front from side-to-side when baby is on tummy (to increase eye movement)
• Mirror for baby to look at reflection (unbreakable)

Cognitive Skills:

• Hold and hug infant, especially during feeding
• Massage hands, feet, back, stomach (can do while changing baby)
• Speak to and sing to baby often
• Make eye contact
• Make facial expressions, especially smiling
• Give baby pacifier, blanket or soft object that is special to help baby calm and quiet self (increase self-soothing skills)

Developmental Checklist for the 1^st Year of Life: 0-2 months Expected Skills

Motor Skills:

• Grasp without voluntary release
• Palmar grasp present
• Can bring hands to mouth
• Rooting and sucking response present in response to food stimulus
• At 1 month, holding thumb inside palm, at 2 months, thumb is outside palm
• Spontaneous stepping when leaned forward while standing
• Asymmetrical Tonic Neck Reflex @ 1 month (strongest at 2 months)
• Movements are synergistically coupled (movements combined to be performed)
• Prefers fetal position

Visual Skills:

• Decreased vision, sees objects best at 9-12 inches distance
• Sees black/white and high contrast color
• At 1 month, eyes can focus on a face and are able to track objects from side to midline; can track past midline at 2 months
• Binocular vision begins at 2 months

Cognitive Skills:

• Developing interest in facial gaze (usually at mother)
• Responds to sound of voice at 1 month
• Responds to touch at 1 month
• Makes sounds and smiles at 2 months
• Responds to stimuli around them at 2 months
• Crying is major form of expression; quiets when picked up

Below is a chart summary of reflexes that begin to develop at birth and take a couple of months to fully integrate. It describes what to do to elicit the reflex and what you should see your child do in response.

Who are the Educational Specialists at Child and Family Development?
Established in 1980, Child and Family Development has been serving the needs of children and their families in Charlotte. Our pediatric therapy team has over 400 years of combined clinical experience, with expertise and additional certifications in many diagnostic areas.

Our Educational Specialists are trained to evaluate and treat the underlying causes of learning difficulties. Learning concerns may involve specific disorders of reading, writing, and mathematics or problems with attention, organization and study skills.

All of the Educational Specialists at C&FD have advanced graduate degrees in the field of Special Education. They help students understand their learning style, strengthen underlying processing weaknesses and develop strategies for school success.

Educational Specialists offer the following services to maximize growth and development:

• Developmental Screenings and School Readiness Assessments for children 3-5 years of age to help parents plan for the most appropriate learning environment for their child.
• Comprehensive Educational Evaluations to identify a child’s learning strengths and weaknesses
• School Consultations to present a child’s learning strengths and weaknesses to the school to provide the ground work for developing a team approach to meeting the child’s school needs and establishing informed parent advocacy.
• Treatment of Learning Disorders in Reading, Mathematics, Written Expression, Literacy Readiness, Handwriting, Dyslexia, Dysgraphia, and Phonological Processing Delays through an Individual Educational Treatment Plan
• Support for children and adolescents with learning concerns including Study Skills, Homework Strategies, Time Management, Test Taking Strategies through individual treatment as well as intensive small group session available if needed

Visit our website or contact us to learn more about Educational services.

When looking at behavior, there are close similarities displayed with both children who have attention difficulties (ADD/ ADHD) and sensory processing disorder (SPD).  Co-morbid diagnoses may include Autism, Developmental Delays, and Learning Disabilities.  Common characteristics for children with both sensory seeking SPD and ADHD (hyperactive/impulsive type) are as follows: impulsivity, excessive activity, disorganization, impatience and poor self-control. 

However, more specifically, children who have SPD tend to be more in control of stopping impulsive behaviors.  They may crave activity relating to a specific sensory system, may become more organized after receiving proper sensory input and may be more patient while waiting if give proper sensory input.  They commonly poke/pull/touch others without proper sensory input.

Those who have ADHD (hyperactive/impulsive type), tend to continue impulsive behaviors, be disorganized and have difficulty waiting-even with sensory input.  They tend to crave activity not related to a specific sensory system.  They often talk a lot, impulsively interrupt, and have difficulty waiting a turn during a conversation.

At Child and Family Development, we offer School Readiness Assessments for children ages 4 to 6 years. Assessments provide valuable information to teachers and parents on school readiness, learning styles, appropriate learning environments, and developmental strengths and weaknesses. We recommend this service for children prior to beginning a formal kindergarten experience.

School readiness testing examines pre-academic/readiness skills in reading math, written language. Development tests of fine motor coordination, auditory memory, receptive language and expressive language help determine developmental readiness. An educational specialist can provide parents with useful information to aid in their school readiness decisions.

The testing is typically completed in two visits to our clinic. During the first appointment, the educator will administer standardized tests as well as complete an informal assessment of ABC knowledge, rhyming, sound blending, and counting. The second appointment is a feedback session for the parent(s). A brief written report will be mailed to the parents following the assessment.
 

If you are interested in learning more, contact us to schedule an appointment with one of our Educational Specialists, Mary Froneberger and Martha Knight.
 

At Child and Family Development, our psychologists can accommodate most requests for testing, including Early Admissions and IQ testing for Charlotte students. 

School readiness assessments of children ages 4 to 6 years provide valuable information to teachers and parents on school readiness, learning styles, appropriate learning environments, and developmental strengths and weaknesses. We recommend this service for children prior to beginning a formal kindergarten experience. If you are pursuing testing for either early admission to kindergarten or an application to a private school requiring standardized testing, we can provide you with the information you need. We are able to administer the following standardized tests:

• Wechsler Preschool and Primary Scale of Intelligence (WPPSI) which assesses children’s learning ability and how they process information. It is an aptitude test.

• Test of Early Reading Ability (TERA) which assesses basic reading skills. It is an achievement test. Young Children's Achievement Test (YCAT) which assesses early academic and pre-academic skills in general knowledge, reading, math, written expression, and spoken language.

• Woodcock-Johnson which assesses academic and pre-academic skills in reading, math, and written expression. It is an achievement test. Wechsler Individual Achievement Test (WIAT) is an achievement test which also assesses skills in reading, math, and written expression.

The testing is typically completed in one visit to our clinic in a 2 1/2 hour appointment.  During that time, the psychologist will spend some time getting to know the child and making sure he is comfortable with the setting and tasks. The psychologist will administer a cognitive test or intelligence test (IQ) and a brief assessment of academic achievement. Once testing is finished with the child, the psychologist will provide a brief verbal interpretation of results to the parents.

A brief written report will be mailed to the parents within 10 business days of the appointment.  The fee for this service is $450.00 and it is due at the time of service.

Read the Psychology tab on our website, www.childandfamilydevelopment.com, to learn more about the C&FD psychology team and our services.

The holidays are a time for family gatherings, traveling, no school, and no routine.  For some that sounds fun, but for children with sensory processing difficulties, Autism, and other developmental delays, it can be a very scary time.
• Children who have auditory and tactile sensitivities will likely struggle most during family gatherings.
• Children who are sensitive to movement or need a lot of movement will have the most difficulty being couped up in a car or airplane while traveling.
• Children who already feel like they have no control over their own body rely on routine to give them a sense of control and organization.  When their environment is unpreditable, these children will likely either shut down or act out.

Remember your child's needs when you are making plans this holiday season.  If you go to a family gathering, make sure that your child has a quiet space to go when they need a break from all of the commotion.  If you are traveling, make sure you are able to take frequent movement breaks to allow your child to more succesfully ride in the car.  Most importantly, remember to keep sleep, meal, and daily routines as close to typical as you are able.

Hope you and your family have a wonderful holiday!

Images via: www.newsrealblog.com and www.bucklesafe.co.uk

Most often it is the more severely involved or neurologically injured child who is referred to physical therapy, occupational therapy or speech therapy at an early age.  However, an increasing number of infants and toddlers have mild to moderate developmental issues that will greatly benefit from the therapeutic expertise of a skilled pediatric therapist. 

Some infants may have a known diagnosis or medical condition.  However, some toddlers may simply be experiencing delays in walking, talking or overall socialization. We believe that once a child is identified, time becomes the most critical component.

When we are able to begin treatment with these children before the age of 3, progress often occurs more rapidly.  Families find their stress and concern lessened because of the support they receive from our team of clinicians.  There are agencies in the area that offer services in a home or natural environment, but Child and Family Development offers clinic-based therapy.

Our clinics are equipped with the tools, toys and equipment that are needed to evaluate and treat children. Parents and caregivers are encouraged to participate in the sessions and are trained to promote continuous progress in the other settings.  We find that many children benefit from working directly with a therapist in a therapeutic setting which is designed to support new learning techniques.  

 We have about 30 physical therapists, occupational therapists, and speech therapists on our staff with two locations to serve the Charlotte region.  Every staff member has specialized and advanced training in pediatric therapy with over 400 years of combined pediatric therapy experience across the practice.  Many staff members also have advanced training in treating infants to address issues of respiration, feeding and movement. 
 

Our practice accepts NC Medicaid, SC Medicaid, BCBS, Aetna, United Healthcare, Medcost and many other insurance plans.
Infants and toddlers are given a priority at our practice and we are able to schedule evaluations, and treatment within just a few weeks. 

Contact us to learn more about our early intervention services for infants and young children. 

With diverse clinical expertise, interests and experiences, the Child and Family Development team of psychologists is ready to provide a wide range of evaluation and treatment services. 

MIDTOWN OFFICE

Carol Capehart, MA, LPA, is a licensed psychological associate with about 20 years of clinical experience. Carol has extensive training and experience in the assessment and treatment of individuals with autism spectrum disorders (ASD) and founded our ASD evaluative services in 2006. Prior to that, she spent many years working in public schools with children of all ages and learning abilities.

Gretchen Hunter, Ph.D., CRC, is a licensed psychologist and Certified Rehabilitation Counselor with a specialty in neuropsychology. She has experience providing neuropsychological evaluations to children and adolescents with neurodevelopmental and behavioral disorders, learning disabilities and attention related disorders. She provides individual, family and group psychotherapy and behavior intervention to children and adolescents.

Kristina Murphy, Psy.D, HSP-P, is a licensed psychologist who provides psychotherapy and evaluations to children, adolescents and young adults. Her specialized focus is adolescents and transitions to High School and College. Areas of clinical expertise include anxiety,

depression, attention disorders, learning disabilities, life transitions and adjustment issues.

SOUTH CHARLOTTE OFFICE

Annada Hypes, Ph.D., is a licensed psychologist specializing in the treatment of adolescents and young adults. Dr. Hypes specializes in treating mood and impulse-control disorders, including depression, self harm, substance abuse, disordered eating and attention disorders. She regularly offers social skills groups for girls. 

Joy Granetz, Ph.D., is a licensed psychologist with over thirteen years of experience. She provides neuropsychological and psychoeducational evaluations with special focus in working with children and adolescents with learning disabilities, attention disorders, head injury, tic disorders and epilepsy. Dr. Granetz is one of a few practitioners in North Carolina offering Cogmed Working Memory Training, an innovative computer based training program to help children with attention difficulties.

Chris Vrabel, Psy.D., is a licensed psychologist specializing in child evaluation and child and family therapy. He has expertise in the assessment of autism spectrum disorders (ASD), attention disorders, learning disabilities and other developmental, behavioral and emotional problems. Dr. Vrabel also provides therapy to children and families with concerns regarding ADHD, behavior problems, depression, anxiety, social difficulties and other issues.

Read the blog, visit the website, or contact the offices to learn more about our child psychology services.

The Family Clinic: Multi-Modal Management of ADHD and Related Emotional Issues was founded in February 1991, a joint effort of Carolina Neurological Clinic and Child and Family Development, to provide services to children diagnosed with attention disorders.

Since 2001, Dr. Pleas Geyer of Carolinas Medical Center has led the collaboration. The Family Clinic has broadened it’s scope to include not only children with ADD/ADHD, but also autism spectrum disorders, developmental disorders, anxiety, depression, Oppositional Defiant Disorder, and other emotional issues.

The Family Clinic meets at our Midtown office on most Wednesday afternoons.

The treatment goal is to carefully monitor and support children with diagnosed ADHD/ADD, anxiety, depression, developmental disorders, Oppositional Defiant Disorder, and related emotional disorders, including medication therapy, focusing on the impact on development and school performance.

Pleas R. Geyer, M.D.. is a child and adolescent psychiatrist who provides care and medication management of children and adolescents diagnosed with emotional and developmental disorders. Dr. Geyer is in the Division of Child and Adolescent Psychiatry at Carolinas Medical Center, and is a Clinical Associate Professor in the Departments of Psychiatry and Pediatrics at the University of North Carolina School of Medicine in Chapel Hill, North Carolina. He brings a depth of experience in his treatment of our child and adolescent population. Dr. Geyer is board certified by the American Board of Psychiatry and Neurology in General Psychiatry, Child and Adolescent Psychiatry, and Forensic Psychiatry.

Contact Jenny at our Midtown office to learn more about The Family Clinic. 

Hello!

I am recently a new member to the Occupational Therapy team at Child and Family Development located at the South Charlotte office! I was born and raised in Charleston, SC. Upon graduating from Clemson University with my BS in Health Science, I decided to go back to Charleston to obtain my Masters degree in Occupational Therapy at the Medical University of South Carolina. Following this graduation and passing my boards, I ventured off to the city of Charlotte, NC to begin working as a Pediatric Occupational Therapist. I have prior experience working with children with autism, fine motor delays and handwriting difficulties, developmental delays, sensory processing disorders, cerebral palsy and down syndrome through my clinical rotations during school.  Since joining the C&FD team, I have gained an even wider knowledge of the practice from working and collaborating with the wonderful staff members in their different areas of expertise. I am looking forward to what the future brings at Child and Family Development!
 
Mary Helen Bailey, M.S., OTR/L
Occupational Therapist
Child and Family Development