Speaking Up: Changes to developmental milestones and impacts on speech and language development

(WBNG) - On Feb. 8, 2022, for the first time in 20 years, the CDC, in partnership with the American Academy of Pediatrics, updated its developmental milestones for kids.

The “Learn the Signs. Act Early” developmental monitoring program details when most children should be able to accomplish particular skills such as walking, talking and even laughing.

However, some experts are raising concerns, stating the new guidelines pushed back some benchmarks, particularly those of speech and language to older ages.

Kara Nunn and Cassandra Natali are Speech Language Pathologists and clinical instructors at Binghamton University.

“Speech Language Pathology is a pretty wide field, said Natali, “We look to assess, prevent, treat, and diagnose a whole bunch of disorders and delays such as speech sound disorders, language disorders, social communication disorders, cognitive-communication disorders, voice fluency, and feeding and swallowing.”

“We look at speech milestones as kind of a guiding light for what we do,” said Nunn, “They’re age norms for when most children would accomplish or reach milestones. Children develop at all different age ranges and different paces so when we’re looking at milestone markers we’re not looking for 100% accuracy but we are looking for an approximation or a majority of those skills to be maintained by a certain age range.”

SLP’s governing body, The American Speech Language Hearing Association (ASHA), has said they are concerned that changes in the CDC’s milestone checklist will slow or inhibit early intervention and has voiced their concerns with both the CDC and AAP.

The CDC added 15 and 30 months to the milestone list, changed the average number of children meeting those milestones from 50% to 75%, and moved some skills to older ages.

For example, since 2004 the CDC stated a 24-month-old should have a vocabulary of ~50 words. Now, that milestone of ~50 words has been moved to 30-months-old.

“It’s not a huge span when people think it’s just a few months, but for child development, a lot of things really happen in a short time frame,” said Natali, “So to move those to a different place may then lead parents to take a wait and see approach and delay some treatment that their child could have had earlier. We’re always going to advocate for as soon as you can get treatment, to get it.”

Speech Therapists at Windsor Central Schools, Crystal Wright and Megan Munson, said while many of these developmental milestones happen before kids step into the classroom, early intervention aids them in their efforts to assist students.

“By the time that we get children in preschool, if they’ve had early intervention we generally may not even have to see that child or the delays are mild as far the developmental gaps are closing,” said Wright, “As opposed to if they don’t have early intervention at all its much harder to close those gaps once they become kindergarten students.”

Wright, who has been a speech therapist for 30 years said the pandemic has also had its impact.

She said the number of students requiring her services has doubled.

“Based on my caseload alone, this is the highest number I have had in pre-K in some years,” said Wright, “So, I think that the pandemic has definitely had an impact as far as speech and language development as a whole.”

Munson said their services are also required more with older age groups.

“I work with middle school students and I can say that I’ve also seen an increase, especially in the middle school years not just in children who are on my caseload already, but children who moved into the district,” said Munson, “I think when I started I had two or three middle schoolers and now I have about 14 so it’s certainly been an increase.”

In terms of the pandemic, experts attribute some of these increases to things like mask-wearing, lack of interaction with peers, and differing access to telehealth therapies.

“We know that masks, while they’re great for mitigating the effects of COVID-19, there were negative impacts to those with hearing disabilities or language issues,” said Natali, “Not being able to see speech sounds puts them at risk especially if other measures weren’t taken in the classroom or home environment to make sure those students were getting what they need, but it also extends beyond that. For example, people were locked in their homes for a really long time and they missed a lot of those routines and learning experiences.”

“I’m seeing more articulation delays, speech sound production, that definitely you need visual feedback for,” said Wright.

“I think with the younger kids it’s definitely been a lot of language, a lot of receptive language, expressive language, answering ‘W H’ questions those types of things,” said Munson, “Also in the middle school, a lot of its pragmatic, it’s social, learning how to advocate for yourself, learning perspectives of other people, problem-solving those types of things.”

But Munson said when intervention does occur and students improve, they can thrive in the classroom.

“It’s really great to see it on the kids’ faces when they finally say a sound that they’ve been struggling with for a really long time and they are so excited,” said Munson, “They want to share it with their peers or with their parents or with their teachers and you can really see their confidence grow.”

“When kids gain more intelligible speech their speech output gives them more confidence to talk, to be verbal and answer questions,” said Wright, “I’ve seen kids that come out of their shell a bit and aren’t afraid to communicate because they’re successful at it.”

Nunn said it is these language skills that will follow them for the rest of their lives.

“To have strong language in those formative years, early preschool or early intervention years, leads to greater academic success in the future and that builds all the way through our middle school and high school populations and it leads to better college readiness,” said Nunn, “So, when we look at early intervention and why is it important, it’s the foundation and the building blocks for strong language throughout our life span.”

Nunn and Natali said parents know their child best and should talk to their pediatrician if they have concerns.

“We really want to make sure we are not taking a wait and see approach,” said Nunn, “Because if a child has a delay, we’d like to get in there and service that language need earlier.”

“In terms of professionals, we’re going to do the same things we do, our tests are still normed by ASHA the same way so none of that has changed for us,” said Natali, “It’s just that we’re having more conversations about it now, which is always good to bring that into the spotlight so parents are aware.”

In the meantime, they said the best thing a parent can do is talk and read to their child.

“The more you talk to them the more you label what’s going on the more they’re going to pick up on that. The quieter the home the less language input they’re getting,” said Natali, “Just engaging your children in fun different learning ways is always going to be huge in terms of learning development.”

Since ASHA voiced their concerns, the CDC and APA released a statement stating they have not lowered the standards of early childhood development.

They stated in part:

“With regard to the concern that language milestones are too low, CDC’s Learn the Signs. Act Early. materials for tracking developmental milestones are not developmental screening tools, nor are they standards or guidelines; they are communication tools that aim to promote developmental monitoring; encourage conversations between parents, doctors, and early childhood providers about child development; and increase developmental screening. CDC has not lowered the standards of early childhood development. The revised milestones should not impact how children are evaluated or how they qualify for services.”

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