Developmental Assessments: Testing for children Five and Under

A psychologist conducts a developmental assessment to evaluate your child’s progress in meeting important milestones of early childhood. Important ‘milestones’ occur in the areas of language, visual motor integration, self-regulation, motor skills, and emotional development. While every child is unique, and develops on his or her own timeline, sometimes there is cause for concern. The American Academy of Pediatrics recently recommended that pediatricians conduct more formal screenings of early childhood development. This is easier said than done. Most pediatricians have to compress their exploration of your little one’s progress into a 15 minute appointment, while also conducting a physical and giving shots, all while the child is crying or running around the room. Its more difficult for pediatricians in a practice where the child sees a different physician every time. Pediatricians refer patients to other professionals such as psychologists, developmental pediatricians, and speech-language pathologists when they suspect that something about the child’s development is either delayed or atypical.

When I use the words ‘delayed’ and ‘atypical’ to describe early childhood development, I mean that some children develop skills more slowly than others (a developmental delay), while other children’s development does not follow the expected course. Atypical development (also misleadingly referred to as a ‘developmental delay’) may mean that a child has an autistic spectrum disorder, suffers the effects of living in an orphanage, or has a genetic difference. For example, children with autistic spectrum disorders may acquire and then ‘lose’ some ability to communicate, while a child with a speech-language delay reaches the typical language milestones (one word, two words, phrases, sentences), just later than his peers.

Parents often want to know what I do during an early childhood evaluation. My job is to study several areas of development, including: social relatedness, intellectual functioning, receptive and expressive language, attention, memory, information processing, adaptive functioning, visual motor integration, behavior (especially play), and sometimes I look at how well they are mastering pre-academic goals like learning their numbers and letters. The trick is to do all of this with the most reliable, child friendly assessment tools I have in the brief time window when I can access the child’s best performance. I have to be ready to be anything from Mr. Rogers to a circus clown to help the child feel comfortable. After data collection, I want to consult with as many of the child’s teachers, doctors and related service providers as I can to get the full picture and to help me interpret what I have observed.

Sometimes when a pediatrician refers a child, the nervous parent will ask me if all this is really necessary, if perhaps their child will just ‘grow out of it’. I am a parent too, and I understand that fear that something is wrong with your child, and how much you hope it will just go away. When a parent calls, here are the ‘red flags’ I am listening for: the child’s expressive or receptive language are well behind schedule, the child is having trouble relating to other people, the child is having temper tantrums that are causing problems at home/school/daycare, the child is having trouble learning at school, the child is exhibiting behaviors that are unusual or severe as compared to same aged peers. Testing gives us answers that we need to address our concerns effectively and with compassion. Testing helps answer what I call the “can’t versus ‘won’t” question. The test data help us make a plan to develop what the child can’t do and guide him toward what he won’t do. The last thing you ever want to do is punish a child for something that is beyond his control.

Sometimes people ask me if I do in-home testing. I strongly prefer to see a child in my office. Generally, home is a very accommodating environment. The child knows all the routines, where everything is, and what every object is called. However, life is not about staying home and functioning in that soft nest of familiarity, it is about transitioning to school, the playground and developing relationships with people outside of your family. I need to see how your child copes with being in a room with a new person, strange toys and unfamiliar tasks. I also need to be more objective than a parent or grandparent, and that includes following standardized testing procedures. Since becoming a parent, I know how hard it is to be objective about your own child, especially when you’re afraid something could be wrong. Using standardized tests and making careful observations allows me to systematically measure your child’s strengths and weaknesses as compared to same aged peers.

Finally, parents come to Mindworks wanting a diagnosis. As psychologists, we do diagnose. This is different from the school system, where the goal is to determine eligibility for special education services (typically under the catch-all early childhood label ‘Developmental Delay’). I believe obtaining a diagnosis is valuable beyond that it helps you access special education services (speech-language therapy, occupational therapy, self-contained pre-school, physical therapy, applied behavior analysis etc.). A diagnosis helps you to empathize with your child, advocate for him, meet his needs, and most importantly to plan for the future.

Unless a child was born with a congenital condition, there is often very little time in between when a delay is identified and when that child will go to school। Early intervention therapies take time. The earlier they begin the more effective they are likely to be. Each family only has so much time, money and energy, and you want to devote those resources to interventions that will matter most. Early childhood services are critical in helping ensure that the transition to elementary school goes a smoothly as possible for a child with a delay or disability. At the end of the day, the reason to do testing is to answer those nagging questions, and to let each family go forth with confidence that they are making the best choices for their child.

-Rebecca Resnik, PsyD
Licensed Clinical Psychologist