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FOCUS Therapy Take on New CDC Developmental Milestones Guidelines
Earlier this year, the U.S. Centers for Disease Control & Prevention (CDC) updated its developmental milestones guidelines used to identify potential red flags indicating a child may need early intervention services. This process was initiated long before the pandemic, and finalized in February.
After taking some time to consider the impact of these new standards, our FOCUS Therapy team has some concerns that we hope parents and local providers will pay attention to when weighing whether a child may require early intervention, such as speech, occupational, physical, feeding, and ABA therapies.
What Are CDC Developmental Milestones?
The milestones guidelines put forth by the CDC are essentially a point-by-point list of activities or skills that most children can do or have mastered by a certain age (primarily between birth and age 5). It includes skills that fall under one of the following categories:
- Social/emotional
- Language/communication
- Cognitive
- Movement/physical development
Examples of identified milestones would be things like waving “bye-bye” or saying words besides “mamma or dada” or taking a first step.
The old milestones can be found here.
The updated milestones can be found here.
Why Did the CDC Update the Milestones?
The CDC, along with the American Association of Pediatricians (AAP) said that the updates were conducted by a group of its experts, with changes required because the standards had not been revisited since 2004.
A spokeswoman for the CDC told Reuters that the agency had been discussing revising the milestones back in 2017, and that the work began in 2019. Analysis of parent understanding and relatability was conducted in mid-2020.
The goal, say agency leaders, was to make the guidelines more helpful to families. The language contained in the previous guidelines was reportedly vague, with parents on many fronts urged to take a “wait-and-see” approach. That approach is now broadly understood to no longer be the best course of action when children are delayed on key developmental milestones.
The updated version now includes checklists for 15 and 30 months, and milestones that are considered “standard” when 75 percent or more kids can be expected to those skills. That differs from the previous standards, which were based at 50 percent mastery.
Why Our FOCUS Therapists Have Concerns About the New Milestones
Certainly, eliminating a wait-and-see approach to any concern regarding kids’ developmental milestones is important. We now know that prompt intervention therapies (speech, occupational, physical, and ABA) are the critical when there are concerns about a child’s development. Early intervention is strongly correlated with optimal long-term prognoses for these kids.
The CDC says that by resetting the bar, they are able to pinpoint kids whose delays are clinically significant and who unquestionably should be funneled into the pipeline for early intervention services. This is as opposed to “worrying families whose children may developing normally at a slower rate than average.”
Our concern at FOCUS Therapy, however, is that in moving the milestone bench marker from “this is the age at which 50 percent of kids have this skill” to “this is the age at which 75 percent of kids have this skill,” the CDC has effectively lowered the standard for who may qualify for early intervention. In turn, that could mean kids who truly need these services may end up waiting even longer than they are now to obtain them.
“We want parents – at the earliest sign of an issue – to start raising the question, pushing for answers from doctors, and getting the ball rolling for evaluations and early intervention therapy services,” said FOCUS Therapy Owner/Founder Jennifer Voltz-Ronco. “This is especially important in regions like South Florida, where it could take months just to get an evaluation, let alone an appointment to see a pediatric developmental specialist and get therapies lined up from there. We don’t want them waiting any longer than they have to because it is already going to take many months to secure these services. All the while, they’re going to be falling further and further behind their peers. The concern with these updated developmental guidelines is that is exactly what’s going to happen.”
There’s also a worry that health insurance companies may not approve treatment for kids if they’re slightly younger than what’s identified in the new guidelines – even if we as parents, therapists, and other health care providers can clearly see the benefit and need for services.
“Our recommendation, if you have any concerns about your child’s development, is to raise them to your child’s pediatrician and press them for a referral to specialists who can conduct assessments,” Voltz-Ronco said. “The earlier we can intervene for kids who have a delay, the better the long-term outcomes.”
FOCUS offers pediatric speech therapy, occupational therapy, feeding therapy, physical therapy, and ABA therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
Additional Resources:
CDC’s Developmental Milestones, CDC
More Blog Entries:
A New Diagnosis: Pediatric Feeding Disorder & How Fort Myers Feeding Therapy Can Help, June 27, 2022, Fort Myers FOCUS Therapy Blog
Tantrum or Sensory Meltdown? Fort Myers ABA Therapists Explain
When working with kids who have varying sensory struggles, it can be difficult to tell the difference between a tantrum or a sensory meltdown. Our Fort Myers ABA therapists recognize that it often takes some detective work to differentiate. But determining which is which is important when formulating the most effective response.
A sensory meltdown can be especially tough to identify because a child’s sensory thresholds can vary from day-to-day or even hour-to-hour.
Some behaviors that may be present in BOTH:
- Screaming
- Kicking
- Name-calling
- Hitting
- Crying
- Hiding or avoidance
Tantrums, however are typically a response to a child not receiving something they want or an anticipated outcome. Sensory meltdowns, meanwhile, stem from sensory overload, with reactions being to the big feelings that the overload can cause.
In the case of a meltdown due to sensory issues, parents may need to formulate a strategy that plans ahead, rather than simply react to the meltdown when it happens. That means meeting their sensory needs through a sensory diet (unique to each child) that can help them avoid feeling completely overloaded and overwhelmed.
We need to look carefully at the sorts of things that can trigger a sensory meltdown. Some possible meltdown triggers can include:
- Being overly tired or hungry.
- Generally not feeling well. (This can stem from illness, food sensitivity, overheating, etc.)
- Being expected to “hold it together” for long periods of time, such as going to summer camp, school, or on play dates.
- An abrupt change in routine – anything outside of the ordinary – can set off sensory overload.
Because the overload may not be immediate, it can sometimes appear like a meltdown “came out of nowhere.” But there is almost always a source when we look very carefully at the “antecedents,” or events that occurred prior to the meltdown. You may even have to go back a few days to pinpoint the cause.
Toddlers and preschoolers may be especially prone to tantrums because they do not have the motor, language, or problem-solving skills to work through some of their frustrations on their own. They may have an emerging desire to be independent, without having the skills to actually BE independent. They might have emerging language skills, and thus are unable to communicate what they actually want or need. They may have big feelings, but lack the prefrontal cortex development to emotionally regulate. They may have a growing understanding of the world around them, but also a lot of anxiety about how to move through it.
Tantrums usually only end when a child gets what they want or when they’re rewarded for better behavior.
Meltdowns, on the other hand, only end when the child tires out or the sensory input is altered. They stem from what we sometimes refer to as a “physiological traffic jam” in the central nervous system. There is too much overstimulation and feeling limited in your ability to “exit.” This can trigger a “fight or flight” response.
As parents, therapists, teachers, and caregivers, it’s important to recognize that the behaviors we’re seeing are not controllable behavioral reactions. Rather, they are physiological responses. This is why our Fort Myers ABA therapists and occupational therapists put such emphasis on identifying which is which so that you can appropriately respond.
With tantrums, you need to recognize the motivation or purpose, reinforce positive behavior, and build skills for success.
Meltdowns, however, can sometimes be avoided when we use visual schedules, social stories, and checklists to help kids know what is expected. There are no surprises or question marks. Reducing the unexpected changes in routine is going to reduce the overall stress that can trigger a meltdown.
We also recommend routine sensory diet activities, like scheduling quiet time or offering them breaks for sensory input.
Parents and teachers should also be able to recognize signs of a child’s distress. This could be covering their ears or rocking back-and-forth or humming or bolting from the room. Once you are able to quickly recognize the signs of overstimulation, you can respond to help them regulate before reaching the meltdown stage.
FOCUS offers pediatric ABA therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
Additional Resources:
Expert Ways to Help Tame Tantrums and Manage Meltdowns, June 18, 2021, By Alescia Ford-Lanza, MS, OTR/L, ATP, Autism Parenting Magazine
More Blog Entries:
Study: Less than 1/2 Kids With Autism Undergo Early Intervention Therapy, July 30, 2022, FOCUS ABA Therapy Blog
Fort Myers Speech Therapist Tips for Kids Who Struggle With “Inside Voices”
How many times a day are you admonishing your child to please use their “inside voice”? As a Fort Myers speech therapist, I love it when kids are engaged and excited to participate in a conversation! That said, I also recognize that sometimes our little friends can get a bit TOO lively – and loud – for the situation.
The reality is all kids frequently yell, stomp, shriek, use screechy or whiny tones – and for all kinds of reasons.
Teaching kids how to control their volume – and practice using “inside voices” – is important because there are many real-life situations that require it.
Learning how and when to adjust voice volume is a life skill – one that may be particularly tough to grasp for kids with social communication deficits.
As a Fort Myers speech therapist, the goal isn’t just to teach kids how to communicate, but how to do so pragmatically, or in a way that is socially accepted and beneficial. That means teaching the “inside voice” (quieter) versus the “outside voice” (louder) is key.
Understanding Reasons Behind Voice Volume
The first step in addressing voice volume issues is understanding WHY kids are speaking loudly. Sometimes, they may feel they need to do so to get attention. They often don’t realize how loud they are actually being. And they also probably don’t understand that in certain spaces, they’re required to use a lower volume, and that failing to do so can have a negative impact on others in that space. (And for kids who are not neurotypical, it may take them more than a few reminders to remember.)
The American Speech-Language Hearing Association (ASHA) reports that it’s only between ages 4 and 5 that kids start talking differently in different settings and with different people. As a Fort Myers speech therapist, I recognize it as a speech development milestone that ultimately paves the way for them to recognize almost instantly whether this a place is one where people are using “inside voices” or “outside voices.”
Talk About Voice Volume With Your Kids
The first step to helping your child know what noise level is expected in a given setting and/or with different people is to TALK about it. That means not only telling them what is expected, but also why.
Study: Less than 1/2 Kids With Autism Undergo Early Intervention Therapy
Early intervention therapy for autism is crucial to optimal long-term outcomes for children on the spectrum. “Early intervention,” defined as a combination of speech therapy, occupational therapy, physical therapy, nutrition/feeding therapy, and ABA therapy, should ideally begin before age 3 to be the most effective. Yet a new study found that more than 50 percent of children with autism do NOT get the critical early intervention that has been proven to lay the foundation for yielding the best sustained results.
Researchers at Rutgers University analyzed the early intervention participation of kids with autism in one state, and found less than half were receiving early intervention therapies before turning 3.
The study, published in JAMA Pediatrics, revealed income and racial disparities unfortunately played a role in how likely children were to have access to early intervention. Study authors opined that the issue was likely worse in other states.
As our FOCUS Therapy Fort Myers team understands it, the researchers analyzed data from the New Jersey Autism Study, a monitoring system that was set up by the Rutgers New Jersey Medical School, focusing on the records of some 23,000 kids. They identified approximately 4,000 8-year-olds diagnosed with autism. Of those, only 1,890 of them had participated in early intervention therapy services. This was true even though these services are required by federal law under the Individuals with Disabilities Education Act.
To identify where the disparities were most prominent, the team analyzed information on wealth indicators (median household income, primarily) and discovered that kids who lived in areas with higher incomes were 80 percent more likely to have access to early intervention autism services than kids who lived in lower-income neighborhoods. They also learned that Black and Hispanic children were less likely to enroll in these services compared to their white counterparts.
Study authors stressed that understanding socioeconomic and cultural barriers to both early diagnosis and these essential therapy services are important components of helping improve education and access.
Early Intervention Therapy Key to Addressing Child Development Concerns
Fort Myers Feeding Therapy Tips for Picky Eaters
Our Fort Myers feeding therapy pros at FOCUS Therapy recognize that it's totally normal for lots of kids to shy away from new, unfamiliar foods. It's not just the difference of taste, but the way it looks, smells, and feels.
For kids with sensory processing disorders and/or conditions like autism who are notoriously risk-averse when it comes to new foods, it can be especially tough to incorporate a healthy variety into their diet. But our Fort Myers feeding therapy experts have many techniques that can help them slowly overcome these obstacles - and have fun while they're doing it!
One tip for parents:
With picky eaters, 
serving new foods 
next to their favs 
means the new food 
won't stand a chance. 
Instead, offer them a small sample of the new food 
with something that's only semi-preferred. 
Let's say you're trying to incorporate a single new vegetable in their diet. Their absolute favorite food is pizza. If you serve them a small side of carrots next to their pizza, those carrots are likely going to go untouched. A better alternative would be to serve those carrots next to another main dish that they like/tolerate just fine, but isn't their favorite food.
If your child is extremely averse to any new foods, you may need some additional help from a feeding therapist. As we mentioned in a recent blog post, pediatric feeding disorder is a new diagnosis that was only formally recognized last October by the American Academy of Pediatrics.
If you're struggling to get your children to incorporate a healthy variety of foods into their diet and it's impeding their growth and well-being, it's time to talk to your pediatrician about getting some help with feeding therapy intervention.
FOCUS offers pediatric speech therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
Additional Resources:
PFD-ICD-10 Toolkit, Feeding Matters
More Blog Entries:
A New Diagnosis: Pediatric Feeding Disorder & How Fort Myers Feeding Therapy Can Help, June 27, 2022, Fort Myers Kids Feeding Therapy Blog for Southwest Florida
Fort Myers Speech Therapists Teach Social Communication to Neurodivergent Kids
Our Fort Myers pediatric speech therapists recognize there is SO much more to communication than just saying words. 
As explained by the American Speech & Hearing Association (ASHA), social communication is how and WHY we use language to interact with others. Even though there isn't precisely a "right" or "wrong" way to communicate, there are so many unwritten rules of communication. Over time, we learn how to adjust not only what we say but how we say it - and when - to meet the particulars of whatever situation we're in.
For example, there are a lot of things you might be thinking that you know would be socially unacceptable to say to someone. You may be bored with the stories they tell or not be the biggest fan of what they're wearing that day. But you know the unwritten rule that saying these things would not only be unkind and hurtful, it doesn't serve any good purpose (like keeping you safe).
When young kids are still learning about social communication, they're likely to break these sorts of rules with regularity. (You may have heard the saying, "Kids say the darndest things." And it's because they are still learning about what "filters" they should be putting on their communication.)
But it's not just about what we say. It's what our body language says, whether we can pick up when someone else is trying to engage us in conversation, whether we can infer what someone might be feeling from their facial expression...
Social communication is something a lot of neurotypical people to take for granted, but for kids with autism and other conditions, it doesn't come easily. Our Fort Myers speech therapists break down each social communication component one-by-one to teach our patients how to better understand the world around them - and effectively communicate.
FOCUS offers pediatric speech therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
Additional Resources:
Social communication in autism, explained, April 19, 2018, By Lydia Denworth, Spectrum News
More Blog Entries:
Why FOCUS Asks Parents to Stay in the Waiting Room During Evals, Sessions, April 2, 2022, FOCUS Therapy Fort Myers Blog
A New Diagnosis: Pediatric Feeding Disorder & How Fort Myers Feeding Therapy Can Help
Virtually all children go through some stage of “picky eating,” and it may be both temporary and harmless. However, when it persists and a child fails to grow and thrive alongside their peers, they may be diagnosed with pediatric feeding disorder – a new diagnosis that Fort Myers feeding therapy can help to treat.
The condition was formally recognized last October, as explained by the American Academy of Pediatrics.
Pediatric feeding disorder (PFD) is understood to involve impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, or psychosocial dysfunction. It lasts more than two weeks, and is associated with 1 or more of the following:
- Medical dysfunction (cardiorespiratory compromise during oral feeding or aspiration/recurrent aspiration pneumonitis).
- Nutritional dysfunction (as evidenced by malnutrition, specific nutrient deficiency/significantly restricted intake of one or more nutrients resulting from restricted dietary diversity, or reliance on enteral feeds/oral supplements for hydration and/or nutrition).
- Feeding skill dysfunction (need for texture modification of liquid or food, use of modified feeding position/equipment, or modified feeding strategies).
- Psychosocial dysfunction (active/passive avoidance of child when being fed, inappropriate caregiver management of child’s feeding needs, disruption of social functioning in a feeding context, or disruption of caregiver-child relationship associated with feeding).
The full diagnostic criteria is spelled out by the Journal of Pediatric Gastroenterology and Nutrition.
Fort Myers ABA Therapists’ Tips for Supporting Siblings of Kids With Autism
Autism Spectrum Disorder (ASD for short) is now diagnosed in 1 in 44 children in the U.S. As a broad range of conditions characterized by deficits in social skills, speech, communication, repetitive behaviors, and other challenges, the ripple effect of the condition impacts more than just the individual diagnosed. In fact, home carryover of early intervention therapies (speech, occupational, and ABA) is most effective when everyone in the home is committed to following our recommended strategies.
Our Fort Myers ABA therapists recognize that families – and neurotypical siblings in particular – may struggle with anxiety, depression, and social difficulties, as outlined in a recent study. On the flip side, researchers also found that children with autism who have a neurotypical older sibling tend to have better social skills than those who did not.
The key is striking a balance, and ensuring that both children are supported – and given the tools to understand each other.
A child with autism may, inevitably, demand more of a parent’s time, energy, focus, and resources. This may leave siblings of kids on the spectrum feeling as if they are being overlooked. It’s important to validate and address these feelings so that it doesn’t grow into a much larger issue as time goes on.
5 Steps to ABA Therapy in South Florida
ABA therapy is considered the gold standard treatment for kids with autism spectrum disorder (ASD). But the process of starting this therapy is not as simple as calling and setting an appointment. There are several steps that must be taken to initiate the process.
It begins by recognizing the early signs of autism, and sharing these concerns with your child’s pediatrician. Doctors should screen all children at 18 months for risk of autism as a matter of routine – but parents absolutely can bring concerns to their doctors at any point. Signs of autism can be clearly identified as early as 12-months-old.
The doctor will then initiate a referral for a full assessment, known as ADOS testing. This test must be administered by a qualified provider. FOCUS Therapy does provide ADOS testing for children in Southwest Florida. The results of the ADOS test are then shared with a pediatric specialist, who ultimately makes the diagnosis and then issues a referral for early intervention services – such as ABA therapy, speech therapy, and occupational therapy.
If your child is under the age of 3 in Florida, they may qualify for early intervention services through a state program called Early Steps. This can serve as an important stop-gap, given that many private therapy clinics that offer Applied Behavioral Analysis in Southwest Florida have waitlists.
Our ABA therapy services at FOCUS Therapy are conducted one-on-one, in-clinic with experienced professionals called RBTs (registered behavior technicians), with oversight from a BCBA (Board Certified Behavior Analyst) and physician specialist.
If you have questions about autism screening, ADOS testing, or ABA therapy in Southwest Florida, our trusted team of therapists, coordinators, and insurance billing professionals can help.
FOCUS offers ABA Therapy and ADOS testing in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
Additional Resources:
What Are the Early Signs of Autism? HealthyChildren.org, American Academy of Pediatrics
More Blog Entries:
5 Fort Myers ABA Therapy Techniques, May 24, 2022, Fort Myers ABA Therapy Blog