Your child may have a problem if...

Things to look for:

Your child may need an evaluation if:

At 9 months is NOT:

• sitting independently
• Bearing weight on feet when supported in standing position
• Turning to locate sounds or loud noises
• Vocalizing or take turns vocalizing with another person
• Reaching out and picking up a toy on the first try

At 12 months is NOT:

• Playing with an object with both hands.
• Cruising (walking holding onto furniture)
• Holding a spoon attempting to feed.
• Saying "mama" or "dada" specifically.
• Communicating by pointing for what he/she wants.
• Recognizing familiar people by facial expressions or physically approaching.

At 18 months is NOT:

• Walking or beginning to run.
• Scribbling or using utensils
• Imitating actions of people in play
• Playing near other children
• Following commands given with gestures.
• Using a vocabulary of at least 5-10 words.

At 24 months is NOT:

• Running well or kicking balls.
• Showing frustration or is easily frustrated.
• Engaging in simple make-believe play.
• Using 50 words or 2 word sentences.

At 3 years is NOT:

• Dressing with pull-on clothing
• Feeding independently
• Following 2-3 step directions
• Asking 'why' 'what' 'when' 'where' questions
• Playing along with other children or sharing toys with some adult prompts.
• Catching a tossed ball.

At 4 years is NOT:

• Forming complete sentences
• Clearly communicating needs
• Paying attention in small groups for more than 5 minutes
• Understanding or following complex directions
• Walking up stairs without a handrail

Reasons for consultation or specialty referral to in-house providers:

To Developmental Pediatrics

1. Developmental Regression of milestones.
2. Atypical facial features.
3. Concerns for the autistic spectrum of disorders.
4. Severe cognitive and communication delays with or without behavioral concerns.
5. Moderate to severe motor delay.

To Speech and Language Pathology (birth-3 years only)

1. Child has no expressive language at 12 months of age.
2. Child has no 2-word combinations at 24 months of age.
3. Child has less than 50 words expressive vocabulary at 2 years of age.

To Physical Therapy

1. Children has not achieved gross motor milestones within appropriate ranges of developmental ages:
   1. 6 months: hands to midline to play with toys.
   2. 9 months: sitting independently, bearing weight on feet when supported in standing.
   3. 12 months: cruising
   4. 18 months: walking or beginning to run
   5. 24 months: running, kicking a ball without loss of balance
   6. 3 years: catching a tossed ball
   7. 4 years: walking up stairs without a handrail, stand/hop on one foot.
2. Evidence of torticollis, severely decreased strength, very low muscle tone or very high muscle tone or spasticity, abnormal movement patterns.
3. Difficulty with playground skills, unable to keep up with peers, frequent falling, tripping, bruising from falls during school.

To Occupational Therapy

1. Children with inability to achieve fine motor milestones within appropriate ranges of developmental ages.
   1. 11-12 months: release of small objects, stacks rings, pushes a car
   2. 18-24 months: controlled functional supination, plays catch/throws with direction, circular/horizontal stokes, builds tower of 5 one inch blocks
   3. 24-30 months: cuts with scissors, builds tower of 9 blocks, preferential use of one hand.
   4. 3-4 years: copies a circle/square, imitates a cross, prints letters, builds tower of 10 blocks, ties a knot, cuts a straight line
   5. 4-5 years: snaps fingers, copies diagonal strokes/triangle, draws a man with 7 parts, color within the lines
2. Awkward grasp, too much or too little pressure with writing utensils. (5+ years)
3. Requires assistance with opening lunch items, orienting clothing, using standard fasteners, or pulling up pants. (3 1/2 years old)
4. Difficulty cutting simple designs with scissors; square, triangle, or circle. (4 yr. Old) Difficulty with cutting out complex shapes following an outline (5 1/2 yr. Old)
5. Hand writing skills are poor when compared to that of peers.

To Audiology

1. Delayed language development.
2. Family history of hearing loss.
3. Jaundice diagnosed as an infant or child.

To Early Childhood Special Educator

1. Child appears to be globally developmentally delayed.
2. Child appears to be at risk for future learning problems.
3. Child exhibits an inability to play creatively with toys or use basic problem solving skills.

To Social Work

1. An inability to learn that cannot be explained by intellectual, sensory or health factors.
2. An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.
3. Atypical behavior under normal circumstances.
4. A tendency to develop physical symptoms or fears associated with personal or school problems.
5. A general pervasive mood of unhappiness or depression.

To Child Psychology

1. Overt symptoms of depression such as depressed mood, blunted affect, markedly decreased energy, decreased appetite, markedly decreased interest/enjoyment in previously preferred activities.
2. Overt symptoms of anxiety, for example expressed fears, excessive obsessions, compulsion or symptoms of panic (i.e. shortness of breath, impending sense of doom, etc.)
3. Overt symptoms of psychosis or thought disorder, including hallucinations, delusions or inappropriate affect.
4. Symptoms of Autism/Pervasive Developmental Disorder, including qualitative impairments in communication or social interactions, or repetitive, stereotypic behaviors or restricted range of interests.
5. Child under three years old with severe cognitive delays.

Clinical indicators for: Community Health Nursing (CHN)

1. Treatments related to educational interventions as directed by Developmental Pediatrician.
2. To write consults that service coordinators need to initiate.
3. Evaluations for health and nutrition concerns.
4. Referrals to agencies within the Okinawa Interagency Coordinating Council.

(Numbers 1 through 3 are all based on orders issued by a physician to the CHN)