GROWTH AND

DEVELOPMENT II
Dr. Anamika Mahato
Lecturer, Pediatrics, Dhulikhel Hospital
Developmental Assessment
(0- 5 years)
DOMAINS OF DEVELOPMENT

• Gross motor: Movements using the large muscles

• Fine motor: Movements using the hands and smaller muscles

• Social: Attachment, self-regulation, and interaction with others

• Language: Receptive and expressive communication, speech, and non-verbal

communication

• Vision and Hearing

TOOLS
• Ten one inch cube, bell, paper, crayons, dangling bright object, picture book,
pellets, foam-board, dolls , ball

VALUE OF DEVELOPMENTAL ASSESMENT

• Follow up of high risk neonates for early detection of cerebral palsy, intellectual disability
• For early diagnosis of vision, hearing disabilities that are easily treatable.
• In anxious parents with infection, illness during pregnancy or family history of intellectual
disability
• Findings on intellectual development
• Observe assessment of treatment in metabolic disorder, exposure to toxic substance, concussion
and meningitis
• Ethical problems with regard to resuscitation of very low birth weight babies or babies suffered
serious brain injury.
• Developmental assessment for adoption
• Medico-legal purposes
 DEVELOPMENTAL PREDICTIONS
Can Do Cannot Do
• Compare the baby’s development as per • Cannot confirm between normal and
age to others of same age in terms of rate abnormal
and adequacy
• Cannot make predictions about future
• Can diagnose moderate to severe achievements or deterioration in
intellectual disability intellect
• Can diagnose cerebral palsy • Cannot measure emotional deprivation
• Can assess muscle tone • Cannot fully assess the major
• Can diagnose moderate to severe hearing neurologic sequelae
or vision defect • Identification of learning disabilities in
• Can diagnose neurological defect in early infancy
infancy • Predict intellectual superiority
• For future genetic counselling
• GROSS MOTOR: Ranges from development of head control to stage of mature walking and
running

• FINE MOTOR: Disappearance of primitive grasp reflex at 2-3months, Hand regard,

maturation of grasp from ulnar side, radial side, finger-thumb grasp and feeding or dressing
• LANGUAGE:
• vocalize with ah, uh in 2-3 months,
• squeals with laughter at 4 months then monosyllable followed by bi-syllable,
words with meaning, sentences
• SOCIAL:
• Smile, Recognizes mother, interest in surrounding, watching movements around,
anticipation to be carried, anxiety, refusal, mimickery, understanding, questioning
• VISION: place a bright object about 8-10 inches from face at midline
• Light response, visual fixation and following light from 45-180 degree, normal
vision
• HEARING: crumple paper about 18 inches from ear
• Turns head to sound along same plane( 3 months), downward( 5 month),
upward( 7 month)
• OTHERS: Sphincter control
 4 WEEKS (1 MONTH)

Gross Motor:
• Ventral suspension: Head held up
momentarily, elbows flexed, hips partly
extended and knees flexed
• Prone: pelvis high, knees drawn up largely
under abdomen. Momentarily lifts chin off
couch. Head predominantly to one side
• Pulled to sit: almost complete head lag
• Held in sitting position: back uniformly
rounded. Head held up momentarily
• Supine: asymmetrical tonic neck reflex seen
when at rest
• Held standing: Flops at knees and hips. Social:
Walking reflex when sole of foot is pressed on • watches mother’s face when she talks to him
flat surface. Vision:
• Supine- regards dangling object (eg ring on string) when
Fine motor: brought into line of vision (3 feet from the eyes) but not
• Hands predominantly closed. Grasp reflex otherwise when in midline. Follows it less than 90’C
Hearing: Quiets when bell is rung
 6 WEEKS (1AND ½ MONTH)
Gross Motor:
• Ventral suspension: Head held up momentarily in same
plane as rest of body. Some extension of hips and
flexion of knees. Flexion of elbows
• Prone: Pelvis high, but knees no longer under
abdomen.. Chin raised intermittently off couch. Head
turned to one side.
• Pulled to sit: Head lag considerable but not complete
• Held in sitting position: Intermittently holds head up.
Held standing- head sags forward. May hold head up
momentarily.
• Supine: asymmetrical tonic neck reflex at rest
intermittently seen.
Fine motor: Hand often open. Grasp reflex may be lost
Social: Smiles at mother in response to overtures
Vision: Eyes fixate on objects, and follow moving
persons. Supine: looks at object held in midline, following
it as it moves from the side mildline (90’C)
 8 WEEKS (2 MONTHS)
Gross Motor:
• Ventral suspension: Can maintain head in same plane as
rest of body
• Prone: Head mostly in midline. Intermittently lifts chin off
couch so that plane of face is at angle of 45’c to couch
• Pulled to sit: less head lag
• Held in sitting position: Less rounding of back. Head is
held up but recurrently bobs forward.
• Supine: head chiefly to side. Asymmetrical tonic neck
reflex seen intermittently at rest.
• Held standing: able to hold head up more than momentarily.
Hands: Frequently open. Only slight grasp reflex
Vocalisation: Smiles and vocalizes when talked to.
Social: Social Smile
Vision:
• Fixation, convergence and focusing. Follows moving person.
In supine- followa dangling toy from side to point beyond
midline, follows objects 180’C
 12 WEEKS (3 MONTHS)
Gross Motor:
• Ventral suspension: Head held up for prolonged
period beyond plane of rest of body
• Prone: .Pelvis flat on couch. Holds chin and shoulders
off couch for prolonged period so that plane of face is
at angle of 45-90 from couch weight born on forearms.
• Pulled to sit: .Only slight head lag. Held in sitting
position head mostly held up but still bobs forward.
• Supine: no more asymmetrical tonic neck reflex.

Fine motor:
• No grasp reflex. Hands loosely open.
• When rattle is placed in hand, holds it for a minute or
more. Looks as if he would like to grasp object, but Vision:
cannot without it being placed in hand, pull at his
dress. Supine: characteristically watches movements of his
Language: Squeals of pleasure “talks” a great deal when own hands (“hand regard”)
spoken to says “aah” or “naah” Follow dangling toy from side to side (180’C).
Social:. Sustained social contact Promptly looks at object in midline.
Hearing: Turns head to sound at the same level
 16 WEEKS ( 4 MONTHS)
Gross Motor:
• Prone: Head and chest off couch so that plane of face is at angle of
90 to couch. Swimming: limbs stretched out in full extension.
• Pulled to sit: Only slight head lag in beginning of movement
• Held in sitting position: Head held up constantly. Child looks
actively around. Head wobble on swaying. Back curved on lumbar
region only
• Supine: Head in midline
Fine motor:
• Hands come together as he plays. Hand regard still present.
• Pulls dress over face in play. Tries to reach object with hands but
overshoots it.
• Plays with rattle in hand for long period and shakes it but can’t pick
it up if he drops it
Social : Excites when food prepared, toys seen, showing massive
reaction involving all four limbs and respirations. Pleasure when
pulled to sit.
Language: Laughs Aloud
Vision: Immediate regard of dangling object
 20 WEEKS (5 MONTHS)
Gross Motor:
• Prone: Weight on forearms
• Pulled to sit: no head lag
• Held in sitting position: no head wobble when body swayed by
examiner-full head control. Back Straight
• Supine: Feet to mouth
• Held in sitting position: Bears most of weight

Fine motor:
• Able to grasp objects voluntarily. Plays with toes. Crumples paper.
• Splashes in bath.
• Objects taken to mouth.
• Cube- grasps, bidextrous approach takes it to mouth.
Social: Smiles at mirror image, pats bottle. No more hand regard
Language: Razzing “Ah-Goo”
Hearing : Turns head towards a sound below the level (5-6 months)
 24 WEEKS (6 MONTHS)
Gross motor:
• Prone: Weight on hands, not forearms, chest and upper part of abdomen
off couch.
• When about to be pulled to sit, lifts head off couch. Sits supported in
high chair
• Held in standing position: almost full weight on legs. Rolls prone to
supine
Fine motor:
• Holds bottle. Grasps his feet
• Cube: Palmar grasp of cube. Drops one cube when another is given
• Feeding: Drinks from cup when it is held to lips
Social :
• When he drops a toy he looks to see where it has gone to and tries to
recover it. May excite on hearing steps.
• Stretches arms out to be taken. Shows like and dislikes.
• May show fear of strangers and are (coy) Displeasure at removal of toy.
• Play: laughs when head is hidden in towel. Imitates cough or protrusion
of tongue.
• Language: Smiles and vocalizes at mirror image, monosyllabic babble
 28 WEEKS (7 MONTHS)
Gross motor:
• Prone: Bears weight on one hand. Sits with hand on
couch for support. Rolls from supine to prone
• Supine: Spontaneously lifts head off couch.
• Held Standing: Bounces with pleasure
Fine motor:
• Feeds self with biscuit. Likes to play with paper.
• Takes all objects to mouth.
• Unidextrous approach. Radial palm, rakes at pellet
• Cube: Bangs cube on table. Transfers it from hand
to hand.
Social :
• Feeding: Chews. Keeps lips closed when he is
• Immitates simple acts. Pats image of self in mirror.
offered more food than he wants. Responds to name.
Speech: • Tries to establish contact with person by cough or
• Polysyllabic sounds formed- ba, da,ka others method. Expectation in response to repetition
of stimulus.
Hearing: Turns head towards a sound above the level
• Prefers mother, enjoys mother, resist if toy is pulled
(7 to 9 month) from hand.
 32 WEEKS (8 MONTHS) 36 WEEKS (9 MONTHS)
Gross motor: Gross motor:
• Sits momentarily on floor without support • Prone: In trying to crawl progresses backwards. May
progress by rolling.
• Adjusts posture to reach object eg leans
forward to reach • Sits steadily on floor for 10 minutes. Lean forward
and recovers balance but cannot lean over sideways.
• Readily bears whole weight on legs when
supported. May stand on holding on • Stands holding in to furniture. Pulls self to stand
Social: Fine motor:
• Reaches persistently for toys out of reach. • Can pick up object of size of currant between tip of
Responds to ‘NO’. Looks for dropped toy finger and thumb.
Imitation: Imitates sounds Cubes: Compares two cubes by bringing them together.
Speech: Combines syllables- da-da, ba-ba Social: Puts arms in front of face to prevent mother
washing his face
 40 WEEKS (10 MONTHS)
Gross motor:
• Prone: Crawl position, on abdomen. Crawls by pulling
self forward with hands
• Sitting: Can go over into prone, or change from prone to
sitting. Can pull self to sitting position. Sits steadily with
little risk of overbalancing
• Standing: Can stand holding on to furniture. Collapses
with a bump

Fine motor: Goes for objects with index finger

Cubes: Beginning to let go of objects (release)

Social:
• Looks around corner for object.
• Responds to words.
• Pulls others clothes for attention.
• Repeats performance when laughed at
Imitation: Waves bye-bye. Plays patacake
 44 WEEKS (11 MONTHS) 48 WEEKS (12 MONTHS)
Gross motor:
Gross motor:
• Prone: creeps, abdomen off couch
• Prone: when creeping, sole of foot may be flat on couch
• Standing: lifts foot
Fine motor: Holds arm out for sleeve or foot out for • Sitting: Pivots, twisting round to pick up object, Walks
shoe. holding in to furniture. Walks two hands held
Cubes: Beginning to put objects in and out of containers Social :
Social :
• Rolls ball to examiner. Will now give toy to examiner,
• Will not object to examiner: holds it but will not releasing it.
release it.
• Drops objects deliberately so that they will be picked • Anticipates body movements when nursery rhyme being
up. said.
• Shows interest in picture book.
• Shakes head for ‘No’
Plays: Plays peep-bo, covering face.
Speech: One word with meaning.
 1 YEAR
Gross motor:
• Prone: walks on hands and feet like a bear.
Walks one hand held. May shuffle on buttock
and hand
Fine motor: Mouthing virtually stopped.
Beginning to throw objects to floor
Social: May understand meaning of phrases.
“where is your shoe” May kiss on request.
Language: two or three words with meaning.
Hearing: Locates sound in all directions
 15 MONTHS
Gross motor:
• Creeps up stairs. Kneels without support
• Walks without help with broad base and high stepping
gait (from 13 months)
• Can get into standing position without support
• Falls by collapse
• Cannot go round corners or stop suddenly
• Several steps sideward
Social:
• Asks for objects by pointing. Mouthing stopped
Fine motor
• Kiss pictures of animal.
• Builds tower of two. Holds two cubes in one hand.
• Imitates mother in domestic duties
• Cannot throw ball without falling
• Likes to take shoes off
Sphincter control:
• Feeding self, picking up cup, drinking, putting it down.
• Begins to tell mother that he wants to use pot.
Manages spoon but rotates it near mouth, self feeding Indicates wet pants
• Imitates scribbling
Language: • Simple formboard : insert round block without
• Jargoning, several intelligible words being told
 18 MONTHS
Gross motor:
• Gets up and down stairs holding rail, without help.
Walks up stairs with one hand held. Walks pulling
toy, carrying doll,
• seats self on chair, runs stiffly, sits on small chair

Fine motor
Social:
• Tower of 3 or 4
• Domestic mimicry. Copies mother in
• Thows ball without falling. dusting, washing, cleaning.
• Dressing: takes off gloves, socks, unzips • Uses stick to reach toy
• Feeding well with spoon without rotation • Points to two or three body parts
• Spontaneous scribbles • Points to picture of dog or cat
• Turns pages 2 or 3 at a time
Sphincter control:
• Dry by day, occasional accident
Language:
• Jargon average 10 words
Simple formboard: block of three
 2 YEARS
Gross motor:
• Goes up and down stairs alone two feet per step
• Walks backward without imitation(from 21 months)
• Picks up objects without falling
• Climbs on furniture

Fine motor
• Kicks ball
• Turns door knobs, unscrew lids, washes and dries hands
• Cubes: tower of 6 or 7 cubes
• Puts on shoes, socks and pants. Takes off shoes and Language:
socks
• Asks for drink, toilet and food
• Immitates vertical and circular stroke
• Repeats things said
• Turns pages singly
• Joins 2 or 3 words in sentences other than imitation

Social:
• Sphincter control: Dry at night if lifted out at
• Pulls people to show them toys. evening
• Listens to stories with pictures
Play: Wraps dolls. Parallel play
• Vision
Picture cards
Points to five, names three
• Common objects – names three to five like
coin, shoe, ball
• Books – turns pages singly
• Parts of body
Point to four body parts
Vision assessment in 2 to 5 years
 2 ½ years child
• Gross motor • Fine motor
Goes upstairs alternating feet Makes vertical and horizontal strokes
Jumps with both feet Makes tower of 8 cubes
Walk on tiptoes when asked Imitates train adding chimney

• Language • Social/ general understanding

Knows full name Helps put things away
Refers to self by I
Begins to notice sex differences
Names five common objects
Pretends in a play

• Color vision- names one colour

• Sphincter control
Attends to toilet need without help except for wiping
• Simple formboard
Inserts all three, adapting after errors
• Picture cards
• Digits: Repeats two in one of the three trial Points to seven, names five.
 3 years child
• Gross motor
-Stands momentarily on 1 foot, jumps off bottom step
-Goes upstairs one foot per step and downstairs two
feet per step
-Rides tricycle

• Language
-Knows age and gender • Fine motor
-Ask questions -Copies circle, Imitates cross, handedness
-Counts upto 10 -Tower of 9 cubes
-Knows some nursery rhymes, Vocabulary=250 -Imitates construction of bridge of 3 cubes
words.
• Colour: names two
• Social
-Plays simple games
-Dresses if helped with buttons and undresses
-Unbuttoning clothes and puts on shoes
-Washes hands

• Play - joins in play, dresses and undresses

doll

• Vision
Picture card – names eight

• Formboard – places three without

error
 4 years
• Gross motor • Fine motor
-Copies bridge, imitates construction of gate of 5
-Skips on one foot, Goes downstairs one foot cubes
per step -copies cross and square
-Use scissors to cut out pictures
-Climbs stairs well • Social:
- Plays with several children, beginning of social
interaction and role-playing
• Language
- Imaginative play with doll(being a nurse)
-Tells stories
-Gesell incomplete man - draws man with 2-4 • Vision
parts besides head -Names three colours
-Cognitive right and left discrimination -Squint, nystagmus, eye contact
-Tumbling E test
• Sphincter control – attends to toilet needs
 5 years
• Gross motor:- Skips on both feet • Fine motor:- Copies triangle

• Language • Social
-Names 4 colours, repeat sentence of 4 syllable -Dresses and undresses
-Ask meaning of words
• Cognitive -Engages in domestic role playing
-Distinguish morning from afternoon
-Names heavier of 2 weight • Dressing - can tie shoe laces

• Vision
• Preposition(Triple order): -Snellens chart
-Put this on the chair, open the door, then give me -Color vision – identifies four Colors
that book

• Digits:- Repeats 4
 Clinical co-relations

• Development delay
Delay in attainment of developmental milestones at the expected ages, in any -
Gross/ fine motor, vision, hearing, speech, language, behavioral, social and emotional.
• Global developmental delay
Significant delay in 2 or more developmental domains, including gross or fine motor,
speech/language, cognitive, social and personal.
• Autism Spectrum Disorder
Persistent impairment in reciprocal social communication and interaction, and restricted, repetitive
patterns of behavior or interests
• Slow starters / delayed maturation of nervous system –
Children who are delayed initially later catch up to normal and shown to have average level of
intelligence.
• Specific developmental delay :
Delay in single domain of development

• Motor delay:
Significant delay in fine or gross motor skills with no impairment in other developmental areas.
1. Congenital Hypothyroidism, Malnutrition
2. Cerebral palsy – Spastic diplegia, Quadriplegia
3. Neuromuscular disease- Muscular dystrophy, Lower motor neuron disorders – SMA, congenital
myasthenia gravis
4. Metabolic disease: Galactosemia, Mucopolysachharidosis, Glycogen storage disease

• Visual sensory impairment:

Condition in the eyes or visual system that affects the normal vision.
• Developmental language disorders: • Development dissociation
Significant delay in receptive and/or
expressive language skills. Significant difference in rate of development
between two streams of skills like autism
1. Expressive language problem
2. Receptive language problem
• Development regression
3. Autism
Child loses previously acquired skills or,
4. Hearing impairment milestones.
5. Cognitive delay

• Developmental deviancy
When development milestone may be skipped
or, does not occur in sequence
SCREENING TOOLS
• Denver Developmental Screening Test
• Bayley scale
• Baroda
• Trivandrum
• Ages & Stages Questionnaires
• Modified Checklist for Autism in Toddlers
• Developmental Quotient=average age of attainment/observed age at
attainment * 100
RED FLAG SIGNS
 2 months
Hearing
● Doesn’t respond to loud sound
Vision
● Doesn’t watch things as they move
Social
● Doesn’t smile at people
Fine Motor
● Doesn’t bring hands to mouth
Gross Motor
● Can’t hold head up when pushing up when on tummy
 4 months
Vision

● Doesn’t watch things as they move

● Has trouble moving one or both eyes in all directions

Social

● Doesn’t smile at people

Language

● Doesn’t coo or make sounds

 6 months

Gross Motor

● Doesn’t roll over in either direction

● Seems very stiff, with tight muscles

Fine Motor

● Doesn’t try to get things that are in reach

● Has difficulty getting things to mouth

Hearing

● Doesn’t respond to sounds around him

Social

● Doesn’t laugh or make squealing sounds

Language

● Doesn’t make vowel sounds (“ah”, “eh”, “oh”)

 9 months
Gross motor

● Doesn’t bear weight on legs with support

● Doesn’t sit with help

Fine motor

● Doesn’t transfer toys from one hand to the other

Language

● Doesn’t babble.

Social

● Doesn’t play any games involving back-and-forth play

Cognition

● Doesn’t respond to own name

 1 year
Gross Motor

● Can’t stand when supported

Language

● Doesn’t say single words like “mama” or “dada”

Cognition

● Doesn’t learn gestures like waving or shaking head

● Doesn’t point to things

● Loss of developmental skills once attained

 18 months
Gross motor

● Can’t walk

Cognition

● Doesn’t know what familiar things are for

Language

● Doesn’t copy others language

● Doesn’t gain new words

● Doesn’t have at least 6 words

Loss of developmental skills once attained

 2 years
Gross Motor

● Doesn’t walk steadily

Fine motor
● has trouble scribbling

Language

● Doesn’t use 2-word phrases (for example, “drink milk”)

Cognition

● Doesn’t know what to do with common things, like a brush, phone, fork, spoon

● Doesn’t follow simple instructions

● Doesn’t copy actions and words

Loss of developmental skills once attained
Social

● Doesn’t copy actions

● Does not show interest while others are playing
Language
● Cannot speak 10 - 15 words, does not use two word phrases
 3 years
Gross Motor

● Falls down a lot or has trouble with stairs

Fine Motor

● Has trouble scribbling

Language

● Has very unclear speech

● Doesn’t speak in sentences

Cognition

● Doesn’t understand simple instructions

Social

● Doesn’t play pretend or make-believe

● Doesn’t want to play with other children or with toys

● Doesn’t make eye contact

● Can’t work simple toys (such as peg boards, simple puzzles, turning handle)
● Loss of developmental skills once attained
 4 Years
Gross Motor

● Can’t jump in place

Fine Motor

● Has trouble scribbling

Social

● Shows no interest in interactive games or make-believe

● Ignores other children or doesn’t respond to people outside the family

● Has no eye contact

Language

● Doesn’t use “me” and “you” correctly

Cognition

● Doesn’t follow 3-part commands

● Doesn’t understand “same” and “different”

● Loses skills he once had

Vision

● Names three colours

● Squint, nystagmus, eye contact
 5 years
Gross Motor

● Doesn’t show a wide range of emotions

Fine Motor

● Doesn’t draw pictures

● Can’t brush teeth, wash and dry hands, or get undressed without help

Social

● Shows extreme behavior (unusually fearful, aggressive, shy or sad)

● Unusually withdrawn and not active

● Doesn’t play a variety of games and activities

Cognition

● Is easily distracted, has trouble focusing on one activity for more than 5 minutes

● Doesn’t respond to people, or responds only superficially

● Can’t tell what’s real and what’s make-believe

Language

● Doesn’t use plurals or past tense properly

● Doesn’t talk about daily activities or experiences

Vision
● Snellens chart
● Color vision – identifies four colors
 RED FLAG SIGNS
TIME LANGUAGE / VISION/ MOTOR SOCIAL
PERIOD HEARING
Neonatal Infant does not respond to loud Muscle tone too low to Caregiver shows indifference
Period sounds feed or disinterest in infant
2 months does not alert to voice Cannot raise head when Lack of looking at faces/lack
prone rolls at younger than 3 of fixation
months
4 months No cooing or gurgling sounds Unable to bring hands to Lack of smiling
midline lacks head control
and who demonstrates
scissoring
6 months Lack of turning toward voices Does not pass object from No smiling, laughing, or
one hand to another. expression.
9 months Lack of babbling with Inability to sit. Lack of Absence of back-and-forth
consonants. rolling. smiles and vocalizations in
“conversation

Developmental Milestones,Rebecca J. Scharf, Graham J. Scharf

and Annemarie Stroustrup, Pediatrics in Review 2016;37;25
TIME PERIOD LANGUAGE/ VISION/ MOTOR SOCIAL
HEARING
12 months Child does not respond to name. Does not stand or bear Indifferent or resistant
Does not understand “no”. weight on legs when attachment to
supported caregiver. Does not look
where caregiver points
15 months Does not use words such as No pincer grasp. Absence of proto-
mama and papa/dada. imperative pointing
(point to desired object
18 months Not using at least 6 words. Inability to walk Absence of proto-
independently. declarative pointing
(point to show interest)
or showing
gestures.
24 months Lack of words and two-word Inability to walk well. Does not imitate actions
meaningful sentences. Inability or words of
to caregivers. Poor eye
follow simple commands contact.

Developmental Milestones,Rebecca J. Scharf, Graham

J. Scharf and Annemarie Stroustrup, Pediatrics in Revi
Red flag signs at 2 year Red flag signs at 3 years

• Gross motor
• Gross motor – cannot walk
Has trouble with stairs
without support • Fine motor
• Fine motor – has trouble scribbling Has trouble scribbling
• Social – does not show interest while • Social
others are playing No eye contact, does not want to play with other
• Cognition – does not know common friends
objects • Language
• Language – cannot speak 10 - 15 words, Does not speak in sentence
does not use two word phrases Does not understand simple instruction
Frequent repetition of words

Loss of developmental skills once attained

Loss of developmental skills once attained
Red flag signs at 4 years Red flag signs at 5 years

• Gross motor: cannot hop off • Gross motor: Cannot throw a ball, walk
• Fine motor: has trouble scribbling stairs
• Social: does not show interest while • Fine motor: Cannot brush teeth, get
others are playing, no interactive games, undressed without help
has no eye contact • Social: Does not play variety of games,
• Language: cannot tell a favourite story, Does not respond to name
use you and me correctly
Easily distracted,
• Language: Does not talk about daily
Loss of skills once had attained activities,
Red Flags at any age
● Strong parental concerns
● Significant loss of skills
● Lack of response to sound or visual stimuli
● Poor interaction with adults or other children
● Lack of, or limited eye contact
● Differences between right and left sides of body in strength, movement or
tone
● Marked low tone (floppy) or high tone (stiff and tense) and significantly
impacting on development and functional motor skill
● THANK YOU!!!!!!