Would a Developmental Assessment be Right for My Child?

Many families seek out psychological services early on in a child’s life (18 months – 4 years), due to concerns about his or her development. They may be following up on recommendations of their family doctor or pediatrician. Concerns may have been brought to a parent’s attention by a daycare provider, a preschool teacher, a professional already working with the child or a family member. Sometimes, parents will be the first to express concern, knowing that their child is not meeting milestones in language, play, motor or self-help skills at the pace that is expected. Also, a child may be displaying challenging behaviours at home.

An Overview

“Developmental assessments” provide a broader understanding of a child’s delays or difficulties within the context of the child’s development. The term, however, can mean different things to different clinicians. At its most comprehensive, it is the name given to an assessment of a child across different domains of functioning: communication skills, problem-solving, play skills, social skills, motor skills, and daily living skills. A child’s social-emotional functioning and family life are also considered in order to make sense of a child’s difficulties. Following an initial intake session with parents, the child is seen for some play-based or structured assessment activities by a Psychologist. Also, parents and teachers/caregivers are usually asked to complete ratings scales to gain valuable information about what the child can do and how the child copes in home, community and social settings. Psychologists want to make sure they have a thorough picture of the child, so observing a child at daycare and consulting with other professionals who may already work with the child can be extremely helpful as well.

Once the process is complete, the assessment provides parents with an overview of where the child’s skill development stands in comparison to other children his or her age in many areas. From this assessment, recommendations for intervention, for programming, and for parenting strategies are provided, to emphasize a child’s areas of strength, while at the same time supporting or targeting their areas of difficulty. Sometimes – if there are very clear signs of impairment – a developmental assessment may lead to a diagnosis of a developmental disorder, an intellectual disorder or a communication disorder.

Assessment for Autism Spectrum Disorder

In many cases, the term “developmental assessment” is used in regards to a very particular type of assessment that seeks to clarify whether or not a child’s current constellation of difficulties in the areas of social communication, play, and behaviour are indicative of Autism Spectrum Disorder (ASD). This targeted assessment is recommended when red flags for ASD have been brought to a parent’s attention (e.g., lack of social communication, restricted or limited play skills, repetitive behaviours, strong sensory interests, poor eye contact and poor joint attention). The primary purpose of this type of assessment is to ascertain whether an ASD diagnosis is appropriate. The use of the Autism Diagnostic Observation Schedule, 2^nd Edition (ADOS-2) – a play-based assessment tool that allows the clinician to assess the presence (or absence) a child’s use of language, his/her social skills, play, sensory interests and restrictive behaviours – is particularly relevant in this case, as is a thorough diagnostic interview with parents. The ADOS-2 is a clinical tool that requires specific training for its administration. It can be used with toddlers (as young as 12 months), preschoolers, and school-age children (as well as adolescents and adults). Similarly, daycare observations, parent and teacher ratings, consultation with other professionals provide the psychologist with a detailed picture of how the child displays skills in different settings. At the end of the assessment process, the psychologist’s impressions are shared with parents, and a diagnosis of ASD may be provided. Recommendations for next steps, intervention priorities and community resources are discussed and provided as well.

Multidisciplinary Developmental Assessments

In a multi-disciplinary paediatric setting like Boomerang Health, the appropriateness of involvement of other disciplines – Speech-Language, Occupational Therapy, Neuro-developmental Physiotherapy – is also discussed at the initiation of services. For example, if a child is displaying clear language difficulties (e.g., a child is not speaking or is communicating in a very limited way), a child may benefit from seeing a Speech-Language Pathologist first, to formally assess language skills. Similarly, when there are significant motor challenges (e.g., delays in the development of fine motor skills or gross motor skills), families may opt for an assessment with Occupational Therapy or Neuro-developmental Physiotherapy, respectively. Assessment findings from each discipline are shared with the Psychologist to compliment her assessment of the child. As a Psychologist, I find that multi-disciplinary developmental assessments provide a particular richness in terms of highlighting the areas in which a child is going to thrive, and what specific supports are needed. Also, multi-disciplinary developmental assessments are particularly valuable if parents are looking for comprehensive discipline-specific treatment recommendations. When professionals work as a team, we are better able to answer the “Now what?” question that most parents express once the assessment is complete, with very specific strategies to enhance a child’s development in different areas.

Getting Started

The scope or specificity of a developmental assessment is determined in collaboration with parents. The assessment process begins with an initial parent interview to gather medical and developmental history, and to discuss current concerns. A doctor’s referral is not necessary, but a discussion with your pediatrician or family doctor can be very helpful in deciding if such an assessment could be of benefit for your child.

If you have any additional questions about what a developmental assessment entails, or whether or not it would be appropriate for your child, call our office – (905) 553-3155.