Tag Archives: early intervention

Accessing Developmental Testing

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child working with blocks

Note: This post is tailored to families in Washington State, but the general process is similar elsewhere.

Monitoring

I encourage all parents and teachers to do developmental monitoring: from time to time check out a developmental checklist to be sure your child is on track. And read developmental newsletters for ideas on how to support well-rounded development. Or, you can check out the Washington Early Learning and Development Guidelines which are an amazing resource for children birth through grade 3, where each developmental level includes ways to support your child’s development, differences in development and guidelines for when/how to seek intervention services.

Screening

About 1 in 6 children has a developmental or behavioral issue, such as autism, ADHD, dyslexia, and developmental delays. Only 30% of those concerns would be detected just through the monitoring process. Early intervention from birth to age 3 can help children learn important skills, and getting support and services for children age 3 and up can have a huge benefit for their schooling.

If you are wondering if your child might have autism or ADHD or developmental delays, start with a screening tool. The results might help to reassure you that your child is actually developing normally or they could validate that seeking further assessment and testing would be beneficial. The ASQ – Ages and Stages questionnaire is one of the best available tools for overall development, and you can complete it yourself in about 15 minutes. The ASQ-SE screens for social-emotional development, and can help to identify possible autism signs. (Learn more about using the ASQ and ASQ-SE and understanding your child’s ASQ results.)

For Washington state residents: you can complete the ASQ and ASQ-SE online and a child development specialist from Within Reach will contact you with the results within a week and discuss those results with you. Oregon offers an online ASQ and ASQ-SE here that appear to be open to anyone – you will see the results when you complete the screening.

Talk with a Professional

A helpful second step is to talk to your child’s doctor or their teacher or childcare provider about your concerns, and share the results of the screening. Here is a tip sheet for talking with a doctor about your concerns.

Your child’s doctor may offer a referral to a specialist, such as a child neurologist or a child psychologist. You could also ask for a written referral for testing, using this form.

You can also directly contact your state’s early childhood system to request a free Child Find Evaluation to find out if your child qualifies for intervention services. You do not need a doctor’s referral to make this call.

Evaluation – for Children under 3

The Individuals with Disabilities Education Act, or IDEA (specifically in Part C) guarantees your child a right to a free developmental evaluation. Some people call it “birth to three services,” “early intervention,” or “Part C services”. If your child qualifies for intervention, services can be billed to insurance, or offered on a sliding scale. You will not be denied services if you can’t pay for them.

In Washington, evaluations are provided through ESIT – Early Support for Infants and Toddlers. (Info for Outside Washington.) Each county has a lead agency that processes referrals and schedules evaluations. All the agencies are listed here. To learn which agency serves your location, you can call the Help Me Grow Washington Hotline at 1-800-322-2588.This statewide, toll-free number offers help in English, Spanish and other languages.

The evaluation process uses standardized tools and observations to evaluate a child’s development in 5 areas: physical, cognitive, social-emotional, communication, adaptive / self-care, and sensory processing skills. The evaluator uses natural situations to look at these skills as a child plays, stacks blocks, draws, etc.

If the evaluation shows your child is eligible for services (eligibility criteria here), they may develop an IFSP – Individualized Family Service Plan – and you will be referred for early intervention services, such as physical therapy, occupational therapy, speech therapy, hearing or vision services. In most cases, services are provided in the home or in a child-care setting.

Learn more about IFSP and Early Intervention, and even more about IFSP.

Evaluations for Children age 3 – 5

In Washington, “Child Find” evaluations are offered through your school district. They are free but you must request them.

You can call your school district coordinator* and say: “I have concerns about my child’s development and I would like to have my child evaluated through the school system for preschool special education services. Can you help me or let me speak with someone who can?” Write down who you speak to, the date, and what was said; you might need this information later.

At some point, you will need to submit a written request for evaluation. Some parents start with that. A sample letter to request evaluation is available on PAVE’s website, or the state offers a referral form. (Learn more about how to make the request for an evaluation.)

From the time of request the school has 25 school days to decide whether to evaluate, then 35 school days to complete the evaluation. Make sure you keep a record of when you started the process. (Learn more about the referral and evaluation process.)

The evaluation might look like academic tests, questionnaires, informal observations of the child and parent interviews. They may measure: communication skills, hearing and vision, motor skills, social skills, academic skills, thinking and reasoning. (Learn more about evaluation.)

IDEA describes 14 disability categories. If your child meets the criteria under one of those categories, they are eligible for an Individualized Education Program (IEP). Learn more about developing an initial IEP. (Tips for preparing for your IEP meeting.)

If they don’t meet IDEA eligibility, but they have a disability that impacts a “major life activity” they can have a section 504 plan for accommodations which enable equitable access. (If they are found not eligible, learn what to do.)

Children with identified disabilities can receive free special education and related services at preschools run by the local public-school district or through Head Start or ECEAP. (Learn more about preschool placement.) Related services might include speech therapy, occupational therapy, mental health counseling or special transportation, etc.

If your child is older than 5:

Contact the public school that your child attends or that they would assigned to (if they are homeschooled or attending private school). From there, the process is much as described above.

Most specialized education is provided by special educators who “push in” with support in the general education classroom. (The IDEA requires education in the Least Restrictive Environment (LRE) to the greatest extent possible with typically developing peers.) Some children do not thrive in typical classrooms, and may receive “pull out” instruction in a specialized setting.

Families that homeschool or attend private school, have the option to receive some services from the public school system, even if they are not attending full-time. Learn more about private school Equitable Services plan.

Private Evaluations

In order to access publicly funded early intervention services and special education, you will only need to complete the free evaluations described above.

It is also possible to have a formal evaluation by a child psychologist or psychiatrist, a occupational therapist or speech/language pathologist, clinic specializing in autism, ADHD, etc. This may lead to a more detailed report about your child’s diagnosis and how you can support them, or it may make you eligible for additional services that could be covered by insurance, or may make your child eligible for medications. These diagnostic evaluations may be covered by your insurance or might require paying out of pocket, and can be expensive, so be sure you check about costs and coverage.

If you’re looking for a provider for a diagnosis, seek recommendations of knowledgeable professionals in your area from:

  • Support groups (for example, Autism Speaks has a national directory of providers;
  • People who have children or other family members with the condition
  • Governmental resources (for example, the Autism Guidebook for WA)
  • Your primary care provider or other health care professionals
  • Early intervention or special education providers

More Resources

*How to Contact Your School District

For children age 3 to 5, you’ll reach out to the special ed team in your child’s school district. Here’s info for all the districts in the state. k12.wa.us/sites/default/files/public/specialed/resourcelibrary/SpEdDirectory.pdf

Here are contacts for district’s on Seattle’s Eastside. (I teach for the Bellevue College Parent Education Program so these are the resources I refer to.) If their websites said what agency provides evaluations for ages birth to 3, I list that after the website URL. (If the Early Intervention provider is not listed, call Help Me Grow Washington Hotline at 1-800-322-2588.)

To refer your child for Kindering services, call (425) 653-4300 or submit an online referral form here.  Kindering provides helpful information about their telehealth evaluations.

Do the ASQ Screening for Your Child

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stick

Why do a developmental screening?

Developmental screenings are a helpful tool for making sure your child is on track with their development. They are a “snapshot” of how your child is doing at this moment. They’re helpful even if you’re pretty sure your child is on track, because they help you get ideas of where to focus your attention in the short-term to make sure they’re well rounded. They’re especially helpful if you have any concerns about your child’s development – a screening tool can either reassure you that they actually are on track, or can verify that they have some challenges that you should seek support for early on.

Developmental delays, learning disorders, and behavioral and social-emotional problems are estimated to affect 1 in every 6 children. Only 20% to 30% of these children are identified as needing help before school begins.(Source)

The ASQ

There are several great screening tools and resources for understanding child development. Today, I’ll walk you through the ASQ – the Ages & Stages Questionnaire, a free online tool, using a method that’s been proven through research with tens of thousands of parents. (Learn more about the ASQ.)

It looks at how your child is doing in five areas: communication, large motor, fine motor, social-emotional, and problem-solving. Learn more about these developmental milestones.

Doing the questionnaire likely takes 15 – 20 minutes. It’s easier to do on a laptop or desktop than on a mobile device. It’s best to do it when your child is around so you can check their skills if there is any answer you’re not sure about. And it’s best if they’re rested, fed, and relaxed so they can show you their best skills. That said, it can also be helpful if another adult is around to help you with distracting the child while you’re filling out questions and can help you figure out answers to questions you’re not sure about.

Note: Some parents choose to download the questionnaire and print it to fill in off and on over the next week, then return to the website to enter their results online so that it will do the scoring for them.

Completing the Online ASQ

Go to https://osp.uoregon.edu/home/checkDevelopment. Click on “Let’s Get Started”

On next page click continue – on next page click to agree to terms and continue, then enter date of birth. Then you’ll get a screen saying something like “For ages 25 months through 28 months – 27 month ASQ” – this is making sure you’re using the right checklist for your child’s current age.

Continue to online questionnaire. (Or download it to fill out by hand and then return to the website later.)

There will be a page where they ask about demographics – ethnicity, education and so on – they ask this because the people who are offering this survey are doing research on who uses the tool, and this is helpful to their research process. They do not do anything with this data which would violate your privacy, and you won’t get any emails from them except the results of this screening.

The next screen will be instructions – they’ll tell you that you need to try every activity with your child before marking an answer – that would be ideal, but you don’t have to… if you know your child can do something easily, it’s OK to just mark it yes. On things you’re not sure about, do have your child try it.

On the questionnaire, you’ll be asked 30 questions – 6 questions per category in 5 areas of child development. You’ll mark “yes” if this is something your child is definitely capable of and has done successfully multiple times. If they have done it a few times or they can sometimes do it but not always, mark “sometimes”. If they’ve never done it, mark “not yet”. The way the survey is designed, we might expect a not yet or a couple sometimes in any given category, so don’t worry if you’re seeing some.

Mark answers as accurately as you can – this screening is not about “making your child look good” – it’s about getting an accurate assessment of where they’re at.

Then there will be a few general questions, like does your child hear well, do they have vision problems. It’s OK to fill those out or to skip them.

Then it will say something like: “For ages 21 through 26 months (24 month ASQ:SE). The ASQ:SE-2 asks simple questions about your child’s behaviors. Before continuing, please read instructions…”

This second questionnaire, the ASQ-SE, is optional. I would say: if you feel like your child has more behavioral challenges than the average child, or more big meltdowns / tantrums, or doesn’t connect to you and others like you see other children do, or there are other things that make you worry that your child may not respond like other kids do, then do this questionnaire. If not, you can choose to skip it. This questionnaire takes 5 – 10 minutes.

Enter your email address to receive results by email. (If you’d prefer not to give your email, then click to skip this step, and it will take you on to a page where you can “download your ASQ Results letter”)

Understanding Your ASQ Results

Your results will look something like this:

Results for your child BXD born on November 23, 2016
Your child’s development appears to be on schedule at this time.
On schedule Communication, Gross Motor, Fine Motor, Problem Solving, Personal-Social
Monitor None
Not on schedule None

or

Results for your child BXD born on November 23, 2016.
ASQSE Social-emotional development is in a monitor area at this time.
Overall Section You noted a concern in this section. See below for follow-up ideas.

Note: if you had a paper version of the questionnaire, results look like this:

tally

The white zone is “on schedule”, the gray zone is “monitor” and the black zone is “not on schedule.”

If your child shows as being “on schedule” that’s good news. This test rarely has any “false positives.” If a developmental screening shows that a child is on track developmentally, we can be pretty reassured that all is well. You can just keep doing what you’re doing with them. Or, if there’s one developmental area where you had more “sometimes” or “not yets” then you may choose to do more activities in that area to ensure they stay well-rounded. For example, if you didn’t mark “yes” on all the large motor questions, then spend a little more time at the playground, pool, or gymnastics or dance classes so they can run, jump, kick, throw…

If your child has some things marked as “monitor” – I think of those as “grey areas”. This test can have “false negatives” where the test shows a possible problem, and it turns out that all is well.

If I see “monitor” in one area, that makes me go “hmmmm…. I wonder why.” Here are the questions I ask myself

  • Can they do similar things? The first thing I do is look back at the questions in that section and how you answered them. (The questionnaire with your answers marked will be attached to your email, or you can find it by clicking on “download your completed ASQ”.) Sometimes there were just super specific questions, for example, there’s a fine motor question of “does your child flip switches on and off” or “can your child string beads on a string” and you said no just because they happen to have not ever done this… but think, are you confident that they have enough fine motor skills that they could do something like that? If so, then there’s no reason to worry about it.
  • Is there something about that question that doesn’t apply to their experience? All standardized questionnaires have some biases or assumptions. For example, there are questions about climbing stairs, and there are children who grow up in a town with no stairs. There are questions about forks and some families tend to only eat finger foods or they use chopsticks so may not use forks at home. When the mother of one of my students was doing this questionnaire, and she showed her daughter the incomplete stick figure drawing in the illustration at the top of this post, her daughter said it showed a teacher. This may not make sense to you, but if you’d met me, it would make sense! (I have one leg and this child knew me well as her first teacher.) If the question doesn’t directly apply to your child, again ask yourself “do they know similar things?”
  • Is there a reason they might be behind in this particular area of development at this particular time? For example, if you are a bilingual or trilingual household, your child might test as “behind” in language in ONE of those languages. But if you think they have solid language skills in BOTH languages, I wouldn’t worry. If you tend to solve problems for your child whenever they get frustrated, they might be “behind” in a problem solving skill, like getting themselves dressed. Or sometimes kids are behind in large motor skills in the winter time just because we haven’t been playing outside where there’s room to run.
  • Is there a reason why they might be behind overall right now? If you’ve had any big stressors in your family recently like a move, a new baby, a death in the family, a divorce – these are all things that might have distracted your child’s learning temporarily.

If you find answers to these questions that satisfy you, it’s likely that all is well and there’s no reason to worry. It wouldn’t hurt to put some extra effort into building your child’s skills over the next two months, and then do another screening just to be sure.

If you’ve taken all of these questions into consideration, and your child still seems to be missing some skills, then definitely work on building those skills (see below) and do another screening in a few months, or seek more information now.

If your child is marked as “not on schedule” in one or more areas, you definitely want to explore it more. Ask yourself the questions above to get a clear understanding of the results, then consult with your child’s doctor, teacher, or another professional to learn more. It is possible that when you investigate more, it will turn out all is well, or there is only a very temporary delay. But it’s important to check to be sure, because if a child does have any developmental challenges, the sooner they get extra support, the better.

Resources if you’re concerned about your child’s development:

Resources to build all kids’ skills

Whether your child is on schedule, not on schedule, or in that gray area of “monitor” they will benefit from diverse learning experiences. I have lots of articles on Play and Fun Activities on this blog. Or check out:

Note: Easter Seals also offers the ASQ online for free: www.easterseals.com/mtffc/asq/. Theirs works just fine as an alternate, I just prefer the uoregon site listed above because Easter Seals asks for more of your private information (name, address, phone number) and will add you to their mailings.

Ages & Stages Questionnaire

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How ASQ works

The Ages & Stages Questionnaire, or ASQ, is simply one of the best tools available for developmental screenings of children from birth to age 5. It has been in development for about 40 years and tested by tens of thousands of participants.

You can purchase questionnaires, or it is now available as a free* online screening tool at https://osp.uoregon.edu/home/checkDevelopment.  A parent may complete it by themselves, or it can be done with a professional. (Parent educator, social worker, child care worker, physician…)

Completing the questionnaire

First, you choose the correct questionnaire for the child’s age: they’re in two month increments for the first two years (2 months, 4 months…. 24 months), then every 3 months (27, 30, 33, 36), then every 6 months (42, 48, 54, 60).

The parent fills out the questionnaire. It asks six questions in each of five realms of child development: communication (what child understands and what they can say), gross motor (running, climbing, throwing), fine motor (hand and finger coordination), problem solving, personal-social (self-help skills and interactions with others).

The form asks simple questions, like “If you point to a picture of a ball (kitty, cup, hat, etc.) and ask your child, ‘What is this?’ does your child correctly name at least one picture?” The parent answers the questions yes, sometimes, or not yet. They are encouraged to try things out with their child as they go through the questionnaire, so they can see what their child’s abilities are for sure.

There is an additional optional questionnaire called ASQ:SE which assesses social-emotional development, such as autonomy, compliance (ability to follow directions), adaptive functioning (sleeping, eating, toileting), self-regulation, emotional affect, interaction (ability or willingness to respond to others), social communication.

Results (and how they’re calculated)

With the online questionnaire, the parent receives a report which lists which categories their child is “on schedule” with, where they should “monitor” and if there are any categories where the child is “not on schedule.”

To give professionals a little more insight into the calculations that lead to these categorizations: The results are scored 10 points for every yes, 5 for sometimes, 0 for not yet, so a maximum of 60 points per category. On the written test, you would then tally it on a table similar to this:

tally

If the child scored as we would expect for a child of this age (on the example above, this would be a score of 40 or higher on problem-solving, shown in the white/un-shaded area of that row), then the child’s development appears to be on schedule. If they scored close to the cut-off (in the gray area, shown as 35 or 40 points on the personal-social row), that would be something to monitor. If they score below the cut-off (a unique number for each category of each questionnaire), then further assessment by a professional is recommended.

This is a screening tool, not a diagnostic tool. If all looks well for the child (all scores are in the white area or the online tool says “on schedule”) then we can be assured that they are likely well on track. If they’re in the gray area / “monitor”, then we ask more questions to figure out why. If there’s a good explanation, then the score probably is not a cause for worry, but you could recommend adding activities to build the child’s skills in those areas and re-screening in a few months. If they’re in the black area / “not on schedule” consider referrals to more resources. The Oregon website offers this helpful ASQ Review Guide to help you determine next steps.

These videos for providers offer more information about how to use the ASQ with parents.

Follow-Up

It’s most effective when this tool is used as the beginning of a conversation with parents. After completing the tool, what do they see as their child’s strengths? Do they have any concerns about their child’s development? Did the screening reduce those concerns (they discovered the child is actually on track) or increase them (child is shown as monitor or not on schedule)? What are some next steps they can do to help their child’s development?

On my post for parents about how to complete the ASQ, you can see how I talk with parents about interpreting their results – whether to worry, how to seek help, etc.

If they completed the online questionnaire, their emailed test results will include links to age appropriate learning activities and play activities.

* The screening is free for parents. Since I know the ASQ is a product that is sold, and is fairly pricey, I wanted to be sure I wasn’t violating copyright by promoting use of the online tool. The website is for the Oregon Screening project, so  I have looked for legal terms on the site to see whether they limit its use to Oregon residents or in any other way, and all I have found is “This site is open to all parents of children ages 1 month up to 72 months.”

The screening is also available free at Easter Seals: www.easterseals.com/mtffc/asq/. I prefer the Oregon screening project, because Easter Seals asks for all of the family’s contact information and will add them to their mailing list.