1. What is a developmental delay?
2. What are the risk factors for developmental delay?
3. What are warning signs of a developmental delay?
4. How is a developmental delay identified?
5. What are early intervention services?
6. Why is early intervention important?
7. What can I do if I am concerned that my child may have a developmental delay?
8. What is an Individualized Education Program (IEP)?
9. What is an Individualized Family Service Plan (IFSP)?
10. What is the difference between an IEP and IFSP?

What is a developmental delay?
Child development refers to the process in which children go through changes in skill development during predictable time periods, called developmental milestones. Developmental delay occurs when children have not reached these milestones by the expected time period. For example, if the normal range for learning to walk is between 9 and 15 months, and a 20-month-old child has still not begun walking, this would be considered a developmental delay.

Developmental delays can occur in all five areas of development or may just happen in one or more of those areas (to read about the five areas of development, click here). Additionally, growth in each area of development is related to growth in the other areas. So if there is a difficulty in one area (e.g., speech and language), it is likely to influence development in other areas (e.g., social and emotional).


What are the risk factors for developmental delay?
Risk factors for developmental problems fall into two categories:

• Genetic
• Environmental

Children are placed at genetic risk by being born with a genetic or chromosomal abnormality. A good example of a genetic risk is Down syndrome, a disorder that causes developmental delay because of an abnormal chromosome. Environmental risk results from exposure to harmful agents either before or after birth, and can include things like poor maternal nutrition or exposure to toxins (e.g. lead or drugs) or infections that are passed from a mother to her baby during pregnancy (e.g., measles or HIV). Environmental risk also includes a child's life experiences. For example, children who are born prematurely, face severe poverty, mother's depression, poor nutrition, or lack of care are at increased risk for developmental delays.

Risk factors have a cumulative impact upon development. As the number of risk factors increases, a child is put at greater risk for developmental delay.


What are the warning signs of a developmental delay?
There are several general "warning signs" of possible delay. These include:

• Behavioral Warning Signs
  • Does not pay attention or stay focused on an activity for as long a time as other children of the same age
  • Focuses on unusual objects for long periods of time; enjoys this more than interacting with others
  • Avoids or rarely makes eye contact with others
  • Gets unusually frustrated when trying to do simple tasks that most children of the same age can do
  • Shows aggressive behaviors and acting out and appears to be very stubborn compared with other children
  • Displays violent behaviors on a daily basis
  • Stares into space, rocks body, or talks to self more often than other children of the same age
  • Does not seek love and approval from a caregiver or parent
  
  
• Gross Motor Warning Signs
  • Has stiff arms and/or legs
  • Has a floppy or limp body posture compared to other children of the same age
  • Uses one side of body more than the other
  • Has a very clumsy manner compared with other children of the same age
  
  
• Vision Warning Signs
  • Seems to have difficulty following objects or people with her eyes
  • Rubs eyes frequently
  • Turns, tilts or holds head in a strained or unusual position when trying to look at an object
  • Seems to have difficulty finding or picking up small objects dropped on the floor (after the age of 12 months)
  • Has difficulty focusing or making eye contact
  • Closes one eye when trying to look at distant objects
  • Eyes appear to be crossed or turned
  • Brings objects too close to eyes to see
  • One or both eyes appear abnormal in size or coloring
  
  
• Hearing Warning Signs
  • Talks in a very loud or very soft voice
  • Seems to have difficulty responding when called from across the room, even when it is for something interesting
  • Turns body so that the same ear is always turned toward sound
  • Has difficulty understanding what has been said or following directions after once she has turned 3 years of age
  • Doesn't startle to loud noises
  • Ears appear small or deformed
  • Fails to develop sounds or words that would be appropriate at her age

In addition, because children usually acquire developmental milestones or skills during a specific time frame or "window", we can predict when most children will learn different skills. If a child is not learning a skill that other children are learning at the same age, that may be a "warning sign" that the child may be at risk for developmental delay. If you want to read about typical developmental milestones children learn at different ages, click here. If a child has not learned these skills during a specific time frame, it does not mean your child is delayed. We would recommend, though, that you let your child's doctor know about your concerns.


How is a developmental delay identified?
Developmental delay is identified through two types of play-based assessments:

• Developmental Screening
• Developmental Evaluation

A developmental screening test is a quick and general measurement of skills. Its purpose is to identify children who are in need of further evaluation. A screening test can be in one of two formats, either a questionnaire that is handed to a parent or childcare provider that asks about developmental milestones or a test that is given to your child by a health or educational professional.

A screening test is only meant to identify children who might have a problem. The screening test may either over-identify or under-identify children with delay. As a result, a diagnosis cannot be made simply by using a screening test. If the results of a screening test suggest a child may have a developmental delay, the child should be referred for a developmental evaluation.

A developmental evaluation is a long, in-depth assessment of a child's skills and should be administered by a highly trained professional, such as a psychologist. Evaluation tests are used to create a profile of a child's strengths and weaknesses in all developmental areas. The results of a developmental evaluation are used to determine if the child is in need of early intervention services and/or a treatment plan.

Learn how you can receive a developmental evaluation if you live in San Diego County by clicking here.



What are early intervention services?
Early intervention services include a variety of different resources and programs that provide support to families to enhance a child's development. These services are specifically tailored to meet a child's individual needs. Services include:

• Assistive technology (devices a child might need)
• Audiology or hearing services
• Counseling and training for a family
• Educational programs
• Medical services
• Nursing services
• Nutrition services
• Occupational therapy
• Physical therapy
• Psychological services
• Respite services
• Speech/Language

These services are provided by public agencies and private organizations for children who are found to be eligible for these services after a developmental evaluation. In San Diego County, children under the age of 3 years can access these services through the California Early Start program. Children over 3 years of age can access these services through their local San Diego School District. In addition, there are other agencies and organizations that serve children in San Diego County (see Resources section of this website).


Why is early intervention important?
If a child is found on a developmental evaluation to have some developmental delays, it is important that intervention occurs early on in childhood for a number of reasons. Generally, children need to learn these developmental skills in a consecutive fashion. For example, a child needs to learn to sit up on her own before she will be able to stand up.

Also, early intervention helps a child advance in all areas of development. Sometimes if a child has a delay in one area (i.e. speech), it can affect other developmental areas (i.e., social and emotional). Therefore, it is vital that a child receive early intervention as soon as possible.

Finally, early intervention is critical for the child to develop good self-esteem. Without early intervention, a child's self-image may suffer and they may become avoidant of school. For example, a child who has a language delay may feel embarrassed to speak in front of their peers and teacher at school. Early intervention can help prevent these embarrassing moments for a child before they begin school.


What can I do if I am concerned that my child may have a developmental delay?
If you are concerned that your child may have a developmental delay, it is important to talk with your child's doctor. Your child's doctor can talk with you, examine your child, and refer you to agencies that help to screen or evaluate children for developmental delay. If your child's doctor does not know of such an agency or if you are more worried than your doctor, you can seek help on your own.

If you live in San Diego, California, the following programs can also be of help. These include:

California Early Start: This program screens and evaluates children ages birth to 36 months who are at risk for developmental delay. It also provides early intervention services at no cost for children who qualify for services. To learn more about California Early Start, click here.

San Diego Regional Center: Regional Center is one of a number of centers throughout California who work specifically with children and adults with mental retardation, cerebral palsy, seizure disorders, and autism. To learn more about Regional Center, click here.

San Diego School Districts: The public school system evaluates children ages 3 years and up with warning signs for developmental delay including serious behavior problems. Even if your child attends a private or parochial school, she can be evaluated through the public school district. Intervention services are provided at no cost for those children who qualify for services. To learn more about services through school districts, click here.

Children's Care Connection (C3): This program helps parents of children in North County determine if their child may have a developmental delay and also provides free classes for parents and children to help parents with any problems their children may be having. To learn more about C3, click here.

Developmental Screening and Enhancement Project (DSEP): This program works with children ages 0-5 years of age entering the foster care system to determine if they have developmental or behavioral problems. To learn more about DSEP, click here.

Other resources: San Diego County has a number of other agencies that can help parents who are concerned that their child may have developmental or behavioral health problems. There are also some very good books and websites that help parents understand their child's needs. To learn more about other resources, click here.

If you live outside of San Diego, visit the National Center on Birth Defects and Developmental Disabilities' website for more resources: http://www.cdc.gov/ncbddd/autism/actearly/screening.html.


What is an Individualized Education Program (IEP)?
An IEP is a written document, ordered by federal law, that defines a child's disabilities, states current levels of academic performance, describes educational needs, and specifies annual goals and objectives. The unique needs of each child determine what specific programs and services are required. The IEP planning process can be very confusing for both parents and professionals. Below you will find answers to commonly asked questions about the IEP process.

• How does the IEP process start and what can I expect?
  • Talk about requesting an IEP with the child's teacher or doctor.
  • Learn about the IEP process on the Internet.
  • Write a letter to the special education office or to the child's school principal requesting an assessment (and date your request). Even if the child is in private school, he or she can be evaluated by the school district.
  • You should receive an assessment plan from the school within 15 days.
  • You have 15 more days in which to agree to the school's assessment plan or request a different one.
  • You should be invited to participate in an IEP meeting within 50 days. All testing must be completed by the meeting date.
  
  
• What is an assessment plan?
  An assessment plan is a description of the various tests (cognitive, motor/perceptual, communication, social/emotional, and educational) to be used in a student's assessment in preparation for his or her IEP meeting. The assessment plan should:
  
  • Be specific regarding which tests will be given. These should be individualized tests and NOT standardized tests given in a group situation.
  • Match your child's perceived disabilities with a test or subtest that clearly assesses that area.
  • Consider all information, including parental input and classroom performance.
  
  
• How do I prepare for the IEP meeting?
  • Talk to your child's teacher and doctor about their observations.
  • Request copies of school and medical records at least 7 days before the IEP meeting. Parents are legally entitled to these results.
  • Understand the test results describing your child's current levels of educational performance, including how your child compares to other children his or her age.
  • Define for yourself your child's problem areas and strengths.
  
  
• What will happen at the IEP planning meeting?
  At the planning meeting, the team will review the test results to determine if your child is eligible for an IEP. If your child qualifies for an IEP, the team will be developing educational and behavioral goals for your child at this meeting. Make sure to ask any questions you may have and pay attention to what is written on the IEP form.
  
  Remember this is a legal document. You are not required to sign it if you don't understand it or are not sure you agree with it.
  
  
• What should the IEP include?
  • An outline of your child's educational needs, including learning styles, teaching methods, and student-teacher ratio.
  • Written goals that match your child's specific needs with benchmarks to determine if an IEP is working on a yearly basis.
  • Standardized measurement criteria for assessing objectives.
  • Decision on the appropriate school placement and educational strategies for your child.
  • Stated plan for how often IEP reviews will occur.

What is an Individualized Family Service Plan (IFSP)?
An IFSP is the coordination of services that are family-centered. It is based on your child's strengths, as well as your concerns and priorities for your child. You can participate in the process of assessment by gathering information concerning your child's medical and developmental history, and also by making observations about his or her strengths and difficulties. The IFSP planning process can be very confusing for parents and professionals. Below you will find answers to commonly asked questions about the IFSP.

• Who develops the IFSP?
  Along with your service coordinator, you have an active role in developing the service plan. You help decide which family members, friends, teachers, physicians, and other professionals should be included, and who will help to write the plan. You let the team know what you want for your child and for your family, and the team will work with you to achieve those goals.
  
  The IFSP should focus on your family's concerns and priorities, and should be supportive of your family's routine, values, and culture. It should also be clearly explained to you, and written in your family's language, if possible.



• How do I prepare for the IFSP planning meeting?
  To prepare for an IFSP planning meeting, you can talk with other parents, learn more about your child's diagnosis, and list your questions and concerns to discuss with your service coordinator. It is especially important to identify needs for transportation, child care, and/or interpreters. Certain questions you may want to consider asking yourself and/or your service coordinator include:
  • What is needed for my child, and how will this be decided?
  • What services are available?
  • What are the options?
  • What will my family's new rights and responsibilities include?


• What can I do during the planning meeting?
  • Share information that you think is important. This could include medical records, a baby book, a growth chart, or other evaluations.
  • Talk about your child, and discuss any concerns or questions you may have about his or her development.
  • Consider how you will be involved in the processes of evaluation, assessment, and service planning.
  • Decide who should be involved, including specific family members as well as others, such as another parent, a friend, or a child care provider.
  • Consider which service delivery environment is best suited to meet your child's needs: home, child care setting, infant development program, etc.


• What should the IFSP include?
  • A statement of your child's level of development, from your own observations and from formal assessment measures (if necessary).
  • A "family assessment," which is a statement of your family's resources and concerns as they relate to your child's development (with your permission).
  • A statement of the outcomes you expect for your child and family, including how and when they will be achieved.
  • A statement of which early intervention services will be provided, and in what environments they will occur (such as your home, child care setting, or a school program).
  • A statement of when services will begin, how often they will be provided, and how long they will continue.
  • A plan for transitions as your child's needs change (this must be included when your child approaches three years of age).
  • The name of your service coordinator.


• How can I help my child meet these developmental milestones?
  Remember that the IFSP is not a finalized document. It is an ongoing process. Your child's needs may change quickly, so your family's IFSP should be reviewed at least every six months, and revised when necessary. If you think your services need to be changed, contact your service coordinator for an IFSP review.
  
  In early intervention, transitions happen whenever your child's services change to better meet both of your needs. Planning for transition requires your participation. Decisions concerning your child cannot be made without you, and no change can be made to the IFSP without your consent.
  

What is the difference between an IEP and IFSP?
For a comparison of federal requirements for an IEP and IFSP click here.